Anesthesia and Intensive Care
Anesthesia and intensive care is examined through preoperative assessment, airway management, sepsis and mechanical ventilation. Expect values: ventilator settings, vasopressor doses, and the sequence of resuscitation.
Core rules
- Preoperative assessment: ASA class, airway prediction, comorbidities, anticoagulation, fasting.
- Difficult airway: anticipate, preoxygenate, have a plan and a backup plan.
- Sepsis: suspected infection plus SOFA ≥2; measure lactate; give 30 mL/kg crystalloid; start broad antibiotics within one hour; norepinephrine for MAP <65 mmHg.
- ARDS (Berlin criteria): tidal volume 6 mL/kg predicted body weight, PEEP titration, prone positioning if PaO2/FiO2 <150.
- Sedation: target a light level (RASS), daily awakening trials, and screen for delirium with CAM-ICU.
Worked example
A 72-year-old with pneumonia has lactate 5 mmol/L and MAP 58 mmHg after 30 mL/kg of crystalloid. Reasoning: septic shock. Start norepinephrine to reach MAP ≥65, take cultures, give broad antibiotics within the hour, and look for source control. Do not wait for culture results before antibiotics.
Traps that cost marks
- Delaying antibiotics to obtain cultures.
- Ventilating with 10–12 mL/kg in ARDS.
- Routine albumin or starches.
- NSAIDs in acute kidney injury.
- Sedating to deep levels without a indication, prolonging ventilation.