Pharmacology, Anesthesia, Sedation, and Perioperative Care
Pharmacology, Anesthesia, Sedation, and Perioperative Care
This domain tests safe drug dosing, local anesthesia, sedation monitoring, and perioperative risk management. The exam favors calculations and patient-safety decisions.
Core rules
- Calculate local anesthetic maximum dose by weight and concentration; lidocaine with epinephrine is commonly limited to 7 mg/kg.
- A 2% solution contains 20 mg/mL; divide the maximum milligram dose by concentration to get milliliters.
- Epinephrine improves hemostasis and duration but adds cardiovascular risk; use caution in unstable cardiac disease.
- Sedation requires preoperative risk assessment, fasting, monitoring, oxygen, suction, and rescue drugs.
- Malignant hyperthermia is triggered by volatile agents and succinylcholine; dantrolene is the specific treatment.
Worked example
A 70 kg patient receives 2% lidocaine with 1:100,000 epinephrine. Reasoning: maximum dose is 7 mg/kg × 70 kg = 490 mg. Because 2% is 20 mg/mL, the maximum volume is 490 ÷ 20 = 24.5 mL. This is a ceiling, not a target; the actual dose and epinephrine load must be documented.
Traps
Confusing milligrams with milliliters; ignoring epinephrine dose; using benzocaine in infants; sedating without airway equipment; failing to recognize methemoglobinemia.