Feelings | Progressive thinking in decision-making in anesthesia

We are very familiar with the "three-step" strategy of cancer pain treatment, ranging from the weakest non-steroidal anti-inflammatory drugs to the strongest opioids.
The medication is individualized based on the patient's pain score and at the same time based on the analgesic effect.
Elevating ladder medication to achieve the best analgesic effect with minimal side effects.

Similar decisions are often encountered in anesthesia work.
During the operation, the blood pressure of the patient is lowered, and the blood pressure is increased first after the finding of the cause is unsuccessful.
What blood pressure drug would you choose? This question may be very confusing for beginners.

The commonly used pressure-boosting drugs have a boosting effect from weak to strong (also known as the decision chain), roughly ephedrine-m-hydroxyamine-dopamine-phenylephrine-norepinephrine-epinephrine.
Before using these drugs, you must be very familiar with each The expected effects of two drugs, such as ephedrine, dopamine, and epinephrine can simultaneously activate α and β receptors, and blood pressure and heart rate are increased; meta-hydroxyamine, phenylephrine, and norepinephrine stimulate α receptors, and blood pressure rises At the same time the heart rate reflex decreases.

In principle, start with the weakest effect and switch to the stronger one until the expected blood pressure is reached.
While the blood pressure rises steadily, there is always room for oneself.
The whole process forms a clear decision-making progressive strategy.

When it is necessary to lower blood pressure, a similar decision chain may be urapidil-nicardipine-nitroglycerin-sodium nitroprusside.
While looking for possible causes, the antihypertensive drugs should be used gradually until the desired effect is achieved.

Hyperkalemia is often encountered in anesthesia management.
It is commonly used in clinical practice and has a more obvious progressive relationship.
I summarize it as calcium-diuretic-glucose+insulin-hemodialysis.

Calcium and diuretics are easy to obtain, but the effect is not good.
Glucose + insulin need to be dispensed but the potassium-lowering effect is good.
The ultimate plan is hemodialysis.
Generally, the first three can achieve the expected effect during the operation.

The choice of anesthesia method is also a similar process.
The anesthesiologist always wants to complete the operation with the smallest block area. Local anesthesia-nerve block-spinal canal block-general anesthesia constitutes the decision chain for the choice of anesthesia method.
The choice of anesthesia method is progressively selected according to the surgical needs.
Sometimes the combined application of different methods may achieve better results.

At work, a clinical goal needs to be achieved, and there may be many choices, and conscious self-cultivation of progressive thinking in decision-making is of great benefit to understanding the various logical relationships in anesthesia.

Among them, it is very important to form a reasonable decision chain.
Each decision can be implemented separately or combined to achieve the best clinical treatment effect.

Apart from the decision chain mentioned above, can you think of anything else? Please leave a message for advice.

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