Most people don’t find pharmacokinetics particularly palatable. This book is arguably one of the most enjoyable ways you can learn about pharmacokinetics. This book doesn’t just entertain but it also gives you a sound understanding of PK concepts as they relate to the practising anaesthetist. It is under 200 pages and can be read in a day. It is fairly non PC which accounts for half its charm. Nothing in there about TCI sadly.
Addendum by woundedwildebeest… I got to see this post when it was a draft and bought the book. I definitely second this recommendation. Funny, educational, with even a dramatic twist on the last page. I’d suggest reading a chapter at a time and applying it in theatre before moving on to the next.
These questions relate to Fibrinogen:
Q. Is designated by the Roman numeral II. TRUE/ FALSE
Q. Is the predominant clotting factor found in Prothrombinex. TRUE/ FALSE
Q. Is the predominant clotting factor found in the circulation. TRUE/ FALSE
Q. Has a reduced concentration in the pregnant individual. TRUE/ FALSE
Q. Is a Vitamin K dependent clotting factor. TRUE/ FALSE
Mercifully brief, this is a great little book written by an American anesthesiologist. You won’t finder a better description of core physiological principles in any of the recommended texts. There are also cool little puzzles at the end of each chapter which I found strangely appealing. The chapter on cerebral perfusion pressure including a discussion of the applied physiology in the giraffe is a real highlight. In fact this is the book you should read first before embarking on Nunn et al.
Many of us use TCI on a daily basis. Indeed some people use it almost exclusively. Fewer appreciate the remarkably small data set that the algorithms were created from. Even fewer understand the limitations of the algorithms. If you want to find the answers to the statements below can I suggest you look at the chapter “Everything you should know about Propofol TCI” in the book The First Year. It can be freely downloaded from the College Library: click on Library Guides> Medical Education> Featured Resources and scroll to the bottom. The pdf is waiting for you. The cover is reproduced above. The TCI pump algorithms are poorly treated in the texts.
Q. A TCI using the Marsh algorithm will give the same dose of propofol to an eighty year old and a twenty year old patient of the same weight. TRUE/ FALSE
Q. TCI can be used for morbidly obese patients. TRUE/ FALSE
Q. The Minto algorithm for Remifentanil was devised by an Australian anaesthetist. TRUE/ FALSE
Q. Plasma or effect site TCI can be used effectively for the Schnider algorithm.
Q. The James equations are used to calculate LBM in the Minto and Schnider algorithms. TRUE/ FALSE
Regarding PGF2 alpha:
Q. It increases uterine tone. TRUE/ FALSE
Q. It can cause bronchoconstriction. TRUE/ FALSE
Q. It reliably causes systemic hypertension. TRUE/ FALSE
Q. Can cause a low grade fever. TRUE/ FALSE
Q. Is administered in small aliquots intravenously. TRUE/ FALSE
The formulation currently being used in my hospital is sourced from Russia. No one in the Department can read Russian.
The joys of pharmacokinetics are relatively few but a sound understanding of PK principles is a necessary evil for the anaesthetist. The following statements relate to the ubiquitous PK parameter, keo.
Q. Is the rate constant that describes transfer of drug from the central compartment to the effect site. TRUE/ FALSE
Q. Is the rate constant for elimination of drug from the effect site. TRUE/ FALSE
Q. Is directly proportional to the t1/2keo. TRUE/ FALSE
Q. Can be measured directly using frequent blood sampling. TRUE/ FALSE
Q. Has units of inverse time. TRUE/ FALSE
These questions relate to ROTEM which seems to be the favourite viscoelastic assay in use at present. Even my humble little hospital has one of these things.
Q. It takes about an hour to provide clinically useful information. TRUE/ FALSE
Q. Will reliably detect platelet dysfunction as a result of clopidogrel therapy. TRUE/ FALSE
Q. Reliably detects the presence of heparin therapy. TRUE/ FALSE
Q. Can detect primary and delayed fibrinolysis. TRUE/ FALSE
Q. Will be abnormal if the patient is hypothermic. TRUE/ FALSE
Q. Is contraindicated in individuals who are colour blind. TRUE/ FALSE
Q. Is a lysine analogue. TRUE/ FALSE
Q. Inhibits the activity of plasmin. TRUE/ FALSE
Q. Should not be given as an IV push. TRUE/ FALSE
Q. Can cause seizures. TRUE/ FALSE
These questions actually relate to Entonox which, as I’m sure you all know, is a 50:50 mixture of oxygen and nitrous oxide.
Q. An Entonox cylinder contains a mixture of liquid and vapour. TRUE/ FALSE
Q. An Entonox cylinder is coloured French blue and white. TRUE/ FALSE
Q. The Poynting effect refers to how interactions between two different gases leads to a change in their physical properties. TRUE/ FALSE
Q. Entonox provides about 0.5 MAC. TRUE/ FALSE
Q. Can cause megaloblastic anaemia. TRUE/ FALSE
Q. They are heavy because they are full of liquid. TRUE/ FALSE
Q. Must be positioned in a particular order if there are two different vaporizers on the machine. TRUE/ FALSE
Q. All require power to operate correctly. TRUE/ FALSE
Q. A Desflurane Tec 6 vaporizer does not require adjustment when used at altitude. TRUE/ FALSE
Q. Should not be laid on their side. TRUE/ FALSE