UCSF Anesthesia Pocket Guide: Essential Protocols, Dosing, and Emergency Procedures5 min read
As an anesthesia provider, having quick access to critical information can mean the difference between life and death. The UCSF Anesthesia Pocket Guide is a comprehensive reference that puts essential protocols, medication dosing, and emergency procedures at your fingertips. This practical guide is designed to help you make informed decisions quickly and confidently in any clinical situation.
Anesthesia Protocols
The UCSF Anesthesia Pocket Guide provides step-by-step protocols for managing common anesthesia scenarios, including:
- General anesthesia induction and maintenance
- Regional anesthesia techniques (spinal, epidural, peripheral nerve blocks)
- Monitored anesthesia care (MAC) for procedures
- Difficult airway management algorithms
- Postoperative pain control regimens
Each protocol is presented in a clear, concise format with key decision points highlighted. The guide also includes helpful tips and precautions based on expert insights and best practices from the UCSF Department of Anesthesia.
General Anesthesia Induction Sequence
The pocket guide outlines a standard induction sequence for general anesthesia:
- Pre-oxygenate with 100% oxygen for 3-5 minutes
- Administer induction agent (e.g., propofol 1-2 mg/kg IV)
- Administer neuromuscular blocking agent (e.g., rocuronium 0.6-1.2 mg/kg IV)
- Perform direct laryngoscopy and endotracheal intubation
- Confirm endotracheal tube placement with end-tidal CO2 and bilateral breath sounds
- Secure endotracheal tube and connect to anesthesia circuit
The guide also provides troubleshooting tips for managing difficult intubations and alternative airway devices like video laryngoscopes and supraglottic airways.
Spinal Anesthesia Dosing Guidelines
For spinal anesthesia procedures, the pocket guide includes dosing recommendations based on patient characteristics and surgical requirements:
| Local Anesthetic | Dose Range | Onset | Duration |
|---|---|---|---|
| Bupivacaine | 7.5-15 mg | 5-10 min | 90-150 min |
| Ropivacaine | 15-25 mg | 3-5 min | 120-240 min |
| Lidocaine | 50-100 mg | 2-5 min | 60-90 min |
The guide also covers indications, contraindications, and potential complications of neuraxial anesthesia techniques. It provides tips for optimizing block success and managing side effects like hypotension and bradycardia.
Emergency Procedures
The UCSF Anesthesia Pocket Guide is an invaluable resource during anesthetic emergencies. It provides concise algorithms and drug dosing for managing:
- Malignant hyperthermia – Includes diagnostic criteria, dantrolene dosing (2.5 mg/kg IV initially), and supportive care measures
- Local anesthetic systemic toxicity (LAST) – Outlines lipid emulsion therapy (1.5 mL/kg 20% lipid emulsion bolus followed by 0.25 mL/kg/min infusion)
- Anaphylaxis – Details epinephrine dosing (10-100 mcg IV boluses for hypotension, 0.3-0.5 mg IM for respiratory distress), H1/H2 blockers, and corticosteroids
- Intraoperative cardiac arrest – Provides ACLS guidelines tailored to the anesthetized patient, including defibrillation and medications like epinephrine, amiodarone, and calcium chloride
The emergency section also includes important phone numbers for the operating room, blood bank, and critical care services at UCSF Medical Center. It provides a quick reference for antidotes and reversal agents commonly used in anesthesia.
Malignant Hyperthermia Crisis Management
Rapid recognition and treatment of malignant hyperthermia (MH) is essential for patient survival. The UCSF Anesthesia Pocket Guide outlines key steps:
- Call for help and notify surgeon
- Discontinue volatile anesthetics and succinylcholine
- Hyperventilate with 100% oxygen at high fresh gas flows (>10 L/min)
- Administer dantrolene 2.5 mg/kg IV rapidly, repeat as needed
- Apply active cooling measures (cold IV fluids, ice packs)
- Treat hyperkalemia with calcium, insulin/glucose, bicarbonate
- Monitor and correct acid-base abnormalities, continue supportive care
The guide emphasizes the importance of early dantrolene administration and provides instructions for reconstituting the drug. It also includes contact information for the Malignant Hyperthermia Association of the United States (MHAUS) hotline for expert guidance.
Drug Dosing and Pharmacology
The UCSF Anesthesia Pocket Guide is a comprehensive pharmacology reference for anesthesia providers. It includes dosing guidelines, preparation instructions, and key pharmacologic properties for commonly used medications:
- Induction agents – Propofol, etomidate, ketamine, thiopental
- Neuromuscular blocking drugs – Succinylcholine, rocuronium, vecuronium, cisatracurium
- Opioids – Fentanyl, hydromorphone, morphine, remifentanil
- Vasoactive drugs – Ephedrine, phenylephrine, epinephrine, vasopressin
- Reversal agents – Neostigmine, sugammadex, naloxone, flumazenil
Each drug entry includes dosing ranges, onset and duration of action, metabolism and elimination, and special considerations. The guide provides recommended infusion rates and titration parameters for continuous medication drips.
Neuromuscular Blockade Monitoring
Proper monitoring of neuromuscular function is critical for managing muscle relaxation during anesthesia. The pocket guide describes techniques for assessing blockade:
- Train-of-four (TOF) monitoring – Assesses depth of non-depolarizing block by stimulating a peripheral nerve with 4 electrical impulses and counting the number of twitches (TOF count)
- Post-tetanic count (PTC) – Evaluates profound blockade by applying a 5-second, 50 Hz tetanic stimulus followed by single twitches; number of post-tetanic twitches correlates with depth of paralysis
- Double burst stimulation (DBS) – Provides a more sensitive visual assessment of residual paralysis by applying two short bursts of 50 Hz tetanic stimuli separated by 750 ms
The guide recommends confirming a TOF ratio >0.9 before extubation to minimize the risk of residual neuromuscular blockade and respiratory complications. It also discusses the use of quantitative monitors and acceleromyography for objective measurement.
Conclusion
The UCSF Anesthesia Pocket Guide is an essential reference for any anesthesia provider. By consolidating key protocols, drug information, and emergency management algorithms in a compact format, this guide enables quick decision-making in the operating room. Its evidence-based recommendations reflect the expertise of the UCSF Department of Anesthesia and incorporate the latest best practices.
Whether you are a trainee learning the fundamentals of anesthesia or an experienced practitioner looking for a reliable clinical resource, the UCSF Anesthesia Pocket Guide belongs in your coat pocket. With this practical tool at your side, you can approach every anesthetic with confidence and deliver the safest possible care to your patients.
How can I get a copy of the UCSF Anesthesia Pocket Guide?
The UCSF Anesthesia Pocket Guide is available for purchase through the UCSF Department of Anesthesia website. Click the “Educational Resources” tab and look for the “Pocket Guide” link to order a print or digital copy. Bulk discounts are available for residency programs and anesthesia groups.
Is the information in the pocket guide peer-reviewed?
Yes, all content in the UCSF Anesthesia Pocket Guide undergoes rigorous peer review by a multidisciplinary team of anesthesiologists, pharmacists, and other experts. The editorial board includes faculty from the UCSF Department of Anesthesia who are recognized leaders in their subspecialty fields. The guide is updated regularly to incorporate new research findings and evolving clinical standards.
Can I use the UCSF Anesthesia Pocket Guide for off-label medication dosing?
While the pocket guide provides dosing ranges for common clinical scenarios, all medication administration should be guided by the specific needs of the individual patient. Off-label use of anesthesia drugs should be based on sound clinical judgment, available scientific evidence, and institutional protocols. When in doubt, consult with a pharmacist or experienced colleague to ensure safe and appropriate dosing.
The Health Insight Team consists of dedicated students and PhD candidates from leading medical schools around the world. Collaborating with experienced medical professionals, our team provides well-researched, evidence-based information on a wide range of health topics, including prescription medications, surgical procedures, anesthesia, and nutritional health. The articles by MedicalHubNews PHD Team are for educational purposes only. For medical issues, consult your doctor or healthcare provider.