Clinical Pharmacology for Anesthesiology

Ken B. Johnson, MD (Salt Lake City, UT) is Associate Professor,Learned Family Associate Professorship; Director, Center for Patient Simulation,Department of Anesthesiology, The University of Utah School of Medicine.

• Section I: A basic primer (i.e. easy to ready with lots of figures) 1. Pharmacokinetics2. Pharmacodynamics3. Biophase4. Drug interactions5. Covariates of interest (age, weight, comorbidities, etc). Section II: For each drug, clincal features of: Pharmacokinetics (some interesting facts like % protien binding, volume of distribution, but more importantly, how age, weight, and comorbidities impact drug concentrations, how drugs behave when given as a bolus or as a continuous infusion); Pharmacodynamics; Simulations of onset and duration of effect for commonly used doses; Common toxicity issues and adverse features (focus only on those that anesthesia clinicians worry about); Unique characteristics (i.e. context sensitive half time); Common preparations (especially for drugs that have to be dissolved) and dosing regimens (bolus versus continuous infusion)6. Analgesics7. Sedatives8. Inhalation Agents9. Muscle Relaxants10. Reversal Agents11. Vasoactive Drugs (inotopres, chronotropes, cholinergic and anticholinergic drugs) Section III: Drug interactions for commonly used anesthetic drug combinations: a look at analgesia for moderate and severe stimuli, sedation, loss of responsiveness, and muscle relaxation. Section IV: Suggested dosing strategies for unique or challenging anesthetics. This section would be simulation based and use PK and combined drug PD interaction models. 12. Drug models13. Preoperative sedation14. Moderate sedation for MAC cases15. Approaches to general anesthesia (conventional TIVA, and multimodal)16. Post operative pain (both PACU and inpatient management)Section V: Cases17. Moderate sedation cases with more than minimal painful stimuli in the elderly (i.e.An approach to analgesia for a retrobulbar block).18. A quick wake up after general anesthesia yet provide analgesia for moderate to severe surgical pain19. An approach to opioid tolerant patients for surgeries associated with moderate to severe surgical pain20. An approach to patients that have lost a considerable amount of blood21. A clinician's guide to dosing PCA's especially in opioid tolerant patients22. Dosing considerations for obese patients with sleep apnea23. General anesthsia for patients with poor cardiac function24. General anesthesia for patient with poor liver function25.CABG or valve replacement, 26.Liver transplant27. AAA repair28. Aneurysm clipping29. Aortic arch procedures that require cirulatory arrest.