1. Succinylcholine is a fast-on (60 seconds), fast-off (10 minutes) paralytic. It is metabolized by plasma acetycholinesterases, not by synaptic AChE, which is why it lasts minutes rather than seconds. It causes membrane depolarization, and thus increases serum K. Normally, it will increase serum K by 0.5-1 mEq, which may not be tolerable in someone with ESRD running high baseline K. In certain patients, however, it increases serum K significantly more, up to 10 mEq-- notably, in patients who have suffered burns >15-20% of their body, or pts who have suffered crush injuries.
2. Active cardiac lesions that necessitate cardiac workup before surgery: 
-Heart failure
-Unstable angina/MI within 30 days of surgery
-Malignant arrhythmias (afib with RVR, v-tac, 3rd-degree block, as it may progress to bradycardia)
-LV outflow obstruction (Aortic stenosis), mitral stenosis
If someone doesn't have any of these lesions, and is capable of walking up a flight of stairs without cardiopulmonary symptoms, and is asymptomatic with a benign history, a cardiac workup is not necessary. In cases where exercise tolerance is not able to be determined (i.e. joint pain that precludes exercise), a workup may be indicated.
3. Predictors for difficult intubation: 
-Mallampati score of 3-4 (1: whole uvula visualized, 2:  most uvula, 3: some uvula, 4: no uvula visualized)
-Obesity: since fat is not added to the back of the head, the head will be extended when the patient is supine, need to stack pillows under head to push head forward into position
-Receding jaw: tongue/tissues compacted into smaller area, harder to maneuver
-Unable to open jaw: can attempt nasal intubation. Nasal intubation-- push scope horizontally, don't push up towards turbinates. Never attempt nasal intubation on someone with confirmed/suspected basilar skull fracture.
-Bloody field: fiberoptic scopes do not work if you can't see. If it's significantly bloody, go to trach.
-Smoker or asthmatic or any history of reactive airway disease. Laryngoscope/ET can trigger bronchospasm.
4. Indications for intubation
-need for positive-pressure ventilation (vs continuous 24/7 bag-mask)
-need for ventilator-assist/PEEP
-need to protect airway
-need to keep airway patent
-pulmonary hygiene (keep mucus and secretions out of airways)
When intubating, pull mandible forward (relative to maxilla), as the tongue is attached to the mandible and it will pull the tongue off of the posterior pharynx. Put the end of the laryngoscope into the vallecula, and pull the tongue upwards.
5. Most MIs happen 2-3 days postop, since the patient is moving around more, cardiac output is increasing, fluids are being mobilized.
6. NPO rules before surgery for people who have normal gastric emptying:
-2 hours: clear fluids
-4 hours: breast milk for infants
-6 hours: cow's milk, light carbohydrate meal
-8 hours: solid meal with fats and proteins.
The half life of clear fluids in the adult stomach is 11 minutes.
7. The maximum non-humidified airflow that can be comfortably tolerated by nasal cannula is 2-3 L/min. This rate is far below the rate of normal breathing, such that a significant portion of inhaled air will come from room air. This will dilute out the administered oxygen, thus the maximum %total inhaled oxygen caps out at about 30%. In someone who has obstructive lung disease, even small increases in % inhaled oxygen may have a significant impact on their saturation, bringing them from 80s to 90s, if they are at the straight part of their curve. Clinically appreciable/visible cyanosis happens at a saturation of about mid-80s.
8. Generic guidelines about medications to stop vs continue through day of surgery:
-anti-HTN: continue taking, except for ACE/ARB since they can inhibit compensatory mechanisms for hypotension in surgery
-cardiac drugs (digoxin, sotalol, amiodarone): continue taking
-oral hypoglycemics: stop the day of surgery. Fasting before surgery can lead to hypoglycemia, which is hard to assess in someone who is unconscious from surgery, and can cause significant morbidity.
-insulin: take 1/2 a dose the day of surgery. The stress of surgery causes hyperglycemia (via endogenous steroids/cortisol, epinephrine, GH), and people who need insulin are at baseline less well controlled on their sugars vs people on oral hypoglycemics. Monitor fingerstick glucoses during surgery and post-op.
-Asthma/COPD maintenance medications: continue taking
-Anticoagulants: difficult to ascertain. Must evaluate specific patient history, conditions, type of surgery, balance clotting (surgery =>hypercoagulable state) vs bleeding. Generally aspirin is continued, coumadin is not, but it really depends.
-Herbals/vitamins: stop 7-10 days before surgery.
9. Revised cardiac risk index to determine risk of perioperative major cardiac event: 
Equally weighted factors, derived from a cohort of 4300 people aged >50. [Circulation]
-History of ischemic heart disease
-Heart failure
-Renal failure (cr>2.0)
-DM I/II (requiring insulin)
-CVA
+high-risk non-cardiac surgery (suprainguinal vascular, thoracic, abdominal)
3+ risk factors- 11% chance of major cardiac complication
2 risk factors- 7%
1 risk factor: 0.9%
0 risk factors: 0.4%
10. Meta-analysis examining ability of revised cardiac risk index (RCRI) to predict cardiac complications: From the abstract of a meta-analysis in the [Ann Intern Med, 2010] examining over 20 studies involving over 700,000 subjects: "The RCRI discriminated moderately well between patients at low versus high risk for cardiac events after mixed noncardiac surgery (area under the receiver-operating characteristic curve [AUC], 0.75 [95% CI, 0.72 to 0.79]); sensitivity, 0.65 [CI, 0.46 to 0.81]; specificity, 0.76 [CI, 0.58 to 0.88]; positive likelihood ratio, 2.78 [CI, 1.74 to 4.45]; negative likelihood ratio, 0.45 [CI, 0.31 to 0.67]). Prediction of cardiac events after vascular noncardiac surgery was less accurate"