1. Ventilators:
-Pressure support: machine gives pre-set pressure either in CPAP (only inspiratory pressure) or BiPAP (inspiratory pressure and expiratory pressure aka PEEP) and records the volume. Normal setting 10/5. Before extubation, will try 5/0 (i.e. no PEEP). You still need the 5 inspiratory pressure because it compensates for the incresaed difficulty breathing in through the tube (more resistance to airflow). Patients control their own tidal volume, breathe on their own.
-Volume support: machine gives pre-set amount of volume, records the pressures needed to achieve that volume. You want low pressures, as they indicate good lung compliance; increased pressures may be seen in laproscopic surgery (blowing up the belly with air), obese patients, and those in trendelenburg for the same reason-- increased pressure against the abdominal surface of the diaphragm, makes it harder to fill the lungs. Patients are not breathing on their own.
-In surgery with general anaesthesia, wean from volume support to pressure support to spontaneous breathing. When weaning from volume to pressure, make sure they can breathe on their own-- have them take 2 deep breaths; check end-tidal CO2 to make sure they're breathing on their own.
2. Explanation for decreased O2 sats after intubation:
-Mainstem intubation
-Atelectasis
-FiO2 is too low.
3. ARDS: decreased surfactant, decreased lung compliance, require increased filling pressures to open alveoli and maintain oxygenation. Patients take shallower, more frequent breaths (vs opiates: they take fewer, deeper breaths). Protip: If your CO2 is rising, you are not ventilating enough, and increasing FiO2 (oxygenation) will not necessarily help.
4. In people with any disease which may lead to thrombocytopenia, avoid spinal or epidural anesthesia as you may cause an epidural hematoma. Think both acquired (ITP, sequestration, leukemia, drug-induced: ie heparin/thymoglobulin, chemotherapy, antibiotics, peroxidase inhibitors) and inherited causes of marrow failure (i.e. Fanconi's anemia)
5. Feeding tubes:
-Dobhoff feedings are associated with less issues of bloating/gastroparesis compared to NG feedings
-NG tubes can stay in longer, are more comfortable to wear
-OG tubes are less traumatic to insert (nasal mucosa is very vascular)
-In kids who are g-tube dependent, a nissen fundoplication will decrease risk of reflux and aspiration.
6. Respiratory depression:
-Opiates: fewer, deeper breaths
-Inhaled anesthetics: more frequent, shallower breaths.
7. Etomidate can be associated with adrenal suppression that occurs days later; treat the hypotension with stress-dose steroids (100mg). However, it causes less cardiac depression than propofol.
8. Preoperative assessment key questions:
-Reason for surgery
-History of problems with anesthesia (n/v, awareness), or in kids who have never had surgery-- family hx of problems with anesthesia
-Time of last consumption of water and food.
-PMHx (particularly organ dysfunction, airway issues)
9. Preoperative assessment relevant ROS:
-Neuro: seizures, TIA
-Cards: Exercise tolerance!! HTN, MI/CAD, CHF, valvular dx, arrhythmia.
-Pulm: COPD (bronch/emphysema), asthma, smoking status, OSA, recent URI (increases risk of bronchospasm)
-GI: GERD,
-Renal/Liver: any dysfunction
-Endo: thyroid, DM, adrenals
-Heme: anemia, bleeding dx
-MSK: arthritis (for positioning), neuromuscular dx
10. Preoperative assessment: exam 
-Airway: Mallampati, thyromental distance, neck flexion/extension, jaw thrust
-Other: lungs CTAB, heart RRR, disconjugate gaze