The 60-second pre-case brush-up: top anesthetic implications for 15 vulnerable populations, hand-written and cited to Miller's, Stoelting's, Coté, and society guidelines.
Down syndrome (Trisomy 21)
Cervical spine caution, small airway, likely congenital heart disease, exaggerated vagal responses.
The pregnant patient (non-obstetric surgery)
Two patients, full stomach, fast desaturation, aortocaval compression — and defer anything elective.
Pediatrics — the quick physiologic reset
High O₂ consumption, small margins, bradycardia = hypoxia until proven otherwise.
The geriatric patient
Lower doses, slower circulation, fragile pressure — and delirium is the complication to design against.
Sickle cell disease
Everything that promotes sickling is on your side of the drapes: hypoxia, cold, acidosis, dehydration, stasis.
Malignant hyperthermia — susceptible patient
Trigger-free technique, prepared machine, dantrolene in the room's orbit — then it's a normal day.
Muscular dystrophy (Duchenne/Becker)
Succinylcholine is forbidden, volatiles are suspect (rhabdo), and the heart is sicker than the child looks.
Myasthenia gravis
Exquisitely sensitive to nondepolarizers, resistant to succinylcholine, and the real question is postop ventilation.
Morbid obesity
Dose by the right scalar, position before you induce, and assume the sats fall twice as fast.
Obstructive sleep apnea
Opioid-sensitive, obstruction-prone, and the danger peaks after you've left — design the whole arc.
CKD & the dialysis patient
Check the potassium, protect the fistula, and pick drugs that don't need kidneys.
Cirrhosis & advanced liver disease
Risk-stratify with MELD/Child-Pugh, respect the rebalanced coagulation, and expect every drug to last longer.
Adult congenital heart disease
Know the lesion, the repair, and which way blood shunts before touching a syringe — and de-air every line.
Chronic opioid use & OUD (incl. buprenorphine/MAT)
Continue the baseline, build the multimodal floor, and never 'save' analgesia for later.
The Jehovah's Witness patient
It's a consent conversation first: document exactly what's acceptable, then engineer the case to never need what isn't.
Educational quick-reference only — not a substitute for clinical judgment, institutional protocols, or the primary texts each sheet cites.