Anesthesia Ready

This release applies a clinical content review of the app's doses, thresholds, crisis algorithms and citations against the primary published sources. Fourteen items were updated, and each corrected claim now carries the source it comes from. LOCAL ANESTHETIC SYSTEMIC TOXICITY - Lipid emulsion 20% now shows both ASRA arms. UNDER 70 kg: bolus about 1.5 mL/kg over 2-3 min, then 0.25 mL/kg/min. OVER 70 kg: bolus about 100 mL over 2-3 min, then infuse about 250 mL over 15-20 min. - The lipid emulsion row in the Dosing Reference reads 1.5 mL/kg, with IV in the route column. - Post-event monitoring is on the card: 2 h after seizure activity, 4-6 h after cardiovascular instability, and longer after cardiac arrest. - The LAST card, the lipid dose row and the lipid agent card cite the ASRA Pain Medicine Local Anesthetic Systemic Toxicity Checklist, 2020 version. MALIGNANT HYPERTHERMIA - The steps follow the MHAUS Emergency Treatment Protocol: notify the surgeon to halt the procedure and stop volatiles and succinylcholine, get dantrolene and the MH cart and call for help, hyperventilate with 100% oxygen at flows of 10 L/min, give dantrolene 2.5 mg/kg, then convert to TIVA with a clean vapor-free circuit and charcoal filters. - The card states that machine and circuit changes must not delay dantrolene. - MHAUS Hotline 1-800-644-9737 (outside the US 001-209-417-3722) is on the card. NEUROMUSCULAR BLOCKADE AND REVERSAL - Neostigmine reflects the 2023 ASA guideline: sugammadex is recommended over neostigmine at deep, moderate and shallow rocuronium or vecuronium block, and neostigmine is a reasonable alternative only at minimal depth (TOF ratio 0.4 up to 0.9). - The vitals tile is labeled "Train-of-four count". A count of 4 is the top of the qualitative count scale and does not on its own establish recovery. - The Vitals screen carries the 2023 ASA requirement to confirm a quantitative train-of-four ratio at or above 0.9 before extubation. BRADYCARDIA - Atropine for adult bradycardia: 1 mg IV first dose, repeat every 3-5 min, maximum total 3 mg, per the AHA 2025 Adult Bradycardia With a Pulse algorithm. The agent card, the dose table and the high or total spinal card all carry this regimen. LOCAL ANESTHETIC MAXIMUMS - Ropivacaine shows no separate with-epinephrine ceiling: epinephrine has no effect on limiting systemic absorption of ropivacaine (Naropin label). - Mepivacaine shows no separate with-epinephrine ceiling. The agent card states the 400 mg single adult dose limit, and notes that the 7 mg/kg (550 mg) figure is not epinephrine-conditioned and is not recommended except in exceptional circumstances (Carbocaine label). PREOPERATIVE MEDICATION - GLP-1 receptor agonists: if holding, consider holding daily dosing on the day of the procedure or surgery, and weekly dosing a week prior (ASA 2023). AGENT DOSING - Ketamine intramuscular induction: 6.5 to 13 mg/kg (Ketalar label). SOURCES - Three citations added: the ASRA LAST Checklist 2020, the 2023 ASA Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade, and the AHA 2025 Adult Bradycardia With a Pulse algorithm. - The ASRA antithrombotic guideline is now labeled "ASRA Anticoag 5e 2025" so the two ASRA documents are distinguishable at a glance.