Audit log

Clinical Sources for Helix Anesthesia

Every dose, max, and protocol in Helix Anesthesia mapped to its primary reference. This document maps each clinical value in the app to a verifiable external source (FDA package insert, society guideline, or primary literature) so any clinician can verify our work.

Review status — pending external peer review. The doses and protocols below were compiled and cross-referenced against the cited sources by the development team. Independent clinical peer review by anesthesia clinicians is in progress. Reviewers who have signed off are listed in the Reviewer Audit Log at the bottom of this document. Until that log shows a reviewer signature for a given section, treat that section as developer-cited but not externally peer-reviewed.

Disclaimer: Doses verified to the best of authors' knowledge against the cited references at the time of authoring. Drug labels change; verify each dose against the most current package insert before clinical use. Helix Anesthesia is a reference tool and does not replace clinical judgment.

How to find any cited source

FDA package inserts — All major drug PIs are searchable at the FDA's DailyMed:

https://dailymed.nlm.nih.gov/dailymed/index.cfm
Direct PDFs hosted at accessdata.fda.gov are linked inline below.

Journal articles — Every cited article can be located on PubMed by entering the citation (author + year + journal):

PubMed search: https://pubmed.ncbi.nlm.nih.gov/
Free abstracts for every cited article; full text may require institutional access via your hospital library.
Many articles are also open-access on PubMed Central (PMC).

Society guidelines — Direct URLs to society documents are listed inline (AHA, ASA, ASRA, ACOG, SMFM, MHAUS, NCCMERP).

Textbook references — Edition-dependent page numbers. Chapter titles are the stable reference. Publisher URLs for textbooks:

Miller's Anesthesia, 10th ed (Gropper, Cohen, Eriksson, Fleisher, Leslie, Johnson-Akeju; Elsevier 2024; ISBN 9780323935920): https://shop.elsevier.com/books/millers-anesthesia-2-volume-set/gropper/978-0-323-93592-0 · Also on ClinicalKey
A Practice of Anesthesia for Infants and Children, 6th ed (Coté, Lerman, Anderson; Elsevier 2018; ISBN 9780323429740): https://shop.elsevier.com/books/a-practice-of-anesthesia-for-infants-and-children/cote/978-0-323-42974-0
Stoelting's Pharmacology & Physiology in Anesthetic Practice, 6th ed (Flood, Rathmell, Urman; LWW 2022; ISBN 9781975126896): https://shop.lww.com/Stoelting-s-Pharmacology---Physiology-in-Anesthetic-Practice/p/9781975126896
Cousins and Bridenbaugh's Neural Blockade, 4th ed (Cousins, Carr, Horlocker, Bridenbaugh; LWW 2009): https://www.wolterskluwer.com/en/solutions/ovid/cousins-and-bridenbaughs-neural-blockade-in-clinical-anesthesia-and-pain-medicine-5380
Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th ed (Cullen, Stock, Ortega; LWW 2023; ISBN 9781975199074): https://shop.lww.com/Barash--Cullen--and-Stoelting-s-Clinical-Anesthesia--Print---eBook-with-Multimedia/p/9781975199074

1. Local Anesthetics — Maximum Doses

The figures below are absolute single-dose ceilings intended for LAST (local anesthetic systemic toxicity) calculation — i.e., the maximum a patient should receive in one administration regardless of technique (infiltration, peripheral block, epidural). Where the FDA label gives an explicit mg/kg, that is quoted directly. Where the FDA label only gives an absolute mg cap (bupivacaine, mepivacaine adult, ropivacaine), the mg/kg figure is the standard textbook back-calculation used across Miller's, Stoelting's, and Barash. Infiltration-only tables in some textbooks (e.g. Miller's 8e Table 36-4) quote more conservative numbers for that specific use — those are not wrong, but they are narrower than the toxicity-ceiling values below.

Agent	Plain (mg/kg)	Plain cap (mg)	With epi (mg/kg)	Epi cap (mg)	Source
Lidocaine	4.5	300	7	500	Xylocaine PI; Miller's 10e Ch. 47
Mepivacaine	5	400	7	500	Carbocaine PI (adult absolute cap); Miller's 10e
Bupivacaine	2.5	175	3	225	Marcaine PI (FDA: "single doses up to 175 mg plain, 225 mg with epi"); Miller's 10e; ASRA
Ropivacaine	3	225	—	—	Naropin PI (cumulative 770 mg/24h); single-dose mg/kg per Miller's 10e / Stoelting's. With-epi ceiling not listed: ropivacaine has intrinsic vasoconstrictor properties and the FDA Naropin label does not endorse epinephrine co-administration; clinicians using ropi + epi off-label should reference a more specialized source.
Chloroprocaine	11	800	14	1000	Nesacaine PI
Procaine	7	500	9	600	Novocain PI
Prilocaine	6	400	8	600	Citanest PI (dental, FDA-approved US form). Plain mg/kg per anesthesia-text convention reflecting methemoglobinemia risk
Tetracaine	1	100	—	—	Pontocaine PI. Modern use is spinal (5-20 mg total) and topical, not infiltration

Primary URLs:

Marcaine (bupivacaine HCl) PI — DailyMed
Xylocaine (lidocaine HCl) PI — DailyMed
Naropin (ropivacaine) PI — DailyMed
Nesacaine (chloroprocaine) PI — DailyMed
Carbocaine (mepivacaine) PI — DailyMed
Novocaine (procaine) PI — DailyMed
Citanest (prilocaine) PI — DailyMed
Pontocaine (tetracaine) PI — DailyMed
Miller's Anesthesia 10e Ch. 47 "Local Anesthetics" — Elsevier
ASRA LAST Checklist (max-dose guidance) — ASRA

2. Sugammadex (Reversal)

Indication	Dose	Source
TOF count ≥ 2 (shallow/moderate block)	2 mg/kg	Bridion PI — DailyMed · FDA label PDF
1-2 PTC, no TOF (deep block)	4 mg/kg	Bridion PI — DailyMed
Immediate reversal of profound block, within 3 min of 1.2 mg/kg rocuronium	16 mg/kg	Bridion PI — DailyMed

URLs:

Bridion (sugammadex) PI — DailyMed search · FDA 2015 label PDF
FDA approval letter — FDA NDA 022225

Caveats noted in app:

Hormonal contraceptive interaction (PI Section 7.1)
CrCl <30 mL/min not recommended (PI Section 8.6)
Bradycardia rare but reported (PI Section 5.2)

3. Sugammadex — Pediatric

Dose	Source
2 mg/kg (TOF ≥ 2)	Bridion PI — DailyMed
4 mg/kg (deep block)	Bridion PI — DailyMed
16 mg/kg (immediate)	Bridion PI — DailyMed

Pediatric dosing extrapolated from adult PI per Bridion label (approved age ≥ 2 years by FDA 2021) — DailyMed Bridion label.

4. Neuraxial / Intrathecal Adjuvants — (`NEURAXIAL_ADJUVANTS`)

Drug	Dose (intrathecal, total)	Source
Fentanyl	10–25 mcg	Miller's 10e Ch. 56 "Spinal Anesthesia" — Miller's product page; Sublimaze PI — DailyMed
Sufentanil	2.5–10 mcg	Miller's 10e Ch. 56 — Miller's; Sufenta PI — DailyMed
Morphine (preservative-free)	100–200 mcg	Duramorph PI — DailyMed; Carvalho B, et al. Anesth Analg 2005;100:1150-1158 — PubMed
Epinephrine	100–200 mcg	Miller's 10e Ch. 56 — Miller's; Adrenalin PI — DailyMed
Clonidine	15–75 mcg total	Catapres PI — DailyMed; Stoelting's Pharmacology, 6th ed — LWW
Dexmedetomidine	3–10 mcg total (off-label)	Kanazi GE, et al. Acta Anaesthesiol Scand 2006;50:222-227 (3 mcg dose) — PubMed; Al-Mustafa MM, et al. Saudi Med J 2009;30:365-370 (5-10 mcg dose) — PubMed

Epidural adjuvants:

Drug	Dose	Source
Fentanyl bolus	50–100 mcg	Stoelting's Pharmacology — LWW; Cousins & Bridenbaugh 4e — Wolters Kluwer; Sublimaze PI — DailyMed
Morphine epidural	1–4 mg	Duramorph PI — DailyMed
Epinephrine test dose	15 mcg with 3 mL 1.5% lidocaine	Moore DC, Batra MS. Anesthesiology 1981;55:693-696 — ASA Pubs

5. Peripheral Block Adjuvants — (`BLOCK_ADJUVANTS`)

Drug	Dose (perineural)	Source
Epinephrine	1:200,000–400,000 (2.5–5 mcg/mL)	Miller's 10e Ch. 57 — Miller's; Adrenalin PI — DailyMed
Dexamethasone	4–8 mg perineural	Choi S, et al. Br J Anaesth 2014;112:427-439 — PubMed
Clonidine	0.5–1 mcg/kg (max 75–150 mcg)	Pöpping DM, et al. Anesthesiology 2009;111:406-415 — PubMed
Sodium bicarbonate	1 mEq per 10 mL lidocaine	Hilgier M. Reg Anesth 1985;10:59-61 (older paper, not indexed in PubMed; see Sources Without a Confirmed Direct URL section for alternative refs)
Buprenorphine	150–300 mcg perineural	Candido KD, et al. Reg Anesth Pain Med 2002;27:162-167 — PubMed
Dexmedetomidine	0.5–1 mcg/kg perineural	Abdallah FW, Brull R. Br J Anaesth 2013;110:915-925 — PubMed

6. Spinal Anesthesia Dose by Procedure

Procedure	Bupivacaine dose	Source
Lower extremity / saddle (T10-L1)	10–15 mg	Cousins & Bridenbaugh 4e — Wolters Kluwer; Miller's 10e Ch. 56 — Miller's
C-section (T4)	10–12 mg hyperbaric	ACOG Practice Bulletin 209 (Obstetric Analgesia/Anesthesia) — ACOG; SOAP Centers of Excellence — SOAP
Lower abdomen / inguinal hernia (T6-T8)	11–15 mg	Cousins & Bridenbaugh 4e — Wolters Kluwer
Saddle block (S2-S5)	5–7 mg, patient sits × 5 min	Cousins & Bridenbaugh 4e — Wolters Kluwer

Alternative LAs (Spinal screen):

Ropivacaine 0.5–0.75%: 12–20 mg (Naropin PI off-label spinal use) — DailyMed
Mepivacaine 1.5–2% isobaric: 40–60 mg — Dose-response study: Zayas VM, et al. Anesth Analg 1999;89:1167-1171 — PubMed
2-Chloroprocaine 3% PF: 30–50 mg — Goldblum E, Atchabahian A. Acta Anaesthesiol Scand 2013 — PubMed; Nesacaine PI — DailyMed
Lidocaine 5% hyperbaric: 60–100 mg (⚠ TNS rate 10-30% — Pollock JE. Anesth Analg 2003) — PubMed; Xylocaine PI — DailyMed
Tetracaine 0.5–1%: 6–12 mg — Pontocaine PI — DailyMed

7. Sevoflurane / Volatile Anesthetics — (MAC values)

MAC values per age group from:

Stevens WC, et al. Anesthesiology 1975;42:197-200 (original MAC isoflurane study; commonly referenced for sevoflurane via comparator data) — ASA Pubs
Mapleson WW. Br J Anaesth 1996;76:179-185 (age-adjustment formula for MAC) — PubMed
Ultane (sevoflurane) PI — DailyMed · FDA 2006 label PDF
Forane (isoflurane) PI — DailyMed
Suprane (desflurane) PI — DailyMed

8. Pediatric Doses — (`pediatricDoseGroups`)

Emergency / Code

Primary reference for this entire section: AHA PALS 2020 — Topjian AA, et al. Circulation 2020;142:S469-S523 — AHA Journals · PubMed · ECC guidelines portal: cpr.heart.org.

Drug	Dose	Source
Epinephrine 1:10,000 IV/IO	0.01 mg/kg (max 1 mg)	AHA PALS 2020 — AHA; Adrenalin PI — DailyMed
Epinephrine 1:1,000 IM (anaphylaxis)	0.01 mg/kg (max 0.5 mg)	Sicherer SH, Simons FER. Pediatrics 2017;139:e20164006 — PubMed; AAAAI Anaphylaxis Practice Parameter — AAAAI
Atropine	0.02 mg/kg (min 0.1 mg, max 0.5 mg)	AHA PALS 2020 — AHA; Atropine sulfate PI — DailyMed
Amiodarone	5 mg/kg, max 300 mg	AHA PALS 2020 — AHA; Cordarone IV PI — DailyMed
Lidocaine	1 mg/kg	AHA PALS 2020 — AHA; Xylocaine PI — DailyMed
Adenosine (1st)	0.1 mg/kg (max 6 mg); (2nd) 0.2 mg/kg (max 12 mg)	AHA PALS 2020 — AHA; Adenocard PI — DailyMed
Calcium chloride 10%	20 mg/kg (max 1 g)	AHA PALS 2020 — AHA; Calcium chloride PI — DailyMed
Calcium gluconate 10%	60 mg/kg (max 3 g)	AHA PALS 2020 — AHA; Calcium gluconate PI — DailyMed
Sodium bicarbonate	1 mEq/kg	AHA PALS 2020 — AHA; Sodium bicarbonate inj PI — DailyMed
Magnesium sulfate	25–50 mg/kg (max 2 g)	AHA PALS 2020 — AHA; Magnesium sulfate PI — DailyMed
Naloxone (emergency)	0.01 mg/kg (max 2 mg)	Naloxone PI — DailyMed
Flumazenil	0.01 mg/kg (max 0.2 mg per dose)	Romazicon PI — DailyMed
Defibrillation	2 J/kg → 4 J/kg → up to 10 J/kg	AHA PALS 2020 — AHA
Cardioversion (sync)	0.5–1 J/kg → 2 J/kg	AHA PALS 2020 — AHA

Premedication

Drug	Dose	Source
Midazolam PO	0.5 mg/kg (max 20 mg)	Versed PI — DailyMed; Coté 6e — Elsevier
Midazolam IN	0.2 mg/kg (max 10 mg)	Karl HW, et al. Anesthesiology 1992;76:209-215 — ASA Pubs
Midazolam IV	0.05 mg/kg (max 5 mg)	Versed PI — DailyMed
Ketamine PO	6 mg/kg (max 300 mg)	Ketalar PI — DailyMed; Sekerci C, et al. Br J Anaesth 1996;76:28-33 — PubMed search
Ketamine IM	4 mg/kg	Ketalar PI — DailyMed
Dexmedetomidine IN	1–2 mcg/kg	Yuen VM. Anesth Analg 2007;105:374-380 — PubMed; Precedex PI — DailyMed
Clonidine PO	4 mcg/kg	Mikawa K, et al. Anesthesiology 1996;85:954-960 — ASA Pubs; Catapres PI — DailyMed

Induction Agents

Drug	Dose	Source
Propofol	2–3 mg/kg	Diprivan PI — DailyMed; Coté 6e Ch. 9 — Elsevier
Ketamine IV	1–2 mg/kg	Ketalar PI — DailyMed
Etomidate	0.3 mg/kg	Amidate PI — DailyMed
Thiopental	4–6 mg/kg	Pentothal PI (historical, US supply discontinued 2011) — DailyMed; Coté 6e Ch. 9 — Elsevier
Sevoflurane mask	8% in 50/50 N2O/O2	Ultane PI — DailyMed; Lerman J, et al. Anesthesiology 1994;80:814-824 — PubMed

Paralytics & Reversal

Drug	Dose	Source
Succinylcholine IV	2 mg/kg (infants), 1–1.5 mg/kg (children)	Anectine PI — FDA label · DailyMed; Cook DR, et al. Anesth Analg 1981 — PubMed
Succinylcholine IM	4 mg/kg	Anectine PI — DailyMed; Liu LM, et al. Anesthesiology 1981 — PubMed search
Rocuronium (intubation)	0.6 mg/kg	Zemuron PI — DailyMed
Rocuronium (RSI)	1.2 mg/kg	Mazurek AJ, et al. Anesth Analg 1998;87:1259-1262 — PubMed; Zemuron PI — DailyMed
Vecuronium	0.1 mg/kg	Norcuron PI — DailyMed
Cisatracurium	0.15 mg/kg	Nimbex PI — DailyMed
Neostigmine	0.05 mg/kg (max 5 mg)	Bloxiverz PI — DailyMed

Analgesia & Opioid Reversal

Drug	Dose	Source
Fentanyl	1–2 mcg/kg	Sublimaze PI — DailyMed; Coté 6e Ch. 9 — Elsevier
Morphine	0.05–0.1 mg/kg	Morphine sulfate inj PI — DailyMed
Hydromorphone	10–15 mcg/kg	Dilaudid PI — DailyMed
Remifentanil	0.05–0.2 mcg/kg/min infusion	Ultiva PI — DailyMed
Ketorolac (Toradol)	0.5 mg/kg IV, max 30 mg/dose	Toradol PI — DailyMed
Acetaminophen IV	15 mg/kg, max 1 g/dose, max 75 mg/kg/day (children), 60 mg/kg/day (infants)	Ofirmev PI — DailyMed
Acetaminophen PR	Load 40 mg/kg PR, then 20 mg/kg q6h	Birmingham PK, et al. Anesthesiology 1997 — PubMed
Naloxone (postop reversal)	1–5 mcg/kg titrated	Naloxone PI — DailyMed
Flumazenil	0.01 mg/kg, max 0.2 mg	Romazicon PI — DailyMed

Antiemetics

Drug	Dose	Source
Ondansetron	0.1 mg/kg (max 4 mg)	Zofran PI — DailyMed
Dexamethasone	0.1–0.15 mg/kg (max 10 mg)	Decadron PI — DailyMed; Henzi I, et al. Anesth Analg 2000 — PubMed
Metoclopramide (Reglan)	0.15 mg/kg (max 10 mg)	Reglan PI — DailyMed
Famotidine	0.25 mg/kg (max 20 mg)	Pepcid PI — DailyMed
Ranitidine (Zantac)	1 mg/kg (max 50 mg) — IV; oral pulled 2020 (NDMA)	FDA recall — fda.gov
Promethazine (Phenergan)	0.25 mg/kg, max 12.5 mg — CONTRAINDICATED < 2 yrs	Phenergan PI (FDA black box) — DailyMed
Diphenhydramine	0.5–1 mg/kg (max 50 mg)	Benadryl PI — DailyMed

Cardiovascular

Drug	Dose	Source
Ephedrine	0.1–0.3 mg/kg IV	Ephedrine sulfate PI — DailyMed; Stoelting's Pharmacology 6e — LWW
Phenylephrine	1–5 mcg/kg IV	Neo-Synephrine PI — DailyMed
Glycopyrrolate	0.005 mg/kg (max 0.2 mg)	Robinul PI — DailyMed
Esmolol	0.5 mg/kg bolus; 50–200 mcg/kg/min infusion	Brevibloc PI — DailyMed
Labetalol	0.2–1 mg/kg IV (max 20 mg/dose)	Trandate PI — DailyMed
Hydralazine	0.1–0.2 mg/kg IV (max 20 mg)	Apresoline / Hydralazine HCl PI — DailyMed
Nitroglycerin	1–5 mcg/kg/min infusion	Nitroglycerin injection PI — DailyMed
Nicardipine	0.5–3 mcg/kg/min infusion	Cardene IV PI — DailyMed

Local Anesthetics (Pediatric)

Drug	Dose	Source
Bupivacaine 0.25% (caudal)	1 mL/kg sacral, 1.25 mL/kg high-lumbar (max 2 mg/kg)	Coté 6e Ch. 17 — Elsevier; Brown TC, et al. Anaesth Intensive Care 1986 — PubMed search
Bupivacaine plain max	2.5 mg/kg, abs cap 175 mg	Marcaine PI — DailyMed
Ropivacaine 0.2% (caudal)	1 mL/kg	Naropin PI — DailyMed; Bösenberg AT, et al. Acta Anaesthesiol Scand 2001;45:1276-1280 — PubMed
Lidocaine plain	4.5 mg/kg	Xylocaine PI — DailyMed
Lidocaine with epi	7 mg/kg	Xylocaine PI — DailyMed
Spinal bupivacaine 0.5% (infant)	0.4–0.6 mg/kg	Williams RK, et al. Anesth Analg 2006;102:67-71 — PubMed

Smooth Emergence

Drug	Dose	Source
Lidocaine IV	1–1.5 mg/kg ~2 min pre-extubation	Yukioka H, et al. Anesth Analg 1985 — PubMed; Xylocaine PI — DailyMed
Propofol (sub-induction)	0.5–1 mg/kg slow IV	Ouellet MF, et al. Can J Anaesth 2023;70:842-850 (propofol bolus for cough at emergence, RCT) — PubMed; Diprivan PI — DailyMed
Dexmedetomidine (bolus)	0.3–0.5 mcg/kg	Precedex PI — DailyMed; Bhana N, et al. Drugs 2000 — PubMed search
Fentanyl (small dose)	0.5–1 mcg/kg ~5 min pre-extubation	Sublimaze PI — DailyMed

MH — Dantrolene

Drug	Dose	Source
Dantrolene initial	2.5 mg/kg IV	MHAUS 2024 guidelines: https://www.mhaus.org/healthcare-professionals/managing-a-crisis/; Ryanodex PI: https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=ryanodex
Dantrolene maintenance	1 mg/kg q4-6h × 24-48 h	MHAUS 2024

9. Apfel PONV Score

Primary: Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999;91:693-700.

PubMed

Antiemetic doses cited in app:

Ondansetron 4 mg IV — Zofran PI — DailyMed
Dexamethasone 4-8 mg IV — Apfel CC, et al. NEJM 2004;350:2441-2451 (IMPACT trial) — PubMed; Decadron PI — DailyMed
Droperidol 0.625-1.25 mg IV — Inapsine PI (FDA black box QT — monitor) — DailyMed
Aprepitant 40 mg PO — Emend PI — DailyMed
Scopolamine 1.5 mg transdermal — Transderm Scop PI — DailyMed

10. RCRI (Lee) + Gupta MICA

RCRI: Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999;100:1043-1049.

URL: https://www.ahajournals.org/doi/10.1161/01.CIR.100.10.1043

Gupta MICA: Gupta PK, Gupta H, Sundaram A, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation 2011;124:381-387.

URL: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.110.015701
NSQIP risk calculator (live tool): https://riskcalculator.facs.org/

The Gupta MICA coefficients used in the app are from the supplement of the Gupta 2011 Circulation paper.

11. STOP-BANG

Primary: Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108:812-821.

URL (PubMed): https://pubmed.ncbi.nlm.nih.gov/18431116/
STOP-Bang official site (additional content): http://www.stopbang.ca/

12. NPO Fasting Guidelines

Primary: ASA Task Force on Preoperative Fasting. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report. Anesthesiology 2017;126:376-393.

URL: https://pubs.asahq.org/anesthesiology/article/126/3/376/19733/
ASA Clear Liquids Update 2023 (extends to 2 hr): https://www.asahq.org/standards-and-practice-parameters

13. ASRA Anticoagulation

Primary: Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: ASRA Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med 2018;43:263-309.

URL: https://rapm.bmj.com/content/43/3/263

14. Crisis Checklists — (`crisisData`)

Crisis	Source
Malignant Hyperthermia	MHAUS Emergency Protocol — MHAUS; Dantrolene PI (Ryanodex) — DailyMed
LAST	ASRA 2020 Checklist for Treatment of Local Anesthetic Systemic Toxicity — ASRA Guidelines; Neal JM, et al. Reg Anesth Pain Med 2018;43:113-123 — PubMed
CICO	Difficult Airway Society 2015 Intubation Guidelines — DAS; ASA 2022 Difficult Airway Guidelines — ASA Pubs
Anaphylaxis	Shaker MS, et al. AAAAI/ACAAI 2020 Anaphylaxis Practice Parameter Update. J Allergy Clin Immunol 2020;145:1082-1123 — PubMed; AAAAI guidance portal — AAAAI
ACLS	AHA 2020 ECC Guidelines — cpr.heart.org; Panchal AR, et al. Circulation 2020;142:S366-S468 — AHA Journals · PubMed
PALS	AHA PALS 2020 — AHA Journals; see Section 8 above
Massive Transfusion Protocol (MTP)	Holcomb JB, et al. PROPPR trial. JAMA 2015;313:471-482 (1:1:1 ratio) — PubMed; CRASH-2 trial collaborators. Lancet 2010;376:23-32 (TXA in trauma) — PubMed; Miller's 10e Ch. 49 "Patient Blood Management" — Miller's
Venous Air Embolism (VAE)	Miller's 10e Ch. 39 "Anesthesia for Neurosurgery" — Miller's; Mirski MA, et al. Anesthesiology 2007;106:164-177 (VAE diagnosis and management review) — PubMed
Bronchospasm	Miller's 10e Ch. 13 "Pulmonary Pharmacology" — Miller's; Stoelting's Pharmacology 6e — LWW; Albuterol PI — DailyMed
Delayed Emergence	Miller's 10e Ch. 84 "Postanesthesia Care" — Miller's; Tzabazis A, et al. J Clin Anesth 2015;27:353-360 (delayed emergence review) — PubMed

15. OB Emergencies — (`obEmergencies`)

Topic	Source
Postpartum hemorrhage (PPH)	ACOG Practice Bulletin 183 — ACOG
Eclampsia / Magnesium toxicity	ACOG Practice Bulletin 222 (2020) — ACOG; Magnesium sulfate PI — DailyMed
Placenta accreta	ACOG Obstetric Care Consensus 7 (replaces Committee Opinion 529): Placenta Accreta Spectrum — ACOG; SMFM Consult #44 (2018) — PubMed
Amniotic Fluid Embolism (AFE)	Society for Maternal-Fetal Medicine. Amniotic fluid embolism: diagnosis and management. Am J Obstet Gynecol 2016;215:B16-B24 — PubMed; SMFM publications portal — SMFM

16. Infusion Drug Concentrations

Final infusion concentrations and standard mixing instructions reference:

Institute for Safe Medication Practices (ISMP) Standard Concentrations of Adult Continuous IV Infusions — ISMP
Hospital pharmacy formulary standard concentrations (institution-specific)
Stoelting's Pharmacology, 6th ed — LWW
Individual PIs linked per drug below.

Drug	Standard infusion conc	Source
Propofol	10 mg/mL (1%) stock	Diprivan PI — DailyMed
Dexmedetomidine	4 mcg/mL (200 mcg in 50 mL NS)	Precedex PI — DailyMed
Ketamine	1 mg/mL (100 mg in 100 mL NS)	Ketalar PI — DailyMed
Remifentanil	50 mcg/mL (5 mg in 100 mL NS, NS only)	Ultiva PI — DailyMed
Fentanyl	50 mcg/mL (stock)	Sublimaze PI — DailyMed
Sufentanil	50 mcg/mL (stock)	Sufenta PI — DailyMed
Lidocaine	20 mg/mL (2% stock)	Xylocaine PI — DailyMed
Rocuronium	10 mg/mL (stock)	Zemuron PI — DailyMed
Cisatracurium	2 mg/mL (stock)	Nimbex PI — DailyMed
Phenylephrine	100 mcg/mL (10 mg in 100 mL NS)	Neo-Synephrine PI — DailyMed
Norepinephrine	16 mcg/mL (4 mg in 250 mL D5W; D5W only, oxidizes in NS)	Levophed PI — DailyMed
Epinephrine	16 mcg/mL (4 mg in 250 mL D5W)	Adrenalin PI — DailyMed
Vasopressin	1 unit/mL (20 units in 20 mL NS)	Vasostrict / Pitressin PI — DailyMed
Dopamine	1.6 mg/mL (400 mg in 250 mL D5W)	Dopamine HCl PI — DailyMed
Dobutamine	1 mg/mL (250 mg in 250 mL D5W)	Dobutrex / Dobutamine HCl PI — DailyMed
Milrinone	0.2 mg/mL (20 mg in 100 mL NS)	Primacor PI — DailyMed
Esmolol	10 mg/mL (premixed bag 2500 mg/250 mL)	Brevibloc PI — DailyMed
Nicardipine	0.1 mg/mL (25 mg in 250 mL D5W)	Cardene IV PI — DailyMed
Amiodarone	1.8 mg/mL (900 mg in 500 mL D5W; PVC binds drug — glass preferred)	Cordarone IV PI — DailyMed

17. Awake Fiberoptic

Topicalization, sedation regimens:

Cousins & Bridenbaugh, Neural Blockade in Clinical Anesthesia and Pain Medicine, 4e (2009) — Wolters Kluwer
Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 ASA Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136:31-81 — ASA Pubs
Glycopyrrolate antisialogogue — Robinul PI — DailyMed
Lidocaine topical / nebulized — Xylocaine PI — DailyMed
Dexmedetomidine sedation — Precedex PI — DailyMed

Lidocaine total dose < 9 mg/kg topical:

Williams KA, Barker GL, Harwood RJ, Woodall NM. Combined nebulization and spray-as-you-go topical local anaesthesia of the airway. Br J Anaesth 2005;95:549-553 — PubMed

18. Difficult Airway Algorithm

Primary: ASA Practice Guidelines for Management of the Difficult Airway 2022.

URL: https://pubs.asahq.org/anesthesiology/article/136/1/31/117507/2022-American-Society-of-Anesthesiologists

19. Procedural Sedation

Primary: Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force. Anesthesiology 2018;128:437-479.

URL: https://pubs.asahq.org/anesthesiology/article/128/3/437/19295

ASA fasting standards (clear liquid 2 hr, etc.): see Section 12.

20. Blood Gas Interpretation

Acid-base / oxygenation formulas (Winters, anion gap, A-a gradient, Hb-binding) — references:

Adrogué HJ, Madias NE. Management of life-threatening acid-base disorders. NEJM 1998;338:26-34, 107-111 — NEJM · PubMed
Berend K, de Vries APJ, Gans ROB. Diagnostic use of base excess in acid-base disorders. NEJM 2018;378:1419-1428 — NEJM · PubMed
Winters' formula (expected PaCO₂ = 1.5 × HCO₃⁻ + 8 ± 2): commonly attributed to Winters RW, The Body Fluids in Pediatrics, Boston: Little, Brown, 1973 (textbook; no online edition). Modern review: Albert MS, et al. Ann Intern Med 1967;66:312-322 (original metabolic-acidosis compensation data) — PubMed

21. Adult Drug Reference — Additions

Drugs in src/screens/DrugsScreen.jsx (drugsData). Doses derived from FDA package inserts (DailyMed search URLs), standard anesthesia textbooks (Miller's 10e, Stoelting's 6e, Barash 9e), and the trial citations listed where evidence-based dosing applies. Pediatric versions of these drugs live in Section 8.

Sedation / Premedication

Drug	Source
Midazolam (Versed)	Versed PI — DailyMed; Stoelting's 6e — LWW
Clonidine	Catapres PI — DailyMed; Stoelting's 6e

Antiarrhythmics & Code Drugs (ACLS doses per AHA 2020)

Drug	Source
Amiodarone	Cordarone PI — DailyMed; AHA ACLS 2020 — PubMed
Lidocaine (IV antiarrhythmic / analgesic)	Xylocaine PI — DailyMed; AHA ACLS 2020
Adenosine (Adenocard)	Adenocard PI — DailyMed; AHA ACLS 2020
Magnesium sulfate	Mg sulfate PI — DailyMed; ACOG eclampsia protocol (Section 15)
Calcium chloride 10%	CaCl₂ PI — DailyMed
Calcium gluconate 10%	Ca gluconate PI — DailyMed
Sodium bicarbonate 8.4%	NaHCO₃ PI — DailyMed
Dextrose 50% (D50)	Dextrose 50% PI — DailyMed

Volatile anesthetics (see also Section 7)

Drug	Source
Sevoflurane (Ultane)	Ultane PI — DailyMed; Lerman J, Anesthesiology 1994;80:814-824 — PubMed

Cardiovascular — Vasodilators / Antihypertensives / Diuretic

Drug	Source
Nitroglycerin (NTG)	NTG PI — DailyMed; Stoelting's 6e
Nicardipine (Cardene IV)	Cardene PI — DailyMed; Stoelting's 6e
Furosemide (Lasix)	Lasix PI — DailyMed

Hemorrhage / Anticoagulation

Drug	Source
Tranexamic acid (TXA)	CRASH-2 (trauma) — Lancet 2010;376:23-32 — PubMed; WOMAN trial (PPH) — Lancet 2017;389:2105-2116 — PubMed; TXA PI — DailyMed
Heparin (unfractionated)	Heparin PI — DailyMed; ASRA 4e 2018 — PubMed
Protamine sulfate	Protamine PI — DailyMed; Horrow JC. Anesth Analg 1985;64:348-361 (protamine reactions)

Hormone / Metabolic

Drug	Source
Insulin (regular)	Humulin R / Novolin R PI — DailyMed

Antiemetics (full list)

Drug	Source
Ondansetron (Zofran)	Zofran PI — DailyMed
Dexamethasone	Decadron PI — DailyMed; Henzi I, Anesth Analg 2000 — PubMed
Diphenhydramine	Benadryl PI — DailyMed
Metoclopramide (Reglan)	Reglan PI — DailyMed
Famotidine (Pepcid)	Pepcid PI — DailyMed
Promethazine (Phenergan)	Phenergan PI — DailyMed; FDA pediatric <2 yr black box (2004)
Scopolamine (Transderm Scōp)	Transderm Scōp PI — DailyMed
Droperidol (Inapsine)	Inapsine PI (FDA QT black box 2001) — DailyMed
Aprepitant (Emend)	Emend PI — DailyMed; Apfel CC, NEJM 2004;350:2441-2451 (IMPACT trial) — PubMed

Opioid additions + reversal

Drug	Source
Buprenorphine	Buprenex/Suboxone PI — DailyMed; Stoelting's 6e
Methadone (intraop single dose)	Murphy GS, et al. Anesthesiology 2015;122:1112-22 (cardiac surgery cohort) — PubMed; Dolophine PI — DailyMed
Meperidine (Demerol)	Demerol PI — DailyMed
Naloxone	Narcan/Naloxone PI — DailyMed
Flumazenil (Romazicon)	Romazicon PI — DailyMed

Reviewer Audit Log

Independent clinical reviewers who have signed off on sections of this document and have opted in to be listed publicly. Reviewers may choose attribution-anonymous review (recorded internally only) — those signatures are not published here.

Date	Reviewer	Credentials	Affiliation	Sections reviewed	Notes
Awaiting first external sign-off

To contribute a clinical review, email clinical@helixanesthesia.com. Reviewers receive the latest source document, may flag any concern with any cited dose or source, and choose at sign-off whether to be listed in this public log or recorded only in the internal review record.

Appendix: PubMed URLs for cited journal articles

Quick links to all journal articles cited above. URLs go to the PubMed abstract page; full text usually requires institutional login.

Citation	PubMed URL
Apfel CC et al. Anesthesiology 1999;91:693-700 (Apfel PONV score)	https://pubmed.ncbi.nlm.nih.gov/10485781/
Apfel CC et al. NEJM 2004;350:2441-2451 (IMPACT trial)	https://pubmed.ncbi.nlm.nih.gov/15190136/
Lee TH et al. Circulation 1999;100:1043-1049 (RCRI)	https://www.ahajournals.org/doi/10.1161/01.CIR.100.10.1043
Gupta PK et al. Circulation 2011;124:381-387 (Gupta MICA)	https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.110.015701
Chung F et al. Anesthesiology 2008;108:812-821 (STOP-BANG)	https://pubmed.ncbi.nlm.nih.gov/18431116/
Topjian AA et al. Circulation 2020;142:S469-S523 (AHA PALS)	https://www.ahajournals.org/doi/10.1161/CIR.0000000000000901
Carvalho B et al. Anesth Analg 2005;100:1150-1158 (intrathecal morphine)	https://pubmed.ncbi.nlm.nih.gov/15781537/
Kanazi GE et al. Acta Anaesthesiol Scand 2006;50:222-227 (intrathecal dex 3 mcg)	https://pubmed.ncbi.nlm.nih.gov/16430546/
Al-Mustafa MM et al. Saudi Med J 2009;30:365-370 (intrathecal dex 5-10 mcg)	https://pubmed.ncbi.nlm.nih.gov/19271064/
Moore DC, Batra MS. Anesthesiology 1981;55:693-696 (epidural test dose)	https://pubs.asahq.org/anesthesiology/article/55/6/693/29823
Choi S et al. Br J Anaesth 2014;112:427-439 (dexamethasone perineural)	https://pubmed.ncbi.nlm.nih.gov/24413428/
Pöpping DM et al. Anesthesiology 2009;111:406-415 (clonidine perineural)	https://pubmed.ncbi.nlm.nih.gov/19602964/
Candido KD et al. Reg Anesth Pain Med 2002;27:162-167 (buprenorphine perineural)	https://pubmed.ncbi.nlm.nih.gov/11915063/
Abdallah FW, Brull R. Br J Anaesth 2013;110:915-925 (dexmedetomidine perineural)	https://pubmed.ncbi.nlm.nih.gov/23587874/
Karl HW et al. Anesthesiology 1992;76:209-215 (IN midazolam peds)	https://pubs.asahq.org/anesthesiology/article/76/2/209/30801
Yuen VM. Anesth Analg 2007;105:374-380 (IN dexmedetomidine peds)	https://pubmed.ncbi.nlm.nih.gov/17646493/
Mikawa K et al. Anesthesiology 1996;85:954-960 (PO clonidine peds)	https://pubs.asahq.org/anesthesiology/article/85/5/954/35728
Lerman J et al. Anesthesiology 1994;80:814-824 (sevoflurane mask peds)	https://pubmed.ncbi.nlm.nih.gov/8024136/
Mazurek AJ et al. Anesth Analg 1998;87:1259-1262 (rocuronium peds RSI)	https://pubmed.ncbi.nlm.nih.gov/9842809/
Birmingham PK et al. Anesthesiology 1997 (rectal APAP peds)	https://pubmed.ncbi.nlm.nih.gov/9286887/
Henzi I et al. Anesth Analg 2000;90:186-194 (dexamethasone PONV)	https://pubmed.ncbi.nlm.nih.gov/10625002/
Williams RK et al. Anesth Analg 2006;102:67-71 (spinal in infants)	https://pubmed.ncbi.nlm.nih.gov/16368805/
Bösenberg AT et al. Acta Anaesthesiol Scand 2001;45:1276-1280 (caudal ropivacaine pharmacokinetics)	https://pubmed.ncbi.nlm.nih.gov/11736682/
Yukioka H et al. Anesth Analg 1985 (IV lidocaine extubation)	https://pubmed.ncbi.nlm.nih.gov/4061901/
Ouellet MF et al. Can J Anaesth 2023;70:842-850 (propofol bolus for cough at emergence)	https://pubmed.ncbi.nlm.nih.gov/36829104/
Adrogué HJ, Madias NE. NEJM 1998;338:26-34 (acid-base disorders)	https://www.nejm.org/doi/full/10.1056/NEJM199801013810107
Berend K et al. NEJM 2018;378:1419-1428 (base excess)	https://www.nejm.org/doi/full/10.1056/NEJMra1711860
Stevens WC et al. Anesthesiology 1975;42:197-200 (sevoflurane MAC)	https://pubs.asahq.org/anesthesiology/article/42/2/197/26839
Mapleson WW. Br J Anaesth 1996;76:179-185 (MAC age adjustment)	https://pubmed.ncbi.nlm.nih.gov/8777094/
Williams KA et al. Br J Anaesth 2005;95:549-553 (airway topicalization)	https://pubmed.ncbi.nlm.nih.gov/16126785/
Pollock JE. Anesth Analg 2003 (TNS with lidocaine spinal)	https://pubmed.ncbi.nlm.nih.gov/12873924/
Goldblum E, Atchabahian A. Acta Anaesthesiol Scand 2013 (chloroprocaine spinal)	https://pubmed.ncbi.nlm.nih.gov/23320599/
Horlocker TT et al. Reg Anesth Pain Med 2018;43:263-309 (ASRA 4e)	https://rapm.bmj.com/content/43/3/263
Apfelbaum JL et al. Anesthesiology 2022;136:31-81 (ASA Difficult Airway 2022)	https://pubs.asahq.org/anesthesiology/article/136/1/31/117507
ASA Procedural Sedation 2018, Anesthesiology 2018;128:437-479	https://pubs.asahq.org/anesthesiology/article/128/3/437/19295
ASA NPO Guidelines 2017, Anesthesiology 2017;126:376-393	https://pubs.asahq.org/anesthesiology/article/126/3/376/19733/
CRASH-2 trial collaborators. Lancet 2010;376:23-32 (TXA in trauma)	https://pubmed.ncbi.nlm.nih.gov/20554319/
WOMAN Trial Collaborators. Lancet 2017;389:2105-2116 (TXA in PPH)	https://pubmed.ncbi.nlm.nih.gov/28456509/
Holcomb JB et al. JAMA 2015;313:471-82 (PROPPR — 1:1:1 transfusion)	https://pubmed.ncbi.nlm.nih.gov/25647203/
Murphy GS et al. Anesthesiology 2015;122:1112-22 (intraop methadone, cardiac)	https://pubmed.ncbi.nlm.nih.gov/25837528/
Mirski MA et al. Anesthesiology 2007;106:164-177 (VAE review)	https://pubmed.ncbi.nlm.nih.gov/17197859/
Tzabazis A et al. J Clin Anesth 2015;27:353-360 (delayed emergence review)	https://pubmed.ncbi.nlm.nih.gov/25912729/

Notes on page numbers

Textbook page numbers vary by edition. Where this document cites a chapter (e.g., "Miller's 10e Ch. 47 'Local Anesthetics'"), the chapter title is the stable reference — find the chapter in your edition rather than relying on a page number. ClinicalKey institutional access provides full text + chapter navigation for Miller's, Coté, and Stoelting's.

Sources without a confirmed direct URL

A small number of cited sources do not have a verifiable direct URL (either pre-internet publications, journals discontinued before PubMed indexing, or society documents distributed only as PDFs to members). For these, I cite the original reference and provide the closest verifiable lookup (society root page or PubMed search):

Reference	Why no direct URL	Closest verifiable lookup
Hilgier M. Reg Anesth 1985;10:59-61 (sodium bicarbonate alkalinization)	Pre-1990, not indexed in PubMed	No verified direct URL. Topic well-established in regional-anesthesia textbooks (Cousins 4e, Stoelting 6e)
Sekerci C, et al. Br J Anaesth 1996;76:28-33 (PO ketamine peds)	Indexing inconsistent	PubMed search
Brown TC, et al. Anaesth Intensive Care 1986 (caudal bupivacaine peds)	Pre-1990, no DOI	PubMed search
Liu LM, et al. Anesthesiology 1981 (succinylcholine IM peds)	Limited PubMed coverage	PubMed search
Bhana N, et al. Drugs 2000 (dexmedetomidine review)	Review article, behind publisher paywall	PubMed search
Salinas FV. Anesth Analg 2004 (mepivacaine spinal)	Could not confirm exact 2004 citation; cited Zayas VM et al. 1999 mepivacaine dose-response instead	Zayas PubMed
Winters RW. Body Fluids in Pediatrics 1973 (Winters' formula)	Pre-internet textbook, no online edition	Original Albert 1967 data — PubMed
AAAAI 2020 Practice Parameter (anaphylaxis)	Society document distributed via journal, not as standalone webpage	Shaker MS, et al. JACI 2020;145:1082-1123 — PubMed; AAAAI portal — aaaai.org
Hospital pharmacy formulary concentrations (Infusion screen mix instructions)	Institution-specific documents	ISMP Standard Concentrations of Adult Continuous IV Infusions — ISMP

If you have a verifiable direct URL for any of the citations above, please email clinical@helixanesthesia.com so we can add it.

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