Intraoperative Hemodynamic Optimization: Looking Beyond IOH to Improve Patient Outcomes
with Desiree Chappell, CRNA, FAANA

Intraoperative hypotension (IOH) is an overt marker of hemodynamic instability, but effective management requires a broader approach beyond simply maintaining blood pressure. This lecture will explore comprehensive strategies for intraoperative hemodynamic optimization using the Fill, Flow, and Pressure framework. CRNAs play a critical role in balancing preload, cardiac output, and vascular tone to ensure adequate organ perfusion and oxygen delivery. This session will cover fluid therapy selection and management, vasopressor and inotrope use, and dynamic assessment tools to guide individualized patient care.

Takeaways are to include:

• Beyond IOH: Recognizing Global Hemodynamic Instability
  • IOH is an indicator, not the sole target of management, of overall hemodynamic instability.
  • Cardiac output (flow), vascular resistance (pressure), and intravascular volume (fill) must be optimized together.
•  Fluid Management: Balancing Fill Without restricting or overloading
  • Crystalloids vs. colloids: When and how much?
  • Avoiding fluid overload and or fluid restriction to improve outcomes.
• Vasoactive Therapy: Choosing the Right Agent for the Right Situation
  • Vasopressors to improve vascular tone.
  • Inotropes to support cardiac output.
  • Chronotropes
• Fill, Flow, and Pressure as a Decision-Making Framework
  • Fill: Optimizing preload to ensure effective stroke volume.
  • Flow: Maintaining adequate cardiac output with inotropes when necessary.
  • Pressure: Supporting systemic vascular resistance with vasopressors while avoiding excessive afterload.

Pediatric Pharmacology
with Saundra Smalley, CRNA, MSN

This session will offer an overview of pediatric pharmacology, emphasizing the unique physiological, metabolic, and developmental factors that influence the dosages and routes of administration of anesthetic medications. Key topics will include common perioperative medications, their pharmacokinetics, and potential adverse effects across various age groups.

Learners will gain additional knowledge on:

• Pre-operative anxiolysis
• Bronchospasm and Laryngospasm prevention and treatments
• Multi-modal treatment of post-operative pain

The Uppers and Downers of Cardiac Pharmacology
with Angela Mund, DNP, CRNA, FAANA, FAAN 

This presentation is an evidence-based review of vasoactive cardiovascular medications. It includes clinical decision-making when choosing either a vasopressor, an inotrope, a vasodilator, etc. Cardiac physiology will be discussed in relation to medication effects on cardiac function and vascular tone.

You will learn how to:

• Classify vasoactive medications according to receptor type and response.
• Compare and contrast the impact of vasoactive medications on hemodynamic parameters.
• Discuss clinical applications of cardiac pharmacology to include vasopressors, inotropes, and vasodilators.

Learners will be able to:

• Identify psychedelic medicines with noted dates of legal approval from both federal and state requirements.
• Understand the pharmacologic nature of psychedelic medications and the application for mental health, pain syndromes, and neurologic disorders.
• Understand general concepts for working in the outpatient community and the general needs as a practitioner to meet state and federal guidelines.