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1
Branchereau, Alain, and Jacobs Michael. Unexpected challenges in vascular surgery. Blackwell Pub., 2005.
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2
Huntington, Dale. Advances and challenges in postabortion care operations research: Summary report of a global meeting, 19-21 January 1998, New York. Population Council, 1998.
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3
Branchereau, Alain, and Michael Jacobs. Unexpected Challenges in Vascular Surgery. Wiley & Sons, Incorporated, John, 2008.
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4
Branchereau, Alain, and Michael Jacobs. Unexpected Challenges in Vascular Surgery. Wiley & Sons, Incorporated, John, 2008.
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5
Eldar, Shai Meron, and Ofer Eldar. Complications and Challenges of Bariatric Surgery in Super-Obese Patients. Edited by Tomasz Rogula, Philip Schauer, and Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0017.
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While the lower weight limits for bariatric surgery are already strictly set, the upper weight limits are still undetermined. The extremely obese patient deserves special consideration: significant comorbidities, technical difficulties, and increased postoperative morbidity and mortality are all expected in this patient population.In view of these factors, how should super-obese patients (BMI > 50 kg/m2) be approached, and is there any preferred procedure? Is there a point where operative risk outweighs surgical benefits? Bariatric surgery for super-obese and super-super-obese patients, including the operative complications and the associated morbidity and mortality, as well as the way they influence the approach to this subgroup of patients, are the subjects of this chapter.
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Rovner, Michelle Sher. Post-Tonsillectomy Bleeding. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0080.
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Post-tonsillectomy bleeding is a well-described complication that can rapidly evolve into one of the most challenging clinical situations in anesthesia. Tonsillectomy and adenoidectomy is one of the most common pediatric surgical procedures. A frequent indication for this procedure is adenotonsillar hyperplasia associated with obstructive sleep apnea. These children may be very challenging to care for and may have significant respiratory and fluid management issues postoperatively. This situation requires immediate attention and action with regard to resuscitation in a hypovolemic patient in combination with the challenges of a potentially difficult airway. This chapter discusses obstructive sleep apnea and its associated increased risk of postoperative complications with regard to tonsillectomy and adenoidectomy. It also reviews risk factors for postoperative tonsillar bleeding and the considerations in treating these children.
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Szabova, Alexandra, and Kenneth R. Goldschneider. Opioid-Tolerant Patient. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0043.
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Caring for patients who are taking chronic opioids may present several challenges for clinicians in the operating room and in the immediate postoperative period. Factors such as tolerance and opioid-induced hyperalgesia can complicate perioperative pain management.
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Ryan, Laura, and Paul Hopkins. Obstructive Sleep Apnea. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0011.
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Adenotonsillectomy is one of the most commonly performed surgeries in children and is the mainstay treatment for obstructive sleep apnea (OSA). Children with OSA have a higher risk of perioperative respiratory morbidity. Diagnosis of OSA is made by overnight polysomnography, but this resource is rare and expensive so children at risk for OSA must be identified based on parental history. Patients with risk factors for postoperative respiratory complications may need to be monitored in the hospital overnight. Anesthetic challenges associate with adenotonsillectomy include perioperative analgesia, prevention and treatment of postoperative nausea and vomiting, risk of airway fire, and management of airway obstruction.
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Howell, Valerie L., Margaret M. Collins, and Lauryn R. Rochlen. Anesthesia for Posterior Fossa Mass. Edited by David E. Traul and Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0002.
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Lesions of the posterior fossa provide challenges for both anesthesiologists and surgeons due to this intracranial cavity’s rigid boundaries, minimal compliance, and vital neuronal contents. Common surgeries in the posterior fossa include excision of tumors, correction of congenital and acquired craniovertebral junction anomalies, and relief of pressure on the brainstem. Symptoms can present acutely and are most commonly due to compression of brain components, obstruction of cerebrospinal fluid, or increased intracranial pressure. Careful planning of the anesthetic is important to prevent exacerbation of preexisting symptoms or pathology, optimize the surgical resection, and aid in the quick diagnosis of postoperative complications. A variety of complications may occur in the perioperative period, many of which are unique to the posterior fossa or surgical approach. Anesthetic management focuses on prevention of common complications, maintenance of hemodynamic stability, facilitation of intraoperative neurophysiologic monitoring. and early postoperative neurologic evaluation through timely emergence.
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Roscoe, Andrew, and Peter Slinger. Anaesthesia for thoracic surgery. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0057.
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The conduct of thoracic anaesthesia requires an understanding of respiratory anatomy and physiology in order to optimize patient care whilst facilitating intrathoracic surgery. The preoperative assessment focuses on the underlying diagnosis, with emphasis on the impact of the surgical procedure on the patient’s cardiovascular and respiratory systems. Intraoperative care frequently necessitates lung isolation and proficiency at the variety of techniques available is essential. Additionally, adept management of one-lung ventilation and correction of hypoxaemia is fundamental to providing favourable outcomes. Thoracic surgical procedures may involve the airways, lung parenchyma, mediastinum, oesophagus, major vascular structures, pleura, and chest wall. Each procedure carries its own issues, including the shared airway, hypoxaemia, tracheobronchial compression, cardiac involvement, or major haemorrhage. Specialized procedures, such as lung transplantation, pulmonary endarterectomy, and bronchopulmonary lavage, introduce highly specific challenges. The provision of adequate analgesia can be challenging for the thoracic anaesthetist, and from the options available, it is often tailored to the individual. Awareness of common postoperative complications is necessary, as perioperative interventions aimed at reducing postoperative risk can improve patient outcome.
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Irwin, Michael G., Chi Wai Cheung, and Gordon Tin Chun Wong. Anaesthesia for ENT, dental, and maxillofacial surgery. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0065.
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The principles of anaesthesia management for otolaryngological and maxillofacial surgery share some similarities and unique challenges. Patients present at all ages and surgery can range from simple, short interventions to major, prolonged, and complicated cases with potential for massive blood loss. Some procedures can be performed under local anaesthesia with sedation whereas, at the other extreme, general anaesthesia with invasive monitoring is required. Microsurgery will necessitate a bloodless field, nerve monitoring is often required, and there is a susceptibility to postoperative nausea and vomiting. Patients with cancer often have poor nutritional status because of catabolism and eating difficulties and, since many head and neck cancers are associated with smoking and excessive alcohol consumption, significant co-morbidity is not unusual. Airway management especially can be challenging because of abnormal anatomy, pathology in this area, and the inherent difficulties of a shared airway. Postoperative management of the airway is particularly challenging as alterations to the anatomy and tissue swelling may have occurred during the course of surgery or thereafter. Last but not least, patients may present acutely with airway complications that require emergent management.
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Nicholson, Grainne, and George M. Hall. Neuroendocrine physiology in anaesthetic practice. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0008.
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This chapter describes the hormonal, metabolic, and inflammatory response to surgery—commonly known as the surgical stress response. The changes in protein, carbohydrate, and fat metabolism to provide fuel for oxidation are outlined as well as changes in salt and water metabolism. Psychological sequelae of fatigue and malaise are also common in patients undergoing surgery. Attenuating the metabolic and endocrine changes associated with surgery may reduce postoperative morbidity and expedite recovery; the choice of anaesthetic drugs and techniques (regional vs general anaesthesia) and the increasing use of laparoscopic surgery have all been used to try to achieve this objective. The most common metabolic disease which anaesthetists have to manage is diabetes mellitus (DM) and its pathophysiology and medical management, as well as that of the related metabolic syndrome are discussed. Adrenal tumours are rare but usually require surgical excision. Phaeochromocytomas present unique anaesthetic challenges, but pre-, intra-, and postoperatively in terms of fluid management and blood pressure control. Conn’s syndrome (primary hyperaldosteronism) can also result in hypertension and electrolyte disturbances. Cushing’s disease (glucocorticoid excess) presents with the clinical effects of steroid excess and many patients have concomitant DM. Finally, perioperative steroid supplementation for patients already taking steroids and undergoing surgery is discussed.
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Dodds, Chris, Chandra M. Kumar, and Frédérique Servin. Anaesthesia for the Elderly Patient (Oxford Anaesthsia Library). Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198735571.001.0001.
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This book provides a timely and authoritative synopsis of the current state of anaesthesia and the elderly patient at a time when the challenge of caring for the growing numbers of elderly patients is probably the greatest faced by healthcare across the globe. The book reviews important developments in the understanding of clinical practice serving the elderly. It describes the need for anaesthesia to deliver ‘best care’ to the elderly, with the aim to maintain their independent living. It then details the key features of ageing and the effect these have on physiology and pharmacology. Specific aspects of practice, including preoperative assessment; day surgery; emergency surgery; anaesthesia for orthopaedic, urological, and gynaecological surgery, as well as major abdominal surgery; neurosurgery; and critical care. Emphasis is placed on managing postoperative care and cognitive dysfunction (POCD), with additional discussion of ethical issues and the law pertaining to the elderly patient. A new chapter reviews the challenges of treating elderly patients in non-theatre environments.
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Starker, Elizabeth Q., Staci N. Allen, and Debnath Chatterjee. Anesthesia for Adolescent Bariatric Surgery. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0064.
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The growing epidemic of childhood obesity has resulted in an increasing number of obese children presenting for a wide range of surgical procedures. Bariatric surgery is gaining popularity as a valid treatment option in severely obese adolescents in whom life style interventions are not successful. The perioperative management of these patients pose several anesthetic challenges. The role of the anesthesiologist in the multidisciplinary model is outlined in this chapter. A case-based approach focuses on the preoperative evaluation, intraoperative anesthetic considerations, appropriate drug dosing, and recommended strategies for postoperative monitoring and analgesia. Common complications encountered during these procedures are also discussed.
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Hickey, Thomas, and Jessica Feinleib. Pain Management in the Patient with Substance Use Disorder. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190457006.003.0015.
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Managing pain in the patient with substance use disorder can be challenging. This chapter describes those challenges and provides strategies to address them. Specifically it discusses the prevalence and specific considerations for commonly abused substances, the need for aggressive communication among perioperative clinicians, and a strategy to decrease acute postoperative pain and associated complications using opioid-sparing, multimodal analgesia. It includes a discussion of the concept of equianalgesic opioid doses and management of opioid-related side effects including respiratory depression, with regard to buprenorphine, naltrexone, and methadone. Specific consideration is given to the surgical patient treated with buprenorphine, and a defined clinical plan is outlined.
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Machado, Sandra. Deep Brain Stimulation/Stereotaxic Surgery. Edited by David E. Traul and Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0019.
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Deep brain stimulation (DBS) is now a widely accepted treatment option for patients with movement disorders such as parkinsonism and essential tremor. DBS surgery presents challenges to the anesthesiologist as often these patients are required to be awake for accurate placement of the stimulators. Additionally, patients with movement disorders often have comorbidities that increase their risk of perioperative and postoperative complications. DBS surgery is often divided into two stages (1) stereotactic implantation of the DBS leads and (2) internalization of the pulse generator, with each of these stages stage having distinct anesthesia demands. Ongoing studies are exploring other indications for the effective use of DBS surgery.
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Fawcett, William J. Anaesthesia for abdominal surgery. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0061.
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Care of patients undergoing major gastrointestinal surgery has been revolutionized in the last decade. The widespread adoption of laparoscopic surgery has bought benefits but also new challenges. Anaesthetic techniques, particularly refinements in analgesic regimens and fluid management, have also brought benefits to patients. However, many more elderly and frail patients are undergoing major surgery which is a challenge in both expertise and resources. Anaesthesia for patients undergoing gastrointestinal surgery has evolved into a package of perioperative care, with the anaesthetist increasingly viewed as the perioperative physician. Anaesthetists are now involved not only within the operating theatre, but with assessing risk for patients, optimizing them prior to surgery, and supervising postoperative care and in particular early recognition and treatment of complications. Liver surgery has become routine for patients particularly with secondary colorectal metastases. Previously, 5-year survival was very rare in these groups of patients, but now approximately half of patients are alive at 5 years. Colorectal surgery has also been transformed and the enhanced recovery programme has typified the way in which many years of dogma have been challenged, to be replaced by evidence-based pathways. Overall, for major elective surgery, results have improved and in general, morbidity, mortality, complications, and length of hospital stay for patients have reduced. For emergency patients, although there have been improvements too, there is still widespread concern about high mortality and marked variation in care between centres.
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Klimek, Markus, Francisco A. Lobo, Luzius A. Steiner, and Cor J. Kalkman. Anaesthesia for neurosurgery and electroconvulsive therapy. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0059.
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Neuroanaesthesia is the subspecialty of anaesthesiology that deals with patients undergoing surgical procedures in or close to the brain and the spinal cord. Neuroanaesthesia can be challenging, because sometimes apparently contradictory demands must be managed, for example, achieving optimal conditions for neurophysiological monitoring while maintaining sufficient anaesthetic depth, or maintaining oxygen delivery to neuronal tissue and simultaneously preventing high blood pressures that might induce local bleeding. Atypical patient positioning, management of increased intracranial pressure, and the need for early postoperative neurological evaluation are other typical challenges. This chapter addresses the general principles of neuroanaesthesia and special aspects of the most relevant procedures. A section on anaesthesia for electroconvulsive therapy is also included.
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Manuel, Solmaz P., Christine L. Mai, and Robert Brustowicz. Orthopedic Surgery. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199398348.003.0018.
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Anesthesia for pediatric orthopedic and spinal surgery presents multiple challenges for the anesthesiologist. Children often present with comorbidities and concomitant diseases that affect the respiratory and cardiovascular functions. Significant blood loss and prolonged operating times can pose significant risks. Airway management in a child with a syndrome can be both difficult and challenging. Orthopedic tumor surgery may be complicated by chemotherapy treatment, anesthetics can be affected by drug interactions, and postoperative pain management can be complex. In this chapter, we review common coexisting diseases in pediatric patients undergoing orthopedic surgeries. These diseases include syndromes such as Down syndrome, Marfan syndrome, and Klippel-Feil syndrome; muscular dystrophies such as Duchenne muscular dystrophy; and bony cancers such as osteosarcoma.
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Gill, Steven J., and Michael H. Nathanson. Central nervous system pathologies and anaesthesia. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0081.
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Anaesthesia induces changes in many organ systems within the body, though clearly none more so than the central nervous system. The physiology of the normal central nervous system is complex and the addition of chronic pathology and polypharmacy creates a significant challenge for the anaesthetist. This chapter demonstrates a common approach for the anaesthetist and specific considerations for a wide range of neurological conditions. Detailed preoperative assessment is essential to gain understanding of the current symptomatology and neurological deficit, including at times restrictions on movement and position. Some conditions may pose challenges relating to communication, capacity, and consent. As part of the consent process, patients may worry that an anaesthetic may aggravate or worsen their neurological disease. There is little evidence to support this understandable concern; however, the risks and benefits must be considered on an individual patient basis. The conduct of anaesthesia may involve a preference for general or regional anaesthesia and requires careful consideration of the pharmacological and physiological impact on the patient and their disease. Interactions between regular medications and anaesthetic drugs are common. Chronically denervated muscle may induce hyperkalaemia after administration of succinylcholine. Other patients may have an altered response to non-depolarizing agents, such as those suffering from myasthenia gravis. The most common neurological condition encountered is epilepsy. This requires consideration of the patient’s antiepileptic drugs, often relating to hepatic enzyme induction or less commonly inhibition and competition for protein binding, and the effect of the anaesthetic technique and drugs on the patient’s seizure risk. Postoperative care may need to take place in a high dependency unit, especially in those with limited preoperative reserve or markers of frailty, and where the gastrointestinal tract has been compromised, alternative routes of drug delivery need to be considered. Overall, patients with chronic neurological conditions require careful assessment and preparation, a considered technique with attention to detail, and often higher levels of care during their immediate postoperative period.
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Khatib, Reem. Anesthesia and Recovery. Edited by Tomasz Rogula, Philip Schauer, and Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0008.
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As a consequence of the obesity epidemic that has developed in the United States over the past few decades, many morbidly obese patients are presenting to the operating room for a variety of procedures, including bariatric surgery. Anesthesiologists must therefore be familiar with the physiologic changes that occur as a consequence of this disease process. Changes in cardiac and respiratory physiology require special consideration as they impact anesthetic management during the perioperative period. Strategies to optimize intraoperative management of the morbidly obese patient presenting for bariatric surgery including successful airway management, fluid management, and prevention of atelectasis are discussed. Finally, common postoperative issues are examined including renal dysfunction, respiratory insufficiency, and ICU outcomes. With planning and communication the challenges these patients present can be managed effectively by the bariatric team
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König, Matthias W., Mohamed A. Mahmoud, and John J. McAuliffe III. Prone Positioning for Posterior Fossa Tumor Resection. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0031.
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The prone position is employed for minor or major procedures on the dorsal aspect of the body. The more major procedures tend to be prolonged and may be associated with swelling of dependent areas, as well as prolonged pressure on certain pressure points. These possible complications must be adequately addressed with families during the preoperative visit in order to appropriately manage expectations when they see their loved ones in the immediate postoperative phase, especially after a long surgery. In order to prevent complications, proper padding and protection of dependent areas should be performed. This chapter considers the logistic challenges of turning a small patient into the prone position, explores potential complications unique to prone positioning, lists strategies to avoid position-related injuries, and discusses cardiopulmonary resuscitation in the prone position.
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Glover, Chris D., and Wallis T. Muhly. Anesthetic Implications for Surgical Correction of Pectus Excavatum. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0019.
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Pectus excavatum is the most common congenital chest wall deformity in children. It is characterized by a posterior depression of the sternum resulting from defective growth of the surrounding rib cartilage. This abnormality in thoracic architecture can lead to a progressive reduction in cardiopulmonary capacity. An early surgical approach popularized by Ravitch involved an open repair with removal of abnormal rib cartilage to allow for regrowth of the rib cartilage to the sternum in a more anterior position. Subsequently, Nuss popularized a minimally invasive repair of pectus excavatum which involves the internal bracing of the chest wall and anterior displacement of the sternum without cutting of the rib cartilage. It is now the most common surgical approach for pectus excavatum correction. Anesthesiologists should acutely be aware of the potential intraoperative complications associated with this procedure as well as the postoperative challenges this procedure poses in terms of pain management.
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Franklin, Andrew. Sickle Cell Disease. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0084.
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Sickle cell disease, a hemoglobinopathy that affects multiple organ systems, is a complex disease entity that presents unique challenges during the perioperative period. The hallmark of sickle cell disease, vaso-occlusion, results from sickling of erythrocytes containing hemoglobin of abnormal conformation due to genetically mutated beta globin genes. The perioperative clinician must properly care for acute sickle cell crises including acute painful episodes and acute chest syndrome, and safely care for the sickle cell patient through the preoperative, intraoperative, and postoperative phases of surgical treatment. Both acute painful episodes and acute chest syndrome result from vaso-occlusive crises, and early stabilization of these emergencies is crucial to ensuring a positive patient outcome. The singular perioperative objective for the care of sickle cell disease patients is both simple and daunting: to achieve physiologic homeostasis in patients with preexisting multiorgan dysfunction undergoing a series of physiologic insults during and after surgery.
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Nelson, Jonathon, and Franklyn P. Cladis. Pediatric Liver Transplantation. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0038.
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Liver transplantation has become a standard surgical treatment for pediatric patients with hepatic failure, tumors, and metabolic derangements. Liver transplantation in the pediatric population can be extremely challenging for the anesthesiologist due to multiple perioperative considerations. The first successful liver transplant was performed in a pediatric patient in the 1960s, and since then, there have been significant advances in immunosuppressant medications and preservation solutions which have led to improved survival. Nevertheless, the number of liver transplants continues to be limited by organ availability, although the pediatric donor pool has been increased by living related donors and split livers. The most common pediatric pathology that results in hepatic failure and transplantation is biliary atresia. This chapter covers the perioperative care of a pediatric patient undergoing a liver transplant, from the preoperative preparation to the intraoperative management, and discusses postoperative challenges which may be encountered while in the intensive care unit.
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Murray, W. Bosseau, Sorin Vaduva, and Benjamin W. Berg. Telemedicine, Teleanesthesia, and Telesurgery. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190495756.003.0033.
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Telemedicine overcomes barriers to the delivery of health care services including, distance, cost, gaps in distribution and availability of providers. Anesthesia and surgery applications include remote robotic anesthesia and surgery, preoperative assessment at a distance, physiologic monitoring, remote mentoring, and comprehensive critical care services. The Patient Protection and Affordable Care Act and other legislation supports expansion of telemedicine by enabling telemedicine regulation and reimbursement. Tele-Anesthesia applications are expanding and future economically viable telehealth programs will address a variety of anesthesia specific challenges and domains including pain management, postoperative assessment, just in time training for new clinical applications and anesthesia procedures. Telemedicine techniques include synchronous and asynchronous interactions, virtual presence, mobile-health, and haptics enabled robotics, which are used alone or in combination. Focus areas for development of efficient and effective new Tele-Anesthesia programs include chronic care, remote emergency care, and disaster support. Provider acceptance in tele-anesthesia requires education and training to achieve the full advantages of telemedicine.
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Elmofty, Dalia H. Opioid-Induced Hyperalgesia, Tolerance, and Chronic Postsurgical Pain: A Dilemma Complicating Postoperative Pain Management. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0037.
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Perioperative pain management continues to be a challenge for physicians. Postoperative pain can compromise patient progress and lead to poor outcomes or chronic pain. Opioid medications, the mainstay of treatment for perioperative pain, can cause opioid-induced hyperalgesia and opioid tolerance. Attempts should be made to modify factors that increase the risk for chronic postsurgical pain. Certain patient factors and anesthetic and surgical techniques have been implicated. Incorporating multimodal methods for perioperative pain management using nonconventional opioids, such as methadone, cyclooxygenase inhibitors, NMDA antagonists, and regional techniques can improve outcomes and prevent opioid-induced hyperalgesia, opioid tolerance, and chronic postsurgical pain in patients on long-term opioid therapy.
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Joyce, David L., and Lyle D. Joyce. Mechanical Circulatory Support. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190909291.001.0001.
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Mechanical circulatory support (MCS) offers life-saving treatment options for patients with advanced heart failure, cardiogenic shock, and acute cardiopulmonary failure. With the development of short-term, long-term, left-sided, right-sided, biventricular, and cardiopulmonary support options, the complexity surrounding this field has evolved substantially in the past decade. This textbook seeks to provide a logical and systematic framework for managing patients who require MCS therapies. In chapters 2–9, a comprehensive approach to selecting and preparing patients for MCS interventions is described. In chapters 10–23, the range of currently available devices is reviewed with updates on the most up-to-date clinical experiences based on recently published outcomes. Chapters 24–30 describe the current state of the art in perioperative strategies for achieving long-term success. Finally, chapters 31–46 outline the myriad of clinical challenges that often occur in the postoperative period, including some of the frequently encountered adverse events that are unique to the physiology associated with this technology. The fundamental principles included in this textbook will provide a framework for the MCS provider that can serve as a road map amidst the rapidly evolving landscape created by the technology pipeline within this industry.
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Servin, Frédérique S., and Valérie Billard. Anaesthesia for the obese patient. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0087.
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Obesity is becoming an epidemic health problem, and the number of surgical patients with a body mass index of more than 50 kg m−2 requiring anaesthesia is increasing. Obesity is associated with physiopathological changes such as metabolic syndrome, cardiovascular disorders, or sleep apnoea syndrome, most of which improve with weight loss. Regarding pharmacokinetics, volumes of distribution are increased for both lipophilic and hydrophilic drugs. Consequently, doses should be adjusted to total body weight (propofol for maintenance, succinylcholine, vancomycin), or lean body mass (remifentanil, non-depolarizing neuromuscular blocking agent). For all drugs, titration based on monitoring of effects is recommended. To minimize recovery delays, drugs with a rapid offset of action such as remifentanil and desflurane are preferable. Poor tolerance to apnoea with early hypoxaemia and atelectasis warrant rapid sequence induction and protective ventilation. Careful positioning will prevent pressure injuries and minimize rhabdomyolysis which are frequent. Because of an increased risk of pulmonary embolism, multimodal prevention is mandatory. Regional anaesthesia, albeit technically difficult, is beneficial in obese patients to treat postoperative pain and improve rehabilitation. Maximizing the safety of anaesthesia for morbidly obese patients requires a good knowledge of the physiopathology of obesity and great attention to detail in planning and executing anaesthetic management. Even in elective surgery, many cases can be technical challenges and only a step-by-step approach to the avoidance of potential adverse events will result in the optimal outcome.
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Turner, Ben. Electrolyte Disturbance in Pyloric Stenosis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0002.
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Pyloric stenosis is a common condition that represents a challenge to the pediatric anesthesiologist. Managing these children requires an understanding of fluid, electrolyte, and acid–base abnormalities, induction techniques where there is potential for a full stomach, and postoperative pain-management choices in small babies. The key perioperative message is to realize this is a medical rather than a surgical emergency. Preoperative correction of the fluid, electrolyte, and acid–base abnormalities is vital in reducing perioperative morbidity. The anesthesiologist needs to be able to accurately assess when a baby's condition is adequately optimized before proceeding to pyloromyotomy.
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Reich, David L., Stephan A. Mayer, and Suzan Uysal, eds. Neuroprotection in Critical Care and Perioperative Medicine. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190280253.001.0001.
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Clinicians caring for patients are challenged by the task of protecting the brain and spinal cord in high-risk situations. These include following cardiac arrest, in critical care settings, and during complex procedural and surgical care. This book provides a comprehensive overview of various types of neural injury commonly encountered in critical care and perioperative contexts and the neuroprotective strategies used to optimize clinical outcomes. In addition to introductory chapters on the physiologic modulators of neural injury and pharmacologic neuroprotectants, the topics covered include: imaging assessment; tissue biomarker identification; monitoring; assessment of functional outcomes and postoperative cognitive decline; traumatic brain injury; cardiac arrest and heart-related issues such as valvular and coronary artery bypass surgery, aortic surgery and stenting, and vascular and endovascular surgery; stroke; intracerebral hemorrhage; mechanical circulatory support; sepsis and acute respiratory distress syndrome; neonatal issues; spinal cord injury and spinal surgery; and issues related to general, orthopedic, peripheral vascular, and ear, nose and throat surgeries.