{"title":"Acute Kidney Injury and Renal Replacement Therapy","authors":"Karen L. Krechmery, Diego Casali","doi":"10.2310/anes.18367","DOIUrl":"https://doi.org/10.2310/anes.18367","url":null,"abstract":"<jats:p />","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132725357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis","authors":"Herbert Chen, Irene Lou","doi":"10.2310/anes.2202","DOIUrl":"https://doi.org/10.2310/anes.2202","url":null,"abstract":"The management of perioperative anticoagulation, antiplatelet therapy, and perioperative venous thromboembolism (VTE) prophylaxis is essentially a balancing act between patient risk factors for thrombosis and surgical risk factors for bleeding. The purpose of this review is to assist surgeons with the identification of patients at increased risk for thromboembolism when antithrombotic therapy is interrupted, patients for whom bridging anticoagulation should be considered, patients who require perioperative VTE prophylaxis, and patients at increased risk for bleeding complications and to briefly review the literature and major guidelines regarding perioperative antithrombotic therapy management and perioperative VTE prophylaxis. Figures show approaches to the management of perioperative anticoagulation, antiplatelet therapy, and VTE prophylaxis. \u0000This review contains 2 figures, 7 tables, and 61 references.\u0000Keywords: Venous thromboembolism, pulmonary embolism, anticoagulation, surgery, perioperative period, prophylaxis\u0000 ","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133664204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Endocrine and Metabolic Systems","authors":"Suwarna Anand","doi":"10.2310/anes.18395","DOIUrl":"https://doi.org/10.2310/anes.18395","url":null,"abstract":"The endocrine system and the nervous system work in synchrony to maintain homeostasis in the body. Growth, development, reproduction, blood pressure, concentrations of ions and other substances in blood, and even behavior are all regulated by the endocrine system. Endocrine physiology involves the secretion of hormones and their subsequent actions on target tissues. The present overview focuses on the endocrine physiology and the pathophysiologic states that influence the growth and development of an individual.\u0000This review contains 11 tables, and 27 references.\u0000Keywords: diabetes mellitus, thyroid, parathyroid hormone, hypoparathyroid, hypothalamus, pituitary, adrenal gland, carbohydrate metabolism, protein, lipids","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125606996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Pharmacology","authors":"M. Droege, E. Mueller","doi":"10.2310/surg.2234","DOIUrl":"https://doi.org/10.2310/surg.2234","url":null,"abstract":"Critically ill patients often require surgical procedures and therapeutic interventions that produce significant pathophysiologic changes. Drug pharmacology can be greatly altered in this population wherein comorbid diseases, varied organ function, and polypharmacy can produce adverse drug reactions (ADRs). This review aims to describe basic pharmacokinetic principles (absorption, distribution, metabolism, elimination) and changes in these processes due to altered organ function in critically ill surgical patients. This knowledge is a key factor in reducing ADRs.\u0000This review contains 10 figures, 2 tables, 101 references\u0000Keywords: adverse drug reactions, drug interactions, obesity, pharmacodynamics, pharmacokinetics, plasma protein binding, therapeutic drug monitoring\u0000 ","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126551210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacologic Considerations for the Obese Patient","authors":"Joy L. Chen, Taylor J. Pak, T. Moon","doi":"10.2310/anes.18332","DOIUrl":"https://doi.org/10.2310/anes.18332","url":null,"abstract":"<jats:p />","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131212950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiovascular System: Part II","authors":"Vanetta Levesque","doi":"10.2310/anes.18408","DOIUrl":"https://doi.org/10.2310/anes.18408","url":null,"abstract":"This chapter gives an overview of blood circulation, then focuses on regional blood flow to a number of organs, and ends with a description of the microcirculation. It begins with venous return and blood volume. Most blood volume is contained within the venous system, and the chapter describes several mechanisms that allow for this volume of blood to be returned to the right heart. Next it describes the various means by which the blood circulation and volume are controlled. The chapter devotes considerable time describing the central, peripheral, and hormonal regulation of circulation and blood volume. Next, regional blood flow is described. Blood flow in different regions of the body is usually autoregulated, and variably controlled by the autonomic nervous system, and various humoral agents. The final section describes the mechanism by which blood flow in the microcirculation delivers nutrients, and removes wastes from the tissue by diffusion. Also described are the regulation of the microcirculation by pre and post capillary sphincters, and the effect of viscosity.\u0000This review contains 5 figures, and 40 references. \u0000Keywords: venous return, vascular compliance, venous capacitance, vasomotor center, hypothalamic-pituitary-adrenal axis (HPA), microcirculation, regional blood flow, mixed venous oxygen saturation","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129991924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiovascular System: Part I","authors":"Vanetta Levesque","doi":"10.2310/anes.18392","DOIUrl":"https://doi.org/10.2310/anes.18392","url":null,"abstract":"This chapter reviews the cardiovascular system in its entirety. It begins with the details of the cardiac cycle, a highly coordinated sequence of electrical and mechanical events that allows blood flow from the atria to the ventricles, which then pump blood out to pulmonary, and systemic circulations. There is an overview of basic ventricular physiology, assessment of ventricular contractility, and systolic and diastolic function. Cardiac output, its determinants, regulation, and its measurement according to the Fick principle and other methods are also extensively reviewed. The chapter moves on to describe the importance of blood pressure and its determinants. It follows with a description of how arterial blood pressure and other intracardiac pressures are measured. Finally, in the event of cardiac arrest, the chapter describes high quality CPR, and several algorithms used in managing patients in cardiac arrest.\u0000This review contains 5 figures, and 51 references.\u0000Keywords: electrocardiogram (ECG), Frank-Starling law, myocardial contractility, Fick principle, cardiac output, blood pressure, intracardiac pressures, advanced cardiac life support","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116728788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preoperative Assessment of Patients with Other Endocrine Disorders","authors":"Gretchen A. Lemmink, Sean A. Josephs","doi":"10.2310/anes.18152","DOIUrl":"https://doi.org/10.2310/anes.18152","url":null,"abstract":"The rate of rise of endocrine disease in the general population is staggering. Roughly 1 in 10 Americans have been diagnosed with an endocrine disorder, the vast majority of which is diabetes mellitus. This is closely followed by thyroid disorders and also includes patients with disease of the adrenal glands, parathyroid glands and pituitary. These individuals present for surgery with a multitude of metabolic and electrolyte derangements. Their disease may be complicated by obesity and severe, poorly controlled hypertension. Frequently, end-organ damage resulting from long-standing endocrinopathy is also present, including renal and cardiovascular abnormalities. These patients often present for surgery with undiagnosed disease due to the subtle physiologic alterations characteristic of many endocrine disorders. Identification and optimization of these individuals is paramount prior to surgery to avoid intraoperative and postoperative complications. This article reviews the wide-ranging challenges unique to endocrine disorders in the perioperative period and specifically addresses preoperative concerns and patient optimization.\u0000This review contains 4 figures, 5 tables, and 42 references.\u0000Keywords: hypothyroidism, hyperthyroidism, thyroid storm, myxedema coma, hyperparathyroidism, hypoparathyroidism, hypercortisolism (Cushing’s Syndrome), hyperaldosteronism, adrenal insufficiency (Addison’s Disease), pheochromocytoma","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116922895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preoperative Assessment of the Patient with Diabetes Mellitus","authors":"Sean A. Josephs, Gretchen A. Lemmink","doi":"10.2310/anes.18404","DOIUrl":"https://doi.org/10.2310/anes.18404","url":null,"abstract":"Diabetes mellitus is a major cause of morbidity and mortality. Nearly 30 million Americans have diabetes, more than 25% of which are undiagnosed. Patients with diabetes have multiple problems that should be addressed prior to surgery. They often have uncontrolled glucose levels that should be treated preoperatively. Current studies suggest that outcomes may be improved if perioperative glycemic control is optimized. Patients with diabetes develop end-organ dysfunction that can complicate perioperative management. Preoperative assessment of cardiac, neurologic, vascular, and renal function is necessary for all patients with diabetes that undergo major surgery. Optimization of cardiac disease in particular can reduce major adverse cardiac events for patients with risk factors such as diabetes. Diabetic patients can occasionally present for major surgery with hyperglycemic emergencies such as diabetic ketoacidosis and hyperglycemic hyperosmolar state. These conditions require urgent treatment to prevent mortality regardless of the need for surgery. This article reviews the preoperative assessment and management of these issues.\u0000This review contains 1 figure, 4 tables, and 37 references.\u0000Key Words: diabetes mellitus (DM), end-organ damage, hyperglycemia, polyuria, polydipsia, polyphagia, perioperative glycemic management, diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), perioperative cardiac risk factors","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131920875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preparation for Advanced Airway Management: Preparation for Awake Intubation","authors":"Arpan Mehta, A. Pichurko","doi":"10.2310/anes.18409","DOIUrl":"https://doi.org/10.2310/anes.18409","url":null,"abstract":"Awake intubation is a key technique in anesthesia, allowing for the safe management of a patient with signs and predictors of a difficult airway/intubation. It is commonly undertaken electively, but can also be used in an emergency. An appropriate history must be taken, along with review of investigations (e.g CT scan, nasendoscopy), followed by a physical examination and development of a safe management plan. A variety of local anesthetic methods exist for topicalization of the airway (2-4% lidocaine), including nerve blocks (glossopharyngeal, recurrent laryngeal, superior laryngeal) to assist this. Sedation and amnesic techniques commonly include the use of benzodiazepines (midazolam), opioids (remifentanil infusion) and alpha agonists (dexmedetomidine). Knowledge of the side effects of these are paramount, including the cardiac and central nervous system with local anesthetic toxicity. 20% lipid emulsions are available in the event of this.\u0000This review contains 4 figures, 5 tables, and 25 references.\u0000Keywords: awake flexible bronchoscopic intubation, awake endoscopic intubation, remifentanil, dexmedetomidine, airway anesthesia, glossopharyngeal nerve block, recurrent laryngeal nerve block, superior laryngeal nerve block, local anesthetic toxicity, lipid emulation.","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122549690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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