{"title":"Preparation for Advanced Airway Management: Pre-oxygenation and Positioning","authors":"Arpan Mehta, A. Pichurko","doi":"10.2310/anes.18129","DOIUrl":"https://doi.org/10.2310/anes.18129","url":null,"abstract":"Preoxygenation allows a margin of safety prior to establishing control of a patient’s airway. Effective preoxygenation is influenced by careful technique, respiratory physiology, blood oxygen content, and total body oxygen consumption. Total body oxygen consumption is increased in the pregnant, pediatric, and obese populations, making maintenance of oxygenation more difficult during apnea. In addition to a standard facemask, advanced equipment such as high-flow nasal cannula, THRIVE, and various mask variants may be used. Positioning of a patient for advanced airway management affects preoxygenation, respiratory mechanics, and the conditions for establishing a definitive airway. The “triple airway support” maneuver consists of head extension, neck flexion, and protrusion of the mandibular teeth over the upper teeth; and provides effective mechanics for positive-pressure mask ventilation. Patients with potentially unstable cervical spines present additional challenges and, especially in emergency situations, require careful negotiation of priorities. Common maneuvers such as head tilt, jaw thrust, cricoid pressure, and manual in-line stabilization can cause motion in the unstable cervical spine with uncertain effects. \u0000This review contains 7 figures, 5 tables, and 43 references.\u0000Keywords: preoxygenation, functional residual capacity, blood oxygen content, alveolar fraction of oxygen, total body oxygen consumption, high-flow nasal cannula, apneic oxygenation, sniffing position, triple airway support maneuver, manual in-line stabilization","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133484537","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":"Airway Physiology","authors":"Gilbert S Tang","doi":"10.2310/anes.18405","DOIUrl":"https://doi.org/10.2310/anes.18405","url":null,"abstract":"An understanding of airway physiology is important for the anesthesiologist, tasked with supporting the patient's respiratory functions which are altered in the conduct of anesthesia and surgery, or which may be abnormal due to co-existing disease. Airflow and airway resistance, lung compliance, spirometric values, flow-volume measurements, work of breathing, ventilation-perfusion matching, and oxygen-carbon dioxide transport are some of the basic principles. Clinical application of physiology allows the anesthesiologist to anticipate and manage changes that may occur when anesthetizing the patient, altering position or manipulating the airway.\u0000This review contains 5 tables, and 25 references.\u0000Keywords: Ohm’s law, laminar vs turbulent flow, Reynold’s number, Heliox, Bernoulli’s principle, compliance vs elasticity, Law of Laplace, spirometry, dead space, hypoxic pulmonary vasoconstriction","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114344688","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":"Medical Imaging of the Airway","authors":"Gilbert S Tang","doi":"10.2310/anes.18406","DOIUrl":"https://doi.org/10.2310/anes.18406","url":null,"abstract":"Non-invasive imaging techniques such as ultrasonography, x-ray, computerized tomography (CT) and magnetic resonance imaging (MRI) provide details about airway anatomy that complement the physical examination. They are of particular value in patients with traumatic injury, malignancy, abscess, foreign body or mass in the airway that displace, distort, disrupt, encroach or compress airway structures in ways that may not be readily apparent otherwise. Many anesthesiologists do not receive formal training in interpreting medical imaging, and a thorough discussion of this subject is beyond the scope of this review. Interpreting the subtleties of normal and abnormal anatomy require years of experience and best left to expert radiologists. The goal here is to introduce the imaging techniques available and examples of clinical applications in airway evaluation of interest to the anesthesiologist.\u0000This review contains 12 figures, 2 tables, and 37 references.\u0000Keywords: piezoelectric effect, photoelectric interaction, Faraday’s law, pneumothorax, cervical spine injury, LeFort fracture, foreign body, airway infection, mediastinal mass","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131039209","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":"Pain Management Strategies for Thoracic Surgery","authors":"B. Weiner, Harman Boparai, Grant H. Chen","doi":"10.2310/anes.18173","DOIUrl":"https://doi.org/10.2310/anes.18173","url":null,"abstract":"Improper management of postoperative pain following thoracic surgery can be quite debilitating and lead to a number of complications due to the multitude of comorbid conditions manifested by the population of patients undergoing these types of procedures. These can include advanced lung disease, advanced age, heart disease, renal insufficiency and obesity.¹ The source of this acute postsurgical pain is multifactorial and can include skin incisions, deep tissue injuries, thoracostomy tubes, costovertebral joint separation and rib or sternal fractures.² Benefits of effective analgesia include decreased risk of perioperative morbidity, decreased hospital stay, decreased cost and increased patient satisfaction.³ There have been numerous studies conducted to determine the best pain management regimen for control of postthoracotomy pain, however, no single technique has thus far proven to be superior. Instead, most clinicians would advocate for a multimodal approach combining regional techniques, such as thoracic epidural analgesia or paravertebral blocks, with systemic analgesic medications including a combination of cyclooxygenase (COX)-2 inhibitors, nonsteroidal anti-inflammatory drugs, opioids and other analgesic adjuncts. This chapter will examine the different analgesic options currently available and being utilized for various types of thoracic surgical procedures. This will include a review of the systemic analgesic and non-analgesic optiondis as well as regional anesthetic techniques. The chapter will conclude with a discussion of chronic post-thoracotomy pain syndrome and currently available treatments.\u0000This review contains 4 tables, and 87 references.\u0000Keywords: systemic analgesic therapy, opioid analgesic medications, regional anesthetic techniques, thoracic epidural analgesia, paravertebral analgesia, chronic post-thoracotomy pain management, Enhanced Recovery After Surgery (ERAS), intrathecal opioid analgesia, intercostal analgesia, intrapleural analgesia","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131038061","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":"Advanced Hepatic Disease","authors":"Courtney R. Jones, Cory France","doi":"10.2310/anes.18149","DOIUrl":"https://doi.org/10.2310/anes.18149","url":null,"abstract":"Advanced liver disease poses many challenges to the anesthesiologist. In this focused review, we will identify the varying etiologies and demographics of the disease before detailing the wide-ranging impact on various organ systems. The effects of liver disease are often profound and require a thorough understanding of the underlying pathophysiology. Particular attention will be paid to those areas in which a thorough evaluation and optimization can enhance perioperative outcomes of those with advanced liver disease. Given the liver’s extensive involvement in drug metabolism, we will also review drug dosing and how it is altered in advanced disease. Procedures commonly performed on patients with advanced hepatic dysfunction will be discussed as their role is increasing in the management of the disease. While liver disease is familiar to the medical community, there have been recent advances that provide the anesthesiologist with new evidence-based management strategies. Though there is still much work to be done to understand the complex interactions of severe hepatic dysfunction, these recent advances will be highlighted to improve current management of these ill patients.\u0000\u0000This review contains 5 tables, and 51 references.\u0000Key Words: Thromboelastogram (TEG), MELD-Na, Prothrombin complex concentrates, Hepatopulmonary Syndrome, Portopulmonary Hypertension, Hepatic hydrothorax, Large volume paracentesis, Non-Alcoholic Fatty Liver Disease (NAFLD)","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131198380","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: Heart Failure, Cardiogenic Shock, Cardiomyopathy","authors":"B. O'Brien, S. Finney, A. Proudfoot","doi":"10.2310/anes.18403","DOIUrl":"https://doi.org/10.2310/anes.18403","url":null,"abstract":"Around 2% of adults have heart failure, and the prevalence increases with advancing ages. This may manifest chronically but also acutely. Cardiogenic shock is the most extreme manifestation of acute heart failure, manifesting as the rapid development of life-threatening tissue hypoperfusion and organ dysfunction. The causes and management of these heart failure syndromes are considered in this set of mini reviews with a focus on management of the precipitating etiology, specifically coronary artery disease. The importance of risk stratification and risk-based management strategies in pulmonary embolism as a cause of acute right ventricular failure is discussed. Mechanical support of the failing heart is possible with intra-aortic balloon pumps and ventricular assist devices. These can be used in acutely or chronically and their indications are reviewed herein. Finally, advances in cardiopulmonary resuscitation are considered.\u0000This review contains 3 figures, 3 tables, and 57 references.\u0000Key Words: cardiovascular system, cardiac tamponade, cardiogenic shock, cardiomyopathy, cardiopulmonary resuscitation, circulatory support, heart failure, mechanical pulmonary embolism","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116871256","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":"Neonatal Emergencies II: Myelomeningocele","authors":"I. Vesselinova","doi":"10.2310/anes.18399","DOIUrl":"https://doi.org/10.2310/anes.18399","url":null,"abstract":"Myelomeningocele is the most common and severe congenital malformation of the central nervous system, associated with substantial neurological morbidity, devastating lifelong medical disability and increased mortality. This review focuses on the perioperative anesthesia considerations of postnatal correction of myelomeningocele.\u0000This contains 3 tables, and 34 references.\u0000Key words: myelomeningocele, Arnold Chiari malformation, tethered spinal cord syndrome, hydrocephalus, cerebrospinal fluid, ventriculo-peritoneal shunt, latex hypersensitivity, morbidity, mortality.","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129258670","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":"Obstetric Anesthetic Complications","authors":"Ying Eva Lu, Linden O. Lee","doi":"10.2310/anes.18193","DOIUrl":"https://doi.org/10.2310/anes.18193","url":null,"abstract":"Anesthesia-associated maternal mortality and complications continue to decline due to improvements in practice and ongoing research in the field of obstetric anesthesiology. This chapter covers key topics in obstetric anesthetic complications, including accidental dural puncture, post-dural puncture headache, general anesthesia-related complications, inadequate labor analgesia, high neural blockade, post-partum back pain, CNS infections, as well as neurological injury.\u0000This review contains 54 references.\u0000Keywords: accidental dural puncture, post-dural puncture headache, general anesthesia-related complications, inadequate labor analgesia, high neural blockade, postpartum back pain, CNS infections, neurological injury.","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115264118","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":"Physiology of Geriatrics","authors":"C. Matadial","doi":"10.2310/anes.18397","DOIUrl":"https://doi.org/10.2310/anes.18397","url":null,"abstract":"The aging population is growing and life expectancy is prolonged. The elderly population is able to enjoy prolonged life with good management of their chronic conditions. Many elderly do not have medical conditions but we still see a decline in their organ function and physiologic reserve that weighs in on their daily living. As well these changes in anatomy, physiology and chemistry puts them at risk of developing medical conditions and experience adverse outcomes during surgery and anesthesia. The central nervous, cardiovascular, respiratory, hepatic and renal systems all work together and are affected as a whole with aging causing physiologic changes but also compensatory mechanisms. In this review we will study the aging physiology of the body and touch on its implications in anesthesia.\u0000This review contains 5 figures, 3 tables, and 55 references.\u0000Keywords: Healthy aging, age-related changes, Postoperative cognitive dysfunction, diastolic dysfunction, vascular stiffening, ventricular arterial coupling, Chronic obstructive pulmonary disease, Spirometry, Glomerular Filtration Rate, hallmarks of aging","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133889532","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":"Ethical Considerations of the Neurosurgical Patient","authors":"B. Tolchin","doi":"10.2310/anes.18073","DOIUrl":"https://doi.org/10.2310/anes.18073","url":null,"abstract":"Neurosurgeons, anesthesiologists, and other clinicians treating patients with neurological disorders can encounter a set of unusually difficult ethical issues, including especially questions about whether to initiate or continue neurosurgical or life-sustaining interventions for neurologically impaired patients. These questions are especially challenging because neurologically injured patients are often unable to make treatment decisions for themselves and because the prognosis for recovery is often uncertain. This article includes ethical frameworks for addressing these difficult questions.\u0000This review contains 5 tables, and 31 references. \u0000Keywords: Bioethics, Autonomy, Beneficence, Justice, Informed consent, Surrogate decision making, Vegetative state, Minimally conscious state, Brain death, Organ donation","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124789125","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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