{"title":"Postoperative and Adjunctive Wound Care","authors":"L. Faucher, Rebecca A. Busch","doi":"10.2310/anes.2200","DOIUrl":"https://doi.org/10.2310/anes.2200","url":null,"abstract":"Wounds are a major source of complications in surgery, but many can be avoided by using a sound, evidence-based approach to wound care. Preoperative considerations are discussed and include smoking cessation, glycemic control, weight loss, and adequate nutritional intake. Intraoperative considerations are presented and include proper classification of surgical wounds, hyperoxia and warming, and fascia closure techniques. Postoperative considerations that are presented include recognizing both early and late fascia complications, understanding skin closure techniques, and using adjuncts to postoperative wound management. \u0000This review contains 7 figures, 24 tables, and 67 references.\u0000Keywords: Surgical site infection, infection, closure, suture, negative pressure wound therapy, open abdomen, mesh, surgery, granulation tissue","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"202 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123596254","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 Management in Children","authors":"J. Peyton, R. Park","doi":"10.2310/anes.18002","DOIUrl":"https://doi.org/10.2310/anes.18002","url":null,"abstract":"Airway management in children is usually very straightforward. Unfortunately, when it is not straightforward complications associated with problems encountered while managing the airway can be life-threatening. Airway management can be considered to consist of several different techniques for oxygenating and ventilating an anesthetized patient, namely mask ventilation, supraglottic airway device ventilation, and tracheal intubation. This chapter discusses these techniques and the factors associated with difficulty in performing them. There are anatomic features associated with difficulty in all of these techniques that are caused by syndromes or abnormal airway anatomy in children, although around 20% of difficult intubations are unanticipated. The majority of complications occur when attempting a difficult tracheal intubation. Morbidity and mortality relating to tracheal intubation correlate to the number of attempts at tracheal intubation. Severe hypoxia is estimated to occur in around 9% of children who are difficult to intubate and hypoxic cardiac arrest in nearly 2%, so the key to successful airway management is to focus on maintaining oxygenation and choosing a technique with the best chance of a successful outcome during the first attempt at airway management.\u0000This review contains 6 figures, 7 tables, and 41 references. \u0000Keywords: cricothyrotomy, difficult airway, direct laryngoscopy, fiberoptic bronchoscopy, front of neck access, intubation, pediatric, videolaryngoscopy","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122088082","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: Necrotizing Enterocolitis and Abdominal Wall Defects","authors":"I. Vesselinova","doi":"10.2310/anes.18009","DOIUrl":"https://doi.org/10.2310/anes.18009","url":null,"abstract":"Recent advances in perinatal care have dramatically improved the survival of the youngest and smallest infants, including critically ill neonates and those born with congenital malformations. This has increased the neonatal population at risk for intraabdominal diseases due to prematurity that require surgical intervention. Thus, the pediatric anesthesiologist is increasingly confronted with the challenging task of providing anesthetic care for these vulnerable patients. Despite our better understanding of the immature transitional physiology and developmental pharmacology, pathology of the diseases of prematurity and impact of surgery and anesthesia on their fragile homeostasis, the risk for adverse perioperative events is still the highest in neonatal patients. Therefore, thoughtful preparation, anticipation of potential complications, and efficient collaboration within the multidisciplinary team are essential to ensure safety and quality of the delivered anesthetic care. This review focuses on the perioperative management of necrotizing enterocolitis and abdominal wall defects, with emphasis on preoperative stabilization and tailoring of anesthetic intraoperative plan to the unique neonatal physiology and disease process.\u0000This review contains 4 tables, and 50 references.\u0000Key Words: anesthesia, necrotizing enterocolitis, gastroschisis, omphalocele, neonatal, prematurity, resuscitation, morbidity, mortality.","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114919228","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":"Respiratory Monitoring and Instrumentation","authors":"O. Predescu, A. Guzzo","doi":"10.2310/anes.18284","DOIUrl":"https://doi.org/10.2310/anes.18284","url":null,"abstract":"The American Society of Anesthesia Standards for Basic Anesthetic Monitoring and the Practice Guidelines for Postanesthetic Care stress the importance and necessity of respiratory monitoring during anesthesia to ensure adequate oxygenation and adequate ventilation. Respiratory monitoring represents a continuous real-time evaluation of the patient’s physiology and is essential in assisting clinical decision-making and ensuring patient safety. This chapter discusses spirometry as well as different monitoring instruments for assessing ventilation and oxygenation. A brief history of each monitoring instrument is outlined.\u0000This review contains 8 figures, 2 tables, and 8 references.\u0000Key Words: capnography, co-oximetry, expired gas concentration, flow-volume loops, infrared absorption spectroscopy, inspiratory pressure, mass spectroscopy, pulse oximetry, Raman scattering, spirometry","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128295197","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":"Minimally Invasive Surgery: Equipment and Troubleshooting","authors":"J. Greenberg, Laura E Fischer","doi":"10.2310/anes.2198","DOIUrl":"https://doi.org/10.2310/anes.2198","url":null,"abstract":"The field of minimally invasive surgery has evolved rapidly since the first laparoscopic appendectomies and cholecystectomies were performed nearly 30 years ago.1 Minimally invasive approaches are now widely used for gastrointestinal resection, hernia repair, antireflux surgery, bariatric surgery, and solid-organ surgery, such as hepatic, pancreatic, adrenal, and renal resections. Although the techniques and equipment needed to access, expose, and dissect vary according to the type of operation and surgeon’s preference, a basic set of equipment is essential for any laparoscopic or robotic procedure: endoscope, camera, light source, signal processing unit, video monitor, insufflator and gas supply, trocars, and surgical instruments. Understanding how to use and troubleshoot this equipment is critical for any surgeon who performs minimally invasive surgery. We review the essentials of basic laparoscopic equipment, including the mechanics of normally functioning equipment and the various types of laparoscopic trocars and instruments. We also discuss robotic equipment and the fundamental differences from laparoscopy. Minilaparoscopy and single-site equipment are briefly explained. Additionally, we discuss potential technical difficulties that surgeons may encounter while performing minimally invasive procedures and provide suggestions for troubleshooting these problems.\u0000This review 13 figure, 2 tables, and 64 references.Key Words: Laparoscopy, Robotic Surgery, Minimally Invasive Surgery, Laparoscopic Surgery, Trocars, Surgical Energy Devices, Insufflator, Laparoscopic Instrumentation, Ergonomics, Single Site Surgery","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"42 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120850066","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":"The Respiratory System","authors":"Zerlina Z Wong, M. Nurok","doi":"10.2310/anes.18401","DOIUrl":"https://doi.org/10.2310/anes.18401","url":null,"abstract":"The pulmonary system is crucial for survival. Managing respiratory mechanics and airway requires a sophisticated understanding of pulmonary physiology. This chapter discusses the ways in which oxygen is brought into the body and carbon dioxide is expelled and reviews the principles of respiratory mechanics, including lung compliance, airway resistance, chemoreceptor and mechanoreceptor control of ventilation, hypoxic pulmonary vasoconstriction, distribution of perfusion, and other properties that affect oxygen and carbon dioxide transport. The respiratory system exists in a state of equilibrium, where the inward elastic recoil of the lungs is balanced with the outward elastic recoil of the chest wall. Airway resistance and compliance are important factors that affect ventilation and air movement. This chapter reviews the role that chemoreceptors and mechanoreceptors have on controlling ventilation, as well as the effects that hypercarbia and hypoxemia have on pulmonary and cerebral circulation, and the Bohr and Haldane effects that elucidate understanding of the hemoglobin dissociation curve. These principles all inform the care of patients who require mechanical ventilation, as we endeavor to support them through their surgery or intensive care stay.\u0000This review contains 7 figures and 38 references.\u0000Key Words: apneic oxygenation, Bohr effect, chemoreceptors, compliance, Haldane effect, hypoxic pulmonary vasoconstriction, resistance, respiratory mechanics, ventilation-perfusion","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130858063","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":"Extubation of the Difficult Airway","authors":"A. Dalton","doi":"10.2310/anes.18131","DOIUrl":"https://doi.org/10.2310/anes.18131","url":null,"abstract":"It is well known that induction and intubation are periods associated with patient risk. Especially in the case of patients with known or suspected difficult airways, extubation may be associated with similar risk. Therefore, attempts at extubation must be well planned, and preparations for urgent or emergent intubation must be in order prior to removal of an endotracheal tube. Preparations should be made on a case-by-case basis with consideration given to that specific patient’s indications for difficult airway management. Patients at risk for airway obstruction from edema require different techniques and preparations compared with those patients at risk for intracranial hypertension. Advanced preparations should include consideration of the best location for extubation (ie, OR, PACU, ICU), required tools (ie, airway exchange catheter, videolaryngoscope, fiberoptic bronchoscope supraglottic device), and personnel. A thorough plan for emergent reintubation should be considered taking into account the patient’s baseline airway anatomy, previous difficulty of intubation, subsequent airway edema, hemodynamics, and other complicating factors (ie, patient now in a Halo device, jaw wiring).\u0000 This review contains 5 figures, 6 tables, and 45 references.\u0000keywords: airway edema, airway exchange catheter, cricothyrotomy, difficult airway, difficult intubation, extubation, fiberoptic bronchoscopy, retrograde intubation","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"9 35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126371735","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":"Anesthesia for Premature Infants and Micropremies","authors":"Elaine Ng","doi":"10.2310/anes.18006","DOIUrl":"https://doi.org/10.2310/anes.18006","url":null,"abstract":"Advances in medicine has led to the increased survival of micropremies and premature infants. The anesthetic management for these patients has unique considerations and should only be provided by experts at specialized pediatric centers. Technical procedures and monitoring can be challenging due to their small size. Related to the physiology and immaturity of the airway, respiratory, cardiac and neurologic systems, there is an increased perioperative risk that may be related to hypoxemia and apnea and rapid desaturation, reversal of intracardiac shunts, and intraventricular hemorrhage. Immature renal and hepatic systems are related to decreased drug metabolism and demand careful and accurate administration of medications. The patients are prone to hypothermia and hypoglycemia. In addition, there may be congenital anomalies, syndromes, or other metabolic issues that may not have been fully worked up at the time of presentation for anesthesia. Emerging information related to potential neurotoxicity related to exposure to anesthetic agents has led to continual research and understanding of these mechanisms in order to provide the safest care. A meticulous approach, careful planning, and collaborative approach with the multidisciplinary neonatal team are essential to ensure the best possible outcome for this unique patient population.\u0000 This review contains 3 figures, 4 tables, and 36 references.\u0000Keywords: inguinal hernia repair, micropremies, prematurity, neonatal anesthesia, neurotoxicity, neonatal intensive care, necrotizing enterocolitis, preterm infants","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126879418","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":"Antepartum and Intrapartum Fetal Assessment and Management","authors":"Jourdan E. Triebwasser, Lori J Day, D. Berman","doi":"10.2310/anes.18189","DOIUrl":"https://doi.org/10.2310/anes.18189","url":null,"abstract":"Antenatal surveillance and intrapartum fetal monitoring are routine components of obstetric care, particularly in the high-risk patient. The goal of antenatal testing is to reduce stillbirths in pregnancies with heightened risk. The goal of intrapartum monitoring is to reduce fetal acidemia, which can lead to asphyxia and long-term neurologic sequelae. Both antepartum and intrapartum monitoring of the fetal heart rate and its variability are sensitive to acidemia. Standard nomenclature exists for describing the features of fetal heart rate tracing. Ultrasonography is a useful adjunct to fetal heart rate monitoring, particularly for antenatal testing. The decision to initiate antenatal testing or intrapartum monitoring depends on many factors, particularly gestational age and maternal status. All forms of surveillance have high false-positive rates and poor positive predictive value. If the results of abnormal testing will not affect clinical management, testing should not be performed.\u0000This review contains 9 figures, 7 tables, and 50 references.\u0000Keywords: acidemia, antenatal testing, assessment, biophysical profile, electronic fetal monitoring, labor and delivery, nonstress test, stillbirth","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132392374","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":"External and Implantable Pacemakers and Defibrillators","authors":"R. Saffary","doi":"10.2310/anes.18286","DOIUrl":"https://doi.org/10.2310/anes.18286","url":null,"abstract":"Approximately 250,000 pacemakers are implanted every year in the United States.26 As the population continues to age, the number is likely to increase; therefore, it is imperative for all physicians, especially anesthesiologists, to become familiar with implantable cardiac devices and the appropriate management of patients with these devices. Anesthesiologists must be comfortable evaluating and managing patients with pacemakers and/or defibrillators during the perioperative period, as more of this patient population present for noncardiac, elective surgery. This requires a strong understanding of the types of devices, indications, settings, and functionality. In addition, it is important to understand and anticipate possible interactions during surgery with surgical instruments, such as bi- and monopolar electrocautery. This review provides a brief overview of the history of implantable devices, presents the guidelines regarding indications for placement, discusses important management considerations, and concludes with recent advances and future directions.\u0000This review contains 1 figures, 5 tables, and 30 references. \u0000Key Words: cardiac, defibrillator, electrophysiology, external, implantable, pacemaker, pacing, transcutaneous, transvenous","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133498536","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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