{"title":"Temperature Measurement and Thermal Management","authors":"Y. Bryan, Kathleen N. Johnson","doi":"10.2310/anes.18287","DOIUrl":"https://doi.org/10.2310/anes.18287","url":null,"abstract":"Temperature measurement and thermal management in surgical patients are both challenging issues that depend on regulating the patient’s immediate thermal environment in the face of the nonphysiologic perturbations that routinely occur in the operation room. Recognizing the different mechanisms involved in the physics of heat transfer, such as radiation, convection, conduction, and evaporation is paramount. In addition, the patient’s comorbidities and prescribed medications combine with the agents used during general anesthesia to further alter thermoregulation. Correctly measuring and monitoring temperature is critical and is an expected part of the American Society of Anesthesiologists (ASA) basic standards for monitoring for all but the shortest or lightest anesthetics. Understanding the advantages and disadvantages of the different anatomic sites available to measure temperature is imperative to prevent erroneous temperature recordings. Correctly preventing inadvertent hypothermia and iatrogenic hyperthermia are critical prior to deciding to institute thermal management. Different mechanisms exist to treat heat loss, using both passive and active warming. Other unique environments within the hospital impose stress on thermoregulation systems such as cardiopulmonary bypass and MRI. This review is a summary of the scientific and medical literature necessary to understand the fundamentals of temperature measurement and thermal management.\u0000\u0000This review contains 3 figures, 3 tables, and 43 references.\u0000Key Words: forced air convection, general anesthetics, hyperthermia, temperature measurement, thermal management, thermoregulation, threshold","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128373363","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 Anesthesia Machine: Managing Exhaled and Waste Gases","authors":"Christine G Jette","doi":"10.2310/anes.18281","DOIUrl":"https://doi.org/10.2310/anes.18281","url":null,"abstract":"Effective and safe CO2 absorption is critical to the anesthesia circle system to prevent rebreathing and hypercapnia. Advances in the original soda lime–based absorbents and their container systems continue to improve patient safety, reducing the risk of compound A and carbon monoxide production, with seemingly little compromise to the efficiency of CO2 absorption capabilities. Scavenging systems and the removal of waste anesthesia gases remain a critical component to anesthesia care, and vigilance to maintain approved systems is a key to operating room staff safety. Advances in anesthesia machine design have resulted in more complicated internal breathing circuits that are increasingly difficult to rid of trace anesthetic gases. This inadvertently led to a necessary change in guidelines on anesthesia machine preparation for patients susceptible to malignant hyperthermia (MH).\u0000 \u0000This review contains 5 figures, 6 tables, and 59 references.\u0000Keywords: carbon dioxide absorption, carbon monoxide, CO2 absorption, compound A, malignant hyperthermia machine preparation, operating room safety, scavenging systems, waste anesthesia gases","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124256241","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":"Electrical and Fire Safety in the OR","authors":"F. Gyulai","doi":"10.2310/anes.18288","DOIUrl":"https://doi.org/10.2310/anes.18288","url":null,"abstract":"In the OR, electrical shocks and fire represent two very important risks and they occur more commonly than most people recognize. Electrical and fire safety in the OR is every team member’s responsibility. Prevention is the first step, but when incidents occur, optimal outcomes depend on concerted efforts. Thisapproach, along with a comprehensive electrical and fire safety program, is a continued effort to create a safer healthcare environment for every worker and patient. Understanding the basic principles of electricity and fire safety is the first step towards this goal. Unfortunately, many institutions do not involve the key players (surgery and anesthesia department members) in the education and preparation process. By involving all team members, optimal outcomes for patients at this vulnerable time may be achieved. Our patients expect us to know the risks and management of these potentially life-threatening occurrences. This chapter endeavours to facilitate these goals.\u0000 \u0000This review contains 9 figures, 3 tables, and 51 references\u0000Keywords: electrosurgical unit, fire extinguisher, ground fault circuit interrupter, grounding, ignition source, line isolation monitor, macroshock, microshock, Ohm law\u0000 ","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115667974","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 Geriatric Patient","authors":"Maggie Mechlin, P. Arrabal","doi":"10.2310/anes.18146","DOIUrl":"https://doi.org/10.2310/anes.18146","url":null,"abstract":"An aging population combined with the increasing availability of invasive medical procedures has created a growing number of elderly patients that anesthesiologists care for every day. Geriatric patients present unique challenges that must be taken into consideration when crafting an anesthetic plan. To start with, one must first decide what it means to be elderly. Is it an age cutoff? If so, at what age does a patient become elderly? Is it a physiologic definition? If so, what amount of physiologic derangement must be present and in how many organ systems for someone to be classified as elderly? Although there is no clear consensus, a reasonable definition would combine age with the patient’s physical tolerance towards the stresses of surgery. This chapter attempts to address the myriad challenges faced by the perioperative physician who is planning to anesthetize an elderly patient. There are unique points to be noted in the preoperative physical examination, cognitive evaluation, creation of the anesthetic plan, and risk stratification. There are additional concerns related to a patient’s wishes regarding code status and potential end-of-life care. By addressing all these issues, anesthesiologists can provide safe, successful, and compassionate care to a complex and diverse elderly population.\u0000This review contains 5 figures, 3 tables, and 52 references.\u0000Key Words: anesthetizing the elderly, code status discussion, delirium, pharmacokinetic changes of aging, postoperative cognitive decline, physiologic changes of aging, regional anesthesia for orthopedic surgery, risk stratification","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127645685","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 Physics of Ultrasound","authors":"B. O’Brien, M. Griffin","doi":"10.1016/b978-1-4160-3356-1.10002-0","DOIUrl":"https://doi.org/10.1016/b978-1-4160-3356-1.10002-0","url":null,"abstract":"","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115173772","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":"Mathematics and Statistics in Anesthesiology","authors":"D. Mortlock","doi":"10.2310/anes.18276","DOIUrl":"https://doi.org/10.2310/anes.18276","url":null,"abstract":"Mathematics is the language of quantitative science, and probability and statistics are the extension of classical logic to real world data analysis and experimental design. The basics of mathematical functions and probability theory are summarized here, providing the tools for statistical modeling and assessment of experimental results. There is a focus on the Bayesian approach to such problems (ie, Bayesian data analysis); therefore, the basic laws of probability are stated, along with several standard probability distributions (eg, binomial, Poisson, Gaussian). A number of standard classical tests (eg, p values, the t-test) are also defined and, to the degree possible, linked to the underlying principles of probability theory.\u0000\u0000This review contains 5 figures, 1 table, and 15 references.\u0000Keywords: Bayesian data analysis, mathematical models, power analysis, probability, p values, statistical tests, statistics, survey design","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"48 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128920342","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 Drugs","authors":"Allison Dalton","doi":"10.2310/anes.18227","DOIUrl":"https://doi.org/10.2310/anes.18227","url":null,"abstract":"Given the dynamic nature of the operating room environment, anesthesiologists must be prepared to handle cardiovascular comorbidities and complications. From perioperative hypertension to cardiovascular shock to cardiac arrhythmias, one must be able to diagnose and treat a wide range of cardiovascular conditions. We will evaluate recent literature to determine the best treatment modalities for the treatment of acute heart failure, cardiogenic shock, vasoplegia after cardiopulmonary bypass, pulmonary hypertension, septic shock, perioperative hypertension, and cardiac arrhythmias. Selection of appropriate inotropic medications and vasopressors may improve mortality in shock. Treatment of pulmonary hypertension, perioperative hypertension, and arrhythmias requires knowledge of a variety of classes of medications with specific applications and adverse effects. \u0000\u0000This review contains 3 figures, 9 tables and 54 references\u0000Keywords: amiodarone, antiarrhythmic, beta blocker, calcium channel blocker, catecholamine, inotrope, nitrate, vasoconstrictor, vasodilator","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134084104","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":"Pancreatic and Adrenal Disorders","authors":"J. Yaung","doi":"10.2310/anes.18362","DOIUrl":"https://doi.org/10.2310/anes.18362","url":null,"abstract":"Critically ill patients who lack preexisting endocrine diagnoses may still develop endocrine dysfunction, as exhibited by critical illness-related corticosteroid insufficiency and glycemic abnormalities. Glycemic control remains an important issue in critically ill patients, as hyperglycemia, hypoglycemia, and glucose variability are all independently associated with increased mortality. Hyperglycemia is a common manifestation of critical illness that may result from an acute response to stress and injury or may reflect preexisting diabetes mellitus. Hypoglycemia most commonly occurs as a result of treatment of hyperglycemia but may also be due to other causes such as sepsis and decreased nutritional intake. Hypoglycemia and other glycemic emergencies such as diabetic ketoacidosis and a hyperosmolar hyperglycemic state must be quickly recognized and treated. This review provides a general overview of diabetes mellitus, glycemic targets in the critically ill, glycemic emergencies, adrenal gland disorders, pheochromocytoma, and carcinoid syndrome.\u0000\u0000This review contains 1 figures, 4 tables, and 43 references.\u0000Keywords: adrenal crisis, carcinoid syndrome, critical illness-related corticosteroid insufficiency, Cushing syndrome, diabetes mellitus, diabetic ketoacidosis, glycemic goals, hyperosmolar hyperglycemic state, hypoglycemia, pheochromocytoma","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114783720","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":"Anesthetic Management of Intracranial Aneurysms","authors":"Matthew Hammer, L. Hemmer","doi":"10.2310/anes.18059","DOIUrl":"https://doi.org/10.2310/anes.18059","url":null,"abstract":"Despite efforts in the past decades to improve outcomes, intracranial aneurysm surgery still carries a considerable mortality risk, and its complications can cause a marked disability. To optimize and safely anesthetize a patient for these high-risk surgeries, the anesthesiologist must have a detailed understanding of the natural history, systemic physiologic perturbations, and intraoperative and postoperative complications of intracranial aneurysms. Various grading scales are used to predict adverse events, such as vasospasm or mortality, and are outlined in this chapter. Endovascular coiling and open surgical clip ligation (clipping) are the two most commonly employed interventions for treatment of aneurysms. The anesthetic goals for these complex patients are summarized.\u0000 \u0000This review contains 2 tables and 59 references. \u0000Key Words: adenosine, burst suppression, emergence hypertension, endovascular coiling, indocyanine green, intracranial aneurysm clipping, intraoperative hypothermia, motor evoked potentials","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"124 8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125766932","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":"Basic Pharmacologic Concepts","authors":"Bryan M. Cook, Lindsay Urben","doi":"10.2310/anes.18221","DOIUrl":"https://doi.org/10.2310/anes.18221","url":null,"abstract":"Pharmacokinetic and pharmacodynamic principles specifically describe the different ways a drug and the body interact with each other. Pharmacokinetics focuses mainly on the absorption of medications into the body, the distribution into various tissues, how the body metabolizes and breaks down medications, and the elimination of any remaining medication or metabolites. Moreover, patient-specific characteristics, such as comorbidities and organ dysfunction, must be considered as they may also influence a drug’s absorption, distribution, metabolism, and elimination. Pharmacodynamics involves the different ways a medication affects the body, particularly when interacting with different receptors and the subsequent biochemical actions that elicit physiologic responses. Different drug-specific properties, such as affinity, efficacy, and agonism, also play a role in a patient’s response to the medication. When the concepts of pharmacokinetics and pharmacodynamics are joined together, computer models and simulations can be utilized to help predict the expected physiologic effects of a drug based on varying dosing parameters while taking tissue distribution and metabolism into consideration.\u0000\u0000This review contains 6 figures, 5 tables and 21 references.\u0000Keywords: biophase, compartment distribution, context-sensitive half-time, dose-response relationship, pharmacodynamics, pharmacokinetics, pharmacogenomics, receptor sensitization","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129949017","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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