Trenton C Wray, Neal Gerstein, Emily Ball, Wendy Hanna, Isaac Tawil
{"title":"Seeing the heart of the problem: transesophageal echocardiography in cardiac arrest: a practical review.","authors":"Trenton C Wray, Neal Gerstein, Emily Ball, Wendy Hanna, Isaac Tawil","doi":"10.1097/AIA.0000000000000411","DOIUrl":"10.1097/AIA.0000000000000411","url":null,"abstract":"In-hospital and out-of-hospital cardiac arrest (CA) is common and associated with poor outcomes despite standardized protocols for advanced cardiac life support (ACLS). Echocardiography is an attractive adjunct to standard ACLS as it has the potential to rapidly diagnose the cause of CA, affect management, facilitate interventions, and guide prognoses. However, difficulty in obtaining adequate acoustic windows for transthoracic echocardiography (TTE) in a timely manner and the associated prolongation of compression pauses have led to an equivocal recommendation on the use of TTE from varying oversight committees and expert reviews. For patients with hemodynamic instability, the American College of Cardiology and other societal guideline committees recommend echocardiography as a first line of assessment, particularly if a cardiac origin is suspected. Critically ill patients often have limited transthoracic windows; and using transesophageal echocardiography (TEE) in this setting has a higher diagnostic yield. As such, TEE is recommended by the American Society of Echocardiography (ASE) in critically ill patients with limited transthoracic views. Not surprisingly, the use in critically ill patients is increasing in the intensive care unit, operating room, emergency department, and even prehospital settings. “Rescue TEE” (TEE performed to rapidly assess for the cause of hemodynamic instability, sometimes also known as “resuscitative TEE”) is particularly useful in the setting of CA. In the intra-arrest and periarrest setting, TEE has the ability to rapidly inform and guide management decisions while avoiding the limitations and interruptions in care that may occur with TTE. The following is a review of the practical application of TEE in CA, including: the benefits, potential harms, a guideline for evaluation, credentialing, and implementation barriers. The utility and benefits of TEE in CA can be divided into intra-arrest and postarrest categories (Table 1). Benefit of TEE during CA resuscitation","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 4","pages":"15-21"},"PeriodicalIF":0.6,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305941","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}
Abhijit Vijay Lele, Marie Angele Theard, Monica S Vavilala
{"title":"Cerebrospinal fluid diversion devices and shunting procedures: a narrative review for the anesthesiologist.","authors":"Abhijit Vijay Lele, Marie Angele Theard, Monica S Vavilala","doi":"10.1097/AIA.0000000000000399","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000399","url":null,"abstract":"","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 3","pages":"29-36"},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10429525","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}
Adele S Budiansky, Emma P Hjartarson, Tomasz Polis, Gregory Krolczyk, John Sinclair
{"title":"Emerging anesthesia techniques for managing intraoperative rupture of cerebral aneurysms.","authors":"Adele S Budiansky, Emma P Hjartarson, Tomasz Polis, Gregory Krolczyk, John Sinclair","doi":"10.1097/AIA.0000000000000400","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000400","url":null,"abstract":"Intraoperative aneurysm rupture (IAR) is one of the most feared complications associated with microsurgical clipping of cerebral aneurysms. To the surgeon, this situation is typi fi ed by an operative fi eld that is rapidly fi lling with blood, often with the ultimate source of hemorrhage not readily identi fi ed. Coupled with the sudden and unexpected nature of the event, an IAR can create great stress for the surgeon and the anesthesiologist. In a survey of neurovascular surgeons, IAR was identi fi ed as one of the major technical challenges to aneurysm clipping. 1 Despite the advancement of endovascular techniques, microsurgical clipping performed via a craniotomy remains indicated for a variety of reasons, such as for patients with subarachnoid hemorrhage (SAH) with mass effect, cranial nerve palsies due to compression by the aneurysm, wide-necked bifurcation or irre-gularly-shaped aneurysms, and ones that have failed endovascular treatment. 2 As microsurgical clipping becomes reserved for more complex indications, the risk of IAR is likely to remain signi fi cant. In the event of IAR, the anesthesiologist plays a critical role, not only in providing adequate resuscitation but also in facilitating the surgeon ’ s visualization and treatment of the bleeding aneurysm. This narrative review focuses on anesthesia techniques that can aid the surgeon in the management of ruptured aneurysms, namely induced hypotension with either adenosine or rapid ventricular pacing (RVP). In addition to the incidence and risk factors for IAR, this review speci fi cally aims to present the management of IAR from the surgeon ’ s","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 3","pages":"64-72"},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10074401","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}
Anuja Rathore, Michael Dinsmore, Lashmi Venkatraghavan
{"title":"Anesthesia management in patients with neurostimulators.","authors":"Anuja Rathore, Michael Dinsmore, Lashmi Venkatraghavan","doi":"10.1097/AIA.0000000000000407","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000407","url":null,"abstract":"Neurostimulators are active implantable devices that clinicians use to perform diverse neuromodulation treatments in patients with neurological and non-neurological disorders. 1 Neuromodulation works on the principle of reverse engineering the disorder allowing the clinicians to think from a patient-system point of view. This enables them to personalize interventions by understanding the patient-speci fi c pathophysiology that can translate insights from cognitive neuroscience into targeted therapies for various disorders. 2 Neurostimulators can be intracranial [deep brain stimulation (DBS)], neuraxial [spinal cord stimulation (SCS), sacral nerve stimulators], or peripheral (vagal nerve trigeminal nerve or other peripheral nerve stimulation). The number of patients using neurostimulators is growing rapidly, making it imperative for anesthesiologists to understand these devices and their potential interactions with other medical equipment. 3 The literature on perioperative management of patients with neurostimulators is scarce, and most of the information comes from case reports and manufacturer recommendations. In this review, we provide an overview of various neurostimulators, general considerations, and recommendations regarding the perioperative management of these patients for speci fi c surgeries.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 3","pages":"13-18"},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10429526","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}
Shobana Rajan, Jad Alchoubassi, Meghana S Bharadwaj, W Andrew Kofke
{"title":"Evolving horizon of global neuroanesthesia education, pathway to standardization, and accreditation.","authors":"Shobana Rajan, Jad Alchoubassi, Meghana S Bharadwaj, W Andrew Kofke","doi":"10.1097/AIA.0000000000000406","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000406","url":null,"abstract":"• With the rapid growth in innovative neurosurgical procedures, the current situation of training in neuroanesthesiology is heterogeneous. • There are a number of gaps pertaining to neuroanesthesiology education that could be bridged under the umbrella of the International Council on Perioperative Neuroscience Training (ICPNT). • The ICPNT serves as a bridge to bring together fellowship programs from around the world. • The Three Pillars of Neuroanesthesiology have formed the basis of the standardized curriculum to train neuroanesthesiologists. • Major changes in education include onlinemodules, webinars, and workshops which foster an environment of collaboration between accredited programs. • Grandfathering the first specialists has been the norm for specialties, but fellowship-trained neuroanesthesiologists are the need of the hour to provide optimal perioperative patient care and foster innovation. • Sustaining and generating interest in this specialty requires proactive steps towardmaking educationmore interactive and interesting, which is important in improving interest in neuroanesthesiology fellowship training. • The focus should be on expanding the specialty to encompass new and upcoming areas in perioperative neurosciences.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 3","pages":"1-7"},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10449887","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}