Refresher courses in anesthesiology最新文献

{"title":"Office-based Anesthesia: Successes and Challenges","authors":"R. Twersky, Saad Mohammad","doi":"10.1097/ASA.0b013e3182995883","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182995883","url":null,"abstract":"O ffice-based surgery (OBS) accounted for 10 million of all elective procedures performed in the United States in 2005 and has doubled since 1995. Although there are no good national registries to accurately determine the number of surgical procedures occurring in offices, the projections have ranged from 17 to 24% of all elective ambulatory surgery procedures. This phenomenon has paralleled, and was certainly driven by, the huge increase in demand for cosmetic surgery over the past 10 years. Newer surgical and anesthetic techniques have allowed more invasive procedures to be performed in nonhospital settings. Economic advantages and physician and patient convenience have fueled the rapid growth of OBS and office-based anesthesia (OBA). Other advantages of OBS include ease of scheduling, greater privacy, lower cost, no risk for nosocomial infection, increased efficiency, and consistency in nursing personnel (Supplemental Digital Content 1, http:// links.lww.com/ASA/A302). Despite these advantages, OBS is not embraced by all surgeons nor is it appropriate for every patient or surgical procedure. In addition, OBA requires a different approach than that used in hospitals and ambulatory surgery centers. The rapid growth of OBA has not been uniformly accompanied by adherence to safety standards followed in hospitals or ambulatory surgery centers. The current status of OBA and challenges faced by office-based anesthesiologists regarding patient safety, patient and procedure selection, and anesthesia management for adult patients are the subject of this chapter.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"125–134"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182995883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62021233","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":"Upper Extremity Regional Anesthesia: Essentials for Your Practice","authors":"J. Neal","doi":"10.1097/ASA.0b013e3182990572","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182990572","url":null,"abstract":"Contemporary data suggest that regional anesthesia for shoulder and arm/hand surgery improves early outcome measures such as superior analgesia, decreased opioid-related side effects, earlier readiness for discharge, and reduced frequency of unplanned hospital admission (see Supplemental Digital Content 1, http://links. lww.com/ASA/A276). Continuous perineural catheters consistently improve analgesia, and may facilitate earlier hospital discharge and rehabilitation after upper extremity surgery of moderate to severe pain intensity (see Supplemental Digital Content 2, http://links.lww.com/ ASA/A277). Furthermore, plexus-based regional anesthetic techniques generally result in superior analgesia as compared with surgeon-placed subacromial infusion or wound infiltration while avoiding concerns over local anesthetic-induced chondrolysis. Thus, brachial plexus regional anesthesia can positively affect outcome in patients undergoing upper extremity surgery.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"78–87"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182990572","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020912","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":"Fast-tracking: Toward a Patient-centered Approach to PACU Bypass","authors":"M. Argalious","doi":"10.1097/ASA.0b013e3182995294","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182995294","url":null,"abstract":"Several scoring criteria have been used to assess patients’ early recovery, including the Aldrete scoring system and its modifications, the Mayo modified discharge score, and the standardized Postanesthesia Care Unit (PACU) bypass/discharge criteria. With the rapid increase in the number of ambulatory surgical procedures and the introduction of shortacting anesthetics, it was recognized that patients frequently meet the criteria for early recovery from anesthesia while in the operating room and before transport to the PACU. Criteria for bypassing phase I recovery (also called fasttracking) were established to identify patient eligibility for PACU bypass, and include the White and Song fast-tracking criteria and the Wake scoring criteria. These criteria, if used by the anesthesia team after the patient emerges from anesthesia, can avoid unnecessary transfer of patients to the PACU if bypass criteria are met and can:","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"147 1","pages":"1–7"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182995294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020963","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":"What’s New in Airway Management","authors":"L. Berkow","doi":"10.1097/ASA.0b013e31829a2031","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31829a2031","url":null,"abstract":"As the condition of patients presenting for anesthesia and surgery continues to become more complex, so has airway management. In addition, the number of patients who require anesthesia and airway management outside the operating room setting is increasing. New airway devices continue to be introduced into the market and clinical practice, making airway management decisions even more challenging. According to the ASA Closed Claims database, the number of claims involving airway management, both inside and outside the operating room setting, is substantial. This chapter discusses some of the new evaluation methods and devices, many of the issues surrounding airway competency, airway management outside the operating room setting, and the role of simulation and standardization in airway education and airway management. In addition, several still-unanswered questions, such as how to predict airway difficulty, which airway device to choose, how to assess airway competency, and how to disseminate difficult airway information to both medical providers and patients, will be addressed.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"31–37"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31829a2031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62021927","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 Art and Science of Disclosing Unanticipated Outcomes to Patients","authors":"Allen N. Gustin","doi":"10.1097/ASA.0b013e3182995571","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182995571","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Discuss the Joint Commission Standard 2.90 R.I. Name two organizations considered to be leaders of disclosure List three elements of an effective disclosure conversation Discuss the concept of an apology/‘‘I’m sorry’’ law Discuss two of the barriers to physician disclosure to patients Discuss two of the facilitators to physician disclosure to patients","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"53–58"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182995571","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62021183","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":"Massive Postcardiopulmonary Bypass-related Hemorrhage: A Rational Approach to Management","authors":"Edwin G. Avery","doi":"10.1097/ASA.0b013e318299f897","DOIUrl":"https://doi.org/10.1097/ASA.0b013e318299f897","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Identify patients at risk for massive post-cardiopulmonary bypass (CPB) hemorrhage Apply sound evidence-based treatment strategies to patients exhibiting severe post-CPB hemorrhage Successfully integrate the administration of allogeneic blood products and pharmacological adjuncts to control severe post-CPB hemorrhage","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"8–14"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e318299f897","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62021407","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 for Interventional Neuroradiology/Endovascular Neurosurgery","authors":"W. Young","doi":"10.1097/ASA.0B013E31829A9A9D","DOIUrl":"https://doi.org/10.1097/ASA.0B013E31829A9A9D","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Explain the rationale for specific monitoring and considerations in vascular access Describe specific considerations in management of anesthesia technique Explain the rationale for choosing different types of anticoagulation agents and the potential reversal of their effects Discuss the indications and technique for application of deliberate hypotension or hypertension Describe the diagnosis and management of neurological and/or procedural crises Describe anesthesia management for specific procedures in interventional neuroradiology","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"141-147"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E31829A9A9D","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62022108","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":"Sepsis: Current Concepts and Perioperative Management","authors":"M. Nunnally","doi":"10.1097/ASA.0b013e31829a1d16","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31829a1d16","url":null,"abstract":"The syndrome sepsis embodies success and failure in modern medical care. Advances such as the development of antibiotics and organ support prevent immediate deaths from infection and organ dysfunction. However, patients with sepsis go on to develop critical illness and multiorgan system failure. Many still die. The result is that the population of patients with sepsis is sicker today than it was 50, or even 10, years ago. Mortality is effectively unchanged, whereas resource utilization increases. Each advance in therapy results in prolonged states of morbidity and unchanged mortalities. In 2005, an elderly patient with chronic obstructive pulmonary disease presenting to an intensive care unit with pneumonia and sepsis would have received a pneumococcal vaccine, an insulin infusion with the goal of ‘‘tight’’ glycemic control (i.e., serum glucose values between 80 and 110 mg/dL), and drotrecogin a (recombinant activated protein C), to disrupt a destructive inflammatory and coagulation cycle and improve end-organ perfusion. Just 7 years later, there is ample evidence to suggest that none of these therapies is helpful, and they may be harmful. Sepsis research has uncovered a complicated process of immune response to illness with broad systemic effects. We know more about the mechanisms that contribute to the syndrome, but efforts to block the response have been largely unsuccessful. Much of what we thought we knew about sepsis turned out to be wrong. With the exceptions of the control of the source of sepsis, timely antibiotics, and resuscitation, little has been discovered to improve outcomes in sepsis (Supplemental Digital Content 1, http://links.lww.com/ ASA/A321). Even these measures are subject to debate. The septic patient remains a therapeutic challenge. As professionals in perioperative medicine, anesthesia providers must be prepared to manage patients with sepsis syndrome. Timely and effective care is essential to the management of the septic patient and demands skills in resuscitation, monitoring, and operative management. For anyone practicing in the field of anesthesia and critical care, understanding sepsis is essential (Supplemental Digital Content 2,","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"95–102"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31829a1d16","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62021638","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":"Management of the Difficult Airway in the ICU","authors":"D. Viernes, A. Joffe","doi":"10.1097/ASA.0b013e31829a1bef","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31829a1bef","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe the incidence of difficult intubation in the out-of-OR setting, with particular attention to the ICU Discuss aspects of optimizing first-attempt success rates for tracheal intubation Evaluate some alternative intubation techniques for airway rescue Stratify risk while considering tracheal extubation","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"135–140"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31829a1bef","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62021844","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":"Update on Strategies for Blood Conservation and Hemostasis in Cardiac Surgery","authors":"C. Mazer, G. Hare","doi":"10.1097/ASA.0B013E31829A20D3","DOIUrl":"https://doi.org/10.1097/ASA.0B013E31829A20D3","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe the risk factors for anemia, acute blood loss, and transfusion in patients undergoing cardiac surgery Identify modifiable risk factors (anemia, antiplatelet and anticoagulant therapy, intraoperative blood loss, postoperative management of anemia) and their treatments to minimize acute blood loss and transfusion during cardiac surgery Explain how to apply blood conservation principles and methods in cardiac surgery","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"45 1","pages":"59-69"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E31829A20D3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62021988","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}