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Anesthesiology Clinics

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https://www.readbyqxmd.com/read/27816137/medically-complex-patients
#1
EDITORIAL
Robert B Schonberger, Stanley H Rosenbaum
No abstract text is available yet for this article.
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816136/the-patient-with-multimorbidities-does-1-1-always-simply-equal-2
#2
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816135/anesthesia-for-patients-with-concomitant-hepatic-and-pulmonary-dysfunction
#3
REVIEW
Geraldine C Diaz, Michael F O'Connor, John F Renz
Hepatic function and pulmonary function are interrelated with failure of one organ system affecting the other. With improved therapies, patients with concomitant hepatic and pulmonary failure increasingly enjoy a good quality of life and life expectancy. Therefore, the prevalence of such patients is increasing with more presenting for both emergent and elective surgical procedures. Hypoxemia requires a thorough evaluation in patients with end-stage liver disease. The most common etiologies respond to appropriate therapy...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816134/anesthesia-for-patients-with-peripheral-vascular-disease-and-cardiac-dysfunction
#4
REVIEW
Sara E Neves
Patients with vascular disease and cardiac dysfunction present particular challenges to the anesthesiologist. They are hemodynamically brittle, at high risk of morbidity and mortality during surgery, and often carry additional comorbidities that increase their complexity and risk. Those with peripheral vascular disease should be assumed to have coronary artery disease and tend to have other systemic vascular problems. Poor cardiac function further worsens perfusion in an already compromised peripheral vascular system...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816133/anesthesia-for-patients-with-concomitant-sepsis-and-cardiac-dysfunction
#5
REVIEW
Abed Abubaih, Charles Weissman
Anesthesiologists faced with a patient with sepsis and concurrent cardiac dysfunction must be cognizant of the patient's cardiac status and cause of the cardiac problem to appropriately adapt physiologic and metabolic monitoring and anesthetic management. Anesthesia in such patients is challenging because the interaction of sepsis and cardiac dysfunction greatly complicates management. Intraoperative anesthesia management requires careful induction and maintenance of anesthesia; optimizing intravascular volume status; avoiding lung injury during mechanical ventilation; and close monitoring of arterial blood gases, serum lactate concentrations, and hematology renal and electrolyte parameters...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816132/anesthesia-for-patients-with-traumatic-brain-injuries
#6
REVIEW
Bishwajit Bhattacharya, Adrian A Maung
Traumatic brain injury (TBI) represents a wide spectrum of disease and disease severity. Because the primary brain injury occurs before the patient enters the health care system, medical interventions seek principally to prevent secondary injury. Anesthesia teams that provide care for patients with TBI both in and out of the operating room should be aware of the specific therapies and needs of this unique and complex patient population.
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816131/anesthesia-patients-with-concomitant-cardiac-and-hepatic-dysfunction
#7
REVIEW
Julianne Ahdout, Michael Nurok
Anesthesia and surgery in patients with hepatic and cardiac dysfunction poses a challenge for anesthesiologists. It is imperative to optimize these patients perioperatively. Cirrhosis is associated with a wide range of cardiovascular abnormalities. Cirrhotic cardiomyopathy is characterized by blunted contractile responsiveness or systolic incompetence, and/or diastolic dysfunction. In liver disease, anesthetic drug distribution, metabolism, and elimination may be altered. Among patients with liver disease, propofol is a reasonable anesthetic choice and cisatracurium is the preferred neuromuscular blocker...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816130/anesthesia-for-patients-with-anemia
#8
REVIEW
Aryeh Shander, Gregg P Lobel, Mazyar Javidroozi
Anemia is a common and often ignored condition in surgical patients. Anemia is usually multifactorial and iron deficiency and inflammation are commonly involved. An exacerbating factor in surgical patients is iatrogenic blood loss. Anemia has been repeatedly shown to be an independent predictor of worse outcomes. Patient blood management (PBM) provides a multimodality framework for prevention and management of anemia and related risk factors. The key strategies in PBM include support of hematopoiesis and improving hemoglobin level, optimizing coagulation and hemostasis, use of interdisciplinary blood conservation modalities, and patient-centered decision making throughout the course of care...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816129/anesthesia-for-patients-with-concomitant-cardiac-and-renal-dysfunction
#9
REVIEW
Radwan Safa, Nicholas Sadovnikoff
Renal disease and cardiovascular disease are commonly encountered in the same patient. The dynamic interactions between renal disease and cardiovascular disease have an impact on perioperative management. Renal failure is an independent risk factor for cardiovascular disease and the link between the two disease states remains to be fully elucidated.
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816128/surgical-critical-care-for-the-patient-with-sepsis-and-multiple-organ-dysfunction
#10
REVIEW
Gary J Kaml, Kimberly A Davis
Sepsis and multiple organ dysfunction syndrome (MODS) is common in the surgical intensive care unit. Sepsis involves infection and the patient's immune response. Timely recognition of sepsis and swift application of evidence-based interventions is critical to the success of therapy. This article reviews the nature of the septic process, existing definitions of sepsis, and current evidence-based treatment strategies for sepsis and MODS. An improved understanding of the process of sepsis and its relation to MODS has resulted in clinical definitions and scoring systems that allow for the quantification of disease severity and guidelines for treatment...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816127/surgical-critical-care-for-the-trauma-patient-with-cardiac-disease
#11
REVIEW
Michael M Woll, Linda L Maerz
The elderly population is rapidly increasing in number. Therefore, geriatric trauma is becoming more prevalent. All practitioners caring for geriatric trauma patients should be familiar with the structural and functional changes naturally occurring in the aging heart, as well as common preexisting cardiac diseases in the geriatric population. Identification of the shock state related to cardiac dysfunction and targeted assessment of perfusion and resuscitation are important when managing elderly patients. Finally, management of cardiac dysfunction in the trauma patient includes an appreciation of the inherent effects of trauma on cardiac function...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816126/coexisting-cardiac-and-hematologic-disorders
#12
REVIEW
Jordan E Goldhammer, Benjamin A Kohl
Patients with concomitant cardiac and hematologic disorders presenting for noncardiac surgery are challenging. Anemic patients with cardiac disease should be approached in a methodical fashion. Transfusion triggers and target should be based on underlying symptomatology. The approach to anticoagulation management in patients with artificial heart valves, cardiac devices, or severe heart failure in the operative setting must encompass a complete understanding of the rationale of a patient's therapy as well as calculate the risk of changing this regimen...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816125/anesthesia-for-the-patient-with-concomitant-hepatic-and-renal-impairment
#13
REVIEW
Tricia E Brentjens, Ryan Chadha
Hepatic and renal disease are common comorbidities in patients presenting for intermediate- and high-risk surgery. With the evolution of perioperative medicine, anesthesiologists are encountering more patients who have significant hepatic and renal disease, both acute and chronic in nature. It is important that anesthesiologists have an in-depth understanding of the physiologic derangements seen with hepatic and renal disease to evaluate and manage these patients appropriately. Perioperative management requires an understanding of the physiologic perturbations associated with each disease process...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816124/anesthetic-management-of-the-adult-patient-with-concomitant-cardiac-and-pulmonary-disease
#14
REVIEW
Misty A Radosevich, Daniel R Brown
Several common diseases of the cardiac and pulmonary systems and the interactions of the two in disease and anesthetic management are discussed. Management of these disease processes in isolation is reviewed and how the management of one organ system impacts another is then explored. For example, in a patient with acute lung injury and right heart failure, lung-protective ventilation may directly conflict with strategies to minimize right heart afterload. Such challenging clinical scenarios require appreciation of each disease entity, their appropriate management, and the balance between competing priorities...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27521202/update-in-neuroanesthesia-an-anesthesiology-clinics-issue-affiliated-with-snacc
#15
EDITORIAL
W Andrew Kofke, William M Armstead, Dhanesh K Gupta, Martin Smith, Michael L Luke James
No abstract text is available yet for this article.
September 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27521201/anesthesiologists-as-clinical-neuroscientists-one-future-for-our-specialty
#16
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
September 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27521200/neuromuscular-disease-in%C3%A2-the-neurointensive-care-unit
#17
REVIEW
Veronica Crespo, Michael L Luke James
Neuromuscular diseases are syndromic disorders that affect nerve, muscle, and/or neuromuscular junction. Knowledge about the management of these diseases is required for anesthesiologists, because these may frequently be encountered in the intensive care unit, operating room, and other settings. The challenges and advances in management for some of the neuromuscular diseases most commonly encountered in the operating room and neurointensive care unit are reviewed.
September 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27521199/subarachnoid-hemorrhage-an-update
#18
REVIEW
Jeremy S Dority, Jeffrey S Oldham
Subarachnoid hemorrhage (SAH) is a debilitating, although uncommon, type of stroke with high morbidity, mortality, and economic impact. Modern 30-day mortality is as high as 40%, and about 50% of survivors have permanent disability. Care at high-volume centers with dedicated neurointensive care units is recommended. Euvolemia, not hypervolemia, should be targeted, and the aneurysm should be secured early. Neither statin therapy nor magnesium infusions should be initiated for delayed cerebral ischemia. Cerebral vasospasm is just one component of delayed cerebral edema...
September 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27521198/controversies-in-the-management-of-traumatic-brain-injury
#19
REVIEW
Sayuri Jinadasa, M Dustin Boone
Traumatic brain injury (TBI) is a physical insult (a bump, jolt, or blow) to the brain that results in temporary or permanent impairment of normal brain function. TBI describes a heterogeneous group of disorders. The resulting secondary injury, namely brain swelling and its sequelae, is the reason why patients with these vastly different initial insults are homogenously treated. Much of the evidence for the management of TBI is poor or conflicting, and thus definitive guidelines are largely unavailable for clinicians at this time...
September 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27521197/brain-oxygenation-monitoring
#20
REVIEW
Matthew A Kirkman, Martin Smith
A mismatch between cerebral oxygen supply and demand can lead to cerebral hypoxia/ischemia and deleterious outcomes. Cerebral oxygenation monitoring is an important aspect of multimodality neuromonitoring. It is increasingly deployed whenever intracranial pressure monitoring is indicated. Although there is a large body of evidence demonstrating an association between cerebral hypoxia/ischemia and poor outcomes, it remains to be determined whether restoring cerebral oxygenation leads to improved outcomes. Randomized prospective studies are required to address uncertainties about cerebral oxygenation monitoring and management...
September 2016: Anesthesiology Clinics
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