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Anesthesiology Clinics

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https://www.readbyqxmd.com/read/28131125/embracing-the-next-phase-in-obstetric-anesthesiology
#1
EDITORIAL
Onyi C Onuoha, Robert R Gaiser
No abstract text is available yet for this article.
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131124/anesthesiologists-in-obstetric-care-beyond-labor-epidurals-and-c-section-care
#2
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131123/update-in-the-management-of-patients-with-preeclampsia
#3
REVIEW
Nerlyne K Dhariwal, Grant C Lynde
Hypertensive disorders of pregnancy complicate approximately 10% of all deliveries in the United States and are a leading cause of maternal and fetal morbidity and mortality. Preeclampsia is defined as hypertension in association with proteinuria, thrombocytopenia, impaired liver function, renal insufficiency, pulmonary edema, or new-onset cerebral or visual disturbances. The greatest risk factor for the development of preeclampsia is a history of preeclampsia. There currently is no effective means for the prevention of preeclampsia...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131122/obstetric-and-anesthetic-approaches-to-external-cephalic-version
#4
REVIEW
Stephanie Lim, Jennifer Lucero
Breech presentation is the most common abnormal fetal presentation and complicates approximately 3% to 4% of all pregnancies. External cephalic version (ECV) should be recommended to women with a breech singleton pregnancy, if there is no maternal or fetal contraindication. ECV increases the chance of cephalic presentation at the onset of labor and decreases the rate of cesarean delivery by almost 40%. The success rate of ECV is approximately 60%. Review of the risks and benefits for performing an ECV and for both the timing of ECV and the number of attempts should be should be discussed with the patient...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131121/general-anesthesia-during-the-third-trimester-any-link-to-neurocognitive-outcomes
#5
REVIEW
Annemaria De Tina, Arvind Palanisamy
Rodent studies on the effect of general anesthesia during the third trimester on neurocognitive outcomes are mixed, but primate studies suggest that a clinically relevant exposure to anesthetic agents during the third trimester can trigger neuronal and glial cell death. Human studies are conflicting and the evidence is weak. This is an up-to-date review of the literature on the neurodevelopmental effects of anesthetic agents administered during the third trimester. Early brain development and critical periods of neurodevelopment as it relates to neurotoxicity are highlighted...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131120/huddles-and-debriefings-improving-communication-on-labor-and-delivery
#6
REVIEW
Emily McQuaid-Hanson, May C M Pian-Smith
Interprofessional teams work together on the labor and delivery unit, where clinical care is often unscheduled, rapidly evolving, and fast paced. Effective communication is key for coordinated delivery of optimal care and for fostering a culture of community and safety in the workplace. The preoperative huddle allows for information sharing, cross-checking, and preparation before the start of surgery. Postoperative debriefings allow the operative team to engage in ongoing process improvement. Debriefings after adverse events allow for shared understanding, mutual healing, and help mitigating the harm to potential "second victims...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131119/the-use-of-ultrasonography-in-obstetric-anesthesia
#7
REVIEW
Chiraag Talati, Cristian Arzola, Jose C A Carvalho
This article provides an overview of the use of ultrasonography in obstetric anesthesia. It discusses the indications, benefits, and techniques of using ultrasonography to optimize the delivery of anesthesia and provide safe and efficacious clinical care. More specifically, it discusses the use of ultrasonography to facilitate neuraxial anesthesia, abdominal field blocks, central and peripheral vascular access, as well as the assessment of the lung fields and gastric contents, and identification of the cricothyroid membrane...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131118/postdural-puncture-headache-an-evidence-based-approach
#8
REVIEW
Robert R Gaiser
Headache after dural puncture is a common complication accompanying neuraxial anesthesia. The proposed cause is loss of cerebrospinal fluid through the puncture into the epidural space. Although obstetric patients are at risk for the development of this headache because of female gender and young age, there is a difference in the obstetric population. Women who deliver by cesarean delivery have a lower incidence of headache after dural puncture compared with those who deliver vaginally. Treatment of postdural puncture headache is an epidural blood patch...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131117/identification-and-management-of-obstetric-hemorrhage
#9
REVIEW
Emily J Baird
Obstetric hemorrhage remains the leading cause of maternal death and severe morbidity worldwide. Although uterine atony is the most common cause of peripartum bleeding, abnormal placentation, coagulation disorders, and genital tract trauma contribute to adverse maternal outcomes. Given the inability to reliably predict patients at high risk for obstetric hemorrhage, all parturients should be considered susceptible, and extreme vigilance must be exercised in the assessment of blood loss and hemodynamic stability during the peripartum period...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131116/awareness-and-aortocaval-obstruction-in-obstetric-anesthesia
#10
REVIEW
Nathaniel Hsu, Robert R Gaiser
Awareness during general anesthesia for cesarean delivery continues to be a major problem. The key to preventing awareness is strict attention to anesthetic technique. The prevalence and implications of aortocaval compression have been firmly established. Compression of the vena cava is a real occurrence when assuming the supine position. Relief of this compression most likely does not occur until the patient is turned 30°, which is not feasible for performing cesarean delivery. Although it is still wise to tilt the patient, the benefit of this tilt may not be as great as once thought...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131115/should-nitrous-oxide-be-used-for-laboring-patients
#11
REVIEW
Michael G Richardson, Brandon M Lopez, Curtis L Baysinger
Nitrous oxide, long used during labor in Europe, is gaining popularity in the United States. It offers many beneficial attributes, with few drawbacks. Cost, safety, and side effect profiles are favorable. Analgesic effectiveness is highly variable, yet maternal satisfaction is often high among the women who choose to use it. Despite being less effective in treating labor pain than neuraxial analgesic modalities, nitrous oxide serves the needs and preferences of a subset of laboring parturients. Nitrous oxide should, therefore, be considered for inclusion in the repertoire of modalities used to alleviate pain and facilitate effective coping during labor...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131114/optimal-pain-management-after-cesarean-delivery
#12
REVIEW
Caitlin Dooley Sutton, Brendan Carvalho
Cesarean delivery rates are increasing worldwide, and effective postoperative pain management is a key priority of women undergoing cesarean delivery. Inadequate pain management in the acute postoperative period is associated with persistent pain, greater opioid use, delayed functional recovery, and increased postpartum depression. In addition to pain relief, optimal management of patients after cesarean delivery should address the goals of unrestricted maternal mobility, minimal maternal and neonatal side effects, rapid recovery to baseline functionality, and early discharge home...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131113/epidural-analgesia-for-labor-continuous-infusion-versus-programmed-intermittent-bolus
#13
REVIEW
Onyi C Onuoha
Despite the traditional practice to maintain labor analgesia with a combination of continuous epidural infusion and patient-controlled epidural analgesia using an automated epidural pump; compelling data now shows that bolus injection through the epidural catheter may result in better distribution of anesthetic solution in the epidural space. The programmed intermittent epidural bolus technique is proposed as a better maintenance mode and may represent a more effective mode of maintaining epidural analgesia for labor, especially prolonged labor...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27816137/medically-complex-patients
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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