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milestones in anesthesia

Terry C Lairmore
BACKGROUND: The last 200 years have seen remarkable achievements in the art and clinical practice of surgery. These advances include the introduction of antisepsis, anesthesia, vascular anastomosis, antimicrobials, organ transplantation, and the widespread application of minimally invasive operative procedures. Very recently, a surgical procedure has been shown to cure diabetes, representing the most effective treatment of a metabolic disorder by surgeons. METHODS: The author reviewed the major surgical milestones in the modern surgical era and prepared this monograph for presentation as the Claude H...
September 30, 2016: American Journal of Surgery
F J Bianco, J I Martínez-Salamanca
FocalyxTM conceived as a response to emerging evidence data across numerous cancer lesions that questions current standard treatment approaches that too often lead to detrimental quality of life yet delivering limited survival benefit, especially in-lieu of advances in imaging technology applicable to cancer patients. The Focalyx paradigm aims to control cancer with improvement in quality of life. We initially devised 5 milestones: 1- Consistently optimize Prostate MRI imaging using the novel published protocols adopted as guidelines by societies such as the European Society of Urology and Radiology; 2- Evaluate fusion platform software solutions that existed; 3- Determine best fusión platform for Focalyx on practicality, precision, and workflow premises; 4- Evaluate commercially available FDA approved ablative technologies to implement our treatment vision; 5- Design a treatment option that can be performed in the office setting under local anesthesia, which would not impact negatively QOL outcomes of Prostate Cancer patients and seamless constant nonintrusive practical patient-physician interaction by the Focalyx app that facilitates follow up and provides early warning signals shall any change in the disease dynamics emerge...
July 2016: Archivos Españoles de Urología
Stephen Yu, Alessandra Szulc, Sharon Walton, Joseph Bosco, Richard Iorio
BACKGROUND: Although pain management after total knee arthroplasty (TKA) affects rehabilitation, length of stay, and functional outcomes, pain management for patients undergoing TKA has yet to be standardized. Femoral nerve blocks (FNBs) are commonly used as an adjunct; however, these can result in transient quadriceps weakness and have been associated with in-hospital falls. Periarticular infiltration of liposomal bupivacaine has been recently introduced as a long-acting analgesic that can be administered without affecting motor function...
February 16, 2016: Clinical Orthopaedics and related Research
Charu Mahajan, Girija P Rath, Parmod K Bithal, Ashok K Mahapatra
BACKGROUND: Giant encephalocele, a rare entity, makes anesthesiologists wary of challenging anesthetic course. Apart from inherent challenges of pediatric anesthesia, the anesthesiologist has to deal with unusual positioning, difficult tracheal intubation, and associated anomalies during the perioperative course. MATERIALS AND METHODS: Medical records of 29 children with giant encephalocele, who underwent excision and repair, during a period of 13 years, were retrospectively analyzed...
February 2, 2016: Journal of Neurosurgical Anesthesiology
Krishna Koirala
BACKGROUND: Laryngeal malignancy is a common malignancy of the head and neck region. Affected patients usually present with features that are characteristic of certain subsites. The larynx is oncologically divided into three: supraglottis, glottis and subglottis. Studies from Western countries have shown that the glottis is the commonest subsite to harbour laryngeal malignancy. However, the supraglottis has been reported to be the commonest subsite in developing countries, including examples in the Indian subcontinent...
2015: Asian Pacific Journal of Cancer Prevention: APJCP
Annette Rebel, Amy DiLorenzo, Regina Y Fragneto, Jeremy S Dority, Greg L Rose, Dung Nguyen, Zaki-Udin Hassan, Randall M Schell
Residency programs are charged with teaching, assessing, and documenting resident competency for a multitude of skills. Documentation of competency requires demonstrating specific milestones mandated by the Accreditation Council for Graduate Medical Education. Our department designed an innovative, competition-based approach to objectively assess the skill level of postgraduate year 1 residents in performing basic anesthesia-related tasks after 1 month of anesthesiology training. We launched an "Olympic" event to assess requisite skills in an environment of friendly competition...
September 1, 2015: A & A Case Reports
Glenn E Woodworth, Patricia A Carney, Joshua M Cohen, Sandy L Kopp, Lindsey E Vokach-Brodsky, Jean-Louis E Horn, Andres Missair, Shawn E Banks, Nathan F Dieckmann, Robert B Maniker
BACKGROUND: Interpretation of ultrasound images and knowledge of anatomy are essential skills for ultrasound-guided peripheral nerve blocks. Competency-based educational models promoted by the Accreditation Council for Graduate Medical Education require the development of assessment tools for the achievement of different competency milestones to demonstrate the longitudinal development of skills that occur during training. METHODS: A rigorous study guided by psychometric principles was undertaken to identify and validate the domains and items in an assessment of ultrasound interpretation skills for regional anesthesia...
July 2015: Regional Anesthesia and Pain Medicine
Richard P Wenzel, Michael B Edmond
New England Journal of Medicine, Volume 372, Issue 21, Page 2062-2063, May 2015.
May 21, 2015: New England Journal of Medicine
William J Fawcett, Gabriele Baldini
Optimal analgesia is a key element of enhanced recovery after surgery (ERAS), not only for humanitarian reasons but also because poorly relieved surgical pain contributes to surgical stress and impairs recovery. A multimodal analgesic approach is advised in order to provide adequate analgesia, reduce opioid consumption, reduce side effects and facilitate the achievement of ERAS milestones. For open surgery, a thoracic epidural for 48 to 72 hours, with regular acetaminophen and antiinflammatories is probably the treatment of choice...
March 2015: Anesthesiology Clinics
Wai-Nang Chao, Chin-Feng Tsai, Po-Hui Wang, Khee-Siang Chan, Yuan-Ti Lee, Ding-Bang Lin, Chun-Chieh Chen, Shiuan-Chih Chen
BACKGROUND: The groin flap represents a milestone in the history of flap development, since it was the first successful free cutaneous flap. Once widely used, it is currently less popular owing to the variations in vascular anatomy and the small, short pedicle. To enhance the clinical applications of the groin flap, its merits need to be promoted and its faults improved, including making some useful innovations. METHODS: From February 2010 to February 2014, we successfully treated 35 patients with soft tissue defects in the extremities (28 patients), buttock (1 patient), and head (6 patients) using new designs in groin flaps: axial free (34 patients) or pedicle (1 patient) groin flaps...
May 2015: Annals of Plastic Surgery
Mingjuan Tan, Lawrence Siu-Chun Law, Tong Joo Gan
PURPOSE: The optimal management of postoperative pain using multimodal analgesia is a key component of Enhanced Recovery After Surgery (ERAS). Pain has adverse clinical implications on postoperative recovery, including prolonging the time to recovery milestones and length of hospital stay. Moreover, the ubiquity of opioids in postoperative analgesic regimens results in adverse effects, such as sedation, postoperative nausea and vomiting, urinary retention, ileus, and respiratory depression, which can delay discharge...
February 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Salvador Navarro
Due to its retroperitoneal location, the pancreas has historically been a mysterious organ that is difficult to examine and which complicates treatment. The discovery of anesthesia and asepsis in the mid-19th century allowed laparotomic diagnosis, which was previously only possible at autopsy. The expectations of surgery were improved by the detection of blood groups, vitamin K synthesis, and the development of intensive care units. In addition, high levels of presurgical diagnosis and an unquestionable improvement of its results were enabled by advances in laboratory methods (serum quantification of amylase and lipase, tumoral markers, genetics, and techniques for measuring exocrine pancreatic function), imaging and endoscopic modalities, and fine tuning of surgical techniques...
May 2015: Gastroenterología y Hepatología
Carlos A Artime, Carin A Hagberg
Tracheal extubation in both the critical care and anesthesia setting is not only an important milestone for patient recovery, but also a procedure that carries a considerable risk of complication or failure. Mechanical ventilation is associated with significant complications that are time-dependent in nature, with a longer duration of intubation resulting in a higher incidence of complications, including ventilator-associated pneumonia, and increased mortality. Extubation failure and subsequent re-intubation are associated with an overall increase in the duration of mechanical ventilation, increased mortality, a greater need for tracheostomy, and higher medical costs...
June 2014: Respiratory Care
Harish Ramakrishna, Benjamin A Kohl, Jacob T Gutsche, Jens Fassl, Prakash A Patel, Hynek Riha, Kamrouz Ghadimi, William J Vernick, Michael Andritsos, George Silvay, John G T Augoustides
This article reviewed selected research highlights of 2013 that pertain to the specialty of cardiothoracic and vascular anesthesia. The first major theme is the commemoration of the sixtieth anniversary of the first successful cardiac surgical procedure with cardiopulmonary bypass conducted by Dr Gibbon. This major milestone revolutionized the practice of cardiovascular surgery and invigorated a paradigm of mechanical platforms for contemporary perioperative cardiovascular practice. Dr Kolff was also a leading contributor in this area because of his important contributions to the refinement of cardiopulmonary bypass and mechanical ventricular assistance...
February 2014: Journal of Cardiothoracic and Vascular Anesthesia
Sayed Mohammad Reza Hadavi, Elaheh Allahyary, Saman Asadi
BACKGROUND: Awareness and recall, though not common, are the major hazards of general anesthesia, especially in Cesarean section (C/S) because of the absence of benzodiazepine and opioids for a significant time during anesthesia. In this study, the Bispectral Index (BIS), end-tidal isoflurane, and hemodynamic parameters were examined to evaluate the depth of the routine general anesthetic technique in C/S. METHODS: This study was carried out on 60 parturient patients undergoing elective C/S...
September 2013: Iranian Journal of Medical Sciences
Thomas J Ebert, Chris A Fox
The Accreditation Council for Graduate Medical Education is transitioning to a competency-based system with milestones to measure progress and define success of residents. The confines of the time-based residency will be relaxed. Curriculum must be redesigned and assessments will need to be precise and in-depth. Core anesthesiology faculty will be identified and will be the "trained observers" of the residents' progress. There will be logistic challenges requiring creative management by program directors. There may be residents who achieve "expert" status earlier than the required 36 months of clinical anesthesia education, whereas others may struggle to achieve acceptable status and will require additional education time...
January 2014: Anesthesiology
Lindsay Murray, W Hardy Hendren, John E Mayer, Mark A Rockoff
Seventy-five years ago, a 7-year-old girl underwent the first successful ligation of a patent ductus arteriosus. This procedure transformed her health and was a milestone in the development of cardiac surgery. The operation was performed by Dr. Robert E. Gross, then the surgical chief resident at Boston Children's Hospital, who went on to have a distinguished career in pediatric surgery. The patient is now a great-grandmother and the oldest known survivor of cardiac surgery.
August 2013: Journal of Pediatric Surgery
Norihiro Sakai, Takaya Inoue, Yasuo Kunugiza, Tetsuya Tomita, Takashi Mashimo
We conducted the prospective randomized controlled trial to test that continuous femoral nerve block (CFNB) improves attainment of 120° knee flexion compared to continuous epidural analgesia (CEA). Sixty-six patients scheduled for unilateral total knee arthroplasty were randomized into two groups; infusion of ropivacaine 0.15% into CEA or CFNB to third postoperative days. We studied the time required to attain 120° knee flexion, variations in thigh and calf circumferences around the treated knee, pain scores, rehabilitation milestones, the need for adjuvant analgesics, and side effects...
May 2013: Journal of Arthroplasty
Jin Young Chon
Sugammadex is a modified gamma-cyclodextrin which is showing favorable outcomes regarding reversal of neuromuscular blockade, especially by rocuronium. It is designed to encapsulate rocuronium and being considered a new class of drugs as selective relaxant binding agents. It has given countless benefits to the patients at risk of incomplete or delayed recovery after neuromuscular block and has renown for another milestone in anesthesia practice. Recurrence of neuromuscular block has not been reported to be associated with the provided doses of sugammadex that are adequate for selected for reversal...
January 2013: Korean Journal of Anesthesiology
Parul Jindal, Gurjeet Khurana, Deepak Oberoi, Jagdish Prasad Sharma
UNLABELLED: This prospective, randomized, double control study was carried out in 84 children aged 2-24 months posted for elective cleft lip surgery. METHODS: Patients were randomally divided into 2 groups of 42 patients each. In Group A patients were induced and maintained on sevoflurane while in Group B patients were induced with sevoflurane and maintained on isoflurane. Standardized anesthesia technique was used. Recovery milestones and post operative complications were recorded...
June 2012: Middle East Journal of Anesthesiology
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