DOCSLIB.ORG

Anesthesia and Cardiovascular Disease Bhavna Gupta*, Lalit Gupta Maulana Azad Medical College and Loknayak Hospital, New Delhi-110002

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anesthesia and Cardiovascular Disease Bhavna Gupta*, Lalit Gupta Maulana Azad Medical College and Loknayak Hospital, New Delhi-110002 Archives of Anesthesiology Volume 1, Issue 1, 2018, PP: 8-16 Anesthesia and Cardiovascular Disease Bhavna Gupta*, Lalit Gupta Maulana Azad Medical College and Loknayak Hospital, New Delhi-110002. [email protected] *Corressponding Author: Bhavna Gupta, Maulana Azad Medical College and Loknayak Hospital, New Delhi. Abstract In this Review article, we have discussed the anesthesia considerations in a case of pre-existing cardiac disease. Successful anesthesia in these patients revolves around careful planning, team work, communication and perioperative formulation of plan, execution and management. Keywords: Anesthesia, Cardiovascular Disease. Introduction An adrenergic surge leading to an imbalance in myocardial O supply-demand ratio. This in turn Administering anesthesia to patients with preexisting 2 causes ischemic myocardium. It is primarily cardiac disease is an anesthetic challenge. Most common cause of peri-operative morbidity and mortality in cardiac patients is ischemic heart disease affecteda) Tachycardia by: (IHD). IHD is number one cause of morbidity and b) increased wall tension mortality all over the world.Successful perioperative c) increased preload management of ischemic heart disease patients undergoing non cardiac surgery requires careful team d) increased after load work and communication between patient, primary e) increased myocardial contractility care physician, anesthesiologist and surgeon. • Myocardial Oxygen Supply: Increase in oxygen requirement of myocardium can be met by intervention strategy, risks associated with non- In assessing the risks and benefits of a perioperative cardiac surgery must be individualized. Therefore the anesthesiologist must exercise judgment to correctly increasing coronary blood flow. It can be affected • Decreased Coronary Blood Flow: which in turn assess perioperative surgical risks and the need for by: further evaluation.Care of these patients require isa. affectedTachycardia by following: which cause decrease in diastolic & optimization, medical therapy, monitoring and the perfusion time identification of risk factors, pre-operative evaluation choice of appropriate anesthetic technique and drugs b. Hypotension especially because of fall in Coronary Artery Disease (Cad) diastolic BP c. Incrreased Pre load by causing decreased Prevention of myocardial ischemia during surgery perfusion pressure decreases the incidence of perioperative myocardial infarction (MI). Optimizing oxygen delivery to the d. Hypocapnia by causing coronary myocardium is equally important for hemodynamic vasoconstriction management. e. Coronary Vasopasm • Myocardial Oxygen Demand: The principal • Decreased Oxygen Content And Availability: determinants of myocardial oxygen demand a. Anemia are wall tension and contractility. The increase which in turn is affected by in stress during perioperative period causes. b. Hypoxia. Archives of Anesthesiology V1 . I1 . 2018 8 Anesthesia and Cardiovascular Disease Hemodynamic Goals 3. patients with cardiovascular disease include 1. Although the precise relationship between statinsPharmacologic and angiotensin-converting agents which may enzymebenefit intraoperative myocardial ischemia and (ACE) inhibitors (stabilize atherosclerotic postoperative MI remains controversial, plaques) and volatile anesthetics (anesthetic there is consensus that a primary goal of a preconditioning). successful anesthetic is the prevention of myocardial ischemia. Monitoring for Ischemia 2. A well balanced approach of combination of A. The preferable monitoring technique (as per availability) for detecting myocardial ischemia anesthetics, sedative agents, muscle relaxants and vasoactive agents are chosen to decrease myocardial oxygen requirements and decrease • involves:Electrocardiogram (Table-1) (ST segment analysis of leads the likelihood of myocardial ischemia. V5 and II) Table 1. Relation between areas of myocardial ischemia and ECG leads1 ECG leads Coronary artery Area of ischemia I, AVL Lateral aspect of left ventricle II, III, AVF CircumflexRight coronary artery artery Right atrium, Right ventricle V3 - V5 Anterior descending artery Anterolateral aspect of left ventricle • Heart rate and blood pressure (not a sensitive myocardial depression; amnesia; and reliable predictor of myocardial ischemia) suppression of sympathetic nervous system responses to surgical stress. Disadvantages include • myocardial depression, systemic hypotension, ischemia-induced papillary muscle dysfunction Pulmonary artery catheter (V waves reflect and lack of postoperative analgesia. • Transesophageal echocardiography (regional Combinations of opioids and volatile anesthetics wall motion abnormalities are the most sensitive may produce the advantages of each with minimal indicator of myocardial ischemia) Selection of Anesthesia anesthetic could be used as a balanced technique. undesirable side effects. It is likely that any volatile There is no ideal anesthetic agent of choice in patients with Ischemic Heart Disease. Choice of anesthetic Isoflurane is a coronary vasodilator (more so depends on the extent of pe existing myocardial than other volatile anesthetics), but this effect is alveolar concentration (MAC). There is no evidence dysfunction and pharmacological properties of clinically insignificant in doses below 1 minimum of an increased incidence of myocardial ischemia or specificI. Opioids drugs. such as fentanyl in higher dosage in the worsened outcome.Desfluraneand sevoflurane possess range 50-100 µg/kg intravenously are preferred the advantage of faster recovery. A sudden increase in in severe myocardial dysfunction as they lack hemodynamic profiles similar to isoflurane but have increased plasma epinephrine concentration. good left ventricular function, opioids may be the inspired concentration of desflurane may result in myocardial depressant effect. In patients with inadequate to depress sympathetic nervous Treatment of Ischemia system activity, requiring the addition of a Anesthetics or vasoactive drugs that enable the heart volatile anesthetic or vasoactive drug. to return to a slower rate, and well-perfused state are frequently essential during anesthesia. II. Inhalation anesthetics have the advantages of dose dependency; easily reversible, titratable a) Nitrates. Nitroglycerin is the drug of choice 9 Archives of Anesthesiology V1 . I1 . 2018 Anesthesia and Cardiovascular Disease for the treatment of coronary vasospasm. As a anxiety, assessment of vital signs, JVP pulsation, venodilator, this drug decreases venous return carotid bruit, and oedema. Investigations thus wall tension. and decreases ventricular filling pressures and 1. Haemogram b) Vasoconstrictors. Phenylephrine increases 2. myocardial oxygen requirements, but this increase 3. CardiacBlood glucose specific levels tests – ECG, ECHO produced by the increased coronary perfusion 4. Blood urea , Serum Creatinine is offset by improvements in oxygen delivery pressure. 5. LFT c) Supplemental Evaluation oxygen balance by preventing or treating β-blockers: β-blockade improves myocardial tachycardia and by decreasing contractility. Atenolol improves long-term survival in patients Done1. Resting in specific LV function situations. It includes: with heart disease undergoing noncardiac 2. Exercise/ Pharmacological Stress Testing surgery. 3. d) Calcium channel blockers are useful in slowing 4. AmbulatoryCoronary Angiography ECG monitoring 5. the ventricular response in atrial fibrillation treatment of perioperative hypertension. and flutter, as coronary vasodilators, and in the Ina. patientsExercise with Echo abnormal resting ECG LBBB,LVF) Preoperative Clinical Evaluation b. Exercise Myocardial perfusion imaging This includes history, physical examination, 6. investigation, clinical risk predictors, risk assessment, a. Dobutamine stress Echo and functional capacity. In patients who cannot exercise: b. Thallium Scintigraphy History Functional capacity 1. Exercise tolerance is assessed by history and is i. Angina at unaccustomed work. No limitation History of Angina: NYHA Grading expressed as metabolic equivalents (MET). (MET; 1 of physical activity ii. Angina on moderate exertion. Mild limitation Duke Activity Status Index in order to estimate the MET = 3.5 ml O2/kg/min) on a scale defined by the of physical activity patient’s maximal oxygen consumption capacity (Table 2). iii. Angina on mild exertion. Marked limitation of physical activity Patients with moderate or excellent functional capacity and low clinical predictors of risk do not need iv. Angina at rest. further cardiac investigation. The functional capacity 2. History of Dyspnea of some patients might be limited by other conditions 3. Oedema (e.g. Respiratory, peripheral vascular or joint disease). These patients and those with poor functional 4. History of Myocardial infarction capacity should undergo detailed cardiac assessment 5. Family History of CAD Preoperative coronary angiography 6. Current medications Indicated in certain conditions like patients with Physical Examination proven CAD, unstable angina, angina resistant to Look for cyanosis, pallor, dyspnea during conversation, medical therapy, urgent surgery in a patient resolving nutritional status, skeletal deformities, tremors & from acute MI. Archives of Anesthesiology V1 . I1 . 2018 10 Anesthesia and Cardiovascular Disease Table 2: Metabolic Equivalents2 MET (metabolic Estimated energy requirements for various activities equivalents) Poor functional Light housework capacity (1-4 MET) Shower or dress without stopping
Load more

Recommended publications
  • Handheld Devices and Informatics in Anesthesia Prasanna Vadhanan,MD1, Adinarayanan S., DNB2
    COMMENTRY Handheld devices and informatics in anesthesia Prasanna Vadhanan,MD1, Adinarayanan S., DNB2 1Associate Professor, Department of Anaesthesiology, Vinayaka Missions Medical College & Hospital, Keezhakasakudimedu, Kottucherry Post, Karaikal, Puducherry 609609, (India) 2Associate Professor, Department of Anaesthesiology & Critical Care. The Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Gorimedu, Puducherry, 605006, (India) Correspondence: Dr. Prasanna Vadhanan, MD, No. 6, P&T Nagar, Mayiladuthurai 609001 (India); Phone: +919486489690; E-mail: [email protected] Received: 02 April 2016; Reviewed: 2 May 2016; Corrected: 02 June 2016; Accepted: 10 June 2016 ABSTRACT Handheld devices like smartphones, once viewed as a diversion and interference in the operating room have become an integral part of healthcare. In the era of evidence based medicine, the need to remain up to date with current practices is felt more than ever before. Medical informatics helps us by analysing complex data in making clinical decisions and knowing recent advances at the point of patient care. Handheld devices help in delivering such information at the point of care; however, too much reliance upon technology might be hazardous especially in an emergency situation. With the recent approval of robots to administer anesthesia, the question of whether technology can replace anesthesiologists from the operating room looms ahead. The anesthesia and critical care related applications of handheld devices and informatics
    [Show full text]
  • A Novel Checklist for Anesthesia in Neurosurgical Cases Ramsis F
    www.surgicalneurologyint.com Surgical Neurology International Editor-in-Chief: Nancy E. Epstein, MD, Clinical Professor of Neurological Surgery, School of Medicine, State U. of NY at Stony Brook. SNI: Neuroanesthesia and Critical Care Editor Ramsis Ghaly, MD Haly Neurosurgical Associates, Aurora, Illinois, USA Open Access Editorial A novel checklist for anesthesia in neurosurgical cases Ramsis F. Ghaly, Mikhail Kushnarev, Iulia Pirvulescu, Zinaida Perciuleac, Kenneth D. Candido, Nebojsa Nick Knezevic Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, United States. E-mail: *Ramsis F. Ghaly - [email protected], Mikhail Kushnarev - [email protected], Iulia Pirvulescu - [email protected], Zinaida Perciuleac - [email protected], Kenneth D. Candido - [email protected], Nebojsa Nick Knezevic - [email protected] ABSTRACT roughout their training, anesthesiology residents are exposed to a variety of surgical subspecialties, many of which have specific anesthetic considerations. According to the Accreditation Council for Graduate Medical Education requirements, each anesthesiology resident must provide anesthesia for at least twenty intracerebral cases. ere are several studies that demonstrate that checklists may reduce deficiencies in pre-induction room setup. We are introducing a novel checklist for neuroanesthesia, which we believe to be helpful for residents *Corresponding author: during their neuroanesthesiology rotations. Our checklist provides a quick and succinct review of neuroanesthetic Ramsis F. Ghaly, challenges prior to case setup by junior residents, covering noteworthy aspects of equipment setup, airway Ghaly Neurosurgical management, induction period, intraoperative concerns, and postoperative considerations. We recommend Associates,, 4260 Westbrook displaying this checklist on the operating room wall for quick reference. Dr., Suite 227, Aurora, Illinois, United States.
    [Show full text]
  • Neurosurgical Anesthesia Does the Choice of Anesthetic Agents Matter?
    medigraphic Artemisaen línea E A NO D NEST A ES Mexicana de IC IO EX L M O G O I ÍA G A E L . C C O . C Revista A N A T Í E Anestesiología S G S O O L C IO I S ED TE A ES D M AN EXICANA DE CONFERENCIAS MAGISTRALES Vol. 30. Supl. 1, Abril-Junio 2007 pp S126-S132 Neurosurgical anesthesia Does the choice of anesthetic agents matter? Piyush Patel, MD, FRCPC* * Professor of Anesthesiology. Department of Anesthesiology University of California, San Diego. Staff Anesthesiologist VA Medical Center San Diego INTRODUCTION 1) Moderate to severe intracranial hypertension 2) Inadequate brain relaxation during surgery The anesthetic management of neurosurgical patients is, by 3) Evoked potential monitoring necessity, based upon our understanding of the physiology 4) Intraoperative electrocorticography and pathophysiology of the central nervous system (CNS) 5) Cerebral protection and the effect of anesthetic agents on the CNS. Consequent- ly, a great deal of investigative effort has been expended to CNS EFFECTS OF ANESTHETIC AGENTS elucidate the influence of anesthetics on CNS physiology and pathophysiology. The current practice of neuroanes- It is now generally accepted that N2O is a cerebral vasodila- thesia is based upon findings of these investigations. How- tor and can increase CBF when administered alone. This ever, it should be noted that most studies in this field have vasodilation can result in an increase in ICP. In addition, been conducted in laboratory animals and the applicability N2O can also increase CMR to a small extent. The simulta- of the findings to the human patient is debatable at best.
    [Show full text]
  • Nurse Anesthesia Program 642 Anesthesia Techniques, Procedures Are Not Allowed to Work at Any Time As an Anesthesia 209 Carroll Street and Simulation Lab 4 Provider
    Accreditation: CORE COURSES: CR The program is fully accredited by the 561 Advanced Phys. Concepts-Health Care I 3 Council on Accreditation of Nurse Anesthesia Educational 562 Advanced Phys. Concepts-Health Care II 3 Program, and the American Association of Colleges of ADDITIONAL INFORMATION 603 Theoretical Basis 3 Nursing. 606 Information Management in Nursing 3 Information in this brochure is subject to change. 607 Policy Issues 2 Call program office for additional information at Employment: Limited student employment of one day 619 Principles of Evidence-Based Practice 3 per week as an RN is allowed in the first 12 months as long 330-972-3387 NURSING Total 17 as progress is satisfactory in the program. Employment The University of Akron OF for the last 15 months of residency is discouraged due NURSING ANESTHESIA (NA) to both academic and clinical responsibilities. Students Nurse Anesthesia Program 642 Anesthesia Techniques, Procedures are not allowed to work at any time as an anesthesia 209 Carroll Street and Simulation Lab 4 provider. Akron, OH 44325-3701 640 Scientific Components of NA 3 SCHOOL 643 Advanced Health Assess. & Prin. of NA I 4 Student Financial Aid Loans, stipends, grants and Brian P Radesic 645 Advanced Health Assess. & Prin. of NA II 4 scholarships are available on a limited basis. DNP, MSN, CRNA 641 Advanced Pharmacology for NA I 3 Program Director 644 Advanced Pharmacology for NA II 3 Non-discrimination Statement: The program does not 647 Professional Roles for Nurse Anesthetist 2 discriminate on the basis of race, color, religion, age, 637 NA Residency I 4 gender, nationality, marital status, disability, sexual 646 NA Residency II 4 Melody Betts orientation, or any factor protected by law.
    [Show full text]
  • Guide to Anesthesiology for Medical Students
    ASA GUIDE TO ANESTHESIOLOGY FOR MEDICAL STUDENTS CHAPTER 3 result, we have been the pioneers in perioperative medicine, Choosing a Career in Anesthesiology intensive care, pain management, resuscitation and patient safety. What traits do anesthesiologists share? Typically these Saundra Curry, M.D. individuals enjoy crisis management as well as watching physiology Clinical Professor of Anesthesiology and pharmacology in action. They also like instant gratification Director, Medical Student Education and don’t mind short-term contact with patients. Since the Department of Anesthesiology operating rooms are the centers of activity, liking surgery and Columbia University Medical Center surgeons are critical. Anesthesiologists also handle stress well. What skills are required to make a great anesthesiologist? There You’re interested in becoming an anesthesiologist. If you are are no personality profiles in literature describing the “ideal” seriously considering this field then you probably have a number anesthesiologist. However, based on the daily work required, of questions. What is anesthesia? What traits do anesthesiologists the best anesthesiologists are smart, willing to work hard and share? What do anesthesiologists do after training? What kinds have “good hands.” Outsiders often see anesthesia as a specialty of skills should I have to become a good anesthesiologist? of procedures, and certainly there are plenty of those, but What are the challenges of the specialty? How should I plan my anesthesia is far more than that. Multitasking is a critical part of fourth year with an eye towards residency? the specialty. There are multiple alarms and monitors that need Anesthesia was an early, important American contribution to to be supervised regularly and simultaneously.
    [Show full text]
  • 2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats*
    VETERINARY PRACTICE GUIDELINES 2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats* Tamara Grubb, DVM, PhD, DACVAAy, Jennifer Sager, BS, CVT, VTS (Anesthesia/Analgesia, ECC)y, James S. Gaynor, DVM, MS, DACVAA, DAIPM, CVA, CVPP, Elizabeth Montgomery, DVM, MPH, Judith A. Parker, DVM, DABVP, Heidi Shafford, DVM, PhD, DACVAA, Caitlin Tearney, DVM, DACVAA ABSTRACT Risk for complications and even death is inherent to anesthesia. However, the use of guidelines, checklists, and training can decrease the risk of anesthesia-related adverse events. These tools should be used not only during the time the patient is unconscious but also before and after this phase. The framework for safe anesthesia delivered as a continuum of care from home to hospital and back to home is presented in these guidelines. The critical importance of client commu- nication and staff training have been highlighted. The role of perioperative analgesia, anxiolytics, and proper handling of fractious/fearful/aggressive patients as components of anesthetic safety are stressed. Anesthesia equipment selection and care is detailed. The objective of these guidelines is to make the anesthesia period as safe as possible for dogs and cats while providing a practical framework for delivering anesthesia care. To meet this goal, tables, algorithms, figures, and “tip” boxes with critical information are included in the manuscript and an in-depth online resource center is available at aaha.org/anesthesia. (J Am Anim Hosp Assoc 2020; 56:---–---. DOI 10.5326/JAAHA-MS-7055) AFFILIATIONS Other recommendations are based on practical clinical experience and From Washington State University College of Veterinary Medicine, Pullman, a consensus of expert opinion.
    [Show full text]
  • CHAPTER 17 Are Writing and Base Your Methods on This Protocol
    ASA GUIDE TO ANESTHESIOLOGY FOR MEDICAL STUDENTS When designing your own protocol, it is impractical for a eight to 12 week commitment, includes 15 percent of your time medical student to think he or she will complete a clinically to be devoted to clinic exposure to anesthesiology, and includes a altering, randomized, double-blinded placebo controlled trial in a travel stipend for you to present your work at the annual American month or two of research. This does not mean one cannot perform Society of Anesthesiologists meeting. For those interested in a clinically relevant investigation that can add substantially to anesthesiology, this is a great opportunity! existing knowledge. A good medical student-initiated research project often consists of a retrospective chart or radiographic Closing Thoughts review of normal anatomic and/or pathologic conditions, and/or Including a research project at some point in your medical case reports. Running prospective trials is often cumbersome as career will expand your understanding of the scientific method, patient enrollment is very sporadic, especially when dealing with a and hopefully, give you a greater ability to scrutinize the many new limited amount of time. good and bad research publications that drive change in current medical practice. Performing a successful research project requires When designing your own protocol, a general outline is as follows: much initiative on your part. Start the process early, especially if you 1. Find a motivating mentor and choose a project. decide to write your own protocol. Know your topic thoroughly as it will aid you immensely in writing your manuscript and answering 2.
    [Show full text]
  • University of Pennsylvania School of Nursing Nurse Anesthesia Program Graduate Student Handbook Addendum 2020-2021
    University of Pennsylvania School of Nursing Nurse Anesthesia Program Graduate Student Handbook Addendum 2020-2021 TABLE OF CONTENTS PART I – GENERAL INFORMATION A. Program Philosophy, Goals & Objectives B. Accreditation Status C. Requirements for Graduation D. Calendar Addendum and Vacation Policy E. Didactic Assignments F. Clinical Assignments & Responsibilities G. On-Call Residency Expectations H. Student Clinical Outcomes I. Orientation to Clinical Courses J. Self-Evaluation Examination (SEE) K. National Certification Exam (NCE) L. Change of Area of Study M. Access to Student Records N. Program Evaluation Policy PART II – NURSE ANESTHESIA PROGRAM STUDENT CONDUCT POLICIES A. Alcohol & Drug Policy B. Sexual Harassment Policy B. Work Regulations PART III – ATTACHMENTS A. Full-Time Plan of Study B. Vacation Request Form C. Daily Clinical Evaluation Tool D. Clinical Objectives The policies covered in this handbook are subject to change at the discretion of The University of Pennsylvania, the School of Nursing, the Nurse Anesthesia Program, or by recommendation of any standing committees. Part I: GENERAL INFORMATION A. PROGRAM PHILOSOPHY, GOALS, AND OBJECTIVES The Nurse Anesthesia program at the University of Pennsylvania School of Nursing provides students with the didactic information and clinical experience to become a professional nurse anesthetist. A nurse anesthetist is an advance practice nurse who may provide services in a variety of settings. Nurse anesthetists can either work alone or in teams to provide safe anesthesia care. The nature of the work is critical and the standards are high. The profession of nurse anesthesia maintains a strong commitment to quality education and lifelong learning. The nurse anesthesia curriculum is a rigorous combination of didactic and clinical modules.
    [Show full text]
  • Karen Sibert, Md
    NEWSLETTER OF THE UCLA DEPARTMENT OF ANESTHESIOLOGY & PERIOPERATIVE MEDICINE EDITOR: KAREN SIBERT, MD Contents 3 4 8 FROM THE CHAIR’S DESK UCLA GOES TO THE ASA UCLA ANESTHESIOLOGISTS LEAD By Aman Mahajan, MD, PhD ASA BRAIN HEALTH INITIATIVE 10 9 OUR FIRST-EVER 11 SOUND WAVES IN CARDIOVASCULAR PERIOPERATIVE GENOMICS: SANTA MONICA THEME SYMPOSIUM NEXT-GENERATION MEDICINE By Prince Neelankavil, MD By Thomas Vondriska, PhD By Louis Saddic, MD, PhD, and Aman Mahajan, MD, PhD 12 14 OUR RESEARCH SUPERSTARS MINING “BIG DATA” 16 TO IMPROVE PATIENT CARE “PREHABILITATION” – By Nirav Kamdar, MD, MPP THE NEXT STEP IN READINESS FOR SURGERY 18 By Victor Duval, MD RESIDENCY TRAINING IN THE OR AND BEYOND 20 By Emily Methangkool, MD, UNIQUE ANESTHESIA CARE and Judi Turner, MD, PhD FOR EYE SURGERY 22 By Elaine Liew, MD, FRCA, and KEEPING OURSELVES HEALTHY Brittany Countryman, CRNA AND RESILIENT 24 By Keren Ziv, MD NURSE ANESTHETISTS: ACTIVE UCLA TEAM MEMBERS! 25 By Deborah Dach, MSN, CRNA OUR NEW FACULTY PHYSICIANS 28 By Shevaughn Marchese OUR FAR-FLUNG ALUMNI ANSWER THE QUESTION: 30 WHERE ARE YOU NOW? WITH YOUR HELP THROUGH GIVING… 2 | UCLA Department of Anesthesiology & Perioperative Medicine From the Chair’s Desk By Aman Mahajan, MD, PhD e are delighted to present a new edition of appropriations to the University of California Wour department’s newsletter, highlighting system have fallen more than $1 billion in some of the exciting work being done by our inflation-adjusted dollars. From 2003 to 2015, the faculty and staff. Our program spans multiple National Institutes of Health (NIH) lost 22 percent clinical and laboratory sites, engaged in all kinds of their capacity to fund research.
    [Show full text]
  • Total Intravenous Anesthesia in Neurosurgery
    THIEME Review Article 141 Total Intravenous Anesthesia in Neurosurgery Narmadhalakshmi Kannabiran1 Prasanna Udupi Bidkar2 1Department of Neuroanaesthesiology, Jawaharlal Institute Address for correspondence Prasanna Udupi Bidkar, MBBS, MD of Postgraduate Medical Education and Research (JIPMER), (Anesthesiology), DNB (Anesthesiology), DM (Neuroanesthesiology) Pondicherry, India MNAMS, MBA, Division of Neuroanaesthesia, Department 2Division of Neuroanaesthesia, Department of Anaesthesiology of Anaesthesiology and Critical Care, Jawaharlal Institute of and Critical Care, Jawaharlal Institute of Postgraduate Medical Postgraduate Medical Education and Research (JIPMER), Pondicherry Education and Research (JIPMER), Pondicherry, India 605006, Tamil Nadu, India (e-mail: [email protected]). J Neuroanaesthesiol Crit Care 2018;5:141–149 Abstract In recent years, neurosurgical anesthesia has been rapidly evolving in the fields of pharmacotherapy and techniques to administer safe anesthesia. Intravenous (IV) anesthetic agents reduce both cerebral blood flow and intracranial pressure besides maintaining flow–metabolism coupling in contrast to inhalational agents. In neuro- anesthesia, the technique and choice of drugs directly influence the outcome of the patients. The purpose of this review is to provide the updated information of total intravenous anesthesia (TIVA) in neuroanesthesia. Administration of TIVA using tar- get-controlled infusion technique is emerging as a standard method to administer safe anesthesia in neurosurgical patients.
    [Show full text]
  • Pocket Anesthesia Reference Card
    OBSTETRICS & OB EMERGENCIES OBSTETRICS & OB EMERGENCIES NEURAXIAL ANESTHESIA EMERGENCIES Pocket Anesthesia (Please see full OB pocket card for details) (Please see full OB pocket card for details) v 0.9 Key Points High Spinal & Total Spinal Hypertensive Disorders Urgent or Emergent C-Section & Emergent GA Reference Card •Uses: C/S, Gyn, Uro, Abdo & LE procedures Signs •Numbness, paresthesia, or weakness of UE’s Pre-Eclampsia: BP > 140/90 x2 ≥ 20 wks, proteinuria, +/- organ dysfunct. For all: Pre-induction checklist •High spinal is a significant cause of morbidity/mortality → see emergencies •Rapid unexpected rise of sensory block Card design by providers from many institutions including: •Consider delivery •Call for help, take AMPLE Hx, IV access, NaCit, pulse ox, LUD. •Monitor BP q1-5 min before, during, & after. Use standard monitors •SOB, apnea, bradycardia, hypotension, or nausea/vomiting •Prevent seizure: Mg 4-6 g IV over 15-20 min + 1-2 g/hr gtt for 24 hr post •Neuraxial preferred if time - plan determined by degree of urgency, •Ensure adequate IV access, vasoconstrictors & GA available •Loss of consciousness (LOC = total spinal), Cardiac arrest delivery (do NOT d/c in OR); (10 g IM load described if no PIV) communication w/OB team, resources, & pt. condition •Consider preloading with IVF (Avoid in pre-eclampsia) • •Tx severe HTN (SBP > 155, DBP > 105): 1st line: Labetalol IV, hydralazine IV, • If CS for fetal distress, ↑ O2 to baby: SPOILT-Stop oxytocin, Position-LUD, O2, IV fluid, Low Tx Call for help & code cart, inform team •Consider starting vasopressor support at time of placement •If cardiac arrest: start CPR, refer to ACLS protocol nifedipine PO and no IV (others okay if 1st line unavailable) BP (give pressor), Tocolytics (terbutaline 250 mcg subQ, +/-NTG SL spray 400 mcg x2) •Ensure aseptic technique for placement •Watch for Mg tox: ↓ DTRs, Resp/cardiac comp.
    [Show full text]
  • Anesthesia for Cosmetic Surgery
    CME Anesthesia for Cosmetic Surgery Peter J. Taub, M.D. Learning Objectives: After studying this article, the participant should be able Sameer Bashey, B.A. to: 1. Recognize the anesthetic choices available to patients undergoing out- Laurence M. Hausman, M.D. patient cosmetic surgery. 2. Identify the various medications selected for use in New York, N.Y. outpatient cosmetic surgery. 3. Understand the complexities of providing safe anesthesia to patients undergoing outpatient cosmetic surgery. Summary: Increasing numbers of plastic surgery procedures are performed in diverse environments, including traditional hospital operating rooms, outpa- tient surgery centers, and private offices. Just as plastic surgeons develop areas of specialization to better care for their patients, anesthesiologists have special- ized in outpatient plastic surgery, both cosmetic and reconstructive. The meth- ods they utilize are similar to those for other procedures but incorporate specific techniques that aim to better relieve preoperative anxiety, induce and awaken patients more smoothly, and minimize postoperative sequelae of anesthesia such as nausea and vomiting. It is important for plastic surgeons to understand these techniques since they are the ones who are ultimately responsible for their patients’ care and are frequently called on to employ anesthesiologists for their practices, surgery centers, and hospitals. The following is a review of the specific considerations that should be given to ambulatory plastic surgery patients and the techniques used to safely administer agreeable and effective anesthesia. (Plast. Reconstr. Surg. 125: 1e, 2010.) he American Society of Plastic Surgeons re- impact both the quality and the quantity of recov- cently reported that more than 11 million ery time.
    [Show full text]