MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Anesthesiology Clinics' source. Sun, 29 Jan 2012 07:38:25 +0100 http://www.medworm.com/index.php?rid=5399990&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751100098X%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399990 Sun, 13 Nov 2011 00:51:36 +0100 5399990 http://www.medworm.com/index.php?rid=5399989&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000875%2Fabstract%3Frss%3Dyes Critical illness can and often does lead to significant cognitive impairment and to the development of psychological disorders. These conditions are persistent and, although they improve with time, often fail to completely abate. Although the functional correlates of cognitive and psychological morbidity (depression, anxiety, and posttraumatic stress disorder) have been studied, they may include poor quality of life, inability to return to work or to work at previously established levels, and inability to function effectively in emotional and interpersonal domains. The potential etiologies of cognitive impairment and psychological morbidity in ICU survivors are particularly poorly understood and may vary widely across patients. Potential contributors may include the potentially toxic effec... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399989 Sun, 13 Nov 2011 00:51:36 +0100 5399989 http://www.medworm.com/index.php?rid=5399988&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000863%2Fabstract%3Frss%3Dyes The objectives of this article are (1) to introduce pediatric delirium and provide understanding of acute brain dysfunction with its classification and clinical presentations (2) to understand how delirium is diagnosed and discuss current modes of delirium diagnosis in the critically ill adult population and translation to pediatrics (3) to understand the prevalence and prognostic significance of delirium in the adult and pediatric critically ill population (4) to discuss the pathophysiology of delirium as currently understood, and (5) to provide general management guidelines for delirium. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399988 Sun, 13 Nov 2011 00:51:36 +0100 5399988 http://www.medworm.com/index.php?rid=5399987&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000851%2Fabstract%3Frss%3Dyes Delirium occurs in 35% to 80% of critically ill hospitalized patients. Little is known of delirium prevention and treatment in the critical care setting. Trials emphasizing early mobilization suggest that this nonpharmacologic approach is associated with improved outcome as well as ‘‘delirium days.’’ Titration and reduction of opiate analgesics and sedatives may improve subsyndromal delirium rates. All critical care caregivers should rigorously screen for alcohol abuse, apply alcohol withdrawal scales in alcoholic patients, and titrate sedative drugs. No nonpharmacologic approach or drug has been shown to be beneficial once delirium is established. Considering the importance and the consequences of delirium in the critical care setting, addiction studies are urgently needed. (Sourc... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399987 Sun, 13 Nov 2011 00:51:36 +0100 5399987 http://www.medworm.com/index.php?rid=5399986&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751100084X%2Fabstract%3Frss%3Dyes Despite considerable information on the pharmacotherapy of sedation in the ICU, there is little published on the pharmacoeconomics of sedation in patients who are critically ill. The purpose of this article is to discuss the various components that contribute to the cost of treating the agitated ICU patient and to critically review the articles published since 2000 that evaluated costs and cost-effectiveness in ICU patients receiving drugs for agitation and/or pain. Clinicians should look beyond the acquisition cost of a sedative and include the effect of sedatives on the cost of care when selecting the most appropriate sedative. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399986 Sun, 13 Nov 2011 00:51:36 +0100 5399986 http://www.medworm.com/index.php?rid=5399985&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000838%2Fabstract%3Frss%3Dyes The management of critically ill patients necessitates the use of sedatives and analgesics to provide patient comfort and cooperation. These drugs exert profound effects on all organ systems, not only the central nervous system, and this article describes the immunologic effects of the commonly used critical care sedatives: propofol, the benzodiazepines, opioids, and α2-adrenoceptor agonists. Benzodiazepines, opioids, and possibly even propofol worsen outcomes in animal models of infection, whereas preliminary evidence suggests that the α2-adrenoceptor agonist, dexmedetomidine, may improve outcomes in the setting of infection. Given the burden of sepsis and secondary infections in critical care, choice of sedation may need to be carefully considered to preserve immune responses in critic... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399985 Sun, 13 Nov 2011 00:51:36 +0100 5399985 http://www.medworm.com/index.php?rid=5399984&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000826%2Fabstract%3Frss%3Dyes This article reviews the relationship between sedation and sleep from physiologic and clinical perspectives. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399984 Sun, 13 Nov 2011 00:51:36 +0100 5399984 http://www.medworm.com/index.php?rid=5399983&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000814%2Fabstract%3Frss%3Dyes Providing sedation and comfort for intensive care patients has evolved in the last few years. New approaches to improving outcomes for intensive care unit (ICU) patients include providing analgesia before adding sedation and recognizing dangerous adverse effects associated with sedative medications, such as prolonged effects of midazolam, propylene glycol toxicity with lorazepam, propofol infusion syndrome, the deliriogenic effects of benzodiazepines and propofol, and bradycardia with dexmedetomidine. There are now reliable and valid ways to monitor pain and delirium in ICU patients. Dexmedetomidine reduces the incidence of delirium, reduces the duration of mechanical ventilation, and appears to be cost effective. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399983 Sun, 13 Nov 2011 00:51:36 +0100 5399983 http://www.medworm.com/index.php?rid=5399982&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000802%2Fabstract%3Frss%3Dyes Liberation from mechanical ventilation is a vital treatment goal in the management of critically ill patients. The duration of mechanical ventilation is affected by strategies for ventilator weaning and sedation. The authors review literature on weaning from mechanical ventilation and delivery of sedation in critically ill patients, including current guidelines recommending the use of spontaneous breathing trials and spontaneous awakening trials. Implementation of these strategies in a wake-up-and-breathe protocol has demonstrated benefit over the use of spontaneous breathing trials alone. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399982 Sun, 13 Nov 2011 00:51:36 +0100 5399982 http://www.medworm.com/index.php?rid=5399981&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000796%2Fabstract%3Frss%3Dyes Administering sedative and analgesic medications is a cornerstone of optimizing patient comfort and minimizing distress, yet may lead to unintended consequences including delayed recovery from critical illness and slower liberation from mechanical ventilation. The use of structured approaches to sedation management, including guidelines, protocols, and algorithms can promote evidence-based care, reduce variation in clinical practice, and systematically reduce the likelihood of excessive and/or prolonged sedation. Patient-focused sedation algorithms are multidisciplinary, including physician, nurse, and pharmacist development and implementation. Key components of sedation algorithms include identification of goals and specific targets, use of valid and reliable tools to assess analgesia, ag... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399981 Sun, 13 Nov 2011 00:51:35 +0100 5399981 http://www.medworm.com/index.php?rid=5399980&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000784%2Fabstract%3Frss%3Dyes The objective of this review is to present the findings of surveys and practice audits, evaluating the management of sedation and analgesia in mechanically ventilated adults in the intensive care unit, and to summarize international critical care sedation practices. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399980 Sun, 13 Nov 2011 00:51:35 +0100 5399980 http://www.medworm.com/index.php?rid=5399979&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000772%2Fabstract%3Frss%3Dyes In this article, the authors discuss the pharmacology of sedative-analgesic agents like dexmedetomidine, remifentanil, ketamine, and volatile anesthetics. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and cooperative sedation without respiratory depression. It has organ protective effects against ischemic and hypoxic injury, including cardioprotection, neuroprotection, and renoprotection. Remifentanil is an ultra–short-acting opioid that acts as a mu-receptor agonist. Ketamine is a nonbarbiturate phencyclidine derivative and provides analgesia and apparent anesthesia with relative hemodynamic stability. Volatile anesthetics such as isoflurane, sevoflurane, and desflurane are in daily use in the operating room in the delivery of general anesthesia. A major... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399979 Sun, 13 Nov 2011 00:51:35 +0100 5399979 http://www.medworm.com/index.php?rid=5399978&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000760%2Fabstract%3Frss%3Dyes Opioids, benzodiazepines, and propofol remain the mainstay by which to optimize patient comfort and facilitate mechanical ventilation in patients who are critically ill. Unfortunately none of these agents share all of the characteristics of the ideal sedative or analgesic agent: rapid onset, rapid recovery, a predictable dose response, a lack of drug accumulation, and no toxicity. To optimize care, critical care clinicians should be familiar with the many pharmacokinetic, pharmacodynamic, and pharmacogenetic variables that can affect the safety and efficacy of these sedatives and analgesics. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399978 Sun, 13 Nov 2011 00:51:35 +0100 5399978 http://www.medworm.com/index.php?rid=5399977&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000887%2Fabstract%3Frss%3Dyes Anyone who has been privileged enough to care for the critically ill over the past 15 years can speak of the rapid evolution of many facets of ICU medicine. Few areas have shifted more than the area of sedation and mechanical ventilation. These inextricably linked components of critical care represent the cornerstones of what we do for patients during their vulnerable course in the ICU. In a nutshell, we have progressed from a culture that embraced nearly universal deep sedation for days on end, with harsh methods of blowing too much air into patients' lungs, to a “kinder and gentler” approach that involves keeping patients much more awake and interactive while delivering much less injurious and smaller puffs of air. Although data from sepsis studies indicate, without a doubt, that ea... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399977 Sun, 13 Nov 2011 00:51:34 +0100 5399977 http://www.medworm.com/index.php?rid=5399976&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000899%2Fabstract%3Frss%3Dyes As perioperative physicians, we are involved with sedation and analgesia in places outside of the operating room. This includes the intensive care unit (ICU), where some of our colleagues actually oversee care. The importance of sedation and analgesia practices in the ICU has increased in recent years as it has become clear that they can influence outcome. It is for this reason that we are publishing this important series of articles, which was also published in Critical Care Clinics. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399976 Sun, 13 Nov 2011 00:51:34 +0100 5399976 http://www.medworm.com/index.php?rid=5399975&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000966%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399975 Sun, 13 Nov 2011 00:51:34 +0100 5399975 http://www.medworm.com/index.php?rid=5399974&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000954%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399974 Sun, 13 Nov 2011 00:51:34 +0100 5399974 http://www.medworm.com/index.php?rid=5399973&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000942%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5399973 Sun, 13 Nov 2011 00:51:34 +0100 5399973 http://www.medworm.com/index.php?rid=5160819&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000681%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160819 Sat, 27 Aug 2011 12:43:21 +0100 5160819 http://www.medworm.com/index.php?rid=5160818&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000504%2Fabstract%3Frss%3Dyes Hydroxyethyl starch (HES) 130/0.4 (Voluven, Fresenius/Hospira, Germany) is indicated for the treatment and prophylaxis of hypovolemia. As the Voluven molecule is smaller than those of other available hydroxyethyl starch products, it is associated with less plasma accumulation and can be safely used in patients with renal impairment. Previous studies have demonstrated that Voluven has comparable effects on volume expansion and hemodynamics as other available HES products. Voluven is also associated with fewer effects on coagulation and may be an acceptable alternative to albumin for volume expansion in situations in which other starches are contraindicated secondary to risk of coagulopathy. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160818 Sat, 27 Aug 2011 12:43:21 +0100 5160818 http://www.medworm.com/index.php?rid=5160817&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000383%2Fabstract%3Frss%3Dyes This article summarizes the use of Amiodarone by anesthesiologists in the operating room and during cardiopulmonary resuscitation. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160817 Sat, 27 Aug 2011 12:43:21 +0100 5160817 http://www.medworm.com/index.php?rid=5160815&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000450%2Fabstract%3Frss%3Dyes Information technology has the potential to provide a tremendous step forward in perioperative patient safety. Through automated delivery of information through fixed and portable computer resources, clinicians may achieve improved situational awareness of the overall operation of the operating room suite and the state of individual patients in various stages of surgical care. Coupling the raw, but integrated, information with decision support and alerting algorithms enables clinicians to achieve high reliability in documentation compliance and response to care protocols. Future studies and outcomes analysis are needed to quantify the degree of benefit of these new components of perioperative information systems. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160815 Sat, 27 Aug 2011 12:43:20 +0100 5160815 http://www.medworm.com/index.php?rid=5160813&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000449%2Fabstract%3Frss%3Dyes Fewer than 5% of anesthesia departments use an electronic medical record (EMR) that is anesthesia specific. Many anesthesia information management systems (AIMS) have been developed with a focus only on the unique needs of anesthesia providers, without being fully integrated into other electronic health record components of the entire enterprise medical system. To understand why anesthesia providers should embrace health information technology (HIT) on a health system–wide basis, this article reviews recent HIT history and reviews HIT concepts. The author explores current developments in efforts to expand enterprise HIT, and the pros and cons of full enterprise integration with an AIMS. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160813 Sat, 27 Aug 2011 12:43:19 +0100 5160813 http://www.medworm.com/index.php?rid=5160811&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000425%2Fabstract%3Frss%3Dyes In 2010, the Centers for Medicare and Medicaid Services (CMS) published its final rule describing plans for incentivizing eligible professionals (EPs) and eligible hospitals to become meaningful users of electronic health record (EHR) technology using funds provided by the Health Information Technology for Economic and Clinical Health (HITECH) Act. Beginning in 2011, non-hospital-based EPs can earn monetary benefits for meeting meaningful use criteria through implementation of certified EHR technology. Most anesthesiologists qualify as non-hospital-based EPs under CMS' new hospital-based definition. The authors distill CMS' final rule into its most basic facts and requirements and explain the implications for US anesthesiologists. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160811 Sat, 27 Aug 2011 12:43:19 +0100 5160811 http://www.medworm.com/index.php?rid=5160810&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000474%2Fabstract%3Frss%3Dyes The number of institutions implementing AIMS is increasing. Shortcomings in the design and implementation of EMRs have been associated with unanticipated consequences, including changes in workflow. These have often resulted from the carryover of paper-based documentation practices into an electronic environment. The new generation of mobile devices allows providers to have situational awareness of multiple care sites simultaneously, possibly allowing for improved proactive decision making. Although potentially facilitating safer anesthetic supervision, technologic and cultural barriers remain. Security, quality of information delivery, regulatory issues, and return on investment will continue as challenges in implementing and maintaining this new technology. (Source: Anesthesiology Clinic... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160810 Sat, 27 Aug 2011 12:43:19 +0100 5160810 http://www.medworm.com/index.php?rid=5160808&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751100053X%2Fabstract%3Frss%3Dyes This article discusses the use of EMRs for observational research. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160808 Sat, 27 Aug 2011 12:43:18 +0100 5160808 http://www.medworm.com/index.php?rid=5160807&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000462%2Fabstract%3Frss%3Dyes This article addresses the brief history of anesthesia information management systems (AIMS) and discusses the vendors that currently market AIMS. The current market penetration based on the information provided by these vendors is presented and the rationale for the purchase of AIMS is discussed. The considerations to be evaluated when making a vendor selection are also discussed. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160807 Sat, 27 Aug 2011 12:43:18 +0100 5160807 http://www.medworm.com/index.php?rid=5160806&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000516%2Fabstract%3Frss%3Dyes Anesthesia information management systems (AIMS) have become more prevalent as more sophisticated hardware and software have increased usability and reliability. National mandates and incentives have driven adoption as well. AIMS can be developed in one of several software models (Web based, client/server, or incorporated into a medical device). Irrespective of the development model, the best AIMS have a feature set that allows for comprehensive management of workflow for an anesthesiologist. Key features include preoperative, intraoperative, and postoperative documentation; quality assurance; billing; compliance and operational reporting; patient and operating room tracking; and integration with hospital electronic medical records. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160806 Sat, 27 Aug 2011 12:43:18 +0100 5160806 http://www.medworm.com/index.php?rid=5160805&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000486%2Fabstract%3Frss%3Dyes From the first anesthetic record developed by E. Amory Codman and Harvey Cushing, the field of Anesthesiology has been data driven. Over the first century the vast majority of anesthetic care was documented on a sheet of paper with increasingly dense organized physiologic and treatment data. For that reason the current-day paper anesthesia record usually needs interpretation by an anesthesiologist to be understood by other caregivers. Because the majority of the data we document are high-resolution electronic monitoring data and structured medication and procedure data, our field readily lends itself to computerized documentation. Given this background, it is surprising that it has taken nearly 30 years from the original attempts at developing an electronic anesthesia information system to... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160805 Sat, 27 Aug 2011 12:43:17 +0100 5160805 http://www.medworm.com/index.php?rid=5160804&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000528%2Fabstract%3Frss%3Dyes Technology has always been an important component and interest in the role of the anesthesiologist. It has allowed anesthesiologists to innovate and make undergoing surgery safer through the use of monitoring. While anesthesiologists have been the leaders in the development of electronic medical records, we could become the laggards in the implementation given the incentives created by the HITECH act. Therefore, it is important to understand the issues relevant to the anesthesiologist in the current health care climate. In this issue of Anesthesiology Clinics, an excellent group of leaders in the field have written on issues of information systems and computers in anesthesia to inform the reader. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160804 Sat, 27 Aug 2011 12:43:17 +0100 5160804 http://www.medworm.com/index.php?rid=5160803&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751100067X%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160803 Sat, 27 Aug 2011 12:43:17 +0100 5160803 http://www.medworm.com/index.php?rid=5160802&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000668%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160802 Sat, 27 Aug 2011 12:43:17 +0100 5160802 http://www.medworm.com/index.php?rid=5160801&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000656%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160801 Sat, 27 Aug 2011 12:43:17 +0100 5160801 http://www.medworm.com/index.php?rid=5160816&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000437%2Fabstract%3Frss%3Dyes This article reviews the available simulation technologies, their evolution, and the current evidence base for their use. The future directions for research in the field and potential applications of simulation technology in anesthesia, critical care, and pain medicine are discussed. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160816 Wed, 20 Jul 2011 23:00:00 +0100 5160816 http://www.medworm.com/index.php?rid=5160814&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000413%2Fabstract%3Frss%3Dyes Intelligent medical displays have the potential to improve patient outcomes by integrating multiple physiologic signals, exhibiting high sensitivity and specificity, and reducing information overload for physicians. Research findings have suggested that information overload and distractions caused by patient care activities and alarms generated by multiple monitors in acute care situations, such as the operating room and the intensive care unit, may produce situations that negatively impact the outcomes of patients under anesthesia. This can be attributed to shortcomings of human-in-the-loop monitoring and the poor specificity of existing physiologic alarms. Modern artificial intelligence techniques (ie, intelligent software agents) are demonstrating the potential to meet the challenges of... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160814 Wed, 20 Jul 2011 23:00:00 +0100 5160814 http://www.medworm.com/index.php?rid=5160809&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000401%2Fabstract%3Frss%3Dyes Adoption of information systems throughout the hospital environment has enabled the development of real-time physiologic alerts and clinician reminder systems. These clinical tools can be made available through the deployment of anesthesia information management systems (AIMS). Creating usable alert systems requires understanding of technical considerations. Various successful implementations are reviewed, encompassing cost reduction, improved revenue capture, timely antibiotic administration, and postoperative nausea and vomiting prophylaxis. Challenges to the widespread use of real-time alerts and reminders include AIMS adoption rates and the difficulty in choosing appropriate areas and approaches for information systems support. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160809 Wed, 20 Jul 2011 23:00:00 +0100 5160809 http://www.medworm.com/index.php?rid=5160812&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000395%2Fabstract%3Frss%3Dyes The Anesthesia Quality Institute has created the National Anesthesia Clinical Outcomes Registry to automatically capture electronic data specific to anesthesia cases. Data come from billing systems, quality management systems, hospital electronic health care records, and anesthesia information management systems. Aggregation of this data will allow for calculation of national and cohort-specific benchmarks for anesthesia outcomes of interest. Provision of this data to anesthesia practitioners through periodic private reports will motivate improvements in the quality of care. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=5160812 Thu, 07 Jul 2011 23:00:00 +0100 5160812 http://www.medworm.com/index.php?rid=4863614&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000334%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863614 Thu, 26 May 2011 14:18:30 +0100 4863614 http://www.medworm.com/index.php?rid=4863613&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000188%2Fabstract%3Frss%3Dyes This article discusses the role and evidence for wound infiltration analgesia in general surgery, orthopedic surgery, neurosurgery, and thoracic surgery. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863613 Thu, 26 May 2011 14:18:30 +0100 4863613 http://www.medworm.com/index.php?rid=4863611&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751100022X%2Fabstract%3Frss%3Dyes The management of acute pain remains challenging, with many patients suffering inadequate pain control following surgery. Certain populations are at unique risk for unrelieved pain. Evidence-based approaches taking into account patients' specific needs and problems will likely substantially improve their perioperative experience. These patients must be identified in the preoperative process, and an anesthetic/analgesic plan discussed and formulated. A targeted multimodal approach to pain management should be considered the best clinical practice. The most challenging patients may benefit most from the surveillance of an acute pain service that is able to monitor and coordinate care into the postoperative period. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863611 Thu, 26 May 2011 14:18:29 +0100 4863611 http://www.medworm.com/index.php?rid=4863609&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751100019X%2Fabstract%3Frss%3Dyes Perioperative nerve injuries are recognized as a complication of regional anesthesia. Although rare, studies suggest the frequency of complications is increasing. Risk factors include neural, traumatic injury during needle or catheter placement, infection, and choice of local anesthetic solution. Neurologic injury due to pressure from improper patient positioning, tightly applied casts or surgical dressings, and surgical trauma are often attributed to regional anesthetic. Body habitus and preexisting neurologic dysfunction may also contribute. The safe conduct of regional anesthesia involves knowledge of patient, anesthetic, and surgical risk factors. Early diagnosis and treatment of reversible etiologies are critical to optimizing neurologic outcome. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863609 Thu, 26 May 2011 14:18:29 +0100 4863609 http://www.medworm.com/index.php?rid=4863608&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000176%2Fabstract%3Frss%3Dyes The incidence of neurologic damage after regional anesthesia is rare. However, this complication may have dramatic consequences for the patient because recovery may take several months. As nerve conduction studies and electromyography are the cornerstones of investigations in cases of postblock deficit, it is mandatory for the anesthesiologist performing regional anesthesia to have a basic understanding of these tests to discuss the cause with the surgeon and inform the patient about the prognosis. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863608 Thu, 26 May 2011 14:18:29 +0100 4863608 http://www.medworm.com/index.php?rid=4863607&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000206%2Fabstract%3Frss%3Dyes This article discusses the mechanisms and clinical presentation, prevention, treatment, and future trends of local anesthetic systemic toxicity. The adverse effects of lipid emulsion therapy are also included. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863607 Thu, 26 May 2011 14:18:29 +0100 4863607 http://www.medworm.com/index.php?rid=4863606&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000231%2Fabstract%3Frss%3Dyes The use of regional anesthesia (RA) improves cost benefit (hospital-centered) and cost utility (patient-centered) over general anesthesia with volatile agents (GAVA), based upon research in outpatient populations. To make the cost savings a reality, the authors recommend: (1) avoidance of GAVA or at least volatile agents, (2) adopting published postanesthesia care unit (PACU)-bypass criteria conducive to RA, (3) maximizing PACU-bypass rates, and (4) utilizing a block induction area. Inpatient-based acute pain services are not uniform, which makes cost analyses and comparison between practices unreliable. Additional review and commentary address surgical site infections, cancer recurrence, blood transfusions, and chronic postsurgical pain. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863606 Thu, 26 May 2011 14:18:28 +0100 4863606 http://www.medworm.com/index.php?rid=4863605&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000164%2Fabstract%3Frss%3Dyes A single-injection peripheral nerve block using long-acting local anesthetic provides analgesia for 12 to 24 hours; however, many surgical procedures result in pain that lasts far longer. One relatively new option is a continuous peripheral nerve block (CPNB): local anesthetic is perfused via a perineural catheter directly adjacent to the peripheral nerve(s) supplying the surgical site, providing potent, site-specific analgesia. CPNB results in decreased pain, opioid requirements, opioid-related side effects, and sleep disturbances; in some cases, accelerating resumption of tolerated passive joint range-of-motion and increasing patient satisfaction. Ambulatory perineural infusion may be provided using a portable infusion pump, in some cases resulting in decreased hospitalization duration a... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863605 Thu, 26 May 2011 14:18:28 +0100 4863605 http://www.medworm.com/index.php?rid=4863603&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000255%2Fabstract%3Frss%3Dyes Management of pain has evolved steadily over the past few years thanks to the knowledge derived from a large number of basic science and clinical research studies. While the management of chronic pain has utilized a significant amount of information from this research, acute pain management has benefited to a lesser extent. Our mainstay of therapy for acute pain remains opioid based, but we have realized that opioid drugs do a less-than-optimal job of relieving activity-associated pain in many acute scenarios. We have also realized the downside to using opioids as we see more and more patients with opioid tolerance, opioid-induced hyperalgesia, and immunosupression. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863603 Thu, 26 May 2011 14:18:28 +0100 4863603 http://www.medworm.com/index.php?rid=4863602&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000243%2Fabstract%3Frss%3Dyes With the increasing emphasis on patient-oriented outcomes and delivery of cost-effective care, there has been a great deal of interest in the use of innovative methods to control acute postoperative pain. These include both novel medication management and the use of regional anesthetics. There is increasing evidence to suggest that these techniques can lead to earlier discharge with greater patient satisfaction related to control of pain symptoms. However, these are not without risks and costs. In this issue of Anesthesiology Clinics, the guest editors have solicited an outstanding collection of articles that highlight many of these issues including complications and the medical legal implications, enumeration of these techniques outside of the hospital, and the economic and practice manag... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863602 Thu, 26 May 2011 14:18:28 +0100 4863602 http://www.medworm.com/index.php?rid=4863601&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000322%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863601 Thu, 26 May 2011 14:18:28 +0100 4863601 http://www.medworm.com/index.php?rid=4863600&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000310%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863600 Thu, 26 May 2011 14:18:28 +0100 4863600 http://www.medworm.com/index.php?rid=4863599&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000309%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863599 Thu, 26 May 2011 14:18:28 +0100 4863599 http://www.medworm.com/index.php?rid=4863612&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000140%2Fabstract%3Frss%3Dyes Chronic postsurgical pain (CPSP) is a pain syndrome that has attracted attention for more than 10 years. CPSP is a pain syndrome that develops postoperatively and lasts for at least 2 months in the absence of other causes for pain (eg, recurrence of malignancy, chronic infection, and so forth). Pain continuing from a preexisting disease is not considered as CPSP. In this article, the authors discuss the etiopathogenesis of CPSP and interventions that can help prevent and treat this condition. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863612 Thu, 05 May 2011 23:00:00 +0100 4863612 http://www.medworm.com/index.php?rid=4863610&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000152%2Fabstract%3Frss%3Dyes Unintentional subdural injection during neuraxial anesthesia/analgesia continues to be a challenge for anesthesiologists. This unusual complication is often poorly recognized, with the diagnosis made in retrospect, or not at all. The clinical presentation of these regional blocks can be heterogeneous, ranging from restricted, patchy, or unilateral sensory blockade all the way to extensive and even life-threatening motor and autonomic nervous system depression. Prompt diagnosis using clinical algorithms and radiographic imaging is crucial for the early discontinuation of the offending catheter. Supportive care is mandatory in cases involving severe depression of consciousness, motor function, and/or sympathetic tone. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863610 Thu, 05 May 2011 23:00:00 +0100 4863610 http://www.medworm.com/index.php?rid=4863604&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000218%2Fabstract%3Frss%3Dyes This article summarizes and critically assesses current data comparing traditional approaches to localizing nerves with those that use ultrasound guidance. In addition, the potential benefits of UGRA that go beyond current information available from comparative studies are explored. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4863604 Thu, 05 May 2011 23:00:00 +0100 4863604 http://www.medworm.com/index.php?rid=4471046&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001291%2Fabstract%3Frss%3Dyes In the article, “Sugammadex: Cyclodextrins, Development of Selective Binding Agents, Pharmacology, Clinical Development, and Future Directions,” by Sadighi Akha et al, in the 28:4 issue of Anesthesiology Clinics, there was an error in reference #34; the location of the abstract presented was incorrect. The correct reference is: Soto R, Jahr JS, Pavlin J, Sabo D, Morte JB. Safety and efficacy of sugammadex reversal of rocuronium-induced block versus spontaneous recovery from succinylcholine. Presented at the New York State Society of Anesthesiologists Post Graduate Assembly in December 2010, New York, NY. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471046 Sun, 13 Feb 2011 15:18:22 +0100 4471046 http://www.medworm.com/index.php?rid=4471045&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000097%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471045 Sun, 13 Feb 2011 15:18:22 +0100 4471045 http://www.medworm.com/index.php?rid=4471044&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001175%2Fabstract%3Frss%3Dyes At New York-Presbyterian Hospital, Weill Cornell Medical Center, an innovative approach to involving housestaff in quality and patient safety, policy and procedure creation, and culture change was led by the Department of Anesthesiology of the Weill Medical College of Cornell University. A Housestaff Quality Council was started in 2008 that has partnered with hospital leadership and clinical departments to engage the housestaff in quality and patient safety initiatives, resulting in measurable improvements in several patient care projects and enhanced working relationships among various clinical constituencies. Ultimately this attempt to change culture has found great success in fostering a relationship between the housestaff and the hospital in ways that have and will continue to improve ... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471044 Sun, 13 Feb 2011 15:18:22 +0100 4471044 http://www.medworm.com/index.php?rid=4471043&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001217%2Fabstract%3Frss%3Dyes This article describes how anesthesiologists can lead innovation and process improvement focused on regulated medical waste reduction and cost savings using a process improvement methodology known as Lean Sigma. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471043 Sun, 13 Feb 2011 15:18:21 +0100 4471043 http://www.medworm.com/index.php?rid=4471042&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001230%2Fabstract%3Frss%3Dyes This article highlights this problem, especially as it deals with patients in the perioperative setting. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471042 Sun, 13 Feb 2011 15:18:21 +0100 4471042 http://www.medworm.com/index.php?rid=4471040&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001151%2Fabstract%3Frss%3Dyes This article details how the interest in health care quality has spurred a similar interest in end-of-life and palliative care in ICUs, defines palliative care and describes how it improves health care quality, and highlights barriers to the incorporation of palliative care in ICUs. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471040 Sun, 13 Feb 2011 15:18:21 +0100 4471040 http://www.medworm.com/index.php?rid=4471039&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001187%2Fabstract%3Frss%3Dyes Multidisciplinary education (MDE) is perceived as the next means of implementing major improvements in the quality and cost-effectiveness of patient care. In this article, the authors discuss various definitions of MDE, evaluate how MDE might be implemented in clinical arenas relevant to the anesthesiologist, and describe several implementations of MDE within their hospital and the anesthesiology department. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471039 Sun, 13 Feb 2011 15:18:21 +0100 4471039 http://www.medworm.com/index.php?rid=4471036&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001163%2Fabstract%3Frss%3Dyes This article reviews the literature on AIMS, focusing on areas where AIMS have been shown to have a meaningful impact on quality, safety, and operational efficiency. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471036 Sun, 13 Feb 2011 15:18:21 +0100 4471036 http://www.medworm.com/index.php?rid=4471035&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001205%2Fabstract%3Frss%3Dyes This article summarizes the current state of technology as it pertains to quality in the operating room, ties the current state back to its evolutionary pathway to understand how the current capabilities and their limitations came to pass, and elucidates how the overlay of information technology (IT) as a wrapper around current monitoring and device technology provides a significant advance in the ability of anesthesiologists to use technology to improve quality along many axes. The authors posit that IT will enable all the information about patients, perioperative systems, system capacity, and readiness to follow a development trajectory of increasing usefulness. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471035 Sun, 13 Feb 2011 15:18:21 +0100 4471035 http://www.medworm.com/index.php?rid=4471033&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001266%2Fabstract%3Frss%3Dyes The objectives of this review are: (1) to identify studies addressing teamwork and communication in the operating room in relation to discrete measures of outcome, (2) to create a classification of studies of the relationship between teamwork and communication and outcomes, (3) to assess the implications of these studies, (4) to explore the methodological challenges of teamwork and communication studies in the perioperative setting, and (5) to suggest future research directions.studies in the perioperative setting, and (5) to suggest future research directions. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471033 Sun, 13 Feb 2011 15:18:20 +0100 4471033 http://www.medworm.com/index.php?rid=4471032&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001278%2Fabstract%3Frss%3Dyes Writing in 1934, Robert Hutchison described “the three great branches of clinical science—diagnosis, prognosis, and treatment.” Today, while none of these three tasks have diminished in importance, physicians, along with the consumers, purchasers, and regulators of health care in the United States, have come to recognize the responsibility to measure and improve quality in health care as a fourth, essential branch of contemporary medical practice. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471032 Sun, 13 Feb 2011 15:18:20 +0100 4471032 http://www.medworm.com/index.php?rid=4471031&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751000128X%2Fabstract%3Frss%3Dyes For the past decade, there has been an interest in focusing on the quality of care delivered as opposed to just the quantity of care. Part of this focus relates to several Institute of Medicine reports, the first of which focused on safety and the second on quality. The rationale for improving quality of care is obvious from a patient perspective, but there is also an economic imperative since higher quality may actually decrease costs. As part of the health care reform debate and legislation in the United States, there has been a focus on value-based purchasing including the development of incentives for achieving “quality.” However, there continues to be debate as to the measurement of quality in different venues and the means to achieve these goals. It is within this context that an... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471031 Sun, 13 Feb 2011 15:18:20 +0100 4471031 http://www.medworm.com/index.php?rid=4471030&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000139%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471030 Sun, 13 Feb 2011 15:18:20 +0100 4471030 http://www.medworm.com/index.php?rid=4471029&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000073%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471029 Sun, 13 Feb 2011 15:18:20 +0100 4471029 http://www.medworm.com/index.php?rid=4471028&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227511000061%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471028 Sun, 13 Feb 2011 15:18:19 +0100 4471028 http://www.medworm.com/index.php?rid=4471038&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001254%2Fabstract%3Frss%3Dyes Postoperative complications are directly related to poor surgical outcomes in the elderly. This review outlines evidence based quality initiatives focused on decreasing neurologic, cardiac, and pulmonary complications in the elderly surgical patient. Important anesthesia quality initiatives for prevention of delirium, the most common neurologic complication in elderly surgical patients, are outlined. There are few age-specific quality measures aimed at prevention of cardiac and pulmonary complications. However, some recommendations for adults can be applied to the geriatric surgical population. In the future, process measures may provide a more global assessment of quality in the elderly surgical population. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471038 Thu, 06 Jan 2011 00:00:00 +0100 4471038 http://www.medworm.com/index.php?rid=4471037&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001199%2Fabstract%3Frss%3Dyes The challenges to prospective randomized controlled trials have necessitated the exploration of observational data sets that support research into the predictors and modulators of preoperative adverse events. The primary purpose and design of quality improvement databases is quality assessment and improvement at the local, regional, or national level. However, these data can also provide the opportunity to robustly study specific questions related to patient outcomes with no additional clinical risk to the patient. The virtual explosion of anesthesia-related registries has opened seemingly limitless opportunities for outcomes research in addition to generating hypothesis for more rigorous prospective analysis. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471037 Mon, 20 Dec 2010 00:00:00 +0100 4471037 http://www.medworm.com/index.php?rid=4471041&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001229%2Fabstract%3Frss%3Dyes Relief from pain is itself a marker of high-quality medical care. Quality assurance in the case of pain management could simply mean successful elimination of pain. Because the means of controlling pain are imperfect, it is essential to consider whether pain interventions actually achieve the primary goal of pain relief and also whether they are safe, cost-effective, and even capable of producing secondary benefits such as early recovery from surgery. Quality assurance and assessment in pain management therefore becomes a complex undertaking that must incorporate into its processes the often-conflicting goals of comfort versus safety versus patients’ rights. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471041 Fri, 17 Dec 2010 00:00:00 +0100 4471041 http://www.medworm.com/index.php?rid=4471034&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001242%2Fabstract%3Frss%3Dyes This article reviews simulation-based research, with a focus on anesthesiology, at 3 different levels of outcome: (1) as measured in the simulation laboratory, (2) as measured in clinical performance, and (3) as measured in patient outcomes. It concludes with a discussion of some current uses of simulation, which include the identification of latent failures and the role of simulation in continuing professional practice assessment for anesthesiologists. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4471034 Fri, 17 Dec 2010 00:00:00 +0100 4471034 http://www.medworm.com/index.php?rid=4159810&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001072%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159810 Sat, 13 Nov 2010 01:41:25 +0100 4159810 http://www.medworm.com/index.php?rid=4159809&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000716%2Fabstract%3Frss%3Dyes Over the last several decades, the average age of patients has steadily increased, whereas the use of general anesthesia and deep sedation has grown largely outside the operating room environment. Currently available general anesthetics and delivery models represent limitations in addressing these trends. At the same time, research has tremendously expanded the knowledge of how general anesthetics produce their beneficial effects and also revealed evidence of previously unappreciated general anesthetic toxicities. The goal of this review is to highlight these important developments and describe translational research on new general anesthetics with the potential to improve and reshape clinical care. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159809 Sat, 13 Nov 2010 01:41:25 +0100 4159809 http://www.medworm.com/index.php?rid=4159808&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000704%2Fabstract%3Frss%3Dyes Levosimendan is a unique therapeutic agent that decreases mortality in acute episodes of decompensated heart failure by increasing myocardial contractility without increasing oxygen consumption or ATP demands, decreasing preload, or decreasing afterload. The mechanism for each accomplishment is novel. The drug is a calcium sensitizer, which increases myocyte contractility by stabilizing troponin C rather than by increasing intracellular calcium. The drug may have implications in numerous other common and chronic medical ailments, even in overdoses of drugs that stun and depress the myocardium. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159808 Sat, 13 Nov 2010 01:41:25 +0100 4159808 http://www.medworm.com/index.php?rid=4159807&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000741%2Fabstract%3Frss%3Dyes HMG CoA reductase inhibitors (statins) are a proven modality to reduce serum cholesterol and have been shown to reduce morbidity and mortality in cardiovascular patients. Statins have also demonstrated improvements in postoperative outcomes among patients taking them in the perioperative period. Many of the studies are limited to select patient populations and/or select surgeries. This review will give an overview of the pharmacology of statins, summarize the mechanisms of the beneficial effects of statins, and provide an overview of evidence in the use of statins in the perioperative period. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159807 Sat, 13 Nov 2010 01:41:24 +0100 4159807 http://www.medworm.com/index.php?rid=4159806&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000984%2Fabstract%3Frss%3Dyes This article reviews the recent advances in cardiovascular medications related to the practice of cardiac anesthesia. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159806 Sat, 13 Nov 2010 01:41:24 +0100 4159806 http://www.medworm.com/index.php?rid=4159805&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000753%2Fabstract%3Frss%3Dyes The selective α-2 adrenoceptor agonist, dexmedetomidine, has been shown to be a useful, safe adjunct in perioperative medicine. Intravenous regional anesthesia is one of the simplest forms of regional anesthesia and has a high degree of success. However, intravenous regional anesthesia is limited by the development of tourniquet pain and its inability to provide postoperative analgesia. To improve block quality, prolong postdeflation analgesia, and decrease tourniquet pain, various chemical additives have been combined with local anesthetics, although with limited success. The antinociceptive effects of α-2 adrenoceptor agonists have been shown in animals and in humans. However, less is known about the clinical effects of dexmedetomidine when coadministered with local anesthetics in pati... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159805 Sat, 13 Nov 2010 01:41:24 +0100 4159805 http://www.medworm.com/index.php?rid=4159804&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000819%2Fabstract%3Frss%3Dyes This article reviews cyclodextrins, development of selective binding agents, clinical development, and future directions of sugammadex. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159804 Sat, 13 Nov 2010 01:41:24 +0100 4159804 http://www.medworm.com/index.php?rid=4159803&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000789%2Fabstract%3Frss%3Dyes Recombinant activated factor VIIa (rFVIIa) has many clinical applications for patients with congenital bleeding disorders and in a variety of clinical settings. Additional studies in the future are ongoing and should provide the clinical anesthesiologist an additional option during certain bleeding states. Specific recommendations as to timing of administration and frequent monitoring of ionized calcium status are suggested at this time. Optimization of fibrinogen levels, platelet levels, pH, and body temperature will enhance efficacy of rFVIIa. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159803 Sat, 13 Nov 2010 01:41:23 +0100 4159803 http://www.medworm.com/index.php?rid=4159802&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000807%2Fabstract%3Frss%3Dyes With a growing number of new anticoagulant/antiplatelet agents being developed, it is likely that an increasing number of patients taking these drugs will present for surgery and other procedures. A familiarity with mechanisms of action and drug interactions helps to maintain optimal patient safety in the perioperative period. Furthermore, it is crucial for anesthesiologists to remain current on recommendations regarding discontinuation or need to continue the newer anticoagulants/antiplatelet drugs in patients presenting for surgery and/or regional anesthesia. Further studies are needed for monitoring of many of these newer agents and to identify antidotes. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159802 Sat, 13 Nov 2010 01:41:23 +0100 4159802 http://www.medworm.com/index.php?rid=4159801&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000765%2Fabstract%3Frss%3Dyes This article provides an evidence-based account of the role of tramadol and tapentadol in modern clinical practice. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159801 Sat, 13 Nov 2010 01:41:22 +0100 4159801 http://www.medworm.com/index.php?rid=4159800&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751000073X%2Fabstract%3Frss%3Dyes Acetaminophen has unique analgesic and antipyretic properties. It is globally recommended as a first-line agent for the treatment of fever and pain due to its few contraindications. Acetaminophen lacks the significant gastrointestinal and cardiovascular side effects associated with nonsteroidal anti-inflammatory drugs and narcotics. An intravenous formulation of acetaminophen is available in Europe and is currently undergoing extensive clinical development for use in the United States. This use may have important implications for management of postoperative pain and fever. This review summarizes recent clinical trial experiences with intravenous acetaminophen for the treatment of postoperative pain and fever in adult and pediatric subjects. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159800 Sat, 13 Nov 2010 01:41:22 +0100 4159800 http://www.medworm.com/index.php?rid=4159799&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000728%2Fabstract%3Frss%3Dyes Opioid abuse is a devastating, costly, and growing problem in the United States, and one for which treatment can be complicated by barriers such as access to care and legal issues. Only 12% to 15% of the opioid-dependent population is enrolled in methadone maintenance programs. A significant breakthrough occurred with passage of the Drug Addiction Treatment Act of 2000 (DATA 2000). For the first time in approximately 80 years, physicians could legally prescribe opioid medications for the treatment of opioid addiction. The opiate, so designated, was buprenorphine (Subutex). (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159799 Sat, 13 Nov 2010 01:41:22 +0100 4159799 http://www.medworm.com/index.php?rid=4159798&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000935%2Fabstract%3Frss%3Dyes This article describes the challenges, advantages, and disadvantages of the use of buprenorphine as an analgesic for postoperative pain in patients with and without preoperative maintenance therapy. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159798 Sat, 13 Nov 2010 01:41:22 +0100 4159798 http://www.medworm.com/index.php?rid=4159797&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000777%2Fabstract%3Frss%3Dyes Moderate-to-severe acute postoperative pain is commonly controlled with opioids administered via programmable intravenous (IV) patient-controlled analgesia (PCA) infusion pumps. Intravenously administered opioids provide effective relief of postoperative pain, and IV PCA enables patients to control their level of analgesia, which has advantages over nurse-administered approaches, including more satisfied patients and improved pain relief. Unfortunately, commonly used opioid analgesics can cause significant adverse effects. Furthermore, IV PCA has drawbacks, such as device programming errors, system errors, medication errors, limitations in patient mobility, and potential for IV tubing kinks, clogging, and transmission of infection. The IV route of administration is also characterized by a ... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159797 Sat, 13 Nov 2010 01:41:22 +0100 4159797 http://www.medworm.com/index.php?rid=4159796&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000790%2Fabstract%3Frss%3Dyes In many academic articles that I have read and written, drugs are described in very abstract and theoretical ways. These drugs might possess novel mechanisms or improved duration of activity. These agents might be less toxic or possess reduced side effects. Clearly, drugs dramatically affect our life spans, as well as our quality of life. For many years as a PhD researcher with a pulmonary vascular laboratory, I looked at them narrowly and impersonally. As the years have gone by, I have a much greater appreciation for their wonders. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159796 Sat, 13 Nov 2010 01:41:21 +0100 4159796 http://www.medworm.com/index.php?rid=4159795&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000996%2Fabstract%3Frss%3Dyes Anesthesiologists have always been considered the clinical pharmacologists of medicine, utilizing drugs to induce and maintain anesthesia and analgesia while also maintaining homeostasis. For many years, new and novel agents were introduced which allowed us to advance the care of our patients and surgery on more complex patients. More recently, there have been fewer such advances despite newer techniques available to create such agents. In this issue of Anesthesiology Clinics, a series of articles has been written to demonstrate that there remains areas in which drug discovery and development is continuing, which will allow us to continue to advance our science. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159795 Sat, 13 Nov 2010 01:41:21 +0100 4159795 http://www.medworm.com/index.php?rid=4159794&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001060%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159794 Sat, 13 Nov 2010 01:41:21 +0100 4159794 http://www.medworm.com/index.php?rid=4159793&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001059%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159793 Sat, 13 Nov 2010 01:41:21 +0100 4159793 http://www.medworm.com/index.php?rid=4159792&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510001047%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=4159792 Sat, 13 Nov 2010 01:41:21 +0100 4159792 http://www.medworm.com/index.php?rid=3974073&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000881%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974073 Tue, 31 Aug 2010 23:00:00 +0100 3974073 http://www.medworm.com/index.php?rid=3974072&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000674%2Fabstract%3Frss%3Dyes The evolution of novel techniques for the treatment of laryngeal pathology has led to a significant expansion of the role of diagnostic assessment and the range of laryngeal procedures performed. These procedures typically benefit from an anesthetic approach that diverges from a standard general endotracheal or laryngeal mask airway—based inhalational anesthetic. The shared airway, need for intraoperative assessment of vocal cord function, risk of airway fire, and desire for rapid emergence and discharge are all important factors. In this article the authors undertake a collaborative anesthesia-surgical discussion of anesthetic management for airway procedures that are optimally performed with a spontaneously breathing, cooperative patient. An overview of pharmacologic approaches to airw... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974072 Tue, 31 Aug 2010 23:00:00 +0100 3974072 http://www.medworm.com/index.php?rid=3974070&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000649%2Fabstract%3Frss%3Dyes The human larynx plays a pivotal role in airway protection, respiration, and phonation. Laryngeal disorders can be divided into two categories, benign lesions and malignant lesions. Most benign lesions are treatable with surgery and speech therapy, whereas the malignant lesions require more invasive surgery as well as radiation and chemotherapy. Preoperative assessment and anesthesia management for adult laryngotracheal surgery are reviewed. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974070 Tue, 31 Aug 2010 23:00:00 +0100 3974070 http://www.medworm.com/index.php?rid=3974066&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000601%2Fabstract%3Frss%3Dyes Operating room fires are rare but can be devastating. These fires can occur during almost any surgical procedure but are more likely during airway surgery, during head and neck surgery, and if volatile flammable liquids are used. Each team in the operating room (ie, anesthesia, surgery, and nursing) has special expertise and responsibility in preventing and responding to a fire. Fires can be prevented by ongoing education and an interdisciplinary discussion of risks and responsibilities prior to each high-risk case. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974066 Tue, 31 Aug 2010 23:00:00 +0100 3974066 http://www.medworm.com/index.php?rid=3974063&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000571%2Fabstract%3Frss%3Dyes Anesthesia and sleep both predispose to upper airway obstruction through state-induced reductions in pharyngeal dilator muscle activation and lung volume. The tendencies are related in patients with obstructive sleep apnea commonly presenting with difficulties in airway management in the perioperative period. This is a period of great potential vulnerability for such patients because of compromise of the arousal responses that protect against asphyxiation during natural sleep. Careful preoperative evaluation and insightful perioperative observation are likely to identify patients at risk. A significant proportion of patients will have previously undiagnosed obstructive sleep apnea and anesthesiologists are well placed to identify this potential. Patients with known or suspected obstructive... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974063 Tue, 31 Aug 2010 23:00:00 +0100 3974063 http://www.medworm.com/index.php?rid=3974062&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000650%2Fabstract%3Frss%3Dyes This article focuses on the anesthetic considerations pertinent to IONM of peripheral cranial nerves during otolaryngologic-head and neck surgery. The specific modality of IONM is EMG, both spontaneous and evoked. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974062 Tue, 31 Aug 2010 23:00:00 +0100 3974062 http://www.medworm.com/index.php?rid=3974059&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000698%2Fabstract%3Frss%3Dyes Few would disagree with the notion that anesthesia for head and neck surgery is a significant component of the bread and butter services provided by many anesthesia groups. We surmise that the volume of debate would grow louder if one advocated for the creation of a subspeciality ENT track in training programs and departments. Why should this be? (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974059 Tue, 31 Aug 2010 23:00:00 +0100 3974059 http://www.medworm.com/index.php?rid=3974058&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000686%2Fabstract%3Frss%3Dyes Anesthesia for head and neck surgery has traditionally not been considered one of the more specialized areas within the field; however, many advances in both surgical techniques as well as airway management and newer drugs have led to advances in care for these patients over the past decade. In particular, minimally invasive surgery has allowed for excision for more invasive tumors with less distortion of the anatomy. New airway devices and techniques have also led to changes in anesthetic management. Finally, short-acting agents have led to the development of techniques which in many cases are safer and allow spontaneous ventilation or easier control of the airway. For these reasons, it became clear that an issue of Anesthesiology Clinics devoted to this topic was warranted. (Source: Anes... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974058 Tue, 31 Aug 2010 23:00:00 +0100 3974058 http://www.medworm.com/index.php?rid=3974057&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751000087X%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974057 Tue, 31 Aug 2010 23:00:00 +0100 3974057 http://www.medworm.com/index.php?rid=3974056&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000868%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974056 Tue, 31 Aug 2010 23:00:00 +0100 3974056 http://www.medworm.com/index.php?rid=3974055&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000923%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974055 Tue, 31 Aug 2010 23:00:00 +0100 3974055 http://www.medworm.com/index.php?rid=3974071&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000662%2Fabstract%3Frss%3Dyes This article presents a comprehensive narrative review of the published literature relating to ultrasound imaging relevant to anesthesia for ear, nose, and throat (ENT) surgery. The review comprises 2 main subject areas: the use of ultrasonography related to assessment and management of the airway, and the use of ultrasonography related to nerve blockade for ENT surgery. The relevant sonoanatomy and suitable probe placement are illustrated in relation to applicable regional anatomy (they are not discussed). The possible value of the use of ultrasonography to improve existing clinical practice in these areas is explored. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974071 Sun, 22 Aug 2010 23:00:00 +0100 3974071 http://www.medworm.com/index.php?rid=3974068&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000625%2Fabstract%3Frss%3Dyes Pediatric airway surgery presents many significant challenges to the anesthesia provider. The clinical experience of the Massachusetts Eye and Ear Infirmary serves as a guide in this review to describe the clinical reasoning and perioperative management of the pediatric patient needing airway surgery, with specific emphasis on diagnostic procedures, trauma, laryngotracheal reconstruction, juvenile recurrent respiratory papillomatosis, and adenotonsillectomy. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974068 Thu, 19 Aug 2010 23:00:00 +0100 3974068 http://www.medworm.com/index.php?rid=3974067&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000613%2Fabstract%3Frss%3Dyes Functional endoscopic sinus surgery has become one of the most common head and neck procedures performed. Proper anesthetic management is essential for a successful outcome. Different anesthesia techniques are discussed that include: local versus general anesthesia, LMA versus ETT, inhaled anesthesia versus TIVA. The anesthetic plan should be tailored taking into consideration patient comorbidities, the surgeon and anesthesiologist experience, and individual preference. Specific anesthetic goals are to ensure the best possible surgical field and stable cardiovascular and respiratory status during the surgery, emergence of anesthesia, and upon recovery. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974067 Sun, 15 Aug 2010 23:00:00 +0100 3974067 http://www.medworm.com/index.php?rid=3974065&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000595%2Fabstract%3Frss%3Dyes The use of laryngeal mask airway (LMA) and its variants in ear, nose, and throat procedures have been extensively described in case reports, retrospective reviews, and randomized clinical trials. The LMA has developed a considerable following because of its lack of tracheal stimulation, which can be a considerable advantage in ear, nose, and throat (ENT) procedures. The incidence of coughing on emergence has been shown to be lower with the LMA than with the endotracheal tube (ETT). Although other approaches to smooth emergence have been described, few would argue that it is as easy to achieve a smooth emergence with an ETT as with an LMA. Although patients certainly exist for whom the LMA is contraindicated, many will experience better results with the LMA because of the features delineate... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974065 Sun, 15 Aug 2010 23:00:00 +0100 3974065 http://www.medworm.com/index.php?rid=3974061&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751000056X%2Fabstract%3Frss%3Dyes This article focuses on TORS and the goal of which is to provide the anesthesiologist with a foundation for caring for the TORS patient in the perioperative period. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974061 Wed, 11 Aug 2010 23:00:00 +0100 3974061 http://www.medworm.com/index.php?rid=3974060&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000558%2Fabstract%3Frss%3Dyes The clinical applications of jet ventilation (JV) in ear, nose, and throat surgery can be best understood by the characteristics that distinguish this form of ventilation from conventional positive pressure ventilation. By definition, JV is based on the application of gas portions under high pressure through an unblocked catheter into the airway, which is open to the ambient air. Beneficial opportunities arise in JV, which otherwise are not available in regular ventilation. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974060 Wed, 11 Aug 2010 23:00:00 +0100 3974060 http://www.medworm.com/index.php?rid=3974069&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000637%2Fabstract%3Frss%3Dyes Special considerations for middle ear surgery include a bloodless surgical field, attention to patient head positioning, facial nerve monitoring, and management of postoperative nausea and vomiting. Middle ear surgery can be done under local or general anesthesia; each has advantages and disadvantages. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974069 Sun, 08 Aug 2010 23:00:00 +0100 3974069 http://www.medworm.com/index.php?rid=3974064&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000583%2Fabstract%3Frss%3Dyes Local and topical anesthetic techniques have long been used for office-based procedures in otorhinolaryngology. There are numerous advantages to using local and topical anesthesia for office-based procedures, including a shorter recovery period, decreased health care cost, and the maintenance of a conscious patient who can communicate with the surgeon and maintain his or her own airway during the procedure. In this manuscript, we review the local and topical anesthetic techniques that can be used for otorhinolaryngic procedures including anesthesia of the external face, ear, nose, oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3974064 Thu, 05 Aug 2010 23:00:00 +0100 3974064 http://www.medworm.com/index.php?rid=3582598&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000480%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582598 Fri, 21 May 2010 12:41:47 +0100 3582598 http://www.medworm.com/index.php?rid=3582597&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000212%2Fabstract%3Frss%3Dyes Office-based anesthesia (OBA) is a unique and challenging venue, and, although the clinical outcomes have not been evaluated extensively, existing data indicate a need for increased regulation and additional education. Outcomes in OBA can be improved by education not only of anesthesiologists but also of surgeons, proceduralists, and nursing staff. Legislators must be educated so that appropriate regulations are instituted governing the practice of office-based surgery and the lay public must be educated to make wise, informed decisions about choice of surgery location. The leadership of societies, along with support from the membership, must play a key role in this educational process; only then can OBA become as safe as the anesthesia care in traditional venues. (Source: Anesthesiology C... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582597 Fri, 21 May 2010 12:41:47 +0100 3582597 http://www.medworm.com/index.php?rid=3582596&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000194%2Fabstract%3Frss%3Dyes Ambulatory, office-based anesthesia (OBA) has experienced an exponential growth in the last decade, and is popular among patients and health care providers alike. About 17% to 24% of all elective ambulatory procedures in the United States are currently being performed in an office-based setting. Special considerations must be made when comparing OBA to a hospital setting, particularly with respect to facility and environment, administration, and accreditation. Increasing regulation will ensure that patient safety remains the primary focus. In the meantime, the anesthesia provider must take adequate steps to ensure that the quality of care in OBA is comparable to that in a hospital. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582596 Fri, 21 May 2010 12:41:47 +0100 3582596 http://www.medworm.com/index.php?rid=3582595&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751000025X%2Fabstract%3Frss%3Dyes Quality of care and service in health care can benefit from the use of algorithm-driven care (standard work) that integrates literature assessment and analysis of local outcome and process data to eliminate unnecessary variation that causes error and waste. Effective management of an ambulatory surgery center requires that leadership emphasize constant improvement in the processes of care to achieve maximum patient safety and satisfaction, delivered with highest efficiency. Process improvement may be achieved by simple measurement alone (the Hawthorne effect). However, as shown in this article, the authors have successfully used the implementation of regular measurement and open discussion of patients' clinical outcomes and other operational metrics to focus active systems improvement proj... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582595 Fri, 21 May 2010 12:41:47 +0100 3582595 http://www.medworm.com/index.php?rid=3582594&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000182%2Fabstract%3Frss%3Dyes The care of the child having ambulatory surgery presents a specific set of challenges to the anesthesia provider. This review focuses on areas of clinical distinction that support the additional attention children often require, and on clinical controversies that require providers to have up-to-date information to guide practice and address parental concerns. These include perioperative risk; obstructive sleep apnea; obesity; postoperative nausea and vomiting; neurocognitive outcomes; and specific concerns regarding common ear, nose, and throat procedures. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582594 Fri, 21 May 2010 12:41:47 +0100 3582594 http://www.medworm.com/index.php?rid=3582593&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000170%2Fabstract%3Frss%3Dyes Supraglottic airway devices (SGAs) offer certain advantages over endotracheal intubation, making them particularly well suited for the specific demands of outpatient anesthesia. Patients may tolerate the placement and maintenance of an SGA at a lower dose of anesthetic than that needed for an endotracheal tube; neuromuscular blocking agents are rarely necessary for airway management with an SGA; the incidence of airway morbidity is lower with SGAs than with endotracheal tubes; and SGAs may facilitate faster recovery and earlier discharge of patients. Two limitations of SGAs are incomplete protection against aspiration of gastric contents and inadequate delivery of positive pressure ventilation. Newer variants of the original laryngeal mask airway, the LMA Classic (LMA North America, Inc), ... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582593 Fri, 21 May 2010 12:41:47 +0100 3582593 http://www.medworm.com/index.php?rid=3582592&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000200%2Fabstract%3Frss%3Dyes The number of diagnostic and therapeutic interventions performed under sedation is growing rapidly. While providing patients with an improved experience secondary to anxiolysis, analgesia, and amnesia, sedation also puts them at risk for associated cardiorespiratory and other complications. Several medications are available for sedation, all of which have unique advantages and disadvantages. The combination of patient characteristics, procedural factors, and side effects associated with each medication places each patient at risk and therefore, vigilance during sedation cannot be overemphasized. Due vigilance includes proper monitoring, training, staffing, and equipment, all of which are essential to the safe delivery of sedation. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582592 Fri, 21 May 2010 12:41:46 +0100 3582592 http://www.medworm.com/index.php?rid=3582591&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000236%2Fabstract%3Frss%3Dyes Several clinical trials have demonstrated the superiority of continuous peripheral nerve block compared with traditional opioid-based analgesia. The ability to provide safe and effective continuous peripheral nerve block at home is an attractive alternative to opioid-based analgesia with its related side effects. In this article, the practical issues related to catheter use in the ambulatory setting are discussed. Techniques for catheter placement, infusion regimens, patient education, and complications are subject to many institutional preferences. In this review, special emphasis is placed on evidence-based techniques. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582591 Fri, 21 May 2010 12:41:46 +0100 3582591 http://www.medworm.com/index.php?rid=3582590&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000224%2Fabstract%3Frss%3Dyes The use of local anesthetics in ambulatory surgery offers multiple benefits in line with the goals of modern-day outpatient surgery. A variety of regional techniques can be used for a wide spectrum of procedures; all are shown to reduce postprocedural pain; reduce the short-term need for opiate medications; reduce adverse effects, such as nausea and vomiting; and reduce the time to dismissal compared with patients who do not receive regional techniques. Growth in ambulatory procedures will likely continue to rise with future advances in surgical techniques, changes in reimbursement, and the evolution of clinical pathways that include superior, sustained postoperative analgesia. Anticipating these changes in practice, the role of, and demand for, regional anesthesia in outpatient surgery wi... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582590 Fri, 21 May 2010 12:41:46 +0100 3582590 http://www.medworm.com/index.php?rid=3582589&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000169%2Fabstract%3Frss%3Dyes Postoperative nausea and vomiting (PONV) continues to be one of the most common complaints following surgery, occurring in more than 30% of surgeries, or as high as 70% to 80% in certain high-risk populations without prophylaxis. The 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists continue to be the mainstay of antiemetic therapy, but newer approaches, such as neurokinin-1 antagonists, a longer-acting serotonin receptor antagonist, multimodal management, and novel techniques for managing high-risk patients are gaining prominence. The related problem of postdischarge nausea and vomiting (PDNV) has received increasing attention from health care providers. The issues of PONV and PDNV are especially significant in the context of ambulatory surgeries, which comprise more than 60% of the... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582589 Fri, 21 May 2010 12:41:46 +0100 3582589 http://www.medworm.com/index.php?rid=3582588&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000248%2Fabstract%3Frss%3Dyes Multimodal (or balanced) analgesia represents an increasingly popular approach to preventing postoperative pain. The approach involves administering a combination of opioid and nonopioid analgesics. Nonopioid analgesics are increasingly being used as adjuvants before, during, and after surgery to facilitate the recovery process after ambulatory surgery. Early studies evaluating approaches to facilitating the recovery process have demonstrated that the use of multimodal analgesic techniques can improve early recovery as well as other clinically meaningful outcomes after ambulatory surgery. The potential beneficial effects of local anesthetics, NSAIDs, and gabapentanioids in improving perioperative outcomes continue to be investigated. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582588 Fri, 21 May 2010 12:41:46 +0100 3582588 http://www.medworm.com/index.php?rid=3582587&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000157%2Fabstract%3Frss%3Dyes Obstructive sleep apnea is the most prevalent breathing disturbance in sleep. It is linked to a host of preexisting medical conditions, and associated with poorer postoperative outcomes. Screening and vigilance during the preoperative assessment identifies patients at high risk of obstructive sleep apnea. Further diagnostic tests may be performed, and plans can be made for tailored intraoperative care. The STOP and the STOP-Bang questionnaires are useful screening tools. Patients with a known diagnosis of obstructive sleep apnea should be seen in the preoperative clinic, where risk stratification and optimization may be done before surgery. This review article presents functional algorithms for the perioperative management of obstructive sleep apnea based on limited clinical evidence, and ... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582587 Fri, 21 May 2010 12:41:46 +0100 3582587 http://www.medworm.com/index.php?rid=3582586&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000261%2Fabstract%3Frss%3Dyes This article focuses on what is appropriate testing for ambulatory surgery patients. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582586 Fri, 21 May 2010 12:41:45 +0100 3582586 http://www.medworm.com/index.php?rid=3582585&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000273%2Fabstract%3Frss%3Dyes This issue of Anesthesiology Clinics is devoted to ambulatory and office-based anesthesia. Outpatient/ambulatory or same-day surgery is not really new. James Nicoll documented the successful administration of 8,988 ambulatory anesthetics in England in a 10-year period from 1899 to 1908. Ralph Waters opened an outpatient facility in 1918 in Sioux City, Iowa. The successes of anesthesia and surgery led to a greater trend toward hospitalization. Despite occasional publications in the surgical literature, there was little organized effort to pursue outpatient surgery and anesthesia until the 1960s. In 1962, the University of California, Los Angeles, opened an outpatient surgical clinic within the hospital. In 1966, George Washington University Hospital opened its ambulatory surgical facility, ... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582585 Fri, 21 May 2010 12:41:45 +0100 3582585 http://www.medworm.com/index.php?rid=3582584&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751000039X%2Fabstract%3Frss%3Dyes Over the past 40 years, there has been a marked increase in the percentage of patients having surgery in an ambulatory setting. This has been the result of multiple factors, including the development of new anesthetic and analgesic agents, new surgical techniques and technology, and an increased desire to reduce costs and improve patient convenience. This issue contains a series of articles highlighting some of the important questions related to delivery of ambulatory care and means of measuring and improving outcomes. It also highlights some of the issues related to a growing area of ambulatory practice—the office-based setting. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582584 Fri, 21 May 2010 12:41:45 +0100 3582584 http://www.medworm.com/index.php?rid=3582583&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000479%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582583 Fri, 21 May 2010 12:41:45 +0100 3582583 http://www.medworm.com/index.php?rid=3582582&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000467%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582582 Fri, 21 May 2010 12:41:45 +0100 3582582 http://www.medworm.com/index.php?rid=3582581&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000455%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3582581 Fri, 21 May 2010 12:41:45 +0100 3582581 http://www.medworm.com/index.php?rid=3487943&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000352%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487943 Mon, 01 Mar 2010 00:00:00 +0100 3487943 http://www.medworm.com/index.php?rid=3487942&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751000011X%2Fabstract%3Frss%3Dyes Tracheal stenosis may occur secondary to trauma, tumors, infection, inflammatory diseases, or iatrogenic causes. Understanding these lesions requires a basic understanding of the physics of airflow. All of these patients must be carefully evaluated and require a series of tests, including pulmonary function tests and radiographic studies. Treatment of tracheal lesions is a multidisciplinary issue and requires the close participation of interventional pulmonologists, anesthesiologists, and surgeons. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487942 Mon, 01 Mar 2010 00:00:00 +0100 3487942 http://www.medworm.com/index.php?rid=3487941&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000042%2Fabstract%3Frss%3Dyes This article focuses on the 4 most commonly encountered endocrinopathies: diabetes mellitus, hyperthyroidism, hypothyroidism, and adrenal insufficiency. Specific challenges pertaining to patients with pheochromocytoma are also discussed. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487941 Mon, 01 Mar 2010 00:00:00 +0100 3487941 http://www.medworm.com/index.php?rid=3487940&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000030%2Fabstract%3Frss%3Dyes Organ toxicity caused by poisons or drug therapy is diverse and may not be commonly encountered clinically. In general, commonly encountered conditions caused by drug/toxin pharmacology can be classified into 7 categories by shared mechanisms of organ injury. This review of drug/toxin-induced injury discusses drug or toxin-induced pathology that the clinician may encounter and therapeutic approaches to these syndromes. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487940 Mon, 01 Mar 2010 00:00:00 +0100 3487940 http://www.medworm.com/index.php?rid=3487939&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000054%2Fabstract%3Frss%3Dyes Trauma is the third leading cause of death in the U.S. Timely acute care anesthetic management of patients following traumatic injury may improve outcome. Recognition of highly-mortal injuries to the brain, heart, lungs, liver, and pelvis should guide trauma-specific management strategies. Rapid intraoperative treatment of life-threatening conditions following injury includes the use of ‘controlled-under resuscitation’ of fluid administration until surgical hemorrhage control, early factor replacement in addition to transfusion of packed red blood cells, and use of adjuvant therapies such as recombinant factor VIIa. These treatment strategies, other recent developments in acute trauma resuscitation, and a review of associated co-existing medical conditions that may impact mortality, ar... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487939 Mon, 01 Mar 2010 00:00:00 +0100 3487939 http://www.medworm.com/index.php?rid=3487938&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000121%2Fabstract%3Frss%3Dyes The anesthetic management of patients with pericardial tamponade is challenging, as they present with not only the cardiovascular compromise that defines pericardial tamponade, but often have comorbid conditions that increase the complexity of their management. This review describes the pathophysiology, etiology, clinical presentation, and anesthetic management of patients with pericardial tamponade, with an emphasis on the intraoperative period and the management of pericardial window procedures, the most common clinical scenario where anesthesiologists will encounter pericardial tamponade. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487938 Mon, 01 Mar 2010 00:00:00 +0100 3487938 http://www.medworm.com/index.php?rid=3487937&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000091%2Fabstract%3Frss%3Dyes Patients with valvular heart disease represent a growing segment of the population and can present major challenges to clinical anesthesiologists. This review focuses on patients with advanced left-sided valvular disease undergoing noncardiac surgery. The pathophysiology and anesthetic implications of aortic stenosis and insufficiency and mitral stenosis and insufficiency are discussed, with a focus on optimizing perioperative management and decision making for patients with these conditions. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487937 Mon, 01 Mar 2010 00:00:00 +0100 3487937 http://www.medworm.com/index.php?rid=3487936&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000029%2Fabstract%3Frss%3Dyes This article reviews the current state of knowledge of the pathophysiology, diagnosis, and treatment of acute coronary syndrome outside and during the perioperative period. It highlights some aspects of relevance for the anesthesiologist caring for these patients. Perioperative modalities for the management of patients suffering from this syndrome, the major guidelines and the evidence behind them, and possible avenues for future research is explored. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487936 Mon, 01 Mar 2010 00:00:00 +0100 3487936 http://www.medworm.com/index.php?rid=3487935&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000078%2Fabstract%3Frss%3Dyes Anesthesiologists often care for patients with renal insufficiency or renal failure. These patients may present to the operating room for a minor procedure such as an inguinal hernia repair or an arteriovenous fistula/graft. Alternatively, they may present for major abdominal operations or coronary artery bypass grafting. Critically ill patients presenting to the operating room may have acute kidney injury. It is imperative that the anesthesiologist understands the ramifications of renal failure and adjusts the anesthetic plan accordingly. Hemodynamic monitoring and fluid management can be challenging in this patient population. Various metabolic abnormalities can ensue that the anesthesiologist must be able to manage in the acute setting of the operating room. (Source: Anesthesiology Clin... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487935 Mon, 01 Mar 2010 00:00:00 +0100 3487935 http://www.medworm.com/index.php?rid=3487934&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000108%2Fabstract%3Frss%3Dyes This article discusses the basic definitions of hypoxia and common pathologic states, reviews the physiology of mechanical ventilation and advanced forms of ventilation available in the ICU, and concludes with recommendations for the management of patients with severe respiratory failure when they are taken to the operating room. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487934 Mon, 01 Mar 2010 00:00:00 +0100 3487934 http://www.medworm.com/index.php?rid=3487933&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000066%2Fabstract%3Frss%3Dyes The acutely septic patient is a multifaceted challenge for the anesthetist. Unlike most elective surgery patients, acutely septic patients have severe systemic disease before the physiologic insults of anesthesia and surgery. The decision to operate is usually informed by the urgent or emergent need to correct a severe surgical problem and weighed against the higher risks of morbidity and mortality from the procedure itself. The care of the septic patient in the intensive care unit can help guide operating room management. However, the acuity and time course of intraoperative events, including hemorrhage and drug-induced shock states, compel the anesthetist to respond aggressively with therapies that may or may not be strongly substantiated with long-term data in the intensive care unit se... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487933 Mon, 01 Mar 2010 00:00:00 +0100 3487933 http://www.medworm.com/index.php?rid=3487932&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS193222751000008X%2Fabstract%3Frss%3Dyes This review outlines the perioperative anesthesia considerations of patients with vascular diseases of the central nervous system, including occlusive cerebrovascular diseases with ischemic risks and various cerebrovascular malformations with hemorrhagic potential. The discussion emphasizes perioperative management strategies to prevent complications and minimize their effects if they occur. Planning the anesthetic and perioperative management is predicated on understanding the goals of the therapeutic intervention and anticipating potential problems. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487932 Mon, 01 Mar 2010 00:00:00 +0100 3487932 http://www.medworm.com/index.php?rid=3487931&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000133%2Fabstract%3Frss%3Dyes By their very nature, surgical patients are “sick”—some more so than others. Anesthesiologists, however, are accustomed to creating a very low-risk environment for their patients. Hence, in the setting of severe disease, the anesthesiologist has a very powerful tendency to want to view such a patient as “too sick for anesthesia.” We believe that this viewpoint, while long-standing and deeply ingrained in traditional anesthesiology practice, is in conflict with a modern view of aggressive surgical care. Severe surgical disease necessitating urgent or emergency surgery often coexists with severe medical illnesses. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487931 Mon, 01 Mar 2010 00:00:00 +0100 3487931 http://www.medworm.com/index.php?rid=3487930&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000145%2Fabstract%3Frss%3Dyes With the constant advances in anesthesiology, patients with increasing comorbidities are being brought to the operating room by our surgical colleagues. Patients who were once too sick for anesthesia are now routinely cared for with good outcomes. Yet, our goal must be to get these patients through the surgery without a further deterioration in organ dysfunction. In this issue of the Anesthesiology Clinics, an outstanding group of contributors have provided us with insights into how best care for these patients. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487930 Mon, 01 Mar 2010 00:00:00 +0100 3487930 http://www.medworm.com/index.php?rid=3487929&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000340%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487929 Mon, 01 Mar 2010 00:00:00 +0100 3487929 http://www.medworm.com/index.php?rid=3487928&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000339%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487928 Mon, 01 Mar 2010 00:00:00 +0100 3487928 http://www.medworm.com/index.php?rid=3487927&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227510000327%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3487927 Mon, 01 Mar 2010 00:00:00 +0100 3487927 http://www.medworm.com/index.php?rid=3031546&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227509001220%2Fabstract%3Frss%3Dyes (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3031546 Fri, 27 Nov 2009 13:42:07 +0100 3031546 http://www.medworm.com/index.php?rid=3031545&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227509000925%2Fabstract%3Frss%3Dyes This article focuses on the unique perioperative concerns of patients with cancer undergoing surgery. Importantly, not all surgical procedures are intended as cures; cancer patients also undergo surgery for noncancer issues. Many of these patients have undergone prior chemotherapy or radiation therapy that can introduce perioperative concerns. These prior treatments, unique to cancer patients, can affect their cardiovascular, pulmonary, gastrointestinal, renal, and endocrine systems adversely, and this article summarizes many important effects of various chemotherapy agents in use today. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3031545 Fri, 27 Nov 2009 13:42:07 +0100 3031545 http://www.medworm.com/index.php?rid=3031544&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227509001050%2Fabstract%3Frss%3Dyes This article presents the current state of emergency surgical care in the United States and the approach to the patient with an emergency surgical illness. The aggressiveness of the surgical intervention is patient- and disease-specific and requires frequent and open communication between all health care providers, the patient, and his or her family. In addition to aggressive resuscitation, life-threatening general surgical conditions often require specific diagnostic and therapeutic interventions. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3031544 Fri, 27 Nov 2009 13:42:07 +0100 3031544 http://www.medworm.com/index.php?rid=3031543&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227509001049%2Fabstract%3Frss%3Dyes This article emphasizes some key points in the preoperative evaluation of patients with neurologic disease. The amount of neurologic disease in the general population is a difficult number to assess accurately. This is, in part, because of the wide-sweeping scope of neurologic disease. The International Classification of Diseases has the highest number of conditions attributable to neurologic disease. Patients with neurologic disease are commonly encountered, and their illness is often complicated by significant comorbid disease. It is important to think of the patient as a whole rather than the sum of his or her systems. While it is tempting to consider the traditional preoperative evaluation from a “cardiac clearance” point of view, we must resist this urge, and evaluate which risk f... Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3031543 Fri, 27 Nov 2009 13:42:07 +0100 3031543 http://www.medworm.com/index.php?rid=3031542&cid=s_37500_5_f&fid=37500&url=http%3A%2F%2Fwww.anesthesiology.theclinics.com%2Farticle%2FPIIS1932227509001037%2Fabstract%3Frss%3Dyes This article uses a case-based approach to present the topics of perioperative warfarin management and postoperative VTE prevention. (Source: Anesthesiology Clinics) Anesthesiology Clinics journals http://www.medworm.com/rss/comments.php?id=3031542 Fri, 27 Nov 2009 13:42:07 +0100 3031542