Perioperative Management of the Adult Patient on Venovenous Extracorporeal Membrane Oxygenation Requiring Noncardiac Surgery
The use of venovenous extracorporeal membrane oxygenation is increasing worldwide. These patients often require noncardiac surgery. In the perioperative period, preoperative assessment, patient transport, choice of anesthetic type, drug dosing, patient monitoring, and intraoperative and postoperative management of common patient problems will be impacted. Furthermore, common monitoring techniques will have unique limitations. Importantly, patients on venovenous extracorporeal membrane oxygenation remain subject to hypoxemia, hypercarbia, and acidemia in the perioperative setting despite extracorporeal support. Treatments of these conditions often require both manipulation of extracorporeal membrane oxygenation settings and physiologic interventions. Perioperative management of anticoagulation, as well as thresholds to transfuse blood products, remain highly controversial and must take into account the specific procedure, extracorporeal membrane oxygenation circuit function, and patient comorbidities. We will review the physiologic management of the patient requiring surgery while on venovenous extracorporeal membrane oxygenation.
CONCLUSION: There is considerable variation in PLLA reconstitution and use. Further well-designed studies are needed to establish the safest, most effective ways to use this product. J Drugs Dermatol. 2019;18(9):880-886. PMID: 31524343 [PubMed - in process]
CONCLUSION: ENB is a minimally invasive procedure reaching acceptable sensitivity in the most difficult patients. ENB can be recommended for the diagnosis of peripheral pulmonary nodules when no other procedure is successful or possible. Its use as a first choice procedure is, for the moment, limited by the cost, but must be weighed against that of non-diagnostic procedures, and the cost of complications of trans-thoracic lung biopsies. PMID: 31522946 [PubMed - as supplied by publisher]
Publication date: 2019Source: European Urology Supplements, Volume 18, Issue 5Author(s): A. Sharma, W. Al-Dhahir, F. Subin, C. Mulholland
Publication date: October 2019Source: The Lancet Global Health, Volume 7, Issue 10Author(s): Bruce M Biccard, David Bishop, Robert A Dyer, Rupert M Pearse
Publication date: October 2019Source: The Lancet Global Health, Volume 7, Issue 10Author(s): J Matthew Kynes, Mark W Newton
I did this rotation kind of on a whim -- I liked the pharmacology and physiology aspect that I was exposed to during my preclinical sciences and even when while studying for my Step 1 (ie blood-gas coefficient, PEEP, MAC, etc. these kinds of things). I don't think I have the personality for surgery, although, I have not yet done my surgery rotation (I've found myself paying attention to the surgeon during the operation more so, sometimes I need to remind myself to return my attention to the... Two days into my very first anesthesiology rotation, and I've got more questions than answers!
I've always used topical lidocaine to spray the above and below the vocal cords in cases less than 2 hours to try to have a smoother extubation. In longer cases, I have run low-dose remifentanil infusions on wakeup for cases such as neuroanesthesia, carotids, certain ENT cases, etc. One of my colleagues was taught to use bupivicaine 0.25% and spray about 3-5 mL using a flexible LMA Madgic atomizer. I've tried it out and it seems... Smooth Extubation with Bupivicaine
CONCLUSION: Lean Six Sigma methodology is a new business management strategy in the health area. It is perfectly inserted in the current context of quality and safety to the patient; therefore, relevant in the practice of anesthesiology. PMID: 31522741 [PubMed - as supplied by publisher]
Back in May, Bruce Schoneboom wrapped up his appointment to the HHS Pain Management Best Practices Inter-Agency Task Force. The group determined best practices for managing chronic and acute pain—and addressed judicious prescribing of opioids. If you didn’t know: The CDC reports there are 192 overdose deaths in the U.S. every day. Forty percent of The post Dr. Bruce Schoneboom and the HHS Pain Task Force appeared first on Johns Hopkins Nursing Magazine.
Background: The correlation between cardiac output (CO) evaluated by echocardiography and CO measured by thermodilution (COth) varies according to different studies. A new transthoracic echocardiography (TTE) tool allows automatic calculation of the subaortic velocity time index (VTIauto) and CO (COauto). The main objective was to evaluate the correlation between COth and COauto in an anesthetized, ventilated piglet hemorrhagic shock (HS) model. The secondary objectives were to evaluate the correlation between COth and CO evaluated by manual measurements of VTI, and the preload-dependency of VTIvaresp. Methods: Eighte...