The Anesthetic Management of Children with Pulmonary Hypertension in the Cardiac Catheterization Laboratory
Children need cardiac catheterization to establish the diagnosis and monitor the response to treatment when undergoing drug therapy for the treatment of pulmonary arterial hypertension (PAH). Children with PAH receiving general anesthesia for cardiac catheterization procedures are at significantly increased risk of perioperative complications in comparison with other children. The most acute life-threatening complication is a pulmonary hypertensive crisis. It is essential that the anesthesiologist caring for these children understands the pathophysiology of the disease, how anesthetic medications may affect the patient&rsq...
Source: Anesthesiology Clinics - December 19, 2013 Category: Anesthesiology Authors: Mark D. Twite, Robert H. Friesen Source Type: research

Neuromonitoring for Scoliosis Surgery
The use of intraoperative neuromonitoring (IONM) during pediatric scoliosis repair has become commonplace to reduce the risk of potentially devastating postoperative neurologic deficits. IONM techniques include somatosensory evoked potentials, motor evoked potentials, electromyography, and intraoperative wake-up tests. Special considerations for scoliosis repair in pediatric patients include preexisting neurologic deficits and young patients with immature neural pathways in whom neurophysiologic monitoring may prove difficult or unreliable. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 16, 2013 Category: Anesthesiology Authors: Chris D. Glover, Nicholas P. Carling Source Type: research

Preface
Pediatric anesthesiology presents clinicians with recurring management issues that warrant review and updating. This issue of Anesthesiology Clinics provides “just what the doctor ordered” for a review of key topics in pediatric anesthesia patient care. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 16, 2013 Category: Anesthesiology Authors: Alan Jay Schwartz, Dean B. Andropoulos, Andrew Davidson Source Type: research

Anesthesia for the Child with Cancer
This article provides a comprehensive overview of the anesthetic management of the child with cancer, focuses on a systems-based approach to the impact from both tumor and its treatment in children, and presents a discussion of the relevant anesthetic considerations. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 12, 2013 Category: Anesthesiology Authors: Gregory J. Latham Source Type: research

Ultrasound for Regional Anesthesia in Children
The use of regional anesthesia in children is increasing. Rapid advancement in the use of ultrasound guidance has allowed for a greater ease in performing peripheral regional anesthesia in pediatrics. Successful peripheral nerve blockade provides children with analgesia that will improve their operative experience. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 9, 2013 Category: Anesthesiology Authors: Santhanam Suresh, Amod Sawardekar, Ravi Shah Source Type: research

Anesthesia for Craniofacial Surgery in Infancy
Anesthetic management of infants undergoing craniofacial surgery can be challenging. Primary concerns for the anesthesiologist include blood loss and its management. The evolution of procedures to treat craniosynostosis has resulted in improvements in perioperative morbidity, including decreased blood loss and transfusion, shorter operations, and shorter hospital stays. An understanding of the procedures performed to treat craniosynostosis is necessary to provide optimal anesthetic management. Descriptions of current surgical techniques and approaches to anesthetic care are presented in this review. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 9, 2013 Category: Anesthesiology Authors: Paul A. Stricker, John E. Fiadjoe Source Type: research

Anesthesia and Analgesia for Pectus Excavatum Surgery
The technique of choice for surgical correction of pectus excavatum is the Nuss procedure, a minimally invasive technique in which rigid metal bars are placed transthoracically beneath the sternum and costal cartilages until permanent remodeling of the chest wall has occurred. Intraoperatively, anesthesia focuses on three areas: the potential for catastrophic blood loss caused by perforation of large capacitance vessels and the heart, the potential for malignant arrhythmias, and the consequences of bilateral iatrogenic pneumothoraces. Postoperatively, analgesia is institutionally dependent and controversial, based on usage...
Source: Anesthesiology Clinics - December 9, 2013 Category: Anesthesiology Authors: Jagroop Mavi, David L. Moore Source Type: research

Anesthetic Neurotoxicity
This article provides an overview of the currently available data from both animal experiments and human clinical studies regarding the effects of sedatives and anesthetics on the developing brain. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 9, 2013 Category: Anesthesiology Authors: Erica P. Lin, Sulpicio G. Soriano, Andreas W. Loepke Source Type: research

Brain Monitoring in Children
Applying scalp sensors in the operating theater, intensive care, or resuscitation scenarios to detect and monitor brain function is achievable, practical, and affordable. The modalities are complex and the output of the monitor needs careful interpretation. The monitor may have technical problems, and a single reading must be considered with caution. These monitors may have a use for monitoring trends in specific situations, but evidence does not support their widespread use. Nevertheless, research should continue to investigate their role. Future techniques and treatments may show that these monitors can monitor brain fun...
Source: Anesthesiology Clinics - December 9, 2013 Category: Anesthesiology Authors: Michael Sury Source Type: research

Challenges in Pediatric Neuroanesthesia: Awake Craniotomy, Intraoperative Magnetic Resonance Imaging, and Interventional Neuroradiology
This article gives a review of 3 challenges in caring for children undergoing neurosurgical and neurointerventional procedures. Anesthesiologists may have experience with certain aspects of these situations but may not have extensive experience with each clinical setting. This review addresses issues with awake craniotomy, intraoperative magnetic resonance imaging, and neurointerventional procedures in children with neurologic disease. Familiarization with these complex clinical scenarios and their unique considerations allows the anesthesiologist to deliver optimal care and helps facilitate the best possible outcome for t...
Source: Anesthesiology Clinics - December 9, 2013 Category: Anesthesiology Authors: Craig D. McClain, Mary Landrigan-Ossar Source Type: research

Major Surgical Procedures in Children with Cerebral Palsy
There are 3 surgical procedures that patients with cerebral palsy (CP) undergo that may be considered major procedures: femoral osteotomies combined with pelvic osteotomies, spine fusion, and intrathecal baclofen pump implant for the treatment of spasticity. Many complications are known to occur at a higher rate in this population, and some may be avoided with prior awareness of the preoperative pathophysiology of the patient with CP. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 9, 2013 Category: Anesthesiology Authors: Mary C. Theroux, Sabina DiCindio Source Type: research

Respiratory Complications in the Pediatric Postanesthesia Care Unit
This article focuses on common respiratory complications in the postanesthesia care unit (PACU). Approximately 1 in 10 children present with respiratory complications in the PACU. The article highlights risk factors and at-risk populations. The physiologic and pathophysiologic background and causes for respiratory complications in the PACU are explained and suggestions given for an optimization of the anesthesia management in the perioperative period. Furthermore, the recognition, prevention, and treatment of these complications in the PACU are discussed. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 9, 2013 Category: Anesthesiology Authors: Britta S. von Ungern-Sternberg Source Type: research

Ethical and Legal Issues Related to the Donation and Use of Nonstandard Organs for Transplants
Transplantation of nonstandard or expanded criteria donor organs creates several potential ethical and legal problems in terms of consent and liability, and new challenges for research and service development; it highlights the need for a system of organ donation that responds to an evolving ethical landscape and incorporates scientific innovation to meet the needs of recipients, but which also safeguards the interests and autonomy of the donor. In this article, the use of deceased donor organs for transplants that fail to meet standard donor criteria and the legitimacy of interventions and research aimed at optimizing the...
Source: Anesthesiology Clinics - December 1, 2013 Category: Anesthesiology Authors: Antonia J. Cronin Source Type: research

Index
Note: Page numbers of article titles are in boldface type. Accountable care organizations (ACOs), 749–762 (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 1, 2013 Category: Anesthesiology Source Type: research

Transplantation in ACOs
The United States exhibits subpar health care outcomes compared with the Organisation for Economic Co-operation and Development peer group. An urgent need exists to address the excessive cost and unsustainable trajectory of expenditures associated with US health care. Health care reform ideas based on the Health Maintenance Organization and Patient-Centered Medical Home concepts are a promising solution to address health care inefficiencies. Accountable Care Organizations seek to simultaneously improve quality of care and reduce expenditure. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 1, 2013 Category: Anesthesiology Authors: Zoltan Hevesi, Laura Hammel Source Type: research

Ethics of Transplantation
Transplantation of nonstandard or expanded criteria donor organs creates several potential ethical and legal problems in terms of consent and liability, and new challenges for research and service development; it highlights the need for a system of organ donation that responds to an evolving ethical landscape and incorporates scientific innovation to meet the needs of recipients, but which also safeguards the interests and autonomy of the donor. In this article, the use of deceased donor organs for transplants that fail to meet standard donor criteria and the legitimacy of interventions and research aimed at optimizing the...
Source: Anesthesiology Clinics - December 1, 2013 Category: Anesthesiology Authors: Antonia J. Cronin Source Type: research

Forthcoming Issues
Pediatric Anesthesiology Alan Schwartz, Dean Andropolous, and Andrew Davidson, Editors (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 1, 2013 Category: Anesthesiology Source Type: research

Contents
Claus U. Niemann Michael Ramsay (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 1, 2013 Category: Anesthesiology Source Type: research

Contributors
LEE A. FLEISHER, MD, FACC, FAHA Robert D. Dripps Professor and Chair of Anesthesiology and Critical Care, Professor of Medicine, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 1, 2013 Category: Anesthesiology Source Type: research

Postoperative Care/Critical Care of the Transplant Patient
Critical care of the general surgical patient requires synthesis of the patient’s physiology, intraoperative events, and preexisting comorbidities. Evaluating an abdominal solid-organ transplant recipient after surgery adds a new dimension to clinical decisions because the transplanted allograft has undergone its own physiologic challenges and now must adapt to a new environment. This donor-recipient interaction forms the foundation for assessment of early allograft function (EAF). The intensivist must accurately assess and support EAF within the context of the recipient’s current physiology and preexisting com...
Source: Anesthesiology Clinics - November 8, 2013 Category: Anesthesiology Authors: Geraldine C. Diaz, Gebhard Wagener, John F. Renz Source Type: research

Intraoperative Care of the Transplant Patient
Patients undergoing abdominal organ transplantation have extensive comorbidities that can affect many organ systems including the cardiovascular system. Intraoperative anesthesia care can be very challenging and requires thorough understanding of the disease specific physiology as well as knowledge of the comorbidities and the surgical procedure. There is no approach to intraoperative anesthesia care that will work equally well for every center but standardization of protocols for each transplant center will improve patient care and safety and ultimately contributes to superior outcomes. In this article we provide backgrou...
Source: Anesthesiology Clinics - November 8, 2013 Category: Anesthesiology Authors: Michael D. Spiro, Helge Eilers Source Type: research

Abdominal Transplantation
Solid organ transplantation is now performed in hundreds of academic and private hospitals across the nation, with most of them being kidney and liver transplants. Patient outcome has dramatically improved over recent decades due to significant advances in immunosuppression and perioperative care of transplant patients. A well-defined, protocol-driven multidisciplinary team approach has been established in most transplant centers; thus transplant services are well ahead of most other surgical service lines. At a minimum, institutional protocols define preoperative, intraoperative, and postoperative management of these comp...
Source: Anesthesiology Clinics - November 8, 2013 Category: Anesthesiology Authors: Claus U. Niemann Source Type: research

Current Research on Organ Donor Management
This article reviews the existing literature and highlights recent trials that can guide management. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - November 4, 2013 Category: Anesthesiology Authors: Mitchell Sally, Darren Malinoski Source Type: research

Patient Selection and Preoperative Evaluation for Transplant Surgery
Candidates for abdominal transplant undergo a pretransplant evaluation to identify associated conditions that may require intervention or that may influence a patient's candidacy for transplant. Coronary artery disease is prevalent in candidates for abdominal organ transplantation. The optimal approach to identify and manage coronary artery disease in the peri-transplant period is currently unclear. In liver transplant candidates portopulmonary hypertension and hepatopulmonary syndrome should be screened for. Identification of the patient who is too sick to benefit from transplant is problematic; with no good evidence avai...
Source: Anesthesiology Clinics - November 4, 2013 Category: Anesthesiology Authors: James Y. Findlay Source Type: research

Infrastructure, Logistics and Regulation of Transplantation: UNOS
Organ transplantation has evolved into the standard of care for patients with end-stage organ failure. Despite considering increasingly complex transplant recipients for organs recovered from donors with increasing comorbid conditions, 1-year patient survival following kidney transplantation is 97% in the United States, whereas liver transplant recipient 1-year survival is 90%. There were 16,485 kidney recipients in the United States in 2012, and 6256 patients who underwent liver transplantation. The intent of this review is to highlight the logistics required for transplantation as well as reviewing the current oversight ...
Source: Anesthesiology Clinics - November 4, 2013 Category: Anesthesiology Authors: Julie K. Heimbach Source Type: research

Advances in Transplantation 1940–2014
The history of medicine is that what was inconceivable yesterday and barely achievable today often becomes routine tomorrow. Liver transplantation began with almost no resources at the same time as the tentative first steps were taken to land a man on the moon. Because human lives would be at stake, both objectives had a sacramental element from the outset: a solemnly binding commitment to perfection. The gift of an organ is really a gift of life, and something as valuable as a life-saving organ is more important to a suffering patient than wealth or power. The concept of a team approach to the care of the transplant patie...
Source: Anesthesiology Clinics - November 4, 2013 Category: Anesthesiology Authors: Michael Ramsay Source Type: research

Allocation of Resources for Organ Transplantation
Over the last 6 decades, organ transplantation has achieved great success to become standard therapy for the treatment of patients with end-stage organ failure. With this success has emerged candidate wait lists that greatly outnumber the current supply of deceased donor organs. The increasing number of candidates and transplants performed has resulted in an organ allocation process that occurs at a local, regional, and sometimes national level. A brief description of the history is presented as well as the methodologies involved in allocation of a donor organ to a single recipient. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 28, 2013 Category: Anesthesiology Authors: Praveen Kandula, T. Anthony Anderson, Parsia A. Vagefi Source Type: research

Index
Note: Page numbers of article titles are in boldface type. Abscess, epidural, related to neuraxial anesthesia, 580–582 (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Source Type: research

Use of Advanced Airway Techniques in the Pregnant Patient
New airway techniques are especially relevant to the obstetric patient requiring anesthesia. Although regional anesthesia is the preferred mode of analgesia for vaginal delivery and of anesthesia for cesarean section, there are scenarios where tracheal intubation is required. Sometimes these cases are anticipated but more often are emergent, and tracheal intubation may be unexpectedly difficult. An unanticipated emergent difficult airway in the labor suite is perhaps the highest stress situation for the anesthesiologist. Anesthesiologists must be proficient in a wide variety of advanced airway techniques with a thorough un...
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Authors: Helene Finegold, Christopher A. Troianos, Hersimren Basi Source Type: research

Forthcoming Issues
Transplantation Claus Niemann, MD, Editor (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Source Type: research

Contents
Robert Gaiser Jason D. Walls and Robert Gaiser (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Source Type: research

Contributors
LEE A. FLEISHER, MD, FACC, FAHA Robert D. Dripps Professor and Chair of Anesthesiology and Critical Care, Professor of Medicine, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Source Type: research

Index
Note: Page numbers of article titles are in boldface type. Abscess, epidural, related to neuraxial anesthesia, 580–582 (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Source Type: research

Use of Advanced Airway Techniques in the Pregnant Patient
New airway techniques are especially relevant to the obstetric patient requiring anesthesia. Although regional anesthesia is the preferred mode of analgesia for vaginal delivery and of anesthesia for cesarean section, there are scenarios where tracheal intubation is required. Sometimes these cases are anticipated but more often are emergent, and tracheal intubation may be unexpectedly difficult. An unanticipated emergent difficult airway in the labor suite is perhaps the highest stress situation for the anesthesiologist. Anesthesiologists must be proficient in a wide variety of advanced airway techniques with a thorough un...
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Authors: Helene Finegold, Christopher A. Troianos, Hersimren Basi Source Type: research

Forthcoming Issues
Transplantation Claus Niemann, MD, Editor (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Source Type: research

Contents
Robert Gaiser Jason D. Walls and Robert Gaiser (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Source Type: research

Contributors
LEE A. FLEISHER, MD, FACC, FAHA Robert D. Dripps Professor and Chair of Anesthesiology and Critical Care, Professor of Medicine, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - September 1, 2013 Category: Anesthesiology Source Type: research

Chronic Pain in the Obstetric Patient
Chronic pain may develop after surgery or trauma. It is defined as pain that persists for 2 months after the initial injury. Although the exact mechanism for the development of chronic pain is not understood, several risk factors have been identified, including female sex, older age, and certain surgical procedures. Chronic pain after cesarean or vaginal delivery has a reported incidence of 10% to 15%. Given the large number of cesarean sections performed, this incidence is concerning. However, a recent study by academic anesthesiologists established the incidence to be much lower than expected. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - August 2, 2013 Category: Anesthesiology Authors: Jason D. Walls, Robert Gaiser Source Type: research

Inhaled Nitrous Oxide for Labor Analgesia
The use of inhaled nitrous oxide for labor analgesia is uncommon but increasing in the United States. It is widely used in several European countries and in Australia and New Zealand. The history of its use for the relief of pain during labor and its efficacy and side effects compared with other methods of labor analgesia are presented. Special equipment is necessary for its safe administration. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - August 1, 2013 Category: Anesthesiology Authors: Sarah A. Starr, Curtis L. Baysinger Source Type: research

Amniotic Fluid Embolism
Amniotic fluid embolism (AFE) is a rare and lethal clinical syndrome. The classic triad of AFE is cardiovascular collapse, respiratory distress, and disseminated intravascular coagulopathy. The understanding of its pathophysiology has changed since it was first described more than 85 years ago, and is now better described as an anaphylactoid reaction of pregnancy. Despite continued investigation into new methods of diagnosis, such as transesophageal echocardiography and insulin-like growth factor binding protein 1, and treatment modalities including intralipid and recombinant factor VIIa, AFE remains one of the major ...
Source: Anesthesiology Clinics - August 1, 2013 Category: Anesthesiology Authors: John M. Kissko, Robert Gaiser Source Type: research

Inhaled Nitrous Oxide for Labor Analgesia
The use of inhaled nitrous oxide for labor analgesia is uncommon but increasing in the United States. It is widely used in several European countries and in Australia and New Zealand. The history of its use for the relief of pain during labor and its efficacy and side effects compared with other methods of labor analgesia are presented. Special equipment is necessary for its safe administration. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - August 1, 2013 Category: Anesthesiology Authors: Sarah A. Starr, Curtis L. Baysinger Source Type: research

Amniotic Fluid Embolism
Amniotic fluid embolism (AFE) is a rare and lethal clinical syndrome. The classic triad of AFE is cardiovascular collapse, respiratory distress, and disseminated intravascular coagulopathy. The understanding of its pathophysiology has changed since it was first described more than 85 years ago, and is now better described as an anaphylactoid reaction of pregnancy. Despite continued investigation into new methods of diagnosis, such as transesophageal echocardiography and insulin-like growth factor binding protein 1, and treatment modalities including intralipid and recombinant factor VIIa, AFE remains one of the major ...
Source: Anesthesiology Clinics - August 1, 2013 Category: Anesthesiology Authors: John M. Kissko, Robert Gaiser Source Type: research

Effects of General Anesthesia During Pregnancy on the Child’s Ability to Learn
As improvements in anesthesiology have minimized mortality and major morbidity, the rare and/or subtle effects of anesthesia are under scrutiny. During the period of rapid brain development, the agents we use to render patients insensate may have long-term effects on the behavior and neurocognitive function of newborns. Studies in fetal and newborn rodents and nonhuman primates present compelling results; more limited retrospective investigations in humans are less conclusive. Two human twin studies are actually reassuring. Although the potential itself is worrisome, at present there is no consensus regarding the cause, pr...
Source: Anesthesiology Clinics - July 26, 2013 Category: Anesthesiology Authors: Tammy Euliano Source Type: research

Neurologic Complications of Neuraxial Anesthesia
Neuraxial anesthesia has significantly enhanced the experience of childbirth, revolutionized the management of labor pain, and decreased maternal morbidity and mortality. Nonetheless, a wide range of neurologic issues can arise secondary to neuraxial anesthesia as well as the birth process. Some of the most common neurologic complaints to come to the attention of anesthesiologists include headaches and peripheral nerve injuries. Minor complications are problematic to patients who are otherwise healthy and for whom uninterrupted time with newborns is valued. Even though anesthetic procedures may result in neurologic sequela...
Source: Anesthesiology Clinics - July 25, 2013 Category: Anesthesiology Authors: Elaine Pages-Arroyo, May C.M. Pian-Smith Source Type: research

Preface
Obstetric anesthesia continues to evolve. Previous problems of dense epidural blockade with possible increased risk of operative delivery have been solved. As old problems are solved, new ones are generated. It is important to examine these new problems because by discussing and exploring these concerns, solutions may be formulated. This issue presents these problems in obstetric anesthesia. Chronic pain in obstetrics, the effect of anesthesia and analgesia on the fetus’s ability to learn, epidural analgesia as a source of maternal fever, and communication among providers have recently been identified as key issues i...
Source: Anesthesiology Clinics - July 15, 2013 Category: Anesthesiology Authors: Robert Gaiser Source Type: research

Index
(Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - June 1, 2013 Category: Anesthesiology Source Type: research