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

Thoracic Endovascular Aortic Repair: Update on Indications and Guidelines
Thoracic endovascular aortic repair (TEVAR) has revolutionized thoracic aortic surgery and has increased the options available to the aortic specialist in treating thoracic aortic disease. TEVAR is less invasive, and is associated with a decrease in perioperative morbidity and mortality when compared with open surgical repair. The dramatic expansion of TEVAR activity has necessitated a better definition for the indications, contraindications, and limitations of this new technology. Ideally TEVAR should be performed in specialized aortic centers providing a full range of diagnostic and treatment options, using a multidiscip...
Source: Anesthesiology Clinics - June 1, 2013 Category: Anesthesiology Authors: Georghios Nicolaou, Mohamed Ismail, Davy Cheng Source Type: research

Blood Management
Blood management is a system-based comprehensive approach that uses evidence-based medicine to facilitate an environment to encourage an appropriate use of blood products in the hospital setting. The ultimate goal of a blood-management program is to improve patient outcomes by integrating all available techniques to ensure safety, availability, and appropriate allocation of blood products. It is a patient-centered, multidisciplinary, multimodal, planned approach to the management of patients and blood products. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - June 1, 2013 Category: Anesthesiology Authors: Ajay Kumar, Moises Auron, Mark Ereth Source Type: research

A Review of Cardiac Transplantation
Perioperative anesthetic management for cardiac transplantation is reviewed. Recent developments in adult cardiac transplantation are noted. This review includes demographics and historical results, recipient and donor selection and evaluation, mechanical circulatory support and heart transplantation techniques, and patient management immediately postimplantation. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - June 1, 2013 Category: Anesthesiology Authors: Sofia Fischer, Kathryn E. Glas Source Type: research

Transcatheter Aortic Valve Replacement
The percutaneous transcatheter aortic valve replacement (TAVR) procedure, introduced in 2002, has emerged as a successful and comparable treatment option for many patients with aortic stenosis. Balanced general anesthesia or monitored anesthesia care in addition to local anesthesia have been used during transfemoral and transapical approaches. The results of different TAVR registries and the PARTNER trial have shown excellent success and survival rates, but stroke and paravalvular insufficiency represent major concerns. The key for successful procedural outcome involves thorough preparedness and knowledge of the pertinent ...
Source: Anesthesiology Clinics - June 1, 2013 Category: Anesthesiology Authors: Andrej Alfirevic, Anand R. Mehta, Lars G. Svensson Source Type: research

Advances and Future Directions for Mechanical Circulatory Support
Although cardiac transplant remains the gold standard for the treatment of end-stage heart failure, limited donor organ availability and growing numbers of eligible recipients have increased the demand for alternative therapies. Limitations of first-generation left ventricular assist devices for long-term support of patients with end-stage disease have led to the development of newer second-generation and third-generation pumps, which are smaller, have fewer moving parts, and have shown improved durability, allowing for extended support. The HeartMate II (second generation) and HeartWare (third generation) are 2 devices th...
Source: Anesthesiology Clinics - June 1, 2013 Category: Anesthesiology Authors: Michelle Capdeville, Nicholas G. Smedira Source Type: research

Ischemic Mitral Regurgitation: Mechanisms, Intraoperative Echocardiographic Evaluation, and Surgical Considerations
Ischemic mitral regurgitation (IMR) is a subcategory of functional rather than organic, mitral valve (MV) disease. Whether reversible or permanent, left ventricular remodeling creates IMR that is complex and multifactorial. A comprehensive TEE examination in patients with IMR may have important implications for perioperative clinical decision making. Several TEE measures predictive of MV repair failure have been identified. Current practice among most surgeons is to typically repair the MV in patients with IMR. MV replacement is usually reserved for situations in which the valve cannot be reasonably repaired, or repair is ...
Source: Anesthesiology Clinics - June 1, 2013 Category: Anesthesiology Authors: John M. Connell, Andrea Worthington, Frederick Y. Chen, Stanton K. Shernan Source Type: research

The Future of Cardiothoracic Anesthesia
The future of cardiothoracic anesthesia, simply stated, depends on establishing and maintaining a unique and differentiated quality and identity that promotes and contributes positive value to patients, surgical colleagues, and health system administrators who are all also responsible for seeking value. Cardiovascular anesthesiologists must therefore be prepared to define their value through demonstrating that unique quality. To do this, they must codify and continue to push the leading edge in education, research, and clinical innovation for the subspecialty of anesthesia and thereby ensure a role in defining true value a...
Source: Anesthesiology Clinics - June 1, 2013 Category: Anesthesiology Authors: Anne Cherry, Solomon Aronson Source Type: research

Cardiac Anesthesia
Anesthesia for patients undergoing cardiac procedures has advanced greatly in the past several decades. It is one of the areas in which anesthesiologists have partnered closely with their surgical colleagues to advance patient care. With the development of less invasive procedures, especially in the electrophysiology laboratory, our role in the care has increased. In this issue of Anesthesiology Clinics, the guest editor has assembled an outstanding group of investigators to discuss a wide range of procedures. Additionally, she has outlined advances in patient management leading to improvement in patient safety. (Source: A...
Source: Anesthesiology Clinics - June 1, 2013 Category: Anesthesiology Authors: Lee A. Fleisher Source Type: research

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

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

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

Epidural Analgesia and Maternal Fever: Real or Fiction?
Epidural analgesia has been associated with increased maternal temperatures and fevers in laboring women. The mechanism for this fever is unlikely to be of infectious origin. The underlying cause seems to be a combination of altered thermoregulation and inflammation after epidural analgesia. Other risk factors for maternal fever increase the need for epidural analgesia and may explain the strong association between maternal fever and epidural analgesia. Further research is needed to investigate the causes and consequences of fever accompanying epidural analgesia during labor. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - May 13, 2013 Category: Anesthesiology Authors: Abha A. Shah, Grace H. Shih Source Type: research

Improving Communication in the Labor Suite
Effective communication on the Labor and Delivery unit is an essential component in achieving the responsibilities and goals of the unit. Efforts should be taken to ensure productive communication among the multiple health care providers involved in caring for parturients as well as between providers and patients. Effective communication contributes to patient safety, and good communication skills lead to improved patient and staff satisfaction. Many of the outcomes associated with effective communication, such as improved efficiency, fewer malpractice suits, and less staff turnover, lead to lower hospital costs. (Source: ...
Source: Anesthesiology Clinics - May 13, 2013 Category: Anesthesiology Authors: M. Faith Lukens, Regina Y. Fragneto Source Type: research

The Changing Role of Magnesium in Obstetric Practice
Magnesium is an intracellular cation that functions as a cofactor in many biological processes, including calcium channel gating, release of neurotransmitters, modulation of vasomotor tone, and regulation of energy reactions. The role of magnesium in such processes makes it clinically applicable in many situations, especially obstetric practice. However, these same functions also result in the side effects and drug interactions associated with magnesium use, and, thus, necessitate careful administration. Peripartum use of magnesium sulfate has been well studied for tocolysis, preeclampsia and the prevention of progression ...
Source: Anesthesiology Clinics - May 13, 2013 Category: Anesthesiology Authors: Wendy A. Haft, Manuel C. Vallejo Source Type: research

Epidural Analgesia and Maternal Fever: Real or Fiction?
Epidural analgesia has been associated with increased maternal temperatures and fevers in laboring women. The mechanism for this fever is unlikely to be of infectious origin. The underlying cause seems to be a combination of altered thermoregulation and inflammation after epidural analgesia. Other risk factors for maternal fever increase the need for epidural analgesia and may explain the strong association between maternal fever and epidural analgesia. Further research is needed to investigate the causes and consequences of fever accompanying epidural analgesia during labor. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - May 13, 2013 Category: Anesthesiology Authors: Abha A. Shah, Grace H. Shih Source Type: research

Improving Communication in the Labor Suite
Effective communication on the Labor and Delivery unit is an essential component in achieving the responsibilities and goals of the unit. Efforts should be taken to ensure productive communication among the multiple health care providers involved in caring for parturients as well as between providers and patients. Effective communication contributes to patient safety, and good communication skills lead to improved patient and staff satisfaction. Many of the outcomes associated with effective communication, such as improved efficiency, fewer malpractice suits, and less staff turnover, lead to lower hospital costs. (Source: ...
Source: Anesthesiology Clinics - May 13, 2013 Category: Anesthesiology Authors: M. Faith Lukens, Regina Y. Fragneto Source Type: research

The Changing Role of Magnesium in Obstetric Practice
Magnesium is an intracellular cation that functions as a cofactor in many biological processes, including calcium channel gating, release of neurotransmitters, modulation of vasomotor tone, and regulation of energy reactions. The role of magnesium in such processes makes it clinically applicable in many situations, especially obstetric practice. However, these same functions also result in the side effects and drug interactions associated with magnesium use, and, thus, necessitate careful administration. Peripartum use of magnesium sulfate has been well studied for tocolysis, preeclampsia and the prevention of progression ...
Source: Anesthesiology Clinics - May 13, 2013 Category: Anesthesiology Authors: Wendy A. Haft, Manuel C. Vallejo Source Type: research

Anesthetic Considerations for Adults Undergoing Fontan Conversion Surgery
This article discusses the anesthetic considerations in adults with single-ventricle physiology and prior repairs who present for Fontan conversion surgery as a demonstration of the challenges of caring for adults undergoing interventions for the repair of congenital heart defects. The care of these patients requires an understanding of the impact of passive pulmonary blood flow and single systemic ventricular physiology. The perioperative morbidity in this patient population remains high. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - March 18, 2013 Category: Anesthesiology Authors: Emad B. Mossad, Pablo Motta, David F. Vener Source Type: research

Quality, Patient Safety, and the Cardiac Surgical Team
This article reviews a decade of discussion surrounding quality and safety issues in cardiac surgery, and concludes with examples of strategies that have shown great promise for improving cardiac surgery quality and safety. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - March 18, 2013 Category: Anesthesiology Authors: Elizabeth A. Martinez Source Type: research

Generating New Knowledge in Cardiac Interventions
Cardiac interventions are among the most quantitatively studied therapies. It is important for all involved with cardiac interventions to understand how information generated from observations made during patient care is transformed into data suitable for analysis, to appreciate at a high level what constitutes appropriate analyses of those data, to effectively evaluate inferences drawn from those analyses, and to apply new knowledge to better care for individual patients. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - March 18, 2013 Category: Anesthesiology Authors: Eugene H. Blackstone Source Type: research

Robotic and Minimally Invasive Cardiac Surgery
The transition of mitral valve surgery away from the traditional sternotomy approach toward more minimally invasive strategies continues to evolve. The use of telemanipulative robotic arms with near 3-dimensional valve visualization has allowed for near complete endoscopic robotic-assisted mitral valve surgery, providing increased patient satisfaction and cosmesis. Studies have shown rapid recovery times without sacrificing perioperative safety or the durability of surgical repair. Although a steep learning curve exists as well as high fixed and disposable costs, continued technological development fueled by increasing pat...
Source: Anesthesiology Clinics - March 15, 2013 Category: Anesthesiology Authors: William Vernick, Pavan Atluri Source Type: research

Anesthetic Considerations for Electrophysiologic Procedures
This article addresses the implications of providing anesthesia safely and effectively in the electrophysiology laboratory. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - February 25, 2013 Category: Anesthesiology Authors: Ryan Anderson, Izumi Harukuni, Valerie Sera Source Type: research

Critical Care of the Cardiac Patient
This article examines 4 areas in critical care where clinical practice is evolving rapidly. Among these are management of mechanical ventilation, thresholds for blood transfusion, strategies for hemodynamic monitoring, and processes for central line insertion. Also reviewed are current approaches to common dilemmas in postoperative cardiac care: diagnosis of tamponade, and the diagnosis and management of low cardiac output states in patients with a ventricular assist device. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - February 11, 2013 Category: Anesthesiology Authors: Avery Tung Source Type: research

Fluid Management in Cardiac Surgery: Colloid or Crystalloid?
The crystalloid-colloid debate has raged for decades, with the publication of many meta-analyses, yet no consensus. There are important differences between colloids and crystalloids, and these differences have direct relevance for cardiac surgical patients. Rather than asking crystalloid or colloid, we believe better questions to ask are (1) High or low chloride content? and (2) Synthetic or natural colloid? In this paper we review the published literature regarding fluid therapy in cardiac surgery and explain the background to these two important and unanswered questions. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - February 8, 2013 Category: Anesthesiology Authors: Andrew Shaw, Karthik Raghunathan Source Type: research

Cardiac Anesthesia
While health care debate has been the rage, real changes in health care are taking place at the patient level, which are affected by the changing demographics of the baby boomer generation, the evolution of surgical and anesthetic techniques, and refinements in quality and appropriateness, going beyond even complicated economic considerations. Over the past 20 years, I have had the privilege to provide anesthesia for cardiovascular surgical patients. Since that time, the landscape has changed considerably. Advances in the field have been rapid, exciting, and remarkable. Development and innovations in technology in the card...
Source: Anesthesiology Clinics - February 8, 2013 Category: Anesthesiology Authors: Colleen G. Koch Source Type: research

Index
(Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - January 25, 2013 Category: Anesthesiology Source Type: research

Training in Trauma Management: The Role of Simulation-Based Medical Education
Simulation-based medical education (SBME) offers a safe and “mistake-forgiving” environment to teach and train medical professionals. The diverse range of medical-simulation modalities enables trainees to acquire and practice an array of tasks and skills. SBME offers the field of trauma training multiple opportunities to enhance the effectiveness of the education provided in this challenging domain. Further research is needed to better learn the role of simulation-based learning in trauma management and education. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - January 25, 2013 Category: Anesthesiology Authors: Haim Berkenstadt, Erez Ben-Menachem, Daniel Simon, Amitai Ziv Source Type: research

Forthcoming Issues
(Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - January 25, 2013 Category: Anesthesiology Source Type: research

Contents
(Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - January 25, 2013 Category: Anesthesiology Source Type: research

Contributors
(Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - January 25, 2013 Category: Anesthesiology Source Type: research

Anesthesia Department Preparedness for a Multiple-Casualty Incident: Lessons Learned from the Fukushima Earthquake and the Japanese Nuclear Power Disaster
In the Great East Japan Earthquake, which occurred on March 11, 2011, many lives were lost in the accompanying giant tsunami. Fukushima prefecture was widely contaminated with radioactive substances emitted by the accident at the nuclear power plant. Only a few trauma and emergency patients were brought to our hospital by ambulance, and an unexpectedly small number of emergency surgeries performed. There were patients with radiation-induced sickness and injury, but no cases of severe exposure requiring surgery or intensive care. As a logistic support hospital, we should prepare for and simulate these cases to respond to an...
Source: Anesthesiology Clinics - December 27, 2012 Category: Anesthesiology Authors: Masahiro Murakawa Source Type: research

Foreword
Trauma is a major cause of morbidity and mortality worldwide. The role of the anesthesiologist in trauma care is critical and an increasing number of departments are developing special programs in trauma education and fellowships. The need to create such programs has resulted in the development of new knowledge of how best to care for these patients. In this issue of Anesthesiology Clinics of North America, the editors have assembled a group of articles that detail many of these advances, including lessons learned from recent disasters. They have also focused on special vulnerable populations. Finally, they have provided i...
Source: Anesthesiology Clinics - December 20, 2012 Category: Anesthesiology Authors: Lee A. Fleisher Source Type: research

Pitfalls of Hemodynamic Monitoring in Patients with Trauma
This article provides an update for the anesthesiology community on the mechanisms and limitations of common modalities used to assess the early hemodynamic status in patients with trauma. Figures are provided to illustrate important concepts through the use of computer simulation and real-world examples. This article is of value to anesthesiologists whose practice includes management of hemorrhagic shock. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 17, 2012 Category: Anesthesiology Authors: Richard R. McNeer, Albert J. Varon Source Type: research

Trauma in the Elderly: Considerations for Anesthetic Management
The volume of geriatric trauma patients is expected to increase significantly in coming years. Recognition of severe injuries may be delayed because they are less likely to mount classic symptoms of hemodynamic instability. Head injuries of any severity may place geriatric patients at increased risk of mortality, but there are currently no geriatric-specific treatment recommendations that differ from usual adult guidelines. Our understanding of best practices in geriatric trauma and anesthesia care continues to expand, as it does in all other areas of medicine. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 17, 2012 Category: Anesthesiology Authors: Shawn E. Banks, Michael C. Lewis Source Type: research

Resuscitation in a Multiple Casualty Event
A major weakness in the emergency medical response to multiple casualty events continues to be the resuscitation component, which should consist of the systematic application of basic, advanced, and prolonged life support and definitive care within 24 hours. There have been major advances in emergency medical care over the last decade, including the feasibility of point-of-care ultrasound to aid in rapid assessment of injuries in the field, damage control resuscitation, and resuscitative surgery protocols, delivered by small trauma/resuscitation teams equipped with regional anesthesia capability for rapid deployment. Wides...
Source: Anesthesiology Clinics - December 17, 2012 Category: Anesthesiology Authors: Roman Dudaryk, Ernesto A. Pretto Source Type: research

Advances in the Management of the Critically Injured Patient in the Operating Room
This article is an evidence-based update of anesthetic considerations for these patients, including management of intracranial pressure, cardiac monitoring, management of the damage control abdomen, fluid and hemodynamic management, and control of coagulopathies. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 17, 2012 Category: Anesthesiology Authors: Kristen Carey Rock, Magdalena Bakowitz, Maureen McCunn Source Type: research

New and Future Resuscitation Fluids for Trauma Patients Using Hemoglobin and Hypertonic Saline
Hemoglobin-based oxygen carriers (HBOC) and hypertonic saline solutions (HSS) are used for resuscitation of trauma patients with hemorrhagic shock. In this review, the clinical application, dosing, administration, and side effects of these solutions are discussed. Although HBOC and HSS are not ideal resuscitation fluids, until rapidly thawed universal donor frozen blood and blood component therapy becomes widely available in North America, these fluids should to be considered immediately after injury and throughout the spectrum of care for patients with hemorrhagic shock, until blood and blood components become available. ...
Source: Anesthesiology Clinics - December 10, 2012 Category: Anesthesiology Authors: Samuel M. Galvagno, Colin F. Mackenzie Source Type: research

Postmarketing Pharmaceutical Product Pitfalls in Trauma Care
Implementing novel therapies into daily medical practice requires thorough research before regulatory approval and thereafter awareness of cumulative postmarketing medical knowledge. This editorial addresses 2 postmarketing controversies affecting trauma treatment: the retraction of published articles regarding hydroxyethyl starch (HES) and the “back-door” (off-label use) introduction of recombinant factor VIIa (rFVIIa) for intractable hemorrhage in nonhemophiliacs. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - December 3, 2012 Category: Anesthesiology Authors: Yoram G. Weiss, Micha Y. Shamir Source Type: research

Point of Care Devices for Assessing Bleeding and Coagulation in the Trauma Patient
Severe trauma is associated with bleeding, coagulopathy, and transfusion of blood and blood products, all contributing to higher rates of morbidity and mortality. The aim of this review is to focus on point-of-care devices to monitor coagulation in trauma. Close monitoring of bleeding and coagulation as well as platelet function in trauma patients allows goal-directed transfusion and an optimization of the patient’s coagulation, reduces the exposure to blood products, reduces costs, and probably improves clinical outcome. Noninvasive hemoglobin measurements are not to be used in trauma patients due to a lack in speci...
Source: Anesthesiology Clinics - November 28, 2012 Category: Anesthesiology Authors: Oliver M. Theusinger, Jerrold H. Levy Source Type: research

Trauma and Aggressive Homeostasis Management
Homeostasis refers to the capacity of the human body to maintain a stable constant state by means of continuous dynamic equilibrium adjustments controlled by a medley of interconnected regulatory mechanisms. Patients who sustain tissue injury, such as trauma or surgery, undergo a well-understood reproducible metabolic and neuroendocrine stress response. This review discusses 3 issues that concern homeostasis in the acute care of trauma patients directly related to the stress response: hyperglycemia, lactic acidosis, and hypothermia. There is significant reason to question the “conventional wisdom” relating...
Source: Anesthesiology Clinics - November 28, 2012 Category: Anesthesiology Authors: Patrick J. Neligan, Dimitry Baranov Source Type: research

Management and Outcomes of Trauma During Pregnancy
Approximately 1% to 4% of pregnant women are evaluated in emergency/delivery room because of traumatic injury, yet there are few educational strategies targeted toward prevention/management of maternal trauma. Use of illicit drugs and alcohol, domestic abuse, and depression contribute to maternal trauma; thus a high index of suspicion should be maintained when treating injured young women. Treating the mother appropriately is beneficial for both the mother and the fetus. Fetal viability should be assessed after maternal stabilization. Pregnancy-related morbidity occurs in approximately 25% of cases and may include pla...
Source: Anesthesiology Clinics - November 22, 2012 Category: Anesthesiology Authors: Sharon Einav, Hen Y. Sela, Carolyn F. Weiniger Source Type: research

Anesthesia in an Austere Setting: Lessons Learned from the Haiti Relief Operation
The practice of medicine to care for injured patients after an earthquake can challenge physicians. The great need requires an open mind to develop anesthetic plans around locally available resources. A focus on monitored anesthetic care and regional anesthesia is frequently practiced and beneficial to patients. Anesthesiologists will serve as leaders to organize perioperative surgical services and provide input into the ethical triage of patients. The physicians should be mentally and physically prepared to enter into service in this disorganized zone of service to provide care. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - November 19, 2012 Category: Anesthesiology Authors: Timothy E. Morey, Mark J. Rice Source Type: research