Fluid Management in Abdominal Surgery What, When, and When Not to Administer
Publication date: March 2015 Source:Anesthesiology Clinics, Volume 33, Issue 1 Author(s): Karthik Raghunathan , Mandeep Singh , Dileep N. LoboTeaser The entire team (including anesthesiologists, surgeons, and intensive care physicians) must work together (before, during, and after abdominal surgery) to determine the optimal amount (quantity) and type (quality) of fluid necessary in the perioperative period. The authors present an overview of the basic principles that underlie fluid management, including evidence-based recommendations (where tenable) and a rational approach for when and what to administer. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - February 27, 2015 Category: Anesthesiology Source Type: research

Monitoring Needs and Goal-directed Fluid Therapy Within an Enhanced Recovery Program
This article places the evidence in context, reviews controversies, and suggests implications for current practice and future research. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - February 27, 2015 Category: Anesthesiology Source Type: research

Cardiopulmonary Exercise Testing for Risk Prediction in Major Abdominal Surgery
Publication date: March 2015 Source:Anesthesiology Clinics, Volume 33, Issue 1 Author(s): Denny Z.H. Levett , Michael P.W. GrocottTeaser Reduced exercise capacity is associated with increased postoperative morbidity. Cardiopulmonary exercise testing variables can be used to risk stratify patients. This information can be used to help guide the choice of surgical procedure and to decide on the most appropriate postoperative care environment. Thus CPET can aid collaborative decision making and improve the process of informed consent. In the future, CPET may be combined with other risk predictors to improve outcome predicti...
Source: Anesthesiology Clinics - February 27, 2015 Category: Anesthesiology Source Type: research

Copyright-Page
Publication date: March 2015 Source:Anesthesiology Clinics, Volume 33, Issue 1 (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - February 27, 2015 Category: Anesthesiology Source Type: research

Prehabilitation to Enhance Perioperative Care
Publication date: Available online 9 January 2015 Source:Anesthesiology Clinics Author(s): Francesco Carli , Celena Scheede-BergdahlTeaser Patients who are elderly, malnourished, anxious, and have a low physical function before surgery are likely to have suboptimal recovery from cancer surgery. A multimodal prehabilitation program is proposed, consisting of exercise training and nutritional and psychological support, which increases physiologic reserve before the stress of surgery. This interventional approach seems to improve ability to undergo the stress of surgery and faster recovery. The integration of exercise, adeq...
Source: Anesthesiology Clinics - January 10, 2015 Category: Anesthesiology Source Type: research

Anesthetic Care for Abdominal Surgery
Publication date: Available online 9 January 2015 Source:Anesthesiology Clinics Author(s): Lee A. Fleisher (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - January 10, 2015 Category: Anesthesiology Source Type: research

Enhanced Recovery and the Changing Landscape of Major Abdominal Surgery
Publication date: Available online 9 January 2015 Source:Anesthesiology Clinics Author(s): Timothy E. Miller , Michael J. Scott (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - January 10, 2015 Category: Anesthesiology Source Type: research

Optimal Analgesia During Major Open and Laparoscopic Abdominal Surgery
Publication date: Available online 9 January 2015 Source:Anesthesiology Clinics Author(s): William J. Fawcett , Gabriele BaldiniTeaser Optimal analgesia is a key element of enhanced recovery after surgery (ERAS), not only for humanitarian reasons but also because poorly relieved surgical pain contributes to surgical stress and impairs recovery. A multimodal analgesic approach is advised in order to provide adequate analgesia, reduce opioid consumption, reduce side effects and facilitate the achievement of ERAS milestones. For open surgery, a thoracic epidural for 48 to 72 hours, with regular acetaminophen and antiin...
Source: Anesthesiology Clinics - January 10, 2015 Category: Anesthesiology Source Type: research

Anesthesia for Hepatobiliary Surgery
Publication date: Available online 31 December 2014 Source:Anesthesiology Clinics Author(s): Chris Snowden , James PrentisTeaser Hepatobiliary surgery outcomes have significantly improved since the early 1970s. Surgical and anesthetic advances related to patient selection, alternative surgical management options, and reduction of operative blood loss have been important. Postoperative analgesic regimens are being modified to include intrathecal opiates and to embrace enhanced recovery regimens. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - January 1, 2015 Category: Anesthesiology Source Type: research

Evidence-Based Anesthesia for Major Gynecologic Surgery
Publication date: Available online 31 December 2014 Source:Anesthesiology Clinics Author(s): Jeanette R. Bauchat , Ashraf S. HabibTeaser Studies on enhanced recovery after gynecological surgery are limited but seem to report outcome benefits similar to those reported after colorectal surgery. Regional anesthesia is recommended in enhanced recovery protocols. Effective regional anesthetic techniques in gynecologic surgery include spinal anesthesia, epidural analgesia, transversus abdominis plane blocks, local anesthetic wound infusions and intraperitoneal instillation catheters. Non-opioid analgesics including pregabalin,...
Source: Anesthesiology Clinics - January 1, 2015 Category: Anesthesiology Source Type: research

Anesthesia for Esophagectomy
Publication date: Available online 31 December 2014 Source:Anesthesiology Clinics Author(s): Adam Carney , Matt DickinsonTeaser Esophagectomy is a high-risk operation with significant perioperative morbidity and mortality. Attention to detail in many areas of perioperative management should lead to an aggregation of marginal gains and improvement in postoperative outcome. This review addresses preoperative assessment and patient selection, perioperative care (focusing on pulmonary prehabilitation, ventilation strategies, goal-directed fluid therapy, analgesia, and cardiovascular complications), minimally invasive surgery...
Source: Anesthesiology Clinics - January 1, 2015 Category: Anesthesiology Source Type: research

Perioperative Management of the Opioid Tolerant Patient for Orthopedic Surgery
This article presents new developments in opioid tolerance and how this knowledge can be applied to clinical practice. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - November 25, 2014 Category: Anesthesiology Source Type: research

Setting Up an Ambulatory Regional Anesthesia Program for Orthopedic Surgery
This article presents an overview of how to set up an ambulatory regional anesthesia program for orthopedic surgery. This information is valuable to anesthesiologists who want to expand their regional anesthesia practice and provides a greater understanding of relevant issues and strategies to maximize success. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - November 25, 2014 Category: Anesthesiology Source Type: research

Optimizing Perioperative Management of Total Joint Arthroplasty
Publication date: December 2014 Source:Anesthesiology Clinics, Volume 32, Issue 4 Author(s): Rebecca L. Johnson , Sandra L. KoppTeaser Clinical pathways for total joint arthroplasty have been shown to reduce costs and significantly impact perioperative outcomes mainly through reducing provider variability. Effective clinical pathways link evidence to individual practice and balance costs with local experience, outcomes, and access to resources for responsible perioperative management. Common components of clinical pathways with major impact on perioperative outcomes are: 1) implementing pathways designed to include multi...
Source: Anesthesiology Clinics - November 25, 2014 Category: Anesthesiology Source Type: research

Developing a Multidisciplinary Fall Reduction Program for Lower-Extremity Joint Arthroplasty Patients
Publication date: December 2014 Source:Anesthesiology Clinics, Volume 32, Issue 4 Author(s): T. Edward Kim , Edward R. MarianoTeaser With the anticipated increase in the number of total joint arthroplasty surgeries and associated fall risks, a fall reduction program can provide greater safety for patients in the postoperative period. Although further prospective studies are needed among total joint arthroplasty patients, there is sufficient evidence to show that a successful fall reduction program can be implemented. Common components to date have included a multidisciplinary team, multicomponent interventions specific t...
Source: Anesthesiology Clinics - November 25, 2014 Category: Anesthesiology Source Type: research

Optimizing Perioperative Care for Patients with Hip Fracture
This article reviews the evidence regarding preoperative, intraoperative, and postoperative considerations, and provides insights into the best strategies with which to optimize the patient’s condition and improve perioperative outcomes. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - November 25, 2014 Category: Anesthesiology Source Type: research

Which Outcomes Related to Regional Anesthesia Are Most Important for Orthopedic Surgery Patients?
This article recapitulates the literature and presents an overview of endpoints. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - November 25, 2014 Category: Anesthesiology Source Type: research

Role of Regional Anesthesia in Orthopedic Trauma
Publication date: December 2014 Source:Anesthesiology Clinics, Volume 32, Issue 4 Author(s): Laura Clark , Marjorie Robinson , Marina VarbanovaTeaser Regional anesthesia plays a key role in the treatment of patients with orthopedic trauma. Trauma-induced pain can be in multiple locations, severe, and can predispose the patient to other morbidities. Additional complications as a result of the overdependence on opioids as a primary pain therapy that can be minimized or avoided with the use of regional anesthesia. Both neuraxial and peripheral regional techniques in patients with orthopedic trauma should be incorporated int...
Source: Anesthesiology Clinics - November 25, 2014 Category: Anesthesiology Source Type: research

Orthopedic Anesthesia
Publication date: December 2014 Source:Anesthesiology Clinics, Volume 32, Issue 4 Author(s): Lee A. Fleisher (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - November 25, 2014 Category: Anesthesiology Source Type: research

Quality Management and Registries
This article provides a review of key concepts in quality management (QM) for ambulatory anesthesia. The importance of collecting data from every case is emphasized, and important outcome measures are recommended. The use of specific data collection tools and methodologies is discussed, including the national registry projects of the Society for Ambulatory Anesthesia and the Anesthesia Quality Institute. A brief overview is provided of how to use QM data to improve patient outcomes within an anesthesia practice. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Anesthesia Information Management Systems in the Ambulatory Setting Benefits and Challenges
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Ori GottliebTeaser Adopting an anesthesia information management system (AIMS) is a challenge for anesthesia departments. The transition requires a physician champion and the support of members in every section. This change can be facilitated by visiting similar institutions that are already using AIMS, shadow charting for a sufficient period of time, and understanding that optimization continues after the go-live date. Once implemented, the benefits outweigh the challenges, but understanding where the potential obstacles lie is crit...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Accreditation of Ambulatory Facilities
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Richard D. Urman , Beverly K. PhilipTeaser With the continued growth of ambulatory surgical centers (ASC), the regulation of facilities has evolved to include new standards and requirements on both state and federal levels. Accreditation allows for the assessment of clinical practice, improves accountability, and better ensures quality of care. In some states, ASC may choose to voluntarily apply for accreditation from a recognized organization, but in others it is mandated. Accreditation provides external validation of safe practices...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Legal Aspects of Ambulatory Anesthesia
This article informs anesthesiologists of some of the legal issues they may encounter in connection with ambulatory surgical center-based or office-based practice. The primary legal issues that anesthesiologists face in connection with practice in such settings can be broken down into practice-related issues and ownership-related issues. Given the complexity of legal issues relating to ambulatory anesthesia, anesthesiologists are advised to consult counsel at an early stage so as to understand the issues that may apply to their practices. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Practice Management/Role of the Medical Director
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Douglas G. MerrillTeaser Although the nature of ambulatory surgery has changed over the years, the ideal role of the medical director mirrors its earliest iterations, focusing on excellent customer service and high quality of care. These efforts are supported by 3 modern methods of quality management borrowed from industry: intentional process improvement, standard care pathways, and monitoring outcomes to determine the efficacy of each. These methods are critical to master in order to lead the facility and providers to the highest q...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Scheduling of Procedures and Staff in an Ambulatory Surgery Center
This article reviews different types of procedure scheduling systems. Characteristics of well-functioning ASCs are also discussed. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Long-Acting Serotonin Antagonist (Palonosetron) and the NK-1 Receptor Antagonists Does Extended Duration of Action Improve Efficacy?
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): M. Stephen Melton , Karen C. Nielsen , Marcy Tucker , Stephen M. Klein , Tong J. GanTeaser In a growing outpatient surgical population, postdischarge nausea and vomiting (PDNV) is unfortunately a common and costly anesthetic complication. Identification of risk factors for both postoperative nausea and vomiting and PDNV is the hallmark of prevention and management. New pharmacologic interventions with extended duration of action, including palonosetron and aprepritant, may prove to be more efficacious. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Acute Pain Management
This article updates acute pain management in ambulatory surgery and proposes a practical three-step approach for reducing the impact and incidence of uncontrolled surgical pain. By identifying at-risk patients, implementing multimodal analgesia, and intervening promptly with rescue therapies, the anesthesiologist may improve outcomes, reduce cost, and optimize the patient’s experience and quality of recovery. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Postoperative Issues Discharge Criteria
This article summarizes the latest evidence and consensus with regard to discharging an ambulatory patient home, the use of patient recovery scoring systems for protocol-based decision making, the concept of fast-track recovery, and requirements for patient escort. Fast-tracking (ie, bypassing the postanesthesia care unit) is an acceptable and safe pathway, provided careful patient selection and assessment are performed. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

New Medications and Techniques in Ambulatory Anesthesia
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): M. Stephen Melton , Karen C. Nielsen , Marcy Tucker , Stephen M. Klein , Tong J. GanTeaser Novel anesthetic and analgesic agents are currently under development or investigation to improve anesthetic delivery and patient care. The pharmacokinetic and analgesic profiles of these agents are especially tailored to meet the challenges of rapid recovery and opioid minimization associated with ambulatory anesthesia practice. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Airway Management
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Jennifer Anderson , P. Allan Klock Jr.Teaser In this article, recent literature related to airway management in the ambulatory surgery setting is reviewed. Practical pointers to improve clinical success and avoid complications of newer airway management techniques are provided. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Initial Results from the National Anesthesia Clinical Outcomes Registry and Overview of Office-Based Anesthesia
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Fred E. Shapiro , Samir R. Jani , Xiaoxia Liu , Richard P. Dutton , Richard D. UrmanTeaser Safe office-based anesthesia practices dictate proper patient and procedure selection, appropriate provider qualifications, adequately equipped facilities, and effective administrative infrastructure. Analysis of patient outcomes can help reduce mortality and morbidity by identifying high-risk patients and procedures. We analyzed data from the Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry. Analysis included patient...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Pediatric Ambulatory Anesthesia
This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Chronic Pain Anesthesia for Procedures
This article describes the anesthetic techniques used in interventional pain procedures and their indications, side effects, and complications. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Nonoperating Room Anesthesia for the Gastrointestinal Endoscopy Suite
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): John E. Tetzlaff , John J. Vargo , Walter MaurerTeaser Anesthesia services are increasingly being requested for gastrointestinal (GI) endoscopy procedures. The preparation of the patients is different from the traditional operating room practice. The responsibility to optimize comorbid conditions is also unclear. The anesthetic techniques are unique to the procedures, as are the likely events that require intervention by the anesthesia team. The postprocedure care is also unique. The future needs for anesthesia services in GI endosco...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Ambulatory Anesthesia for the Cardiac Catheterization and Electrophysiology Laboratories
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): J. Devin RobertsTeaser The cardiac catheterization laboratory (CCL) and electrophysiology laboratory (EPL) environments present unique clinical challenges. These challenges include unfamiliar work areas and staff, limited space with physical barriers separating the patient from the care provider, remote locations, and procedures with rare but potentially catastrophic clinical complications. Ambulatory anesthesiologists must familiarize themselves with these new surroundings and practice vigilant preoperative planning and continual co...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Anesthesia for Ambulatory Diagnostic and Therapeutic Radiology Procedures
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Daniel RubinTeaser The radiology suite presents the anesthesia provider with a unique set of challenges such as ionizing radiation, intravascular contrast, magnetic fields, physical separation and barriers from the patient, so-called borrowed space, and the large range of procedures performed. Most of these procedures will continue to be performed without the presence of an anesthesia team but, because of the ever-increasing complexity of the procedures being performed and the increasing comorbidities of patients, the anesthesia prov...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Neuraxial Anesthesia for Outpatients
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Elizabeth A. Alley , Michael F. MuloryTeaser Neuraxial anesthesia for outpatient surgery can provide excellent anesthesia for certain patients. The short-acting local anesthetic 2-chloroprocaine has an appropriate length of action for short outpatient procedures with a very low risk of transient neurologic symptoms. Epidural anesthesia with short-acting agents can provide good outpatient anesthesia for procedures lasting 90 minutes or longer. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Peripheral Nerve Blocks for Ambulatory Surgery
This article provides a broad overview of the indications and clinically useful aspects of the most commonly used upper and lower extremity PNBs in the ambulatory setting. Emphasis is placed on approaches that can be used for single-injection PNBs and continuous PNB techniques. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Management of Diabetes Medications for Patients Undergoing Ambulatory Surgery
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Mary Ann VannTeaser A stress-free actively managed perioperative experience is crucial to successful ambulatory surgery for diabetes patients. Practitioners who integrate diabetes treatment regimens into their perioperative management can facilitate a good outcome, smooth recovery, and rapid return to normal life. Hypoglycemia, hyperglycemia, and glucose variability must be avoided and patients should be maintained near their usual blood glucose. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Perioperative Consideration of Obstructive Sleep Apnea in Ambulatory Surgery
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Raviraj Raveendran , Frances ChungTeaser The prevalence of obstructive sleep apnea (OSA) is increasing and a significant number of patients with OSA are undiagnosed. The suitability of ambulatory surgery in patients with OSA remains controversial, and the evidence regarding the safety of ambulatory surgery for patients with OSA is limited. Preoperative screening and careful selection of patients for ambulatory surgery is the most important step. Patients diagnosed and suspected of having OSA should be managed with a systematic algori...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Perioperative Evaluation and Management of Cardiac Disease in the Ambulatory Surgery Setting
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): J. Devin Roberts , BobbieJean SweitzerTeaser Preoperative cardiac evaluation focuses on risk assessment and reduction. Diagnostic testing and interventions are used only when the risk of adverse outcomes is high and intervention will lower the risk. The evaluation is performed in a stepwise fashion according to guidelines in the literature. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

The Four Ps: Place, Procedure, Personnel, and Patient
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Jeffrey L. Apfelbaum , Thomas W. Cutter (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Ambulatory Anesthesia
Publication date: June 2014 Source:Anesthesiology Clinics, Volume 32, Issue 2 Author(s): Lee A. Fleisher (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Index
Publication date: September 2014 Source:Anesthesiology Clinics, Volume 32, Issue 3 (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Postoperative ICU Management of Vascular Surgery Patients
Publication date: September 2014 Source:Anesthesiology Clinics, Volume 32, Issue 3 Author(s): Ettore Crimi , Charles C. HillTeaser Critical care management of vascular surgical patients poses significant challenges owing to patients’ comorbidities and the magnitude of the surgical procedures. The primary goals of the anesthesiologist and intensivist are reestablishing preoperative homeostasis, optimizing hemodynamics until return of normal organ function, and managing postoperative complications promptly and effectively. Postoperative critical care management demands a detailed knowledge of the various vascular sur...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Considerations for Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair
Publication date: September 2014 Source:Anesthesiology Clinics, Volume 32, Issue 3 Author(s): Brant W. Ullery , Jason T. LeeTeaser Endovascular aneurysm repair has taken over open surgery as the primary strategy for treatment of patients with abdominal and thoracic aneurysms. The minimally invasive nature of these techniques requires alterations in preoperative workup, intraoperative management, and familiarity with unique complications that can occur. Familiarity from the anesthetic standpoint of endovascular techniques, including treatment of patients with fenestrated, chimney, snorkel, and periscope grafts, is necessa...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Perioperative Management of Combined Carotid and Coronary Artery Bypass Grafting Procedures
The objective of this review is to provide a high level overview on current thinking for treatment of patients with combined carotid and coronary artery disease given that these patients are at higher risk of adverse cardiac events, stroke, and death. This review discusses (1) the current literature addressing perioperative stroke risk in the setting of coronary artery bypass graft, (2) the literature regarding different surgical approaches when both carotid and coronary revascularization are being considered, and (3) the data available to guide optimal management of this complex patient population to minimize complication...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Intraoperative Management of Carotid Endarterectomy
This article explores and reviews the literature on anesthetic management and considerations of patients undergoing CEA. (Source: Anesthesiology Clinics)
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Perioperative Management of Lower Extremity Revascularization
Publication date: September 2014 Source:Anesthesiology Clinics, Volume 32, Issue 3 Author(s): James M. Anton , Marie LaPenta McHenryTeaser Patients presenting for lower extremity revascularization often have multiple systemic comorbidities, making them high-risk surgical candidates. Neuraxial anesthesia and general anesthesia are equivocal in their effect on perioperative cardiac morbidity and improved graft patency. Postoperative epidural analgesia may improve perioperative cardiac morbidity. Systemic antithrombotic and anticoagulation therapy is common among this patient population and may affect anesthetic techniques....
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research

Regional Anesthesia for Vascular Surgery
Publication date: September 2014 Source:Anesthesiology Clinics, Volume 32, Issue 3 Author(s): James Flaherty , Jean-Louis Horn , Ryan DerbyTeaser Patients presenting for vascular surgery present a challenge to anesthesiologists because of their severe systemic comorbidities. Regional anesthesia has been used as a primary anesthetic technique for many vascular procedures to avoid the cardiovascular and pulmonary perturbations associated with general anesthesia. In this article the use of regional anesthesia for carotid endarterectomy, open and endovascular abdominal aortic aneurysm repair, infrainguinal arterial bypass, l...
Source: Anesthesiology Clinics - October 12, 2014 Category: Anesthesiology Source Type: research