Laparoscopic surgery results in physiologic changes that encompass multiple organ systems, with respiratory, cardiovascular and neurologic and splanchnic effects. Insufflation of the peritoneum results in reduced lung volumes, atelectasis, and endobronchial migration of the endotracheal tube. Pneumoperitoneum can result in changes to venous return, cardiac output and blood pressure. Hypercapnia due to carbon dioxide gas used in insufflation can reduce cerebral perfusion pressure. Complications during laparoscopic surgery often occur during port placement and creation of the pneumoperitoneum. Problems include injury to blood vessels during trocar entry, vascular injury in the pneumoperitoneum with limited surgical access, severe bradycardia and arrhythmias due to vagal stimulation from peritoneal stretching, subcutaneous emphysema, pneumothorax, gas embolism, and complications associated with steep Trendelenburg positioning. A thorough understanding of the physiologic changes associated with laparoscopic procedures and recognition of potential complications will facilitate in optimal patient care. This review contains 4 figures, 1 table and 52 references Keywords: Laparoscopy; laparoscopic surgery; carbon dioxide; pneumoperitoneum; capnothorax; general anesthesia; subcutaneous emphysema; insufflation
{"title":"Anesthesia for Laparoscopic Surgery: Anesthetic Management and Complications","authors":"E. Bittner, S. Cao","doi":"10.2310/anes.18345","DOIUrl":"https://doi.org/10.2310/anes.18345","url":null,"abstract":"Laparoscopic surgery results in physiologic changes that encompass multiple organ systems, with respiratory, cardiovascular and neurologic and splanchnic effects. Insufflation of the peritoneum results in reduced lung volumes, atelectasis, and endobronchial migration of the endotracheal tube. Pneumoperitoneum can result in changes to venous return, cardiac output and blood pressure. Hypercapnia due to carbon dioxide gas used in insufflation can reduce cerebral perfusion pressure. Complications during laparoscopic surgery often occur during port placement and creation of the pneumoperitoneum. Problems include injury to blood vessels during trocar entry, vascular injury in the pneumoperitoneum with limited surgical access, severe bradycardia and arrhythmias due to vagal stimulation from peritoneal stretching, subcutaneous emphysema, pneumothorax, gas embolism, and complications associated with steep Trendelenburg positioning. A thorough understanding of the physiologic changes associated with laparoscopic procedures and recognition of potential complications will facilitate in optimal patient care. \u0000\u0000This review contains 4 figures, 1 table and 52 references\u0000Keywords: Laparoscopy; laparoscopic surgery; carbon dioxide; pneumoperitoneum; capnothorax; general anesthesia; subcutaneous emphysema; insufflation ","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115078133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Benedetti, J. Burnett, Meredith Degnan, Danielle Horne, A. Missair, Joshua Oppenheimer, Evan Peskin, Adi Pulikal
The neuronal, chemical, and electrical transmission of pain is a complex and intricate subject that continues to be studied and expounded. This review discusses the relevant physiology and influential factors contributing to the experience and subjective variation in a variety of acute and chronic pain presentations. This review contains 4 figures, 4 tables, and 30 references Keywords: acute pain, chronic pain, somatic pain, neuropathic pain, visceral pain, nociception, pain perception, gender-related pain, cancer pain, spine pain
{"title":"Central and Peripheral Nervous System","authors":"E. Benedetti, J. Burnett, Meredith Degnan, Danielle Horne, A. Missair, Joshua Oppenheimer, Evan Peskin, Adi Pulikal","doi":"10.2310/anes.18391","DOIUrl":"https://doi.org/10.2310/anes.18391","url":null,"abstract":"The neuronal, chemical, and electrical transmission of pain is a complex and intricate subject that continues to be studied and expounded. This review discusses the relevant physiology and influential factors contributing to the experience and subjective variation in a variety of acute and chronic pain presentations.\u0000\u0000This review contains 4 figures, 4 tables, and 30 references\u0000Keywords: acute pain, chronic pain, somatic pain, neuropathic pain, visceral pain, nociception, pain perception, gender-related pain, cancer pain, spine pain","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"15 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123275563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Candidiasis","authors":"Brett A Melnikoff, R. Myers","doi":"10.2310/anes.2364","DOIUrl":"https://doi.org/10.2310/anes.2364","url":null,"abstract":"<jats:p />","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131631701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Critically ill patients may have preexisting endocrine disorders that need to be recognized and addressed. Disruption of normal endocrine gland function leads to inappropriate hormone secretion, resulting in hormone excess or deficiency. Both extremes may have detrimental systemic consequences and may pose significant challenges to the intensivist. Proper recognition of endocrine emergencies such as severe hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion, thyroid storm, and myxedema coma is vital, as delay in treatment may result in significant morbidity or death. This review provides an overview of common pituitary, thyroid, and parathyroid disorders and emergencies, including definitions, manifestations, diagnosis, and management. This review contains 2 figures, 7 tables, and 30 references. Key Words: acromegaly, diabetes insipidus, hyperparathyroidism, hypoparathyroidism, myxedema coma, nonthyroidal illness syndrome, syndrome of inappropriate antidiuretic hormone secretion, thyrotoxicosis, thyroid storm
{"title":"Pituitary, Thyroid, and Parathyroid Disorders","authors":"J. Yaung","doi":"10.2310/anes.18402","DOIUrl":"https://doi.org/10.2310/anes.18402","url":null,"abstract":"Critically ill patients may have preexisting endocrine disorders that need to be recognized and addressed. Disruption of normal endocrine gland function leads to inappropriate hormone secretion, resulting in hormone excess or deficiency. Both extremes may have detrimental systemic consequences and may pose significant challenges to the intensivist. Proper recognition of endocrine emergencies such as severe hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion, thyroid storm, and myxedema coma is vital, as delay in treatment may result in significant morbidity or death. This review provides an overview of common pituitary, thyroid, and parathyroid disorders and emergencies, including definitions, manifestations, diagnosis, and management.\u0000\u0000This review contains 2 figures, 7 tables, and 30 references.\u0000Key Words: acromegaly, diabetes insipidus, hyperparathyroidism, hypoparathyroidism, myxedema coma, nonthyroidal illness syndrome, syndrome of inappropriate antidiuretic hormone secretion, thyrotoxicosis, thyroid storm","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"76 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116289478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Physiologic and Pathophysiologic Responses to Intubation","authors":"Gilbert S Tang","doi":"10.2310/anes.18407","DOIUrl":"https://doi.org/10.2310/anes.18407","url":null,"abstract":"<jats:p />","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126702393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preoperative Evaluation of the Obese Patient","authors":"Joy L. Chen, Taylor J. Pak, T. Moon","doi":"10.2310/anes.18331","DOIUrl":"https://doi.org/10.2310/anes.18331","url":null,"abstract":"<jats:p />","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133300693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anesthesia for Urologic Surgery","authors":"Dan B. Ellis, Anton Wintner","doi":"10.2310/anes.18349","DOIUrl":"https://doi.org/10.2310/anes.18349","url":null,"abstract":"<jats:p />","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"44 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114102730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anesthesia for Cesarean Delivery","authors":"Emily E. Naoum, R. Minehart","doi":"10.2310/anes.18192","DOIUrl":"https://doi.org/10.2310/anes.18192","url":null,"abstract":"<jats:p />","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122682916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacologic Differences in Children","authors":"R. Park, L. Ugarte","doi":"10.2310/anes.18001","DOIUrl":"https://doi.org/10.2310/anes.18001","url":null,"abstract":"<jats:p />","PeriodicalId":345138,"journal":{"name":"DeckerMed Anesthesiology","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133834303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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