Pub Date : 2023-12-08DOI: 10.1097/AIA.0000000000000420
Enrico M. Scarpelli, Chang H. Park, Christina L. Jeng
{"title":"Regional anesthesia and anticoagulation: a narrative review of current considerations","authors":"Enrico M. Scarpelli, Chang H. Park, Christina L. Jeng","doi":"10.1097/AIA.0000000000000420","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000420","url":null,"abstract":"","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"46 11","pages":"1 - 9"},"PeriodicalIF":0.6,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138587308","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}
Pub Date : 2023-12-08DOI: 10.1097/AIA.0000000000000424
Maxim Pochebyt, Steven M. Herron, Stephanie J. Pan, Mark Burbridge, A. Bombardieri
{"title":"Regional anesthesia for head and neck neurosurgical procedures: a narrative review in adult and pediatric patients","authors":"Maxim Pochebyt, Steven M. Herron, Stephanie J. Pan, Mark Burbridge, A. Bombardieri","doi":"10.1097/AIA.0000000000000424","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000424","url":null,"abstract":"","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"46 44","pages":"10 - 20"},"PeriodicalIF":0.6,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138588458","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}
Pub Date : 2023-12-08DOI: 10.1097/AIA.0000000000000426
Elizabeth A. Scholzen, John B. Silva, Kristopher M. Schroeder
The only interface that many patients have with medical systems often occurs in the emergency department (ED) setting. It is in these front-line arenas that patients present with uncontrolled pain from a variety of sources, including trauma or pre-existing medical conditions. Intervening on behalf of patients in this setting has the potential to decrease hospital admissions, decrease the overall opioid load in the community, and unburden over-whelmed ED systems. There are a variety of conditions for which the application of regional anesthesia in this environment may be bene fi cial. Further, patients in the ED setting may bene fi t from the creation of collaborative analgesic efforts with anesthesiologist colleagues to ensure that regional anesthesia is consistently performed in a safe and ef fi cacious manner that is consistent with contemporary ASA and ASRA Pain Medicine guidelines. 1,2 In addition, emergency medicine residency training has grown to include regional ultrasound training. Ultrasound-guided regional anesthesia is now viewed as a valuable skill among emergency medicine residency programs, but few have established formal credentialling pathways. 3 There are a variety of potential concerns associated with regional anesthesia in the ED that may be related to either training, patient follow-up, or complication management. However, these likely represent obstacles that can be thoughtfully overcome in most settings to not preclude regional anesthesia offerings to patients in need. Similarly, while efforts to extend the bene fi ts of regional anesthesia to patients in the perioperative setting have been greatly successful, there remain signi fi cant patient cohorts who experience pain in the setting of nonoperating room anesthesia (NORA) encounters that might also bene fi t from a reappraisal of analgesic strategies. NORA represents an increasing share of anesthetizing locations and is projected to represent greater than 50% of all cases in the next decade. 4,5 These cases can be incredibly diverse in scope and can involve collaborations with specialists within psychiatry, gastroenterology, cardiology, interventional
{"title":"Unique considerations in regional anesthesia for emergency department and non-or procedures","authors":"Elizabeth A. Scholzen, John B. Silva, Kristopher M. Schroeder","doi":"10.1097/AIA.0000000000000426","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000426","url":null,"abstract":"The only interface that many patients have with medical systems often occurs in the emergency department (ED) setting. It is in these front-line arenas that patients present with uncontrolled pain from a variety of sources, including trauma or pre-existing medical conditions. Intervening on behalf of patients in this setting has the potential to decrease hospital admissions, decrease the overall opioid load in the community, and unburden over-whelmed ED systems. There are a variety of conditions for which the application of regional anesthesia in this environment may be bene fi cial. Further, patients in the ED setting may bene fi t from the creation of collaborative analgesic efforts with anesthesiologist colleagues to ensure that regional anesthesia is consistently performed in a safe and ef fi cacious manner that is consistent with contemporary ASA and ASRA Pain Medicine guidelines. 1,2 In addition, emergency medicine residency training has grown to include regional ultrasound training. Ultrasound-guided regional anesthesia is now viewed as a valuable skill among emergency medicine residency programs, but few have established formal credentialling pathways. 3 There are a variety of potential concerns associated with regional anesthesia in the ED that may be related to either training, patient follow-up, or complication management. However, these likely represent obstacles that can be thoughtfully overcome in most settings to not preclude regional anesthesia offerings to patients in need. Similarly, while efforts to extend the bene fi ts of regional anesthesia to patients in the perioperative setting have been greatly successful, there remain signi fi cant patient cohorts who experience pain in the setting of nonoperating room anesthesia (NORA) encounters that might also bene fi t from a reappraisal of analgesic strategies. NORA represents an increasing share of anesthetizing locations and is projected to represent greater than 50% of all cases in the next decade. 4,5 These cases can be incredibly diverse in scope and can involve collaborations with specialists within psychiatry, gastroenterology, cardiology, interventional","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"82 16","pages":"43 - 53"},"PeriodicalIF":0.6,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138586958","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}
Pub Date : 2023-10-01Epub Date: 2023-08-21DOI: 10.1097/AIA.0000000000000411
Trenton C Wray, Neal Gerstein, Emily Ball, Wendy Hanna, Isaac Tawil
In-hospital and out-of-hospital cardiac arrest (CA) is common and associated with poor outcomes despite standardized protocols for advanced cardiac life support (ACLS). Echocardiography is an attractive adjunct to standard ACLS as it has the potential to rapidly diagnose the cause of CA, affect management, facilitate interventions, and guide prognoses. However, difficulty in obtaining adequate acoustic windows for transthoracic echocardiography (TTE) in a timely manner and the associated prolongation of compression pauses have led to an equivocal recommendation on the use of TTE from varying oversight committees and expert reviews. For patients with hemodynamic instability, the American College of Cardiology and other societal guideline committees recommend echocardiography as a first line of assessment, particularly if a cardiac origin is suspected. Critically ill patients often have limited transthoracic windows; and using transesophageal echocardiography (TEE) in this setting has a higher diagnostic yield. As such, TEE is recommended by the American Society of Echocardiography (ASE) in critically ill patients with limited transthoracic views. Not surprisingly, the use in critically ill patients is increasing in the intensive care unit, operating room, emergency department, and even prehospital settings. “Rescue TEE” (TEE performed to rapidly assess for the cause of hemodynamic instability, sometimes also known as “resuscitative TEE”) is particularly useful in the setting of CA. In the intra-arrest and periarrest setting, TEE has the ability to rapidly inform and guide management decisions while avoiding the limitations and interruptions in care that may occur with TTE. The following is a review of the practical application of TEE in CA, including: the benefits, potential harms, a guideline for evaluation, credentialing, and implementation barriers. The utility and benefits of TEE in CA can be divided into intra-arrest and postarrest categories (Table 1). Benefit of TEE during CA resuscitation
{"title":"Seeing the heart of the problem: transesophageal echocardiography in cardiac arrest: a practical review.","authors":"Trenton C Wray, Neal Gerstein, Emily Ball, Wendy Hanna, Isaac Tawil","doi":"10.1097/AIA.0000000000000411","DOIUrl":"10.1097/AIA.0000000000000411","url":null,"abstract":"In-hospital and out-of-hospital cardiac arrest (CA) is common and associated with poor outcomes despite standardized protocols for advanced cardiac life support (ACLS). Echocardiography is an attractive adjunct to standard ACLS as it has the potential to rapidly diagnose the cause of CA, affect management, facilitate interventions, and guide prognoses. However, difficulty in obtaining adequate acoustic windows for transthoracic echocardiography (TTE) in a timely manner and the associated prolongation of compression pauses have led to an equivocal recommendation on the use of TTE from varying oversight committees and expert reviews. For patients with hemodynamic instability, the American College of Cardiology and other societal guideline committees recommend echocardiography as a first line of assessment, particularly if a cardiac origin is suspected. Critically ill patients often have limited transthoracic windows; and using transesophageal echocardiography (TEE) in this setting has a higher diagnostic yield. As such, TEE is recommended by the American Society of Echocardiography (ASE) in critically ill patients with limited transthoracic views. Not surprisingly, the use in critically ill patients is increasing in the intensive care unit, operating room, emergency department, and even prehospital settings. “Rescue TEE” (TEE performed to rapidly assess for the cause of hemodynamic instability, sometimes also known as “resuscitative TEE”) is particularly useful in the setting of CA. In the intra-arrest and periarrest setting, TEE has the ability to rapidly inform and guide management decisions while avoiding the limitations and interruptions in care that may occur with TTE. The following is a review of the practical application of TEE in CA, including: the benefits, potential harms, a guideline for evaluation, credentialing, and implementation barriers. The utility and benefits of TEE in CA can be divided into intra-arrest and postarrest categories (Table 1). Benefit of TEE during CA resuscitation","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 4","pages":"15-21"},"PeriodicalIF":0.6,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305941","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}
Pub Date : 2023-07-01DOI: 10.1097/AIA.0000000000000399
Abhijit Vijay Lele, Marie Angele Theard, Monica S Vavilala
{"title":"Cerebrospinal fluid diversion devices and shunting procedures: a narrative review for the anesthesiologist.","authors":"Abhijit Vijay Lele, Marie Angele Theard, Monica S Vavilala","doi":"10.1097/AIA.0000000000000399","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000399","url":null,"abstract":"","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 3","pages":"29-36"},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10429525","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}
Pub Date : 2023-07-01DOI: 10.1097/AIA.0000000000000400
Adele S Budiansky, Emma P Hjartarson, Tomasz Polis, Gregory Krolczyk, John Sinclair
Intraoperative aneurysm rupture (IAR) is one of the most feared complications associated with microsurgical clipping of cerebral aneurysms. To the surgeon, this situation is typi fi ed by an operative fi eld that is rapidly fi lling with blood, often with the ultimate source of hemorrhage not readily identi fi ed. Coupled with the sudden and unexpected nature of the event, an IAR can create great stress for the surgeon and the anesthesiologist. In a survey of neurovascular surgeons, IAR was identi fi ed as one of the major technical challenges to aneurysm clipping. 1 Despite the advancement of endovascular techniques, microsurgical clipping performed via a craniotomy remains indicated for a variety of reasons, such as for patients with subarachnoid hemorrhage (SAH) with mass effect, cranial nerve palsies due to compression by the aneurysm, wide-necked bifurcation or irre-gularly-shaped aneurysms, and ones that have failed endovascular treatment. 2 As microsurgical clipping becomes reserved for more complex indications, the risk of IAR is likely to remain signi fi cant. In the event of IAR, the anesthesiologist plays a critical role, not only in providing adequate resuscitation but also in facilitating the surgeon ’ s visualization and treatment of the bleeding aneurysm. This narrative review focuses on anesthesia techniques that can aid the surgeon in the management of ruptured aneurysms, namely induced hypotension with either adenosine or rapid ventricular pacing (RVP). In addition to the incidence and risk factors for IAR, this review speci fi cally aims to present the management of IAR from the surgeon ’ s
{"title":"Emerging anesthesia techniques for managing intraoperative rupture of cerebral aneurysms.","authors":"Adele S Budiansky, Emma P Hjartarson, Tomasz Polis, Gregory Krolczyk, John Sinclair","doi":"10.1097/AIA.0000000000000400","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000400","url":null,"abstract":"Intraoperative aneurysm rupture (IAR) is one of the most feared complications associated with microsurgical clipping of cerebral aneurysms. To the surgeon, this situation is typi fi ed by an operative fi eld that is rapidly fi lling with blood, often with the ultimate source of hemorrhage not readily identi fi ed. Coupled with the sudden and unexpected nature of the event, an IAR can create great stress for the surgeon and the anesthesiologist. In a survey of neurovascular surgeons, IAR was identi fi ed as one of the major technical challenges to aneurysm clipping. 1 Despite the advancement of endovascular techniques, microsurgical clipping performed via a craniotomy remains indicated for a variety of reasons, such as for patients with subarachnoid hemorrhage (SAH) with mass effect, cranial nerve palsies due to compression by the aneurysm, wide-necked bifurcation or irre-gularly-shaped aneurysms, and ones that have failed endovascular treatment. 2 As microsurgical clipping becomes reserved for more complex indications, the risk of IAR is likely to remain signi fi cant. In the event of IAR, the anesthesiologist plays a critical role, not only in providing adequate resuscitation but also in facilitating the surgeon ’ s visualization and treatment of the bleeding aneurysm. This narrative review focuses on anesthesia techniques that can aid the surgeon in the management of ruptured aneurysms, namely induced hypotension with either adenosine or rapid ventricular pacing (RVP). In addition to the incidence and risk factors for IAR, this review speci fi cally aims to present the management of IAR from the surgeon ’ s","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 3","pages":"64-72"},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10074401","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}
Pub Date : 2023-07-01DOI: 10.1097/AIA.0000000000000407
Anuja Rathore, Michael Dinsmore, Lashmi Venkatraghavan
Neurostimulators are active implantable devices that clinicians use to perform diverse neuromodulation treatments in patients with neurological and non-neurological disorders. 1 Neuromodulation works on the principle of reverse engineering the disorder allowing the clinicians to think from a patient-system point of view. This enables them to personalize interventions by understanding the patient-speci fi c pathophysiology that can translate insights from cognitive neuroscience into targeted therapies for various disorders. 2 Neurostimulators can be intracranial [deep brain stimulation (DBS)], neuraxial [spinal cord stimulation (SCS), sacral nerve stimulators], or peripheral (vagal nerve trigeminal nerve or other peripheral nerve stimulation). The number of patients using neurostimulators is growing rapidly, making it imperative for anesthesiologists to understand these devices and their potential interactions with other medical equipment. 3 The literature on perioperative management of patients with neurostimulators is scarce, and most of the information comes from case reports and manufacturer recommendations. In this review, we provide an overview of various neurostimulators, general considerations, and recommendations regarding the perioperative management of these patients for speci fi c surgeries.
{"title":"Anesthesia management in patients with neurostimulators.","authors":"Anuja Rathore, Michael Dinsmore, Lashmi Venkatraghavan","doi":"10.1097/AIA.0000000000000407","DOIUrl":"https://doi.org/10.1097/AIA.0000000000000407","url":null,"abstract":"Neurostimulators are active implantable devices that clinicians use to perform diverse neuromodulation treatments in patients with neurological and non-neurological disorders. 1 Neuromodulation works on the principle of reverse engineering the disorder allowing the clinicians to think from a patient-system point of view. This enables them to personalize interventions by understanding the patient-speci fi c pathophysiology that can translate insights from cognitive neuroscience into targeted therapies for various disorders. 2 Neurostimulators can be intracranial [deep brain stimulation (DBS)], neuraxial [spinal cord stimulation (SCS), sacral nerve stimulators], or peripheral (vagal nerve trigeminal nerve or other peripheral nerve stimulation). The number of patients using neurostimulators is growing rapidly, making it imperative for anesthesiologists to understand these devices and their potential interactions with other medical equipment. 3 The literature on perioperative management of patients with neurostimulators is scarce, and most of the information comes from case reports and manufacturer recommendations. In this review, we provide an overview of various neurostimulators, general considerations, and recommendations regarding the perioperative management of these patients for speci fi c surgeries.","PeriodicalId":46852,"journal":{"name":"INTERNATIONAL ANESTHESIOLOGY CLINICS","volume":"61 3","pages":"13-18"},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10429526","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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