Pub Date : 2013-01-01DOI: 10.1097/ASA.0b013e31829aeb53
Sheila R. Barnett
Learning Objectives: As a result of completing this activity, the participant will be able to Discuss the definition and anesthetic implications of frailty Describe current demographic challenges and morbidity and mortality curves for the elderly Discuss the natural consequences of aging and the concept of reserve function Describe risk reduction strategies that can be applied to the oldest old Describe management strategies that could be used as quality indicators
{"title":"Frail, Feeble, or Fit? The Oldest Old: What Should We Do Differently for the Geriatric Patient Undergoing Anesthesia—If Anything?","authors":"Sheila R. Barnett","doi":"10.1097/ASA.0b013e31829aeb53","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31829aeb53","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Discuss the definition and anesthetic implications of frailty Describe current demographic challenges and morbidity and mortality curves for the elderly Discuss the natural consequences of aging and the concept of reserve function Describe risk reduction strategies that can be applied to the oldest old Describe management strategies that could be used as quality indicators","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"22–30"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31829aeb53","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62021943","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 : 2013-01-01DOI: 10.1097/ASA.0B013E31829953FC
Javier H. Campos
Double-lumen tubes or bronchial blockers are used to provide one-lung ventilation (OLV) in patients undergoing lung, esophageal, thoracic vascular, minimally invasive cardiac, and occasionally mediastinal surgery. During OLV, an intrapulmonary shunt may result in hypoxemia related in part to collapse of the nondependent lung and increased atelectatic areas in the dependent lung. Hypoxemia by definition is a decrease in oxygen saturation (SpO2) to less than 90% 4 or an arterial oxygen tension (PaO2) of less than 60 mmHg when the patient is being ventilated at an inspired oxygen fraction (FiO2) of 1.0. 5 The incidence of hypoxemia during OLV has been reported to be 1 to 10%. This relative infrequency is related in part to advances with routine use of a fiberoptic bronchoscope for optimal placement of lung isolation devices. It is also attributable to the introduction of newer volatile anesthetics that cause less inhibition of hypoxic pulmonary vasoconstriction (HPV) in a dose-dependent manner and less venous admixture during OLV. This review focuses on the predictors of hypoxia during OLV, the pathophysiology of HPV, protective ventilation maneuvers to restore or improve arterial oxygenation, the effects of anesthetics on hypoxia and inflammation, and cerebral desaturation episodes and hypoxia during OLV.
{"title":"Hypoxia During Thoracic Surgery: Practical Advice for the Anesthesiologist","authors":"Javier H. Campos","doi":"10.1097/ASA.0B013E31829953FC","DOIUrl":"https://doi.org/10.1097/ASA.0B013E31829953FC","url":null,"abstract":"Double-lumen tubes or bronchial blockers are used to provide one-lung ventilation (OLV) in patients undergoing lung, esophageal, thoracic vascular, minimally invasive cardiac, and occasionally mediastinal surgery. During OLV, an intrapulmonary shunt may result in hypoxemia related in part to collapse of the nondependent lung and increased atelectatic areas in the dependent lung. Hypoxemia by definition is a decrease in oxygen saturation (SpO2) to less than 90% 4 or an arterial oxygen tension (PaO2) of less than 60 mmHg when the patient is being ventilated at an inspired oxygen fraction (FiO2) of 1.0. 5 The incidence of hypoxemia during OLV has been reported to be 1 to 10%. This relative infrequency is related in part to advances with routine use of a fiberoptic bronchoscope for optimal placement of lung isolation devices. It is also attributable to the introduction of newer volatile anesthetics that cause less inhibition of hypoxic pulmonary vasoconstriction (HPV) in a dose-dependent manner and less venous admixture during OLV. This review focuses on the predictors of hypoxia during OLV, the pathophysiology of HPV, protective ventilation maneuvers to restore or improve arterial oxygenation, the effects of anesthetics on hypoxia and inflammation, and cerebral desaturation episodes and hypoxia during OLV.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"41 1","pages":"38-46"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E31829953FC","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62021121","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 : 2013-01-01DOI: 10.1097/ASA.0b013e31829a1f54
R. Miguel
Over the past 20 years, drug overdose deaths in the United States have tripled. More than 100 people die each day secondary to prescription drug use, whether related to drug abuse, misuse, or adverse events. In July 2012, the Drug Abuse Warning Network reported that of 4.8 million drug-related visits to US emergency departments in 2010, 46.8% were due to drug abuse or misuse. Prescription drugs had the highest representation of all abused drugs at a frequency of 435 per 100,000 population. Because Florida is the state with the greatest number of medications dispensed and the highest drug mortality, the actions of that state have a far-reaching impact because of the enormous volume of drugs diverted from Florida. Recognizing the problem, the US Food and Drug Administration (FDA) started Risk Evaluation and Mitigation Strategies (REMS) as a source of education. REMS require drug manufacturers to educate physicians who, in turn, will educate their patients about the proper use of high-risk medications, including opioids. This chapter addresses the problem of clinics that appear to operate as pain clinics but really exist to dispense prescriptions for medication, or ‘‘pill mills,’’ and their contribution to the national prescription drug epidemic. A template for responsible controlled substance prescribing, which includes complete history taking and physical examination with particular attention to comorbidities (including psychiatric disorders), is described. Finally, an overview of the available risk assessment and ongoing management tools is presented.
{"title":"Risk Evaluation and Mitigation Strategies (REMS), Pill Mills, and Responsible Opioid Prescribing","authors":"R. Miguel","doi":"10.1097/ASA.0b013e31829a1f54","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31829a1f54","url":null,"abstract":"Over the past 20 years, drug overdose deaths in the United States have tripled. More than 100 people die each day secondary to prescription drug use, whether related to drug abuse, misuse, or adverse events. In July 2012, the Drug Abuse Warning Network reported that of 4.8 million drug-related visits to US emergency departments in 2010, 46.8% were due to drug abuse or misuse. Prescription drugs had the highest representation of all abused drugs at a frequency of 435 per 100,000 population. Because Florida is the state with the greatest number of medications dispensed and the highest drug mortality, the actions of that state have a far-reaching impact because of the enormous volume of drugs diverted from Florida. Recognizing the problem, the US Food and Drug Administration (FDA) started Risk Evaluation and Mitigation Strategies (REMS) as a source of education. REMS require drug manufacturers to educate physicians who, in turn, will educate their patients about the proper use of high-risk medications, including opioids. This chapter addresses the problem of clinics that appear to operate as pain clinics but really exist to dispense prescriptions for medication, or ‘‘pill mills,’’ and their contribution to the national prescription drug epidemic. A template for responsible controlled substance prescribing, which includes complete history taking and physical examination with particular attention to comorbidities (including psychiatric disorders), is described. Finally, an overview of the available risk assessment and ongoing management tools is presented.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"27 1","pages":"70–77"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31829a1f54","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62022300","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 : 2012-01-01DOI: 10.1097/ASA.0B013E31825F3C30
M. Keegan
As perioperative physicians, anesthesiologists regularly face dilemmas in patients who have gas exchange and acid–base abnormalities. Even in the absence of technical problems, some individuals are difficult to oxygenate and ventilate intraoperatively. Hypoxemia and hypercapnia commonly occur in the postanesthesia care unit and on the surgical wards. Intensive care unit patients with respiratory failure and metabolic derangements may require operative intervention and pose significant management problems. Furthermore, the effects on patient physiology of a variety of perioperative metabolic insults must be considered. Assessment of acid–base and metabolic derangements requires evaluation of blood gases, electrolytes, and other laboratory data. This chapter discusses acid–base physiology as it applies to the perioperative period, and provides an approach to the interpretation of arterial blood gases and electrolytes with a focus on acid–base disorders.
{"title":"Perioperative Acid–Base Disturbances: Evaluation and Management","authors":"M. Keegan","doi":"10.1097/ASA.0B013E31825F3C30","DOIUrl":"https://doi.org/10.1097/ASA.0B013E31825F3C30","url":null,"abstract":"As perioperative physicians, anesthesiologists regularly face dilemmas in patients who have gas exchange and acid–base abnormalities. Even in the absence of technical problems, some individuals are difficult to oxygenate and ventilate intraoperatively. Hypoxemia and hypercapnia commonly occur in the postanesthesia care unit and on the surgical wards. Intensive care unit patients with respiratory failure and metabolic derangements may require operative intervention and pose significant management problems. Furthermore, the effects on patient physiology of a variety of perioperative metabolic insults must be considered. Assessment of acid–base and metabolic derangements requires evaluation of blood gases, electrolytes, and other laboratory data. This chapter discusses acid–base physiology as it applies to the perioperative period, and provides an approach to the interpretation of arterial blood gases and electrolytes with a focus on acid–base disorders.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"87-94"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E31825F3C30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020331","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 : 2012-01-01DOI: 10.1097/ASA.0b013e3182622bab
M. Murray
Preparing to manage disasters originating from natural events, industrial accidents, or, of more interest recently, caused intentionally by terrorists using chemical, biological, radiological, nuclear, or highexplosive (CBRNE) agents is a high priority for the US government and military as well as the American Society of Anesthesiologists. Even though natural and man-made disasters have occurred for millennia, the use of CBRNE agents and devices by terrorists in recent decades has emphasized the need for increased preparedness. Natural disasters that occurred in 2011 killed tens of thousands of people and caused more than 350 billion dollars in losses. The earthquake and resulting tsunami in Japan, earthquakes in Haiti and New Zealand, the floods in Thailand and the Eastern United States (caused by Hurricane Irene), and the tornados that touched down in Joplin, Missouri, and in Alabama have produced calamities that were almost unimaginable in the past. In Alabama and Missouri, whole neighborhoods were wiped off the map. In addition to the direct damage caused by the earthquake and tsunami in Japan, the effect on the Fukushima nuclear power plant in Okuma continues to cause significant concern and morbidity. The intent of this chapter is to review and highlight what anesthesiologists need to know to manage victims when natural disasters occur or when CBRNE devices or agents, whether used by terrorists or released during an industrial accident, result in a major disaster causing a high number of casualties.
{"title":"Emergency Preparedness: Managing Victims of Chemical, Biological, Radiological, Nuclear, or High-explosive (CBRNE) Agents","authors":"M. Murray","doi":"10.1097/ASA.0b013e3182622bab","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182622bab","url":null,"abstract":"Preparing to manage disasters originating from natural events, industrial accidents, or, of more interest recently, caused intentionally by terrorists using chemical, biological, radiological, nuclear, or highexplosive (CBRNE) agents is a high priority for the US government and military as well as the American Society of Anesthesiologists. Even though natural and man-made disasters have occurred for millennia, the use of CBRNE agents and devices by terrorists in recent decades has emphasized the need for increased preparedness. Natural disasters that occurred in 2011 killed tens of thousands of people and caused more than 350 billion dollars in losses. The earthquake and resulting tsunami in Japan, earthquakes in Haiti and New Zealand, the floods in Thailand and the Eastern United States (caused by Hurricane Irene), and the tornados that touched down in Joplin, Missouri, and in Alabama have produced calamities that were almost unimaginable in the past. In Alabama and Missouri, whole neighborhoods were wiped off the map. In addition to the direct damage caused by the earthquake and tsunami in Japan, the effect on the Fukushima nuclear power plant in Okuma continues to cause significant concern and morbidity. The intent of this chapter is to review and highlight what anesthesiologists need to know to manage victims when natural disasters occur or when CBRNE devices or agents, whether used by terrorists or released during an industrial accident, result in a major disaster causing a high number of casualties.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"114–118"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182622bab","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020512","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 : 2012-01-01DOI: 10.1097/ASA.0b013e3182622c62
J. Ehrenwerth
Operating room (OR) fires are probably more common today than when anesthesiologists used explosive agents. This is the result of more combustible materials in the OR, more ignition sources, and the prevalent use of open oxygen during monitored anesthesia care. The Emergency Care Research Institute (ECRI) estimates that 500 to 600 OR fires occur each year in the United States. Most are self-limited and do not result in significant injury to the patient. However, there are many instances of a patient receiving a serious burn and occasionally death has been reported. As recently as 2009, a 65-year-old woman in southern Illinois died a few days after she was burned in an OR fire. Approximately 65% of fires today involve surgery on the head, neck, and upper chest area.
{"title":"A Fire in the Operating Room: It Could Happen to You!","authors":"J. Ehrenwerth","doi":"10.1097/ASA.0b013e3182622c62","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182622c62","url":null,"abstract":"Operating room (OR) fires are probably more common today than when anesthesiologists used explosive agents. This is the result of more combustible materials in the OR, more ignition sources, and the prevalent use of open oxygen during monitored anesthesia care. The Emergency Care Research Institute (ECRI) estimates that 500 to 600 OR fires occur each year in the United States. Most are self-limited and do not result in significant injury to the patient. However, there are many instances of a patient receiving a serious burn and occasionally death has been reported. As recently as 2009, a 65-year-old woman in southern Illinois died a few days after she was burned in an OR fire. Approximately 65% of fires today involve surgery on the head, neck, and upper chest area.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"65 1","pages":"26–31"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182622c62","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020659","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 : 2012-01-01DOI: 10.1097/ASA.0b013e31825da79e
K. Gipson, J. Gross
Safety in the delivery of anesthesia is inextricably linked to the proper functioning of anesthesia equipment and resuscitative equipment, and to the presence of a consultant in anesthesia who can maintain safety in the face of equipment failure. This consultant relies upon basic principles in troubleshooting and evaluation of alternatives when equipment malfunction occurs. This chapter reviews the standards and principles that underlie the function of anesthesia equipment, including measurement of patient variables and prevention of common safety mishaps (see Supplemental Digital Content 1, http://links.lww.com/ASA/A124).
{"title":"Physics in Anesthesiology: Basic Science Review","authors":"K. Gipson, J. Gross","doi":"10.1097/ASA.0b013e31825da79e","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825da79e","url":null,"abstract":"Safety in the delivery of anesthesia is inextricably linked to the proper functioning of anesthesia equipment and resuscitative equipment, and to the presence of a consultant in anesthesia who can maintain safety in the face of equipment failure. This consultant relies upon basic principles in troubleshooting and evaluation of alternatives when equipment malfunction occurs. This chapter reviews the standards and principles that underlie the function of anesthesia equipment, including measurement of patient variables and prevention of common safety mishaps (see Supplemental Digital Content 1, http://links.lww.com/ASA/A124).","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"40–49"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825da79e","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019931","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 : 2012-01-01DOI: 10.1097/ASA.0b013e31825e9a9e
L. Shore-lesserson, L. Enriquez
Learning Objectives: As a result of completing this activity, the participant will be able to Explain heparin resistance and alternatives to overcome it Describe heparin-induced thrombocytopenia and employ alternatives to heparin in the cardiac patient Compare and contrast the various direct thrombin inhibitors Understand the utilization of antifibrinolytic therapy in cardiac surgery Describe the various antiplatelet medications and use of point-of-care testing to guide therapy Describe the use of recombinant activated factor VII as rescue therapy in the bleeding cardiac patient
{"title":"Hematological Issues in Cardiovascular Surgery Patients","authors":"L. Shore-lesserson, L. Enriquez","doi":"10.1097/ASA.0b013e31825e9a9e","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825e9a9e","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Explain heparin resistance and alternatives to overcome it Describe heparin-induced thrombocytopenia and employ alternatives to heparin in the cardiac patient Compare and contrast the various direct thrombin inhibitors Understand the utilization of antifibrinolytic therapy in cardiac surgery Describe the various antiplatelet medications and use of point-of-care testing to guide therapy Describe the use of recombinant activated factor VII as rescue therapy in the bleeding cardiac patient","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"129–135"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825e9a9e","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020055","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 : 2012-01-01DOI: 10.1097/ASA.0b013e31825e9958
S. Wald
The challenge inherent to the care of infants and children is the basic principle that their development is a dynamic process. This is an important consideration when caring for a pediatric patient with a difficult airway. This is compounded by the fact that growth and change has extra metabolic demands such that the smaller the patient, the higher their relative metabolism. This increases oxygen consumption and in the cases of respiratory compromise hastens the effects of apnea. It is for these reasons that the difficult pediatric airway is particularly demanding of special attention.
{"title":"A Child With a Difficult Airway: What Do I Do Next?","authors":"S. Wald","doi":"10.1097/ASA.0b013e31825e9958","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825e9958","url":null,"abstract":"The challenge inherent to the care of infants and children is the basic principle that their development is a dynamic process. This is an important consideration when caring for a pediatric patient with a difficult airway. This is compounded by the fact that growth and change has extra metabolic demands such that the smaller the patient, the higher their relative metabolism. This increases oxygen consumption and in the cases of respiratory compromise hastens the effects of apnea. It is for these reasons that the difficult pediatric airway is particularly demanding of special attention.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"150–155"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825e9958","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020205","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 : 2012-01-01DOI: 10.1097/ASA.0b013e31826304c3
B. Gentz
Introduction The provision of anesthesia outside the operating room provides a unique set of challenges. The standards and principles that underlie the care of the patient should not be abandoned in satellite locations. However, patients who are referred for procedures in satellite locations may present with minimal preoperative information, possess challenging physical and anesthetic histories, and be scheduled in such a manner as to limit preparation time. The layout and special requirements of the satellite location can create unexpected barriers and may limit access to the patient and the availability of the anesthesia equipment. The challenges for the anesthesiologists include an unfamiliar environment, inadequate anesthesia support and insufficient number of trained personnel, and cramped, dark quarters and variability of monitoring modalities. In radiation oncology, MRI and occasionally the GI suite problems with noise and suboptimal positioning of the patient may be an issue.
{"title":"Anesthesia in Satellite Locations","authors":"B. Gentz","doi":"10.1097/ASA.0b013e31826304c3","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31826304c3","url":null,"abstract":"Introduction The provision of anesthesia outside the operating room provides a unique set of challenges. The standards and principles that underlie the care of the patient should not be abandoned in satellite locations. However, patients who are referred for procedures in satellite locations may present with minimal preoperative information, possess challenging physical and anesthetic histories, and be scheduled in such a manner as to limit preparation time. The layout and special requirements of the satellite location can create unexpected barriers and may limit access to the patient and the availability of the anesthesia equipment. The challenges for the anesthesiologists include an unfamiliar environment, inadequate anesthesia support and insufficient number of trained personnel, and cramped, dark quarters and variability of monitoring modalities. In radiation oncology, MRI and occasionally the GI suite problems with noise and suboptimal positioning of the patient may be an issue.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"32–39"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31826304c3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020681","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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