Pub Date : 2012-01-01DOI: 10.1097/ASA.0b013e318261329e
M. Swaminathan
Acute kidney injury (AKI) is a significant cause of morbidity and mortality among hospitalized patients, especially in the postoperative setting. In addition, it remains a significant complication of cardiac surgery throughout the world. Consequences of AKI include an increase in mortality risk that can exceed 60% among patients requiring dialysis. Even when serum creatinine values remain within the normal range, modest increases from baseline values are associated with higher odds of death and end-stage renal disease, as well as longer hospital stays and increased costs. The presence of multiple patient-related risk factors in the cardiac surgery population adds to unique intraoperative and procedurerelated factors, making this group of patients particularly vulnerable to the adverse effects of an acute renal insult. In general, there have been no improvements in incidence or mortality despite many recent advances in our understanding of the etiology and pathophysiology of AKI. Although the phenomenon of postoperative renal injury has been recognized for many decades, its definitions have continually evolved as its significance to outcomes has emerged. Multiple definitions initially hampered efforts at comparing results from different studies. However, with new consensus on a uniform definition of AKI, there are hopes for not only establishing the importance of this complication, but also for evaluating new biomarkers and assessing the effectiveness of preventive and therapeutic interventions in a universally acceptable manner.
{"title":"Postoperative Acute Kidney Injury in Cardiac Surgery","authors":"M. Swaminathan","doi":"10.1097/ASA.0b013e318261329e","DOIUrl":"https://doi.org/10.1097/ASA.0b013e318261329e","url":null,"abstract":"Acute kidney injury (AKI) is a significant cause of morbidity and mortality among hospitalized patients, especially in the postoperative setting. In addition, it remains a significant complication of cardiac surgery throughout the world. Consequences of AKI include an increase in mortality risk that can exceed 60% among patients requiring dialysis. Even when serum creatinine values remain within the normal range, modest increases from baseline values are associated with higher odds of death and end-stage renal disease, as well as longer hospital stays and increased costs. The presence of multiple patient-related risk factors in the cardiac surgery population adds to unique intraoperative and procedurerelated factors, making this group of patients particularly vulnerable to the adverse effects of an acute renal insult. In general, there have been no improvements in incidence or mortality despite many recent advances in our understanding of the etiology and pathophysiology of AKI. Although the phenomenon of postoperative renal injury has been recognized for many decades, its definitions have continually evolved as its significance to outcomes has emerged. Multiple definitions initially hampered efforts at comparing results from different studies. However, with new consensus on a uniform definition of AKI, there are hopes for not only establishing the importance of this complication, but also for evaluating new biomarkers and assessing the effectiveness of preventive and therapeutic interventions in a universally acceptable manner.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"142–149"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e318261329e","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020698","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.0b013e31825e545d
E. Seet, F. Chung
Author Disclosure Information: Dr. Seet has disclosed that he has no financial interests in or significant relationship with any commercial companies pertaining to this educational activity. Dr. Chung has disclosed that she receives funding for research from Pfizer, the ResMed Foundation, and the Respironic Foundation. Obstructive sleep apnea (OSA) is a clinical syndrome defined by repetitive partial or complete upper airway obstruction, characterized by episodes of breathing cessation during sleep lasting 10 or more seconds. The inherent pharyngeal collapsibility due to depression of pharyngeal muscle regulation during sleep and anesthesia predisposes to impaired respiration. Recurring airway obstruction causes repeated arousals and increased sympathetic output, cumulating in daytime hypersomnolence, memory loss, executive dysfunction, and other psychological disturbances.
{"title":"Perioperative Assessment and Risk Management in Patients With Obstructive Sleep Apnea","authors":"E. Seet, F. Chung","doi":"10.1097/ASA.0b013e31825e545d","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825e545d","url":null,"abstract":"Author Disclosure Information: Dr. Seet has disclosed that he has no financial interests in or significant relationship with any commercial companies pertaining to this educational activity. Dr. Chung has disclosed that she receives funding for research from Pfizer, the ResMed Foundation, and the Respironic Foundation. Obstructive sleep apnea (OSA) is a clinical syndrome defined by repetitive partial or complete upper airway obstruction, characterized by episodes of breathing cessation during sleep lasting 10 or more seconds. The inherent pharyngeal collapsibility due to depression of pharyngeal muscle regulation during sleep and anesthesia predisposes to impaired respiration. Recurring airway obstruction causes repeated arousals and increased sympathetic output, cumulating in daytime hypersomnolence, memory loss, executive dysfunction, and other psychological disturbances.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"119–128"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825e545d","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020147","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.0b013e31825e54d4
G. Gravlee
Learning Objectives: As a result of completing this activity, the participant will be able to Describe the major types of destination left ventricular assist devices and their anesthetic implications Describe major long-term complications of continuous-flow left ventricular assist devices Discuss the anesthetic management and acute complications of percutaneous MitraClip device placement Explain the two approaches to placement of transcutaneous aortic valves and describe critical intraprocedural management concerns and complications of the procedure Discuss the potential complications of percutaneous laser-assisted lead extraction and describe controversies about anesthetic management of the procedure
{"title":"Update on Cardiac Anesthesia","authors":"G. Gravlee","doi":"10.1097/ASA.0b013e31825e54d4","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825e54d4","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe the major types of destination left ventricular assist devices and their anesthetic implications Describe major long-term complications of continuous-flow left ventricular assist devices Discuss the anesthetic management and acute complications of percutaneous MitraClip device placement Explain the two approaches to placement of transcutaneous aortic valves and describe critical intraprocedural management concerns and complications of the procedure Discuss the potential complications of percutaneous laser-assisted lead extraction and describe controversies about anesthetic management of the procedure","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"50–57"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825e54d4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020193","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.0b013e318261324e
A. Buvanendran
Multimodal analgesia captures the effectiveness of individual agents in optimal dosages that maximize efficacy and attempts to minimize side effects from one analgesic (mainly opioids). This important concept employs the theory that agents with different mechanisms of analgesia that may have synergistic effects in preventing or treating acute pain when used in combination. These regimens must be tailored to individual patients, keeping in mind the procedure being performed, side effects of individual medications, and patients’ pre-existing medical conditions.1 The concept and theory of multimodal analgesia is not new; however several novel pharmacological agents have emerged and can be added to the drugs that can be used in this fashion. It is vital to realize that blocking the neuronal pathway during surgery with local anesthetics does not decrease the humeral biochemical responses that occur during surgery which have to be inhibited by administering systemic pharmacological therapy.2 This abstract will only focus on the recent advances in pharmacological agents for multimodal therapy.
{"title":"Multimodal Analgesia for Perioperative Pain Management","authors":"A. Buvanendran","doi":"10.1097/ASA.0b013e318261324e","DOIUrl":"https://doi.org/10.1097/ASA.0b013e318261324e","url":null,"abstract":"Multimodal analgesia captures the effectiveness of individual agents in optimal dosages that maximize efficacy and attempts to minimize side effects from one analgesic (mainly opioids). This important concept employs the theory that agents with different mechanisms of analgesia that may have synergistic effects in preventing or treating acute pain when used in combination. These regimens must be tailored to individual patients, keeping in mind the procedure being performed, side effects of individual medications, and patients’ pre-existing medical conditions.1 The concept and theory of multimodal analgesia is not new; however several novel pharmacological agents have emerged and can be added to the drugs that can be used in this fashion. It is vital to realize that blocking the neuronal pathway during surgery with local anesthetics does not decrease the humeral biochemical responses that occur during surgery which have to be inhibited by administering systemic pharmacological therapy.2 This abstract will only focus on the recent advances in pharmacological agents for multimodal therapy.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"1–6"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e318261324e","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020641","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.0b013e31825e9a10
J. Jacobs
B ioethics vignettes classically involve end-of-life, consent, and Jehovah’s Witness challenges, but there are many other situations that affect the practicing anesthesiologist. Some of these topics involve clinical practice, some deal with professional relationships, and others revolve around national and political issues. The unique feature of these situations is their removal from the usual doctor–patient interaction. The goal of this chapter is to outline three of these unusual bioethical issues and help formulate a strategy for addressing them.
{"title":"Ethical Dilemmas Coming Your Way: A Trio of Turmoil","authors":"J. Jacobs","doi":"10.1097/ASA.0b013e31825e9a10","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825e9a10","url":null,"abstract":"B ioethics vignettes classically involve end-of-life, consent, and Jehovah’s Witness challenges, but there are many other situations that affect the practicing anesthesiologist. Some of these topics involve clinical practice, some deal with professional relationships, and others revolve around national and political issues. The unique feature of these situations is their removal from the usual doctor–patient interaction. The goal of this chapter is to outline three of these unusual bioethical issues and help formulate a strategy for addressing them.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"58–64"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825e9a10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020251","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.0b013e3182603dab
W. Johnston
Both the severity and duration of intraoperative arterial hypotension correlate directly with surgical mortality. Particularly in elderly patients, delayed or inadequate correction of hypotension comprises nearly 40% of substandard intraoperative care and is closely associated with postoperative myocardial ischemia and infarction. Prompt correction of hypotension with restoration of normal blood pressure markedly reduces subsequent morbidity. Consequently, the practicing anesthesiologist needs an efficient and effective approach for diagnosing the cause of intraoperative hypotension and providing appropriate management. This chapter examines the basic cardiovascular physiological principles that regulate blood pressure using the algorithm depicted in Figure 1 (Supplemental Digital Content 1, http://links.lww.com/ASA/A212).
{"title":"Applied Cardiac Physiology","authors":"W. Johnston","doi":"10.1097/ASA.0b013e3182603dab","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182603dab","url":null,"abstract":"Both the severity and duration of intraoperative arterial hypotension correlate directly with surgical mortality. Particularly in elderly patients, delayed or inadequate correction of hypotension comprises nearly 40% of substandard intraoperative care and is closely associated with postoperative myocardial ischemia and infarction. Prompt correction of hypotension with restoration of normal blood pressure markedly reduces subsequent morbidity. Consequently, the practicing anesthesiologist needs an efficient and effective approach for diagnosing the cause of intraoperative hypotension and providing appropriate management. This chapter examines the basic cardiovascular physiological principles that regulate blood pressure using the algorithm depicted in Figure 1 (Supplemental Digital Content 1, http://links.lww.com/ASA/A212).","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"73–79"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182603dab","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020529","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.0000000000000025
I. Theruvath, S. Reeves
Learning Objectives: As a result of completing this activity, the participant will be able to Describe the most common congenital heart lesions encountered in patients who reach adulthood Discuss the anesthetic implications of long-term altered physiology in adult congenital heart disease Describe major difficulties in anesthetic management of adult congenital heart disease patients undergoing noncardiac surgery
{"title":"Congenital Heart Disease in the Adult Presenting for Noncardiac Surgery","authors":"I. Theruvath, S. Reeves","doi":"10.1097/ASA.0000000000000025","DOIUrl":"https://doi.org/10.1097/ASA.0000000000000025","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe the most common congenital heart lesions encountered in patients who reach adulthood Discuss the anesthetic implications of long-term altered physiology in adult congenital heart disease Describe major difficulties in anesthetic management of adult congenital heart disease patients undergoing noncardiac surgery","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"112-119"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0000000000000025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62017153","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.0b013e31825f5d02
S. Eagle, Annemarie Thompson
Learning Objectives: As a result of completing this activity, the participant will be able to: Describe the pathophysiology and surgical repair of common types of congenital heart lesions in the adult patient Explain the long-term physiological effects of unrepaired, repaired/palliated lesions in the adult congenital heart patient Describe the perioperative management of adults with unrepaired, repaired/palliated congenital heart lesions
{"title":"Congenital Heart Disease in the Adult Presenting for Noncardiac Surgery","authors":"S. Eagle, Annemarie Thompson","doi":"10.1097/ASA.0b013e31825f5d02","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825f5d02","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to: Describe the pathophysiology and surgical repair of common types of congenital heart lesions in the adult patient Explain the long-term physiological effects of unrepaired, repaired/palliated lesions in the adult congenital heart patient Describe the perioperative management of adults with unrepaired, repaired/palliated congenital heart lesions","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"18–25"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825f5d02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020425","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.0b013e31825ca3d6
B. Jericho
Learning Objectives: As a result of completing this activity, the participant will be able to Describe the similarities and differences between aviation and health care Explain the safety methods and tools used in the aviation industry Describe how health care can utilize the aviation industry’s safety methods and tools to improve patient safety Summarize existing healthcare patient safety initiatives and their roles in patient safety
{"title":"Come Fly With Me: Safety and Human Factors: Bringing Aviation into the Operating Room","authors":"B. Jericho","doi":"10.1097/ASA.0b013e31825ca3d6","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825ca3d6","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe the similarities and differences between aviation and health care Explain the safety methods and tools used in the aviation industry Describe how health care can utilize the aviation industry’s safety methods and tools to improve patient safety Summarize existing healthcare patient safety initiatives and their roles in patient safety","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"55 1","pages":"65–72"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825ca3d6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019845","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.0b013e31825f5c88
M. Stiegler
What does it feel like to be wrong? How can we know when we are making a mistake? We cannot, of course, because being wrong feels exactly like being right. We are oblivious to our errors at the time that we commit them. There is only the experience of realizing that we have been wrong. This idea of error blindness, put forth by Kathryn Schulz, may be summarized as: ‘‘We can be wrong, or we can know it, but we can’t do both at the same time’’ (Supplemental Digital Content 1, http://links.lww.com/ ASA/A200). The time lapse between thinking a wrong thought or making a wrong decision, and subsequently realizing it, may be very brief or very protracted. Indeed, there are likely many errors you have made of which you will never be aware. Despite error blindness, we must still endeavor to understand our thinking processes and aim to reduce errors and recover from them better and faster (Figure 1).
{"title":"Cognitive Errors in Anesthesiology: Making Mistakes Even When We “Know” Better","authors":"M. Stiegler","doi":"10.1097/ASA.0b013e31825f5c88","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825f5c88","url":null,"abstract":"What does it feel like to be wrong? How can we know when we are making a mistake? We cannot, of course, because being wrong feels exactly like being right. We are oblivious to our errors at the time that we commit them. There is only the experience of realizing that we have been wrong. This idea of error blindness, put forth by Kathryn Schulz, may be summarized as: ‘‘We can be wrong, or we can know it, but we can’t do both at the same time’’ (Supplemental Digital Content 1, http://links.lww.com/ ASA/A200). The time lapse between thinking a wrong thought or making a wrong decision, and subsequently realizing it, may be very brief or very protracted. Indeed, there are likely many errors you have made of which you will never be aware. Despite error blindness, we must still endeavor to understand our thinking processes and aim to reduce errors and recover from them better and faster (Figure 1).","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"34 1","pages":"136–141"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825f5c88","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019914","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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