Pub Date : 2011-01-01DOI: 10.1097/ASA.0b013e31822a1255
C. Wong
Learning Objectives: As a result of completing this activity, the participant will be able to Describe the effects of neuraxial labor analgesia on the rate of cesarean delivery Examine the effects of neuraxial labor analgesia on the rate of instrumental vaginal delivery, including how the density of neuroblockade influences the risk of operative delivery Explain the effects of neuraxial labor analgesia on the duration of labor
{"title":"Neuraxial Labor Analgesia and Pregnancy Outcome: Fact and Fiction","authors":"C. Wong","doi":"10.1097/ASA.0b013e31822a1255","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31822a1255","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe the effects of neuraxial labor analgesia on the rate of cesarean delivery Examine the effects of neuraxial labor analgesia on the rate of instrumental vaginal delivery, including how the density of neuroblockade influences the risk of operative delivery Explain the effects of neuraxial labor analgesia on the duration of labor","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"155–161"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31822a1255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019720","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 : 2011-01-01DOI: 10.1097/ASA.0B013E318228851B
J. OʼHara
Learning Objectives: As a result of completing this activity, the participant will be able to Describe how new surgical techniques for transurethral resection of the prostate (TURP) have impacted anesthetic management and patient outcome Explain current perioperative challenges in urological robotic and renal calculi procedures Interpret the anesthesiologist’s role in renal transplantation in distinct perioperative phases (donor management, allograft preservation, and recipient management) that determine transplant outcome
{"title":"Anesthesia for Select Urologic Procedures","authors":"J. OʼHara","doi":"10.1097/ASA.0B013E318228851B","DOIUrl":"https://doi.org/10.1097/ASA.0B013E318228851B","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe how new surgical techniques for transurethral resection of the prostate (TURP) have impacted anesthetic management and patient outcome Explain current perioperative challenges in urological robotic and renal calculi procedures Interpret the anesthesiologist’s role in renal transplantation in distinct perioperative phases (donor management, allograft preservation, and recipient management) that determine transplant outcome","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"115-119"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E318228851B","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62018872","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 : 2011-01-01DOI: 10.1097/ASA.0b013e3182299ff4
Y. Beilin
Neuraxial analgesia is routinely administered to the parturient. A devastating, albeit rare, complication of neuraxial anesthesia is spinal or epidural hematoma, and primarily occurs in patients with disorders of hemostasis. A parturient with a clinically active coagulation disorder or someone with a history of easy bruising and/or bleeding is considered to have an absolute contraindication to regional anesthesia. However, many areas of controversy exist. The concern most anesthesiologists have regarding thrombocytopenia is determining the lowest platelet count at which it is still safe to perform a neuraxial anesthetic technique. In addition, an increasing number of women are receiving anticoagulant medications during pregnancy and low molecular weight heparin (LMWH) is a commonly used agent. The role of platelets in the coagulation process, the most common disorders in pregnancy that lead to thrombocytopenia, and the laboratory tests available to assess platelet function will be reviewed and practical recommendations provided as to the anesthetic management of the parturient with thrombocytopenia and one who is taking LMWH.
{"title":"Thrombocytopenia and Low Molecular Weight Heparin in the Parturient: Implications for Neuraxial Anesthesia","authors":"Y. Beilin","doi":"10.1097/ASA.0b013e3182299ff4","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182299ff4","url":null,"abstract":"Neuraxial analgesia is routinely administered to the parturient. A devastating, albeit rare, complication of neuraxial anesthesia is spinal or epidural hematoma, and primarily occurs in patients with disorders of hemostasis. A parturient with a clinically active coagulation disorder or someone with a history of easy bruising and/or bleeding is considered to have an absolute contraindication to regional anesthesia. However, many areas of controversy exist. The concern most anesthesiologists have regarding thrombocytopenia is determining the lowest platelet count at which it is still safe to perform a neuraxial anesthetic technique. In addition, an increasing number of women are receiving anticoagulant medications during pregnancy and low molecular weight heparin (LMWH) is a commonly used agent. The role of platelets in the coagulation process, the most common disorders in pregnancy that lead to thrombocytopenia, and the laboratory tests available to assess platelet function will be reviewed and practical recommendations provided as to the anesthetic management of the parturient with thrombocytopenia and one who is taking LMWH.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"6–12"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182299ff4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019475","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 : 2011-01-01DOI: 10.1097/ASA.0b013e3182289832
R. Litman
Learning Objectives: As a result of completing this activity, the participant will be able to Explain the ambulatory surgery center protocols for diagnosis and treatment of malignant hyperthermia (MH) Employ the current guidelines for anesthetic management and discharge of MH-susceptible patients in an ambulatory setting Discuss MH-associated diseases: Who should receive a trigger-free technique?
{"title":"Management of Malignant Hyperthermia and Malignant Hyperthermia–susceptible Patients in the Ambulatory Setting","authors":"R. Litman","doi":"10.1097/ASA.0b013e3182289832","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182289832","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Explain the ambulatory surgery center protocols for diagnosis and treatment of malignant hyperthermia (MH) Employ the current guidelines for anesthetic management and discharge of MH-susceptible patients in an ambulatory setting Discuss MH-associated diseases: Who should receive a trigger-free technique?","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"86–91"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182289832","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019130","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 : 2011-01-01DOI: 10.1097/ASA.0B013E3182287C4C
B. Gold
In the outpatient setting the preoperative anesthesia assessment – which exists in a variety of forms is a key tool for both optimizing medical and administrative outcomes. Proactive identification and management of medical problems avoids last minute surprises that at best interrupt ambulatory surgery center patient flow and at worst contribute to adverse medical outcomes. This lecture will review: 1) the basic requirements for preoperative evaluation as determined by payers and regulators 2) models of preoperative evaluation and their merits and 3) preanesthetic evaluation of selected co-morbidities which are particularly relevant to the outpatient setting such as obesity, sleep apnea, cardiac disease, and insulin requiring diabetes.
{"title":"Preoperative Evaluation of the Adult Outpatient","authors":"B. Gold","doi":"10.1097/ASA.0B013E3182287C4C","DOIUrl":"https://doi.org/10.1097/ASA.0B013E3182287C4C","url":null,"abstract":"In the outpatient setting the preoperative anesthesia assessment – which exists in a variety of forms is a key tool for both optimizing medical and administrative outcomes. Proactive identification and management of medical problems avoids last minute surprises that at best interrupt ambulatory surgery center patient flow and at worst contribute to adverse medical outcomes. This lecture will review: 1) the basic requirements for preoperative evaluation as determined by payers and regulators 2) models of preoperative evaluation and their merits and 3) preanesthetic evaluation of selected co-morbidities which are particularly relevant to the outpatient setting such as obesity, sleep apnea, cardiac disease, and insulin requiring diabetes.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"57-64"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E3182287C4C","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62018772","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 : 2011-01-01DOI: 10.1097/ASA.0B013E3182287E0B
Catherine M. Kuhn
The goal of any anesthesiology practice, academic or private, should be to add partners and employees who improve the function and value of the group. Hiring a person who underperforms immediately decreases the productivity of the organization. Managers realize quickly that they spend a disproportionate amount of their time dealing with underperforming employees, at a cost to their groups. The best employees require relatively little effort once established in the group. How is it, then, that nearly every organization at some point fails to hire the best person for its needs?
{"title":"How to Avoid Recruiting the Problem Employee (and What to Do Once You Have One)","authors":"Catherine M. Kuhn","doi":"10.1097/ASA.0B013E3182287E0B","DOIUrl":"https://doi.org/10.1097/ASA.0B013E3182287E0B","url":null,"abstract":"The goal of any anesthesiology practice, academic or private, should be to add partners and employees who improve the function and value of the group. Hiring a person who underperforms immediately decreases the productivity of the organization. Managers realize quickly that they spend a disproportionate amount of their time dealing with underperforming employees, at a cost to their groups. The best employees require relatively little effort once established in the group. How is it, then, that nearly every organization at some point fails to hire the best person for its needs?","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"80-85"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E3182287E0B","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62018789","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 : 2011-01-01DOI: 10.1097/ASA.0b013e3182284608
L. Clark
Learning Objectives: As a result of completing this activity, the participant will be able to Choose techniques in the airway algorithm for application in the trauma patient Explain the current rationale behind fluid and blood administration in the trauma patient Illustrate why organization is the key to success in caring for the trauma patient Specify why the treatment of pain in the trauma patient may be important to outcomes
{"title":"Regional Anesthesia in Trauma","authors":"L. Clark","doi":"10.1097/ASA.0b013e3182284608","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182284608","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Choose techniques in the airway algorithm for application in the trauma patient Explain the current rationale behind fluid and blood administration in the trauma patient Illustrate why organization is the key to success in caring for the trauma patient Specify why the treatment of pain in the trauma patient may be important to outcomes","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"23–32"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182284608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62018704","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 : 2011-01-01DOI: 10.1097/ASA.0B013E3182284668
A. Kopman
Learning Objectives: As a result of completing this activity, the participant will be able to Describe the various stimulus sequences used in evaluating depth of neuromuscular block Demonstrate how adequate recovery from nondepolarizing neuromuscular block is defined Explain the clinical implications of various trainof-four values Discuss the various technologies (EMG, AMG, MMG) used to measure the indirectly evoked muscle response
{"title":"Monitoring Neuromuscular Function: Facts and Fallacies","authors":"A. Kopman","doi":"10.1097/ASA.0B013E3182284668","DOIUrl":"https://doi.org/10.1097/ASA.0B013E3182284668","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe the various stimulus sequences used in evaluating depth of neuromuscular block Demonstrate how adequate recovery from nondepolarizing neuromuscular block is defined Explain the clinical implications of various trainof-four values Discuss the various technologies (EMG, AMG, MMG) used to measure the indirectly evoked muscle response","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"72-79"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E3182284668","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62018719","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 : 2011-01-01DOI: 10.1097/ASA.0B013E3182287F2F
R. Pearl
In 1973, when the World Health Organization organized the first international conference on pulmonary hypertension (PH), there were no effective therapies and median survival for patients with primary PH (now termed idiopathic pulmonary arterial hypertension) was under three years. Today, there are multiple therapies and survival has more than doubled. As a result, more patients with PH undergo anesthesia and surgery. Successful perioperative management of a patient with PH requires multiple steps (Table 1): recognizing the disorder, diagnosing the etiology, assessing the severity of the disease, assessing the risks and benefits of anesthesia and surgery, developing an anesthetic plan, and managing systemic hypotension and right heart failure.
{"title":"Perioperative Management of Patients With Pulmonary Hypertension","authors":"R. Pearl","doi":"10.1097/ASA.0B013E3182287F2F","DOIUrl":"https://doi.org/10.1097/ASA.0B013E3182287F2F","url":null,"abstract":"In 1973, when the World Health Organization organized the first international conference on pulmonary hypertension (PH), there were no effective therapies and median survival for patients with primary PH (now termed idiopathic pulmonary arterial hypertension) was under three years. Today, there are multiple therapies and survival has more than doubled. As a result, more patients with PH undergo anesthesia and surgery. Successful perioperative management of a patient with PH requires multiple steps (Table 1): recognizing the disorder, diagnosing the etiology, assessing the severity of the disease, assessing the risks and benefits of anesthesia and surgery, developing an anesthetic plan, and managing systemic hypotension and right heart failure.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"126-133"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E3182287F2F","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62018964","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 : 2011-01-01DOI: 10.1097/ASA.0b013e3182288329
M. Rosen
Learning Objectives: As a result of completing this activity, the participant will be able to Identify maternal physiologic changes that affect anesthetic management Recognize potential adverse impact of surgery during pregnancy on fetal well-being Recognize the difficulties associated with definitive identification of potential teratogenic agents Assess the merits and problems of intraoperative fetal monitoring
{"title":"Anesthesia for the Pregnant Patient Undergoing Nonobstetric Surgery","authors":"M. Rosen","doi":"10.1097/ASA.0b013e3182288329","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182288329","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Identify maternal physiologic changes that affect anesthetic management Recognize potential adverse impact of surgery during pregnancy on fetal well-being Recognize the difficulties associated with definitive identification of potential teratogenic agents Assess the merits and problems of intraoperative fetal monitoring","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"134–141"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182288329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019149","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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