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Korean Journal of Anesthesiology Feb 2020The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these... (Review)
Review
The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.
Topics: Age Factors; Aged; Anesthesiologists; Anesthesiology; Anesthetics; Humans; Perioperative Care; Postoperative Complications
PubMed: 31636241
DOI: 10.4097/kja.19391 -
International Anesthesiology Clinics 2019
Review
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Anesthetics; Child; Fontan Procedure; Humans; Surgical Procedures, Operative
PubMed: 31503095
DOI: 10.1097/AIA.0000000000000250 -
Medicine Jul 2023The level of endothelial glycocalyx (EG) shedding is associated with morbidity and mortality, and vascular endothelial barrier dysfunction is one of the pivotal clinical... (Review)
Review
The level of endothelial glycocalyx (EG) shedding is associated with morbidity and mortality, and vascular endothelial barrier dysfunction is one of the pivotal clinical problems faced by critically ill patients, so research on the protective effects of EG is of great clinical significance for the treatment of critically ill diseases. Studies have illustrated that clinical anesthesia has different degrees of effects on vascular EG. Therefore, we reviewed the effects of distinct anesthesia methods and diverse anesthetic drugs on EG, aiming to provide a brief summary of what we know now, and to discuss possible future directions for investigations in this area. So as to provide a theoretical basis for future research on potential EG-positive drugs and targets, to minimize perioperative complications and improve the prognosis of surgical patients.
Topics: Humans; Glycocalyx; Critical Illness; Anesthesia; Anesthesiology; Endothelium, Vascular; Vascular Diseases; Anesthetics
PubMed: 37443493
DOI: 10.1097/MD.0000000000034265 -
Canadian Journal of Anaesthesia =... May 2015While a few publications specify the anesthetic implications of either brain or cardiac death, they lack detail on how to provide anesthesia during organ donation... (Review)
Review
PURPOSE
While a few publications specify the anesthetic implications of either brain or cardiac death, they lack detail on how to provide anesthesia during organ donation surgery. We provide a thorough description of important anesthetic considerations during organ donation surgery in patients with either brain or cardiac death.
SOURCE
A thorough literature review was undertaken to locate all relevant articles that describe systemic effects of brain and cardiac death and their anesthetic implications. We searched PubMed, Pubget, and EMBASEā¢ for relevant articles using the following search terms: anesthesia, management, donation cardiac death, donation brain death. In addition, we reviewed the relevant protocols at our own institution.
PRINCIPAL FINDINGS
Highly specific intraoperative management by an anesthesiologist is required during organ procurement after brain death. To manage the heart-beating brain-dead donor, the anesthesiologist must incorporate knowledge of the effects of brain death on each organ system as well as the effects of the preoperative measures that the donor required in the intensive care unit. It is also important to know which organs are going to be procured in order to establish specific goals and implement strategies (e.g., lung-protective ventilation or intraoperative glycemic control) to optimize donor outcome. During organ procurement after cardiac death, an anesthesiologist's direct involvement is particularly important for lung donors.
CONCLUSION
Anesthesiologist-guided physiological optimization of the brain-dead donor may be a factor in determining the outcome of the organ recipient. Additionally, anesthesiologists have an important role in helping to ensure that the highest quality and most appropriate care are rendered to non-heart-beating donors. This is achieved through establishing protocols in their hospitals for donation after cardiac death that maximize the number of available organs with the best chance for long-term graft viability.
Topics: Anesthesia; Anesthesiology; Anesthetics; Brain Death; Death; Humans; Quality of Health Care; Tissue and Organ Harvesting; Tissue and Organ Procurement
PubMed: 25715847
DOI: 10.1007/s12630-015-0345-8 -
Pain Physician May 2017Patients with implanted spinal cord stimulators (SCS) present to the anesthesia care team for management at many different points along the care continuum. Currently,... (Review)
Review
BACKGROUND
Patients with implanted spinal cord stimulators (SCS) present to the anesthesia care team for management at many different points along the care continuum. Currently, the literature is sparse on the perioperative management. What is available is confusing; monopolar electrocautery is contraindicated but often used, full body magnetic resonance imaging (MRI) is safe with particular systems but with other manufactures only head and specific extremities exams are safe. Moreover, there are anesthetizing locations outside of the operating room where implanted SCS can interact with surrounding medical equipment and pose significant risk to patient and device.
OBJECTIVES
The objective of this review is to present relevant known literature about the safe management of SCS in the perioperative period and to begin to develop recommendations.
STUDY DESIGN
A review of current literature and each manufacturers' labeling was performed to assess risk of interference and patient harm between SCS and technology used in and around typical anesthetizing locations.
METHODS
A systematic search of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A computerized search was conducted for English articles in print up to April 2016 via PubMed www.ncbi.nlm.nih.gov/pubmed; EMBASE www.embase.com; and Cochrane Library www.thecochranelibrary.com. Search terms included "spinal cord stimulator AND MRI," "spinal cord stimulator AND ECG," "spinal cord stimulator AND implanted cardiac device," "spinal cord stimulator AND electrocautery," and "spinal cord stimulator AND obstetrics." In addition, a search of Google and Google Scholar was performed. Websites of SCS manufactures were reviewed.
RESULTS
Generalized recommendations include turning the amplitude of the SCS to the lowest possible SETTING and turning off prior to any procedure. Monopolar electrocautery is contraindicated but is still often utilized; placing grounding pads as far away from the device can reduce the risk to device and patient. Bipolar cautery is favored. Implanted cardiac devices can interfere with SCS, but risks can be minimized. Neuraxial anesthesia can be attempted in a patient with implanted SCS, provided the device is not in the expected path. MRI labeling differences present the biggest difference among SCS manufactures. Medtronic's SureScan SCS, Boston Scientific's Precision system, St. Jude's Proclaim, and Stimwave's Freedome SCS are full body MRI compatible under specific conditions, while other manufacturers have labeling that restricts exams of the trunk and certain extremities.
LIMITATIONS
This review was intended to be a comprehensive, cumulative review of recommendations for perioperative SCS management; however, the limitations of a review of this nature is the complete reliance on previously published research and the availability of these studies using the methods outlined.
CONCLUSIONS
SCS is being used earlier in the treatment algorithm for patients with chronic pain. The anesthesia care team needs working knowledge of where the device resides in the neuraxial space and what risks different medical technologies pose to the patient and device. This understanding will lead to appropriate perioperative management which can reduce risk and improve patient outcomes.
Topics: Anesthesiology; Anesthetics; Chronic Pain; Humans; Pain Management; Perioperative Care; Spinal Cord; Spinal Cord Stimulation
PubMed: 28535554
DOI: No ID Found -
Current Clinical Pharmacology 2015Kidney transplants are routinely performed at medical centers around the world. Concurrent with improved surgical techniques, a better understanding of the pharmacology... (Review)
Review
Kidney transplants are routinely performed at medical centers around the world. Concurrent with improved surgical techniques, a better understanding of the pharmacology involved in the perioperative anesthetic management has led to improved outcomes in these patients. This chapter reviews the perioperative pharmacologic considerations surrounding kidney transplant patients from the viewpoint of the transplant anesthesiologist.
Topics: Anesthesiology; Anesthetics; Animals; Humans; Kidney Diseases; Kidney Transplantation
PubMed: 24521193
DOI: 10.2174/1574884709666140212100059 -
Current Clinical Pharmacology 2015The number of patients with end stage liver disease is growing worldwide. This is likely a result of advances in medical science that have allowed these patients to lead... (Review)
Review
The number of patients with end stage liver disease is growing worldwide. This is likely a result of advances in medical science that have allowed these patients to lead longer lives since the incidence of diseases such as alcoholic cirrhosis and viral hepatitis have remained stable or even decreased in recent years, at least in more developed nations. Many of these patients will require anesthetic care at some point. The understanding and application of basic principles of pharmacokinetics is paramount to the practice of anesthesia. An understanding of pharmacokinetic principles provides the anesthesiologist with a scientific foundation for achieving therapeutic objectives associated with the use of any drug; however, pathologic conditions often alter the expected kinetic profile of many drugs. Anesthesia providers caring for these patients must be aware of the altered pharmacokinetics that may occur in these patients. We review normal liver physiology, pathophysiology of liver disease in general, and how liver failure affects the pharmacokinetics and pharmacodynamics of anesthetic agents; providing some specific examples.
Topics: Anesthesiology; Anesthetics; Animals; End Stage Liver Disease; Humans; Liver Transplantation
PubMed: 24521189
DOI: 10.2174/1574884709666140212110036 -
British Journal of Anaesthesia Nov 2020The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere,... (Review)
Review
The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere, land, and waterways. We surveyed the 'state of the art' environmental sustainability research in anaesthesia and critical care, addressing why it matters, what is known, and ideas for future work. Focus is placed upon the atmospheric chemistry of the anaesthetic gases, recent work clarifying their relative global warming potentials, and progress in waste anaesthetic gas treatment. Life cycle assessment (LCA; i.e. 'cradle to grave' analysis) is introduced as the definitive method used to compare and contrast ecological footprints of products, processes, and systems. The number of LCAs within medicine has gone from rare to an established body of knowledge in the past decade that can inform doctors of the relative ecological merits of different techniques. LCAs with practical outcomes are explored, such as the carbon footprint of reusable vs single-use anaesthetic devices (e.g. drug trays, laryngoscope blades, and handles), and the carbon footprint of treating an ICU patient with septic shock. Avoid, reduce, reuse, recycle, and reprocess are then explored. Moving beyond routine clinical care, the vital influences that the source of energy (renewables vs fossil fuels) and energy efficiency have in healthcare's ecological footprint are highlighted. Discussion of the integral roles of research translation, education, and advocacy in driving the perioperative and critical care environmental sustainability agenda completes this review.
Topics: Anesthesia; Anesthesiology; Anesthetics; Carbon; Climate Change; Conservation of Natural Resources; Critical Care; Environmental Pollutants; Environmental Pollution; Equipment Reuse; Humans; Recycling; Shock, Septic
PubMed: 32798068
DOI: 10.1016/j.bja.2020.06.055 -
Minerva Anestesiologica Jan 2019
Topics: Anesthesia; Anesthesiology; Anesthetics, Inhalation; Xenon
PubMed: 30394076
DOI: 10.23736/S0375-9393.18.13303-7 -
Anesthesia and Analgesia Apr 2018
Review
Topics: Anesthesiology; Anesthetics; Drug Costs; Drugs, Essential; Government Regulation; Health Policy; Health Services Accessibility; Humans; Patient Safety; Policy Making; Quality Control; Risk Assessment; Risk Factors
PubMed: 29547430
DOI: 10.1213/ANE.0000000000002746