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    636 results match your criteria Anesthesiology Clinics[Journal]

    1 OF 13

    Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery.
    Anesthesiol Clin 2017 Sep 5;35(3):539-553. Epub 2017 Jul 5.
    Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, F5-704, Chicago, IL 60611, USA.
    As solid organ transplantation increases and patient survival improves, it will become more common for these patients to present for nontransplant surgery. Recipients may present with medical problems unique to the transplant, and important considerations are necessary to keep the transplanted organ functioning. A comprehensive preoperative examination with specific focus on graft functioning is required, and the anesthesiologist needs pay close attention to considerations of immunosuppressive regimens, blood product administration, and the risk benefits of invasive monitoring in these immunosuppressed patients. Read More

    Anesthesia and Perioperative Care in Reconstructive Transplantation.
    Anesthesiol Clin 2017 Sep 5;35(3):523-538. Epub 2017 Jul 5.
    Departments of Surgery, Ophthalmology and Bioengineering, US Air Force, Wake Forest Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, Richard H. Dean Biomedical Building, 391 Technology Way, Winston Salem, NC 27101, USA. Electronic address:
    Reconstructive transplantation of vascularized composite allografts (VCAs), such as upper extremity, craniofacial, abdominal, lower extremity, or genitourinary transplants, has emerged as a cutting-edge specialty, with more than 50 programs in the United States and 30 programs across the world performing these procedures. Most VCAs involve complicated technical planning and preparation, protracted surgery, and complex immunosuppressive or immunomodulatory protocols, each associated with unique anesthesiology challenges. This article outlines key procedural, patient, and protocol-related aspects of VCA relevant to anesthesiology management with the goal of ensuring patient safety and optimizing surgical, immunologic, and functional outcomes. Read More

    Anesthesia for Intestinal Transplantation.
    Anesthesiol Clin 2017 Sep 5;35(3):509-521. Epub 2017 Jul 5.
    Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
    The diagnosis of irreversible intestinal failure confers significant morbidity, mortality, and decreased quality of life. Patients with irreversible intestinal failure may be treated with intestinal transplantation. Intestinal transplantation may include intestine only, liver-intestine, or other visceral elements. Read More

    Anesthesia for Liver Transplantation.
    Anesthesiol Clin 2017 Sep 10;35(3):491-508. Epub 2017 Jul 10.
    Department of Anesthesiology, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA. Electronic address:
    The provision of anesthesia for a liver transplant program requires a dedicated team of anesthesiologists. Liver transplant anesthesiologists must have an understanding of liver physiology and anatomy; the spectrum of clinical disease associated with liver dysfunction; the impact of warm and cold ischemia times, surgical techniques in liver transplantation, and the impact of ischemia-reperfusion syndrome; and optimal practices to protect the liver. The team must provide a 24-hour service, be actively involved in the selection committee process, and stay current with advances in the subspecialty. Read More

    Anesthesia for Lung Transplantation.
    Anesthesiol Clin 2017 Sep 5;35(3):473-489. Epub 2017 Jul 5.
    Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine, University of California, 757 Westwood Boulevard, Suite 3325, Los Angeles, CA 90095, USA.
    Perioperative management of patients undergoing lung transplantation is challenging and requires constant communication among the surgical, anesthesia, perfusion, and nursing teams. Although all aspects of anesthetic management are important, certain intraoperative strategies (mechanical ventilation, fluid management, extracorporeal mechanical support deployment) have tremendous impact on the subsequent evolution of the lung transplant recipient, especially with respect to allograft function, and should be carefully considered. This review highlights some of the intraoperative anesthetic challenges and opportunities during lung transplantation. Read More

    Anesthesia for Heart Transplantation.
    Anesthesiol Clin 2017 Sep 5;35(3):453-471. Epub 2017 Jul 5.
    Department of Anesthesiology, Loma Linda Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA.
    This article seeks to evaluate current practices in heart transplantation. The goals of this article were to review current practices for heart transplantation and its anesthesia management. The article reviews current demographics and discusses the current criteria for candidacy for heart transplantation. Read More

    Anesthesia for Kidney and Pancreas Transplantation.
    Anesthesiol Clin 2017 Sep 10;35(3):439-452. Epub 2017 Jul 10.
    Department of Anesthesiology, Columbia University Medical Center, College of Physicians & Surgeons, Columbia University, PH 527-B, 630 West 168th Street, New York, NY 10032, USA. Electronic address:
    Kidney transplants are the most common solid organ abdominal transplant and are occasionally performed simultaneously with pancreas transplants in diabetic patients. Preoperative evaluation of potential transplant recipients should focus on the potential for occult cardiovascular disease while also screening for other signs of end-organ dysfunction. Intraoperatively, it is of utmost importance to ensure adequate graft perfusion to limit the risk of postoperative graft dysfunction or rejection. Read More

    Anesthetic Management of Pediatric Liver and Kidney Transplantation.
    Anesthesiol Clin 2017 Sep 10;35(3):421-438. Epub 2017 Jul 10.
    Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, 225 East Chicago Avenue, Box 19, Chicago, IL 60611-2605, USA.
    Pediatric patients with liver dysfunction and renal failure may exhibit many comorbidities. There are often associated congenital syndromes to be taken into account. Liver and renal transplantation offer a solution and substantial improvement in quality of life. Read More

    Transfusion Medicine and Coagulation Management in Organ Transplantation.
    Anesthesiol Clin 2017 Sep 10;35(3):407-420. Epub 2017 Jul 10.
    Department of Anesthesiology and Pain Management, William P. Clements University Hospital, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, MC 9202, Dallas, TX 75390, USA. Electronic address:
    Organ transplantation recipients present unusual challenges with regard to blood transfusion. Although this patient population requires a larger proportion of blood product resources, liberal transfusion of allogeneic blood products can lead to a plethora of complications. Recent trends suggest that efforts to minimize bleeding, conserve products, and target transfusion to specific deficits and needs are increasingly becoming the standard practice; these must all occur with optimization of graft function and preservation in mind. Read More

    Anesthesia Management of Organ Donors.
    Anesthesiol Clin 2017 Sep 5;35(3):395-406. Epub 2017 Jul 5.
    Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Anesthesiology, Greater Los Angeles VA Hospital, Los Angeles, CA, USA.
    The shortage of suitable organs is the biggest obstacle for transplants. At present, most organs for transplant in the United States are from donation after neurologic determination of death (brain death). Potential organs for transplant need to maintain their viability during a series of insults, including the original disease, physiologic derangements during the dying process, ischemia, and reperfusion. Read More

    Infectious Complications and Malignancies Arising After Liver Transplantation.
    Anesthesiol Clin 2017 Sep 5;35(3):381-393. Epub 2017 Jul 5.
    Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address:
    Since the first liver transplant was performed in 1963, great advancements have been made in hepatic transplantation. Surgical techniques have been revised and improved, diagnostic methods for identifying and preventing infections have been developed, and a more conservative use of immunosuppressive agents has resulted in better long-term posttransplant outcomes. A total of 7841 liver transplantations were performed in the United States in 2016, resulting in greater than 85% survival at 1 year posttransplant. Read More

    Overview of Immunosuppressive Therapy in Solid Organ Transplantation.
    Anesthesiol Clin 2017 Sep;35(3):365-380
    Clinical Research Program, UCLA Department of Surgery, Dumont-UCLA Transplant Center, David Geffen School of Medicine at UCLA, 650 CE Young Drive South, Room 77-123CHS, Los Angeles, CA 90095-7054, USA. Electronic address:
    Mechanisms of rejection, new pharmacologic approaches, and genomic medicine are major foci for current research in transplantation. It is hoped that these new agents and personalized immunosuppression will provide for less toxic regimens that are effective in preventing both acute and chronic allograft rejection. Until new agents are available, practitioners must use various combinations of currently approved agents to find the best regimens for improved long-term outcomes. Read More

    New Hypnotic Drug Development and Pharmacologic Considerations for Clinical Anesthesia.
    Anesthesiol Clin 2017 Jun 14;35(2):e95-e113. Epub 2017 Apr 14.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    Since the public demonstration of ether as a novel, viable anesthetic for surgery in 1846, the field of anesthesia has continually sought the ideal anesthetic-rapid onset, potent sedation-hypnosis with a high therapeutic ratio of toxic dose to minimally effective dose, predictable clearance to inactive metabolites, and minimal side effects. This article aims to review current progress of novel induction agent development and provide an update on the most promising drugs poised to enter clinical practice. In addition, the authors describe trends in novel agent development, implications for health care costs, and implications for perioperative care. Read More

    Pharmacologic Considerations of Anesthetic Agents in Pediatric Patients: A Comprehensive Review.
    Anesthesiol Clin 2017 Jun 14;35(2):e73-e94. Epub 2017 Apr 14.
    Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, PO Box 33932, Shreveport, LA 71130-3932, USA.
    Acute pain in the pediatric population has important differences in terms of biology, intrapopulation variation, and epidemiology. Discussion as to the pharmacologic considerations of anesthetic agents, such as induction agents, neuromuscular blockers, opioids, local anesthetics, and adjuvant agents, is presented in this article. Special considerations and concerns, such as risk for propofol infusion syndrome and adverse potential side effects of anesthesia agents, are discussed. Read More

    An Update on Nonopioids: Intravenous or Oral Analgesics for Perioperative Pain Management.
    Anesthesiol Clin 2017 Jun 30;35(2):e55-e71. Epub 2017 Mar 30.
    Department of Anesthesiology, LSU School of Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
    Despite an appreciation for many unwanted physiologic effects from inadequate postoperative pain relief, moderate to severe postoperative pain remains commonplace. Although treatment options have evolved in recent years, the use of nonopioid analgesics agents can reduce acute pain-associated morbidity and mortality. This review focuses on the importance of effective postoperative nonopioid analgesic agents, such as acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoid agents, NMDA antagonists, alpha 2 agonists, and steroids, in opioid sparing and enhancing recovery. Read More

    Pharmacology of Antiemetics: Update and Current Considerations in Anesthesia Practice.
    Anesthesiol Clin 2017 Jun;35(2):e41-e54
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
    Postoperative nausea and vomiting (PONV) is associated with delayed recovery and dissatisfaction after surgical procedures. A key component to management is identifying risk factors and high-risk populations. Advances in pharmacologic therapeutics have resulted in agents targeting different pathways associated with the mediation of nausea and vomiting. Read More

    Anticoagulation and Neuraxial/Peripheral Anesthesia.
    Anesthesiol Clin 2017 Jun;35(2):e21-e39
    Department of Anesthesiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. Electronic address:
    Novel anticoagulants (NAGs) have emerged as the preferred alternatives to vitamin K antagonists. In patients being considered for regional anesthesia, these drugs present a layer of complexity in the preprocedure evaluation. There are no established tests to monitor anticoagulant activity and our experience is short with these drugs. Read More

    Revisiting Oxycodone Analgesia: A Review and Hypothesis.
    Anesthesiol Clin 2017 Jun 14;35(2):e163-e174. Epub 2017 Mar 14.
    Department of Anesthesiology, Louisiana State University Health Science Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
    Oxycodone, a semisynthetic opioid analgesic, is widely used in clinical practice. Oxycodone and morphine seem to be equally effective and equipotent; however, morphine is 10 times more potent than oxycodone when given epidurally. This article provides an updated review of the basic pharmacology of oxycodone with a special focus on pharmacokinetic/pharmacodynamics properties. Read More

    Pharmacology of Acetaminophen, Nonsteroidal Antiinflammatory Drugs, and Steroid Medications: Implications for Anesthesia or Unique Associated Risks.
    Anesthesiol Clin 2017 Jun 14;35(2):e145-e162. Epub 2017 Mar 14.
    Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA; Department of Anesthesiology, University of Illinois, 1740 W. Taylor Street, Chicago, IL 60612, USA; Department of Surgery, University of Illinois, 840 S. Wood Street, Chicago, IL 60612, USA.
    Acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), and corticosteroids, historically used in perioperative management, are potent analgesic medications. They primarily inhibit the cyclooxygenase (COX) enzyme, decreasing the synthesis of prostaglandins, and modulating pain and temperature. Acetaminophen does not inhibit this synthesis at the inflammatory site. Read More

    Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines.
    Anesthesiol Clin 2017 Jun;35(2):e115-e143
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. Read More

    Ketorolac, Oxymorphone, Tapentadol, and Tramadol: A Comprehensive Review.
    Anesthesiol Clin 2017 Jun 14;35(2):e1-e20. Epub 2017 Apr 14.
    Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA.
    Pain remains a tremendous burden on patients and for the health care system, with uncontrolled pain being the leading cause of disability in this country. There are a variety of medications that can be used in the treatment of pain, including ketorolac, oxymorphone, tapentadol, and tramadol. Depending on the clinical situation, these drugs can be used as monotherapy or in conjunction with other types of medications in a multimodal approach. Read More

    An Analysis of New Approaches and Drug Formulations for Treatment of Chronic Low Back Pain.
    Anesthesiol Clin 2017 Jun 14;35(2):341-350. Epub 2017 Mar 14.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    The prevalence of chronic low back pain (CLBP) is increasing. Treatment is effective in less than 50% of patients after 1 year. This review investigates new treatments for CLBP. Read More

    Pharmacology of Octreotide: Clinical Implications for Anesthesiologists and Associated Risks.
    Anesthesiol Clin 2017 Jun;35(2):327-339
    Department of Anesthesiology, LSUHSC, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
    Many patients presenting with a history of foregut, midgut neuroendocrine tumors (NETs) or carcinoid syndrome can experience life-threatening carcinoid crises during anesthesia or surgery. Clinicians should understand the pharmacology of octreotide and appreciate the use of continuous infusions of high-dose octreotide, which can minimize intraoperative carcinoid crises. We administer a prophylactic 500-μg bolus of octreotide intravenously (IV) and begin a continuous infusion of 500 μg/h for all NET patients. Read More

    Pharmacologic Properties of Novel Local Anesthetic Agents in Anesthesia Practice.
    Anesthesiol Clin 2017 Jun 14;35(2):315-325. Epub 2017 Apr 14.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    Therapeutic duration of traditional local anesthetics when used in peripheral nerve blocks is normally limited. This article describes novel approaches to extend the duration of peripheral nerve blocks currently available or in development. Three newer approaches on extending the duration of peripheral nerve blocks include site-1 sodium channel blockers, novel local anesthetics delivery systems, and novel adjuvants of local anesthetics. Read More

    Novel Anticoagulant Agents in the Perioperative Setting.
    Anesthesiol Clin 2017 Jun 7;35(2):305-313. Epub 2017 Apr 7.
    Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    An increasing number of oral anticoagulants have become available over the past decade. Each of these agents has differing implications on both regional and neuraxial anesthetic techniques. This article describes the pharmacology, pharmacokinetics, and pharmacodynamics of the most commonly used novel oral anticoagulants (NOACs). Read More

    Pharmacogenomics in Pain Management.
    Anesthesiol Clin 2017 Jun;35(2):295-304
    Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    There is interpatient variability to analgesic administration. Much can be traced to pharmacogenomics variations between individuals. Certain ethnicities are more prone to reduced function of CYP2D6. Read More

    Pharmacogenomics in Anesthesia.
    Anesthesiol Clin 2017 Jun;35(2):285-294
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    A significant number of commonly administered medications in anesthesia show wide clinical interpatient variability. Some of these include neuromuscular blockers, opioids, local anesthetics, and inhalation anesthetics. Individual genetic makeup may account for and predict cardiovascular outcomes after cardiac surgery. Read More

    Cardiovascular Pharmacology: An Update and Anesthesia Considerations.
    Anesthesiol Clin 2017 Jun 14;35(2):273-284. Epub 2017 Apr 14.
    Department of Anesthesiology, LSU School of Medicine, T6M5, 1542 Tulane Avenue, Room 656, New Orleans, LA 70112, USA.
    Cardiovascular disease remains a leading cause of morbidity and mortality worldwide. The development of therapeutic agents for the treatment of cardiovascular diseases has always been a priority because of the huge potential market for these drugs. These medications should be part of the anesthesiologist's armamentarium because the typical surgical patient is older and has more comorbidities than in the past. Read More

    Pharmacologic Considerations of Anesthetic Agents in Geriatric Patients.
    Anesthesiol Clin 2017 Jun 30;35(2):259-271. Epub 2017 Mar 30.
    Department of Anesthesiology, Louisiana State University, 1542 Tulane Avenue, Room 659, New Orleans, LA 70112, USA.
    Aging is a natural process of declining organ function and reserve. Census data show that the geriatric population is expected to grow to nearly 30%. More than half of geriatric patients have 1 or more surgical procedures in their lifetimes. Read More

    Perioperative Pharmacologic Considerations in Obesity.
    Anesthesiol Clin 2017 Jun;35(2):247-257
    Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA. Electronic address:
    Obesity has increased in incidence worldwide. Along with the increased number of obese patients, comorbid conditions are also more prevalent in this population. Obesity leads to changes in the physiology of patients along with an altered response to pharmacologic therapy. Read More

    Alpha-2 Agonists.
    Anesthesiol Clin 2017 Jun 30;35(2):233-245. Epub 2017 Mar 30.
    Department of Anesthesiology and Perioperative Medicine, Ronald Regan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA. Electronic address:
    Alpha-2 adrenergic receptors are spread throughout the central and peripheral nervous system, specifically in the pontine locus coeruleus, medullospinal tracts, rostral ventrolateral medulla, and the dorsal horn of the spinal cord. Alpha-2 agonist agents cause neuromodulation in these centers, leading to sedation, analgesia, vasodilatation, and bradycardia with little effect on the respiratory drive, which accounts for their good safety profile. The 2 major drugs in this group are clonidine and dexmedetomidine. Read More

    Pulmonary Vasodilators and Anesthesia Considerations.
    Anesthesiol Clin 2017 Jun 14;35(2):221-232. Epub 2017 Apr 14.
    Department of Anesthesiology, Louisiana State University Health Science Center-Shreveport, Shreveport, LA, USA.
    Pulmonary hypertension (PH) is a complex disease process of the pulmonary vasculature system characterized by elevated pulmonary arterial pressures. Patients with PH are at increased risk for morbidity and mortality, including intraoperatively and postoperatively. Appreciation by the clinical anesthesiologist of the pathophysiology of PH is warranted. Read More

    Uterotonic Medications: Oxytocin, Methylergonovine, Carboprost, Misoprostol.
    Anesthesiol Clin 2017 Jun 30;35(2):207-219. Epub 2017 Mar 30.
    Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA.
    Uterine atony is a common cause of primary postpartum hemorrhage, which remains a major cause of pregnancy-related mortality for women worldwide. Oxytocin, methylergonovine, carboprost, and misoprostol are commonly used to restore uterine tone. Oxytocin is the first-line agent. Read More

    Anticoagulant Reversal and Anesthetic Considerations.
    Anesthesiol Clin 2017 Jun 30;35(2):191-205. Epub 2017 Mar 30.
    Department of Anesthesiology, University of Utah Medical School, 30 North 1900 East, Room 3C444, Salt Lake City, UT 84132-2501, USA.
    Bleeding complications are a common concern with the use of anticoagulant agents. In many situations, reversing of neutralizing their effects may be warranted. Prothrombin complex concentrate replaces coagulation factors lowered by warfarin, as does fresh frozen plasma, but in a more concentrated form. Read More

    Total Parenteral and Enteral Nutrition in the ICU: Evolving Concepts.
    Anesthesiol Clin 2017 Jun 14;35(2):181-190. Epub 2017 Apr 14.
    Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA. Electronic address:
    Appropriate nutrition in the hospital setting, particularly in critically ill patients, has long been tied to improving clinical outcomes. During critical illness, inflammatory mediators and cytokines lead to the creation of a catabolic state to facilitate the use of endogenous energy sources to meet increased energy demands. This process results in increasing the likelihood of overfeeding. Read More

    Update in the Management of Patients with Preeclampsia.
    Anesthesiol Clin 2017 Mar 12;35(1):95-106. Epub 2016 Dec 12.
    Department of Anesthesiology, Emory University, 1354 Clifton Road Northeast, Atlanta, GA 30322, USA. Electronic address:
    Hypertensive disorders of pregnancy complicate approximately 10% of all deliveries in the United States and are a leading cause of maternal and fetal morbidity and mortality. Preeclampsia is defined as hypertension in association with proteinuria, thrombocytopenia, impaired liver function, renal insufficiency, pulmonary edema, or new-onset cerebral or visual disturbances. The greatest risk factor for the development of preeclampsia is a history of preeclampsia. Read More

    Obstetric and Anesthetic Approaches to External Cephalic Version.
    Anesthesiol Clin 2017 Mar;35(1):81-94
    Division of Obstetric Anesthesia, Department of Anesthesia & Perioperative Care, University California San Francisco School of Medicine, San Francisco, CA 94143, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, University California San Francisco School of Medicine, San Francisco, CA 94143, USA. Electronic address:
    Breech presentation is the most common abnormal fetal presentation and complicates approximately 3% to 4% of all pregnancies. External cephalic version (ECV) should be recommended to women with a breech singleton pregnancy, if there is no maternal or fetal contraindication. ECV increases the chance of cephalic presentation at the onset of labor and decreases the rate of cesarean delivery by almost 40%. Read More

    General Anesthesia During the Third Trimester: Any Link to Neurocognitive Outcomes?
    Anesthesiol Clin 2017 Mar 12;35(1):69-80. Epub 2016 Dec 12.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street - CWN L1, Boston, MA 02115, USA. Electronic address:
    Rodent studies on the effect of general anesthesia during the third trimester on neurocognitive outcomes are mixed, but primate studies suggest that a clinically relevant exposure to anesthetic agents during the third trimester can trigger neuronal and glial cell death. Human studies are conflicting and the evidence is weak. This is an up-to-date review of the literature on the neurodevelopmental effects of anesthetic agents administered during the third trimester. Read More

    Huddles and Debriefings: Improving Communication on Labor and Delivery.
    Anesthesiol Clin 2017 Mar 12;35(1):59-67. Epub 2016 Dec 12.
    Departments of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Jackson 440, Boston, MA 02114, USA.
    Interprofessional teams work together on the labor and delivery unit, where clinical care is often unscheduled, rapidly evolving, and fast paced. Effective communication is key for coordinated delivery of optimal care and for fostering a culture of community and safety in the workplace. The preoperative huddle allows for information sharing, cross-checking, and preparation before the start of surgery. Read More

    The Use of Ultrasonography in Obstetric Anesthesia.
    Anesthesiol Clin 2017 Mar;35(1):35-58
    Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 19-103, Toronto, Ontario M5G 1X5, Canada; Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 19-103, Toronto, Ontario M5G 1X5, Canada. Electronic address:
    This article provides an overview of the use of ultrasonography in obstetric anesthesia. It discusses the indications, benefits, and techniques of using ultrasonography to optimize the delivery of anesthesia and provide safe and efficacious clinical care. More specifically, it discusses the use of ultrasonography to facilitate neuraxial anesthesia, abdominal field blocks, central and peripheral vascular access, as well as the assessment of the lung fields and gastric contents, and identification of the cricothyroid membrane. Read More

    Postdural Puncture Headache: An Evidence-Based Approach.
    Anesthesiol Clin 2017 Mar;35(1):157-167
    Department of Anesthesiology, University of Kentucky, Lexington, KY 40506, USA. Electronic address:
    Headache after dural puncture is a common complication accompanying neuraxial anesthesia. The proposed cause is loss of cerebrospinal fluid through the puncture into the epidural space. Although obstetric patients are at risk for the development of this headache because of female gender and young age, there is a difference in the obstetric population. Read More

    Identification and Management of Obstetric Hemorrhage.
    Anesthesiol Clin 2017 Mar;35(1):15-34
    Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mailcode UH2, Portland, OR 97239, USA. Electronic address:
    Obstetric hemorrhage remains the leading cause of maternal death and severe morbidity worldwide. Although uterine atony is the most common cause of peripartum bleeding, abnormal placentation, coagulation disorders, and genital tract trauma contribute to adverse maternal outcomes. Given the inability to reliably predict patients at high risk for obstetric hemorrhage, all parturients should be considered susceptible, and extreme vigilance must be exercised in the assessment of blood loss and hemodynamic stability during the peripartum period. Read More

    Awareness and Aortocaval Obstruction in Obstetric Anesthesia.
    Anesthesiol Clin 2017 Mar 12;35(1):145-155. Epub 2016 Dec 12.
    Department of Anesthesiology, University of Kentucky, Lexington, KY 40506, USA.
    Awareness during general anesthesia for cesarean delivery continues to be a major problem. The key to preventing awareness is strict attention to anesthetic technique. The prevalence and implications of aortocaval compression have been firmly established. Read More

    Should Nitrous Oxide Be Used for Laboring Patients?
    Anesthesiol Clin 2017 Mar;35(1):125-143
    Department of Anesthesiology, Vanderbilt University Medical Center, 4202 VUH, 1211 Medical Center Drive, Nashville, TN 37232, USA.
    Nitrous oxide, long used during labor in Europe, is gaining popularity in the United States. It offers many beneficial attributes, with few drawbacks. Cost, safety, and side effect profiles are favorable. Read More

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