799 results match your criteria Anesthesiology Clinics[Journal]


Gender, Racial, and Socioeconomic Issues in Perioperative Medicine.

Anesthesiol Clin 2020 Jun 1;38(2):xv-xvi. Epub 2020 Apr 1.

Department of Anesthesiology, University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908-0710, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2020.03.001DOI Listing

Gender, Racial, and Socioeconomic Issues in Perioperative Medicine.

Authors:
Lee A Fleisher

Anesthesiol Clin 2020 Jun 1;38(2):xiii-xiv. Epub 2020 Apr 1.

Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles 680, Philadelphia, PA 19104, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2020.03.002DOI Listing

Women and Underrepresented Minorities in Academic Anesthesiology.

Anesthesiol Clin 2020 Jun;38(2):449-457

Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, F5-704, Chicago, IL 60611, USA.

The demographics of the United States is changing with 51% of the population being female, and 32% of the population identifying as an underrepresented minority (URM, ie, African American/black, Hispanic/Latino, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Women and URMs have been historically underrepresented in medicine and in academic anesthesiology. This article provides an overview of the current status of women and URM faculty in academic anesthesiology and provides a framework for academic advancement. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.004DOI Listing

Effects of Gender and Race/Ethnicity on Perioperative Team Performance.

Anesthesiol Clin 2020 Jun;38(2):433-447

Wagner School of Public Service, New York University, 295 Lafayette Street, New York, NY 10012, USA.

We judge each other every day using demographic characteristics (such as gender and race/ethnicity), and these social identities shape our lives in profound ways. The impacts of demographic diversity in perioperative teams are poorly understood, and mixed results are reported in other team-based work settings. Drawing from decades' worth of organizational behavior literature, the authors propose a model of critical factors related to interplays between diversity, communication, and conflict, all which take place in a hierarchical environment influenced by power differences. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.013DOI Listing

Role of Gender and Race in Patient-Reported Outcomes and Satisfaction.

Anesthesiol Clin 2020 Jun;38(2):417-431

Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Feinberg Pavilion, Suite 5-704, 251 E. Huron Street, Chicago, IL 60611, USA. Electronic address:

The role of gender, race, and socioeconomic status in outcomes and satisfaction are reflected in patient-reported outcomes using measurement tools representing outcome domains. These domains include pain relief, physical and emotional functioning, adverse events, participant disposition, and patient satisfaction. Measurement tools exist for each of the outcomes in both acute and chronic pain. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.012DOI Listing

Gender Differences in Postoperative Outcomes After Cardiac Surgery.

Anesthesiol Clin 2020 Jun 1;38(2):403-415. Epub 2020 Apr 1.

Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA. Electronic address:

Women presenting for cardiac surgery tend to be older and have hypertension, diabetes, and overweight or underweight body mass index than men. Despite improvements in surgical techniques and medications, women have increased risk for morbidity and mortality after multiple types of cardiac surgery. Women presenting for transcatheter aortic valve replacement are older and frailer than men, and have increased risk of intraoperative complications, but lower mortality at mid- and long-term ranges compared with men. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.007DOI Listing

Ethical Issues Confronting Muslim Patients in Perioperative and Critical Care Environments: A Survey of Islamic Jurisprudence.

Anesthesiol Clin 2020 Jun 1;38(2):379-401. Epub 2020 Apr 1.

Trauma Research Center, Baqiyatallah University of Medical Sciences, P.O. Box 19575-174, Sheykh bahayi Stress, Vanak Square, Tehran, Iran.

Ethical dilemmas may arise when medical management conflicts with a patient's values, culture, religion, or legal considerations. Many Muslims encounter ethical dilemmas as patients in perioperative and critical care settings. This article discusses the fundamentals of Islamic jurisprudence and how this may affect hospitalized patients in terms of cleanliness and prayer in the setting of stoma and urinary catheters, fasting, transfusion, transplants, xenografts and animal-based medications, do-not-resuscitate orders, and postmortem examinations. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.002DOI Listing

Two Sides of the Same Coin: Addressing Racial and Gender Disparities Among Physicians and the Impact on the Community They Serve.

Anesthesiol Clin 2020 Jun 1;38(2):369-377. Epub 2020 Apr 1.

University of Utah School of Medicine, 30 North 1900 East, Room 3C444 SOM, Salt Lake City, UT 84132, USA.

The influence of historical cultural norms is evident when analyzing the physician demographics in the United States. To this day, there exists a paucity in diversity as it pertains to gender balance and ethnicity. This phenomenon is particularly concerning when studies support the notion that race and gender concordance are associated with improved outcomes. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.001DOI Listing

The Flaw of Medicine: Addressing Racial and Gender Disparities in Critical Care.

Anesthesiol Clin 2020 Jun 1;38(2):357-368. Epub 2020 Apr 1.

University of Utah School of Medicine, 30 North 1900 East, Room 3C444 SOM, Salt Lake City, UT 84132, USA.

The age of modern medicine has ushered in remarkable advances and with them increased longevity of life. The questions are, however: Has everyone benefited from these developments equally? and Do all lives truly matter? The presence of gender and racial health disparities indicates that there is work still left to be done. The first target of intervention may well be the medical establishment itself. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.011DOI Listing

Genetics and Gender in Acute Pain and Perioperative Opioid Analgesia.

Anesthesiol Clin 2020 Jun 1;38(2):341-355. Epub 2020 Apr 1.

Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H3580, Stanford, CA 94305, USA. Electronic address:

Experimental and clinical acute pain research in relation to biological sex and genetics started in the 1980s. Research methods became more powerful and sensitive with the advancement in affordable gene sequencing methods and high-throughput genetic assays. Decades of research has identified several potential pharmaceutical targets, providing insights into future research direction, and understanding of acute pain and opioid analgesic effects in the clinical setting. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.003DOI Listing

Racial Disparities in Pediatric Anesthesia.

Anesthesiol Clin 2020 Jun 23;38(2):327-339. Epub 2020 Mar 23.

Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.

Racial disparities in health care have been extensively documented. Although race is a recognized determinant of the incidence and outcome of disease, few studies have examined the role of race in the delivery of pediatric perianesthesia care. Whereas racial differences in health outcomes may not be easy to modify, disparities in health care delivery are modifiable. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.010DOI Listing

Considerations for Transgender Patients Perioperatively.

Anesthesiol Clin 2020 Jun;38(2):311-326

Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C330F, New York, NY 10065, USA.

With a shift in the cultural, political, and social climate surrounding gender and gender identity, an increase in the acceptance and visibility of transgender individuals is expected. Anesthesiologists are thus more likely to encounter transgender and gender nonconforming patients in the perioperative setting. Anesthesiologists need to acquire an in-depth understanding of the transgender patient's medical and psychosocial needs. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.009DOI Listing

Perioperative Considerations Regarding Sex in Solid Organ Transplantation.

Anesthesiol Clin 2020 Jun 20;38(2):297-310. Epub 2020 Mar 20.

Department of Anesthesiology, University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908, USA. Electronic address:

Sex plays a role in all stages of the organ transplant process, including listing, sex/size matching of organs, complications, graft survival, and mortality. Sex-related differences in organ transplantation are likely multifactorial related to biological and social characteristics. More information is needed to determine how sex-related differences can lead to improved outcomes for future donors and recipients of solid organs. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.008DOI Listing

Racial Differences in Pregnancy-Related Morbidity and Mortality.

Anesthesiol Clin 2020 Jun;38(2):279-296

Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 440, Boston, MA 02114, USA.

Racism in the United States has deep roots that affect maternal health, particularly through pervasive inequalities among black women compared with white. Anesthesiologists are optimally positioned to maintain vigilance for these disparities in maternal care, and to intervene with their unique acute critical care skills and knowledge. As leaders in patient safety, anesthesiologists should drive hospitals and practices to develop and implement national bundles for patient safety, as well as using team-based training practices designed to improve hospitals that care for racially diverse mothers. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.006DOI Listing

Special Considerations Related to Race, Sex, Gender, and Socioeconomic Status in the Preoperative Evaluation: Part 2: Sex Considerations and Homeless Patients.

Anesthesiol Clin 2020 Jun;38(2):263-278

Northwestern University Feinberg School of Medicine, 251 East Huron, Feinberg 5-704, Chicago, IL 60611, USA. Electronic address:

Patients anticipating surgery and anesthesia often need preoperative care to lower risk and facilitate services on the day of surgery. Preparing patients often requires extensive evaluation and coordination of care. Vulnerable, marginalized, and disenfranchised populations have special concerns, limitations, and needs. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.02.001DOI Listing

Special Considerations Related to Race, Sex, Gender, and Socioeconomic Status in the Preoperative Evaluation: Part 1: Race, History of Incarceration, and Health Literacy.

Anesthesiol Clin 2020 Jun;38(2):247-261

Northwestern University Feinberg School of Medicine, 251 East Huron, Feinberg 5-704, Chicago, IL 60611, USA. Electronic address:

Patients anticipating surgery and anesthesia often need preoperative care to reduce risk and facilitate services on the day of surgery. Preparing patients often requires extensive evaluation and coordination of care. Vulnerable, marginalized, and disenfranchised populations have special concerns, limitations, and needs. Read More

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http://dx.doi.org/10.1016/j.anclin.2020.01.005DOI Listing

Anesthesia at the Edge of Life.

Anesthesiol Clin 2020 Mar 2;38(1):xv-xvi. Epub 2020 Jan 2.

Department of Anesthesiology, Internal Medicine, and Surgery, Section of Perioperative and Adult Anesthesia, Critical Care Fellowship, Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520-8051, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2019.12.001DOI Listing

Anesthesia at the Edge of Life.

Authors:
Lee A Fleisher

Anesthesiol Clin 2020 Mar 30;38(1):xiii. Epub 2019 Dec 30.

Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles 680, Philadelphia, PA 19104, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2019.12.002DOI Listing

Anesthesia for Obstetric Disasters.

Anesthesiol Clin 2020 Mar;38(1):85-105

Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520-8051, USA.

Over the past 30 years, maternal mortality has increased in the United States to 18 deaths per 100,000 live births. Obstetric emergencies, including hemorrhage, hypertensive disorders in pregnancy, HELLP syndrome, and amniotic fluid embolism, and anesthesia complications, including high neuraxial blockade, local anesthetic systemic toxicity, and the difficult obstetric airway, contribute to maternal cardiac arrest and maternal and fetal morbidity and mortality. Expeditious intervention by the obstetric anesthesiologist is critical in these emergent scenarios, and knowledge of best practices is essential to improve maternal and fetal outcomes. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.005DOI Listing

Anesthesia for Neurosurgical Emergencies.

Anesthesiol Clin 2020 Mar;38(1):67-83

Department of General Anesthesiology, Cleveland Clinic Foundation, 9500 Euclid Avenue # E31, Cleveland, OH 44195, USA.

Neurosurgical procedures are unique in that the best monitoring modality is the neurologic examination and the most important sign includes an intact mental status. Anesthesiologists play a vital role in medical management of neurosurgical emergencies. The authors discuss the important management strategies for these emergencies, including increased intracranial pressure and impending brain herniation, acute alteration of mental status, status epilepticus, and trauma to cervical spine. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.004DOI Listing

Anesthetic Considerations for Patients on Renal Replacement Therapy.

Anesthesiol Clin 2020 Mar 2;38(1):51-66. Epub 2020 Jan 2.

Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.

The number of patients presenting for surgery with renal dysfunction requiring renal replacement therapy (RRT) is expected to increase as the population ages and improvements in therapy continue to be made. Every aspect of the perioperative period is affected by renal dysfunction, its associated comorbidities, and altered physiology secondary to RRT. Most alarming is the increased risk for perioperative cardiac morbidity and mortality seen in this population. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.003DOI Listing

Anesthesia for the Patient with Severe Liver Failure.

Anesthesiol Clin 2020 Mar 3;38(1):35-50. Epub 2020 Jan 3.

Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. Electronic address:

The incidence of liver failure continues to increase, and it is associated with increased perioperative morbidity and mortality. Liver failure is associated with multiorgan dysfunction, including central nervous, cardiac, respiratory, gastrointestinal, renal, and hematological systems. Preoperative identification, optimization, and tailored anesthetic management are essential for optimum outcomes in patients with liver disease undergoing surgery. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.002DOI Listing

Ethical Issues in Organ Transplantation at End of Life: Defining Death.

Anesthesiol Clin 2020 Mar;38(1):231-246

Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA; Bioethics, University of Washington, Seattle, WA, USA. Electronic address:

End-of-life vital organ transplantation involves singular ethical issues, because survival of the donor is impossible, and organ retrieval is ideally as close to the death of the donor as possible to minimize organ ischemic time. Historical efforts to define death have been met with confusion and discord. Fifty years on, the Harvard criteria for brain death continue to be problematic and now face significant legislative efforts to limit their authority. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.009DOI Listing

Emergency Anesthesia in Resource-Limited Areas.

Anesthesiol Clin 2020 Mar;38(1):213-230

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, 600 North Wolfe Street, Meyer 297A, Baltimore, MD 21287, USA. Electronic address:

Anesthesia providers play a critical role in the gap between unmet surgical need and access to safe surgical care. Providers from high-income countries can help fill this gap, particularly during crises, but it is critical to provide care responsibly and ethically. Most unmet surgical need is in low-income and middle-income countries where limited infrastructural, human, and material resources pose significant challenges. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.011DOI Listing

Anesthesia for the Morbidly Obese Patient.

Anesthesiol Clin 2020 Mar 2;38(1):197-212. Epub 2020 Jan 2.

Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 6413-JCP, Iowa City, IA 52242, USA.

Obesity is considered a major comorbidity, and it is imperative for an anesthesiologist to put increased emphasis on preoperative evaluation and perioperative management. A multidisciplinary team approach is the key for a successful outcome. This article encompasses basic tenets like pathophysiology and pharmacology pertaining to obesity. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.008DOI Listing

Anesthesia at the Edge of Life: Mechanical Circulatory Support.

Anesthesiol Clin 2020 Mar 3;38(1):19-33. Epub 2020 Jan 3.

Department of Anesthesiology, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA. Electronic address:

Mechanical circulatory support devices are increasingly being used for patients presenting with heart failure. The primary goal of these devices is to maintain perfusion to all organs. Intra-aortic balloon pump and extracorporeal membrane oxygenators are temporary devices that are usually reserved for patients presenting with acute heart failure. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.11.002DOI Listing

Anesthesia for Electroconvulsive Therapy.

Authors:
Nikhil Chawla

Anesthesiol Clin 2020 Mar 3;38(1):183-195. Epub 2020 Jan 3.

Department of Anesthesiology, Yale Medicine, Yale University, 333 Cedar Street, TMP-3, New Haven, CT 06510, USA. Electronic address:

This article deals with anesthesia for patients receiving ECT for a variety of mood disorders. It includes indications, contraindications, patient selection, workflow, anesthetic management, and postprocedure complications of electroconvulsive therapy. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.007DOI Listing

Malignant Hyperthermia Update.

Anesthesiol Clin 2020 Mar;38(1):165-181

Department of Anesthesiology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.

Malignant hyperthermia (MH) is a rare but potentially lethal skeletal muscle disorder affecting calcium release channels. It is inherited in a mendelian autosomal dominant pattern with variable penetration. The initial clinical manifestations are of a hypermetabolic state with increased CO2 production, respiratory acidosis, increased temperature, and increased oxygen demands. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.010DOI Listing

Anesthesia for Endocrine Emergencies.

Anesthesiol Clin 2020 Mar 2;38(1):149-163. Epub 2020 Jan 2.

Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98101, USA; Division of Critical Care Medicine, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98101, USA. Electronic address:

Although endocrine emergencies are not common occurrences, their identification and careful perioperative management are of paramount importance for reduction of patient morbidity and mortality. The most common critical endocrine abnormalities are associated with functional tumors, such as pheochromocytomas, insulinomas, and carcinoid tumors, leading to carcinoid syndrome, abnormal thyroid function, or disturbances in the hypothalamus-pituitary-adrenal axis, causing adrenal insufficiency. This article aims to discuss the pathophysiology, diagnosis, and perioperative management of pheochromocytomas, hyperthyroidism, hypothyroidism, adrenal insufficiency, carcinoid disease, and insulinomas. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.006DOI Listing

Anesthesia for Patients with Extensive Trauma.

Anesthesiol Clin 2020 Mar 2;38(1):135-148. Epub 2020 Jan 2.

Department of Anesthesiology, Bruce W. Carter Medical Center, Department of Veteran's Health Administration, 1201 Northwest 16th Street, Room B333, Miami, FL 33136, USA.

Trauma anesthesiology is a unique and growing subspecialty. With the growing number of adult and pediatric trauma centers in the United States, a thorough understanding of the early management of severely injured patients with trauma is an important aspect of anesthesia. Trauma anesthesiology requires the ability to adapt to different work environments, including the trauma bay, the operating room, and even the intensive care unit, where a patient room may require conversion to an operating suite for emergencies. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.012DOI Listing

Perioperative Management of Patients with Sepsis and Septic Shock, Part II: Ultrasound Support for Resuscitation.

Anesthesiol Clin 2020 Mar;38(1):123-134

Division of Adult Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 297, Baltimore, MD 21287, USA.

Point-of-care ultrasound is capable of identifying the precise causes of hemodynamic failure in patients with septic shock. Patients in shock demonstrate complex alterations in their circulation, including changes in loading conditions (preload and afterload), right and left ventricular function, and development of obstructive physiology, and some of them have a burden of underlying cardiac disease. Knowledge of underlying hemodynamic derangements in such situations allows targeted interventions, that is, fluids, vasoactive, and inotropic medications, to optimize patient's perfusion. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.11.001DOI Listing

Perioperative Management of Patients with Sepsis and Septic Shock, Part I: Systematic Approach.

Anesthesiol Clin 2020 Mar 2;38(1):107-122. Epub 2020 Jan 2.

Division of Adult Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 297, Baltimore, MD 21287, USA.

Sepsis and septic shock are medical emergencies, with high associated mortality. The Surviving Sepsis Campaign has developed definitions and management guidelines, emphasizing the use of hour-1 care bundle. Anesthesiologists frequently encounter sepsis when source control is required. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.013DOI Listing

Anesthesia for Major Surgery in the Neonate.

Anesthesiol Clin 2020 Mar;38(1):1-18

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H3582, Stanford, CA 94305, USA.

Perioperative risk of morbidity and mortality for neonates is significantly higher than that for older children and adults. At particular risk are neonates born prematurely, neonates with major or severe congenital heart disease, and neonates with pulmonary hypertension. Presently no consensus exists regarding the safest anesthetic regimen for neonates. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.001DOI Listing

Cardiothoracic Anesthesia and Critical Care: An Ever-Changing (and Evolving) Field.

Anesthesiol Clin 2019 Dec;37(4):xv-xvii

Department of Anaesthesia, Westmead Hospital, CNR Hawkesbury Road/Darcy Road, Westmead, NSW 2145, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2019.08.012DOI Listing
December 2019

Cardiac Anesthesia and Critical Care: New Procedures and Dilemmas Inside and Outside Our Operating Rooms.

Authors:
Lee A Fleisher

Anesthesiol Clin 2019 Dec 13;37(4):xiii-xiv. Epub 2019 Sep 13.

Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles 680, Philadelphia, PA 19104, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2019.08.013DOI Listing
December 2019

The Future Directions of Research in Cardiac Anesthesiology.

Anesthesiol Clin 2019 Dec 9;37(4):801-813. Epub 2019 Oct 9.

Department of Anesthesia, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Departments of Anesthesia and Physiology, University of Toronto, Toronto, ON, Canada. Electronic address:

This article provides an overview of knowledge gaps that need to be addressed in cardiac anesthesia, including mitigating the inflammatory effects of cardiopulmonary bypass, defining myocardial infarction after cardiac surgery, improving perioperative neurologic outcomes, and the optimal management of patients undergoing valve replacement. In addition, emerging approaches to research conduct are discussed, including the use of new analytical techniques like machine learning, pragmatic trials, and adaptive designs. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.008DOI Listing
December 2019
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Cardiac Surgery and the Blood-Brain Barrier.

Anesthesiol Clin 2019 Dec 9;37(4):787-800. Epub 2019 Oct 9.

Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Anesthesia, Halifax Infirmary Hospital, Room 5452, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.

Neurologic abnormality after cardiac surgery is common, and neurologic complications after cardiac surgery are among the most devastating problems that can occur in the postoperative period. Disruption of the blood-brain barrier (BBB) plays an important role in these complications. Assessment of the BBB integrity relies on cognitive testing, MRI, and measurement of brain biomarkers. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.009DOI Listing
December 2019
1 Read

Mitochondrial Dysfunction in Cardiac Surgery.

Authors:
Anne D Cherry

Anesthesiol Clin 2019 Dec 12;37(4):769-785. Epub 2019 Oct 12.

Department of Anesthesiology, Duke University, DUMC Box 3094, Durham, NC 27712, USA. Electronic address:

Mitochondria are key to the cellular response to energetic demand, but are also vital to reactive oxygen species signaling, calcium hemostasis, and regulation of cell death. Cardiac surgical patients with diabetes, heart failure, advanced age, or cardiomyopathies may have underlying mitochondrial dysfunction or be more sensitive to perioperative mitochondrial injury. Mitochondrial dysfunction, due to ischemia/reperfusion injury and an increased systemic inflammatory response due to exposure to cardiopulmonary bypass and surgical tissue trauma, impacts myocardial contractility and predisposes to arrhythmias. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986803PMC
December 2019

Heart Failure in Adult Patients with Congenital Heart Disease.

Anesthesiol Clin 2019 Dec 27;37(4):751-768. Epub 2019 Sep 27.

Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands.

Adult patients with congenital heart disease are a complex population with a variety of pathophysiologic conditions based on the anatomy and type of surgery or intervention performed, usually during the first years of life. Nowadays, the majority of patients survive childhood and present for a number of noncardiac surgeries or interventions needing appropriate perioperative management. Heart failure is a major contributing factor to perioperative morbidity and mortality. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.005DOI Listing
December 2019
1 Read

Prevention of Cardiac Surgery-Associated Acute Kidney Injury: A Review of Current Strategies.

Anesthesiol Clin 2019 Dec 21;37(4):729-749. Epub 2019 Sep 21.

Division of Renal Medicine, Brigham and Women's Hospital, 75 Francis Street, Medial Research Building Room MR416B, Boston, MA 02115, USA.

Acute kidney injury is a common and often severe postoperative complication after cardiac surgery, and is associated with poor short-term and long-term outcomes. Numerous randomized controlled trials have been conducted to investigate various strategies for prevention of cardiac surgery-associated acute kidney injury. Unfortunately, most trials that have been conducted to date have been negative. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.007DOI Listing
December 2019

Optimizing Perioperative Blood and Coagulation Management During Cardiac Surgery.

Anesthesiol Clin 2019 Dec 27;37(4):713-728. Epub 2019 Sep 27.

Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, Berlin 10249, Germany.

Bleeding and transfusion are common in cardiac surgery and associated with poorer outcome. Bleeding is frequently due to coagulopathy caused by the complex interaction between cardiopulmonary bypass, major surgical trauma, anticoagulation management, and perioperative factors. Patient blood management has emerged to improve outcome by the prediction, prevention, monitoring, and treatment of bleeding and transfusion. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.006DOI Listing
December 2019
1 Read

Assessing Right Ventricular Function in the Perioperative Setting, Part II: What About Catheters?

Anesthesiol Clin 2019 Dec 10;37(4):697-712. Epub 2019 Oct 10.

Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium; Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel University Hospital, Spitalstrasse 21, Basel 4031, Switzerland. Electronic address:

An-depth assessment of right ventricular function is important in a many perioperative settings. After exploring 2-dimensional echo-based evaluation, other proposed monitoring modalities are discussed. Pressure-based methods of right ventricular appraisal is discussed. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.004DOI Listing
December 2019

Assessing Right Ventricular Function in the Perioperative Setting, Part I: Echo-Based Measurements.

Anesthesiol Clin 2019 Dec 9;37(4):675-695. Epub 2019 Oct 9.

Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium; Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel University Hospital, Spitalstrasse 21, Basel 4031, Switzerland. Electronic address:

This article reviews transesophageal echocardiography-based assessment of perioperative right ventricular function and failure, including catheter-based methods, three-dimensional echocardiography, and their combination to make pressure-volume loops. It outlines right ventricular pathophysiology, multiple assessment methods, and their relationship to analogous transthoracic echocardiogram measurements. technologies used and developed for transthoracic or left ventricular assessment show significant limitations when applied to transesophageal assessment of the right ventricle. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.011DOI Listing
December 2019

Ethical Considerations for Mechanical Support.

Anesthesiol Clin 2019 Dec 11;37(4):661-673. Epub 2019 Oct 11.

Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 8E, 101, New York, NY 10032, USA.

Extracorporeal life support can support patients with severe forms of cardiac and respiratory failure. Uncertainty remains about its optimal use owing in large part to its resource-intensive nature and the high acuity illness in supported patients. Specific issues include the identification of patients most likely to benefit, the appropriate duration of support when prognosis is uncertain, and what to do when patients become dependent on extracorporeal life support but no longer have hope for recovery or transplantation. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.001DOI Listing
December 2019

New Techniques for Optimization of Donor Lungs/Hearts.

Anesthesiol Clin 2019 Dec 27;37(4):639-660. Epub 2019 Sep 27.

Department of Cardiothoracic Surgery, University Medical Center Utrecht, Room E03.511, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.

Injuries sustained by donor heart and lung allografts during the transplantation process are multiple and cumulative. Optimization of allograft function plays an essential role in short- and long-term outcomes after transplantation. Therapeutic targets to prevent or attenuate injury are present in the donor, the preservation process, during transplantation, and in postoperative management of the recipient. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.010DOI Listing
December 2019
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Recent Developments in Catheter-Based Cardiac Procedures.

Anesthesiol Clin 2019 Dec;37(4):621-638

Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany. Electronic address:

New developments in transcatheter valve technologies including aortic valve replacement and mitral valve and tricuspid valve interventions are described. Recent studies evaluating the success rate, patient outcomes, and anesthesiologic management of the procedures are discussed. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.014DOI Listing
December 2019
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Modulating Perioperative Ventricular Excitability.

Anesthesiol Clin 2019 Dec 9;37(4):609-619. Epub 2019 Oct 9.

Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Biomedical Science Tower W1401, 200 Lothrop Street, Pittsburgh, PA 15213, USA.

Ventricular arrhythmias are associated with significant morbidity and mortality. In the perioperative period, more than 10% of patients undergoing a general anesthetic have an abnormal heart rhythm. Arrhythmia development is a dynamic interplay between an arrhythmogenic substrate, myocardial electrophysiologic properties, modifying factors, and triggering factors. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.002DOI Listing
December 2019
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Anesthetic Management for Endovascular Repair of the Thoracic Aorta.

Anesthesiol Clin 2019 Dec 17;37(4):593-607. Epub 2019 Sep 17.

Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Mail Code 9068, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.

Thoracic endovascular aneurysm repair (TEVAR) is fast becoming the primary treatment of thoracic aortic aneurysms, thoracic aortic dissections, acute aortic injuries, and other conditions affecting the thoracic aorta. Patients scheduled for TEVAR tend to have a host of comorbid conditions, including coronary artery disease, diabetes, and chronic obstructive pulmonary disease. Intraoperative management should optimize end-organ perfusion, facilitate neuromonitoring, and adjust hemodynamic management. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.07.001DOI Listing
December 2019
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Aging Gracefully: The Evolution of Perioperative Care for Older Adults.

Anesthesiol Clin 2019 Sep 19;37(3):xv-xvi. Epub 2019 Jun 19.

Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street PH5-546, New York, NY 10032, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2019.05.003DOI Listing
September 2019
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Geriatric Anesthesia: Ensuring the Best Perioperative Care for Older Adults.

Authors:
Lee A Fleisher

Anesthesiol Clin 2019 Sep 19;37(3):xiii-xiv. Epub 2019 Jun 19.

Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles 680, Philadelphia, PA 19104, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2019.05.004DOI Listing
September 2019