719 results match your criteria Anesthesiology Clinics[Journal]


Modern Day Trauma Care for the Anesthesiologist.

Anesthesiol Clin 2019 Mar 10;37(1):xv-xvi. Epub 2018 Dec 10.

Department of Anesthesiology and Critical Care Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, Suite 3600, Los Angeles, CA 90033, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2018.11.001DOI Listing

Perioperative Care of the Trauma Patient: New Concepts Since Wartime Learning.

Authors:
Lee A Fleisher

Anesthesiol Clin 2019 Mar 10;37(1):xiii-xiv. Epub 2018 Dec 10.

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.2018.11.002DOI Listing

The Use of Point-of-Care Ultrasonography in Trauma Anesthesia.

Anesthesiol Clin 2019 Mar 17;37(1):93-106. Epub 2018 Nov 17.

Department of Anesthesiology, Division of Cardiovascular Anesthesia, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, 4401 Wornall Road, Room 3103, Kansas City, MO 64111, USA; Department of Anesthesiology, Division of Critical Care Medicine, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, 4401 Wornall Road, Room 3103, Kansas City, MO 64111, USA.

Caring for the trauma patient requires an in-depth knowledge of the pathophysiology of trauma, the ability to rapidly diagnose and intervene to reverse the derangements caused by shock states, and an aptitude for the use of advanced monitoring techniques and perioperative point-of-care ultrasonography (P-POCUS) to assist in diagnosis and delivery of care. Historically, anesthesiology has lagged behind in wholly embracing this technology. P-POCUS has the potential to allow the trauma anesthesiologist to diagnose numerous injuries, quickly guide the placement of central vascular catheters and invasive monitors, and assess the efficacy of interventions. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.011DOI Listing

Pain Management in Trauma in the Age of the Opioid Crisis.

Anesthesiol Clin 2019 Mar 19;37(1):79-91. Epub 2018 Dec 19.

Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104, USA. Electronic address:

It is imperative to find the balance between pain control and addressing the opioid epidemic. Opioids, although effective in the acute pain management, have multiple side effects and can lead to dependence, abuse, overdose, or death. Physicians should identify patients who abuse opioids, using their states' prescription drug-monitoring programs and use screening tools to identify patients at increased risk of developing opioid dependence. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.010DOI Listing
March 2019
1 Read

Enhanced Recovery After Surgery: Are the Principles Applicable to Adult and Geriatric Acute Care and Trauma Surgery?

Anesthesiol Clin 2019 Mar 22;37(1):67-77. Epub 2018 Nov 22.

Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, CWN L1, Boston, MA 02115, USA.

The incorporation of enhanced recovery after surgery (ERAS) fundamentals into perioperative medicine has improved the patient care experience and hastened recovery time while reducing hospital costs. Research studies have shown that incorporating ERAS principles in the adult or geriatric acute care surgery populations minimizes time to resumption of preoperative activity and reduces hospital length of stay. ERAS principles are widely applicable to these patient cohorts and may be applicable in trauma patients. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.10.001DOI Listing
March 2019
1 Read

Viscoelastic Monitoring to Guide the Correction of Perioperative Coagulopathy and Massive Transfusion in Patients with Life-Threatening Hemorrhage.

Anesthesiol Clin 2019 Mar 19;37(1):51-66. Epub 2018 Dec 19.

Trauma Anesthesiology Society, Inc, 1001 Fannin St Ste 3700, Houston, TX 77002-6785, USA; Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF School of Medicine, 1001 Potrero Avenue, Building 5, Room 3C-38, San Francisco, CA 94110, USA.

The resuscitation of patients with traumatic hemorrhage remains a challenging clinical scenario. The appropriate and aggressive support of the patient's coagulation is of critical importance. Conventional coagulation assays present several shortcomings in this setting. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.004DOI Listing

Trauma Airway Management: Induction Agents, Rapid Versus Slower Sequence Intubations, and Special Considerations.

Anesthesiol Clin 2019 Mar 19;37(1):33-50. Epub 2018 Dec 19.

Department of Anesthesiology and Critical Care, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 3451, Los Angeles, CA 90033, USA.

Trauma patients who require intubation are at higher risk for aspiration, agitation/combativeness, distorted anatomy, hemodynamic instability, an unstable cervical spine, and complicated injuries. Although rapid-sequence intubation is the most common technique in trauma, slow-sequence intubation may reduce the risk for failed intubation and cardiovascular collapse. Providers often choose plans with which they are most comfortable. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.002DOI Listing

Future Trends in Trauma Care: Through the Lens of the Wounded How Lessons from the Battlefield May Be Used at Home.

Anesthesiol Clin 2019 Mar 19;37(1):183-193. Epub 2018 Dec 19.

Department of Anesthesiology, Medical Corps, U.S. Navy, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.

The coordinated terrorist attacks of 2001 thrust the United States and its allies to war. Through an evolving battlefield, the paradigm of large fixed medical facilities advanced to become nimble surgical and resuscitative platforms, able to provide care far forward. Innovations like tactical combat casualty care, evacuation, fresh whole-blood administration, freeze-dried plasma, and forward surgical care military medicine helped reduce combat mortality to its lowest levels in history. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.008DOI Listing
March 2019
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Novel Methods for Hemorrhage Control: Resuscitative Endovascular Balloon Occlusion of the Aorta and Emergency Preservation and Resuscitation.

Anesthesiol Clin 2019 Mar;37(1):171-182

Department of Anesthesiology, Texas A&M School of Medicine, US Anesthesia Partners, 12222 Merit Drive, Dallas, TX 75251, USA. Electronic address:

Hemorrhage is the leading cause of preventable death after trauma. Junctional and extremity hemorrhage can be temporized with direct pressure and tourniquet application, but noncompressible torso hemorrhage has traditionally required operative or angiographic intervention. Retrograde endovascular balloon occlusion of the aorta (REBOA) can temporize patients with hemorrhage below the diaphragm long enough to enable definitive surgery. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.003DOI Listing

Hospital Planning and Response to an Active Shooter Incident: Preparing for the n = 1.

Authors:
Kevin B Gerold

Anesthesiol Clin 2019 Mar 27;37(1):161-169. Epub 2018 Dec 27.

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; National Tactical Officers Association (NTOA), 7150 Campus Drive Suite 215, Colorado Springs, CO 80920, USA. Electronic address:

Changing patterns of violence in the United States and around the world are increasingly manifest as acts of mass violence and acts of terrorism. Preventing such attacks, reducing harms, and maintaining operations following such events requires the bolstering of key infrastructure facilities, such as hospitals, and developing response plans capable of detecting and withstanding such attacks. Attacks occurring in a hospital or clinic present unique challenges that differ from workplaces or schools. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.006DOI Listing

The Anesthesiologist's Response to Hurricane Natural Disaster Incidents: Hurricane Harvey.

Anesthesiol Clin 2019 Mar 19;37(1):151-160. Epub 2018 Dec 19.

Department of Anesthesiology, University of Texas McGovern Medical School, MSB 5.020, 6431 Fannin Street, Houston, TX 77030, USA. Electronic address:

From personal experience and available resources, such as the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness templates from the manual for department procedures, the authors describe the primarily flooding impact of Hurricane Harvey in their area of Texas. They review the necessary analysis, development, and implementation of logistics; staffing and relief models; coordination with hospital partners; and dissemination of the planned procedures. The authors emphasize the commitment of anesthesiologists to patient care and rescue efforts outside of the operating room. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.005DOI Listing
March 2019
1 Read

The Lifetime Effects of Injury: Postintensive Care Syndrome and Posttraumatic Stress Disorder.

Anesthesiol Clin 2019 Mar 19;37(1):135-150. Epub 2018 Dec 19.

Surgical Services, Department of Surgery, Division of Trauma, Surgical Critical Care and Emergency Surgery, Hospital of the University of Pennsylvania, Veteran's Administration Medical Center, Corporal Michael J Crescenz VA Medical Center, Perelman School of Medicine, University of Pennsylvania, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.

Postintensive care syndrome (PICS) is a heterogeneous syndrome marked by physical, cognitive, and mental health impairments experienced by critical care survivors. It is a syndrome that bears significant human and health care costs. Additional research is needed to identify risk factors and diagnostic, preventative, and treatment strategies for PICS. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.012DOI Listing
March 2019
2 Reads

Advanced Trauma Life Support Update 2019: Management and Applications for Adults and Special Populations.

Anesthesiol Clin 2019 Mar 27;37(1):13-32. Epub 2018 Dec 27.

Trauma Committee, Anesthesiology Liaison, Pediatric Anesthesiology Simulation, Pediatric Advanced Life Support Program, Department of Anesthesiology, Perioperative, and Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street Suite A-3300, Houston, TX 77030, USA.

As the principal operating room resuscitationists, anesthesiologists must be familiar with the principles of Advanced Trauma Life Support, 10th edition. This edition recommends a highly structured approach to trauma patients and endorses several advances in trauma resuscitation. There are less stringent guidelines for crystalloid administration, references to video-assisted laryngoscopy, suggested use of viscoelastic methods to guide transfusion decisions, and other changes reflecting recent advances. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.009DOI Listing

Pediatric Traumatic Brain Injury and Associated Topics: An Overview of Abusive Head Trauma, Nonaccidental Trauma, and Sports Concussions.

Anesthesiol Clin 2019 Mar;37(1):119-134

Department of Anesthesiology, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA.

Pediatric traumatic brain injury (TBI) uniquely affects the pediatric population. Abusive head trauma (AHT) is a subset of severe pediatric TBI usually affecting children in the first year of life. AHT is a form of nonaccidental trauma. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.10.002DOI Listing
March 2019
2 Reads

Gender Disparities in Trauma Care: How Sex Determines Treatment, Behavior, and Outcome.

Anesthesiol Clin 2019 Mar 27;37(1):107-117. Epub 2018 Nov 27.

Acute Care Surgery [Trauma, Burn, Critical Care, Emergency Surgery], Department of Surgery, Trauma and Surgical Critical Care, University of Michigan Health System, University Hospital, Room 1C340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5033, USA.

Trauma data bank and other research reveal sex disparities in trauma care. Risk-taking behaviors leading to traumatic injury have been associated with sex, menstrual cycle timing, and cortisol levels. Trauma patient treatment stratified by sex reveals differences in access to services at trauma centers as well as specific treatments, such as venous thromboembolism prophylaxis and massive transfusion component ratios. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.007DOI Listing
March 2019
1 Read

Recognizing Preventable Death: Is There a Role of Survival Prediction Algorithms?

Anesthesiol Clin 2019 Mar 19;37(1):1-11. Epub 2018 Dec 19.

Department of Anaesthesiology, Center Hospitalier Universitaire Vaudois - CHUV, Rue du Bugnon 21, Vaud, Lausanne CH-1011, Switzerland.

Monitoring the quality of trauma care is important but particularly challenging. Preventable death assessment aims to identify those cases where the patient's death would have not occurred if the patient had been treated differently. Determination of preventable death in trauma care is often based on calculated probability of survival, commonly by using the Trauma and Injury Severity Score (TRISS). Read More

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http://dx.doi.org/10.1016/j.anclin.2018.09.001DOI Listing

Preoperative Patient Evaluation: Practicing Evidence-Based, Cost-Effective Medicine.

Anesthesiol Clin 2018 Dec 12;36(4):xvii-xviii. Epub 2018 Oct 12.

Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2018.08.001DOI Listing
December 2018
3 Reads

Preoperative Evaluation: Is It Time to View It as a Component of Perioperative Optimization?

Authors:
Lee A Fleisher

Anesthesiol Clin 2018 Dec 11;36(4):xv-xvi. Epub 2018 Oct 11.

Perelman School of Medicine at 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.2018.08.002DOI Listing
December 2018
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Optimizing Preoperative Anemia to Improve Patient Outcomes.

Anesthesiol Clin 2018 Dec 12;36(4):701-713. Epub 2018 Oct 12.

Division of Regional Anesthesia and Acute Pain, Department of Anesthesiology, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA. Electronic address:

Anemia is a decrease in red blood cell mass, which hinders oxygen delivery to tissues. Preoperative anemia has been shown to be associated with mortality and morbidity following major surgery. The preoperative care clinic is an ideal place to start screening for anemia and discussing potential interventions in order to optimize patients for surgery. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.017DOI Listing
December 2018
30 Reads

Preoperative Evaluation of the Pediatric Patient.

Anesthesiol Clin 2018 Dec;36(4):689-700

Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Anaesthesia, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address:

The article reviews frequently encountered preoperative concerns with a goal of minimizing complications during administration of pediatric anesthesia. It is written with general anesthesiologists in mind and provides a helpful overview of concerns for pediatric patient preparation for routine and nonemergent procedures or interventions. It covers unique topics for the pediatric population, including gestational age, respiratory and cardiovascular concerns, fasting guidelines, and management of preoperative anxiety, as well as the current hot topic of the potential neurotoxic effects of anesthetics on the developing brain. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.016DOI Listing
December 2018
10 Reads

Perioperative Surgical Home Models.

Authors:
Thomas R Vetter

Anesthesiol Clin 2018 Dec 12;36(4):677-687. Epub 2018 Oct 12.

Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA; Department of Population Health, Dell Medical School at the University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA. Electronic address:

The rising prominence of value-based health care and population health management supports evolving perioperative surgical home (PSH) models that rely on continuously evolving evidence-based best practice and telemedicine and telehealth, including mobile technologies and connectivity. To successfully deliver greater perioperative valued-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing perioperative management and its associated services and care provider skills must be expanded. This article focuses on the PSH model as continued opportunity and mechanism for delivering greater value-based, comprehensive perioperative assessment and global optimization of surgical patients. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.015DOI Listing
December 2018
2 Reads

Preoperative Management of Medications.

Anesthesiol Clin 2018 Dec;36(4):663-675

Department of Anesthesiology and Perioperative Medicine, Centro de Desarrollo de Destrezas Medicas, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vaco de Quiroga #15, Col. Belisario Dominguez Sección XVI, Mexico City 14080, Mexico.

Increasingly complex medication regimens for many comorbidities in patients for planned surgical and procedural interventions necessitate detailed preoperative evaluation of the pharmacologic therapy, including the indications, the specific drugs, and dosing amount and interval. The implications of continuing or withholding these agents in the perioperative period need to be elucidated, as well as the risks of interactions and side effects. A comprehensive plan of the management of the therapeutic agents should be devised during the preoperative visit, with input from all relevant specialists, and clearly communicated to the patients in a format that ensures their comprehension and consistent compliance. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.012DOI Listing
December 2018
13 Reads

Creating a Pathway for Multidisciplinary Shared Decision-Making to Improve Communication During Preoperative Assessment.

Anesthesiol Clin 2018 Dec;36(4):653-662

Department of Anesthesiology, Perioperative and Pain Medicine, Center for Perioperative Research, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.

Shared decision-making (SDM) is essential for high-quality surgical care. Barriers to SDM exist in clinical practice but there is evidence these obstacles can be overcome. SDM requires clinician and patient engagement. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.011DOI Listing
December 2018
1 Read

Genomics Testing and Personalized Medicine in the Preoperative Setting.

Anesthesiol Clin 2018 Dec 12;36(4):639-652. Epub 2018 Oct 12.

Department of Anesthesiology, University of California, San Diego, 200 W Arbor Dr, San Diego, CA 92103, USA.

Pharmacogenomics (PGx) is the study of how individuals' personal genotypes may affect their responses to various pharmacologic agents. The application of PGx principles in perioperative medicine is fairly novel. Challenges in executing PGx programs into health care systems include physician buy-in and integration into usual clinical workflow, including the electronic health record. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.014DOI Listing
December 2018
7 Reads

Preoperative Assessment of the Pregnant Patient Undergoing Nonobstetric Surgery.

Anesthesiol Clin 2018 Dec 12;36(4):627-637. Epub 2018 Oct 12.

Department of Anesthesiology, LSU School of Medicine, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA. Electronic address:

The anesthetic management of pregnant patients can present a variety of challenges and a thorough preoperative assessment is necessary before initiating any anesthetic services. Both the mother and the fetus need to be considered when formulating an anesthetic plan and discussing informed consent. The overall aims in assessing a pregnant patient are to identity potential issues that can lead to catastrophic complications, provide adequate information allowing the mother to make informed decisions, and to obtain knowledge for tailoring an anesthetic that maintains maternal and fetal homeostasis. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.010DOI Listing
December 2018
13 Reads

Management of Challenging Pharmacologic Issues in Chronic Pain and Substance Abuse Disorders.

Anesthesiol Clin 2018 Dec 12;36(4):615-626. Epub 2018 Oct 12.

Department of Anesthesiology, LSU Health Science Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA; Department of Pharmacology, LSU Health Science Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA.

Drug abuse and addiction are persistent problems in the United States and around the world. This is an ongoing issue for health care providers, as substance abuse is seen in 25% to 40% of patients admitted to hospitals for general treatment. Many patients with substance use disorders have a higher risk for adverse events; however, only a small percentage will volunteer information regarding prior substance use. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.009DOI Listing
December 2018
18 Reads

Preoperative Management of the Geriatric Patient: Frailty and Cognitive Impairment Assessment.

Anesthesiol Clin 2018 Dec 12;36(4):599-614. Epub 2018 Oct 12.

Section Critical Care, Department of Cardiovascular Surgery, Mount Sinai Hospital System, Icahn School of Medicine, Mount Sinai Medical Center, Box 1028, 1 Gustave L. Levy Place, New York, NY 10029, USA.

As the population ages, more geriatric patients will be presenting for surgical procedures. Preoperative evaluation seeks to assess patients for geriatric syndromes: frailty, sarcopenia, functional dependence, and malnutrition. Age-related changes in physiology increase risk for central nervous system, cardiovascular, pulmonary, renal, hepatic, and endocrine morbidity and mortality. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.008DOI Listing
December 2018
6 Reads

Diabetes Mellitus: Preoperative Concerns and Evaluation.

Anesthesiol Clin 2018 Dec;36(4):581-597

Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, E-31 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, E-31 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address:

Diabetes is an important cause of morbidity in the adult population resulting in blindness, renal dysfunction, cardiovascular events, and amputation. Such morbidities may have an impact on perioperative anesthetic care and outcomes. In this review, the authors discuss the preoperative considerations in managing patients with diabetes as well as those without diabetes albeit hyperglycemic. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.007DOI Listing
December 2018
4 Reads

Surgical Prehabilitation: Nutrition and Exercise.

Anesthesiol Clin 2018 Dec;36(4):567-580

Duke University School of Medicine, Duke University Health System, 5th Floor HAFS, DUMC 3094, 2301 Erwin Road, Durham, NC 27710, USA.

Complications after major surgery account for a disproportionate amount of in-hospital morbidity and mortality. Recent efforts have focused on preoperative optimization in an attempt to modify the risk associated with major surgery. Underaddressed, but important, modifiable risk factors are physical fitness and nutritional status. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.013DOI Listing
December 2018
2 Reads

Hematologic Disorders.

Anesthesiol Clin 2018 Dec 12;36(4):553-565. Epub 2018 Oct 12.

Department of Anesthesia and Critical Care, University of Chicago, 5841 S. Maryland Avenue, MC 4028, Chicago, IL 60637, USA.

The hematologic system is responsible for several of the body's most critical functions, including delivery of oxygen and nutrients to tissues, clearance of toxic metabolic byproducts, defense against offending pathogens, and maintenance of hemostasis in the setting of trauma. Its exquisite complexity is difficult to overstate and poses a great challenge to review in short form. This article provides highlights and clinical pearls in managing patients suffering from some of the most common hematologic afflictions encountered in the perioperative setting. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.006DOI Listing
December 2018
2 Reads

Stratification and Risk Reduction of Perioperative Acute Kidney Injury: An Update.

Authors:
Sheela Pai Cole

Anesthesiol Clin 2018 Dec 12;36(4):539-551. Epub 2018 Oct 12.

Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Dr, H3580, Stanford, CA 94305, USA. Electronic address:

Perioperative acute kidney injury is associated with morbidity and mortality. Several definitions have been proposed, incorporating small changes of serum creatinine and urinary output reduction as diagnostic criteria. In the surgical patient, comorbidities, type and timing of surgery, and nephrotoxins are important. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.005DOI Listing
December 2018
16 Reads

Preoperative Evaluation: Estimation of Pulmonary Risk Including Obstructive Sleep Apnea Impact.

Anesthesiol Clin 2018 Dec 12;36(4):523-538. Epub 2018 Oct 12.

Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst street, Toronto, Ontario M5T2S8, Canada. Electronic address:

One in 4 deaths occurring within a week of surgery are related to pulmonary complications, making it the second most common serious morbidity after cardiovascular events. The most significant predictors of the postoperative pulmonary complications (PPCs) are American Society of Anesthesiologists physical status, advanced age, dependent functional status, surgical site, and duration of surgery. The overall risk of PPCs can be predicted using scores that incorporate readily available clinical data. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.004DOI Listing
December 2018
8 Reads

Preoperative Cardiac Evaluation for Noncardiac Surgery.

Anesthesiol Clin 2018 Dec;36(4):509-521

Department of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA.

Cardiac risk stratification before surgery informs consent, may advise optimization interventions, and guides intraoperative and postoperative management and monitoring. Published guidelines provide an outline for risk stratification but are only updated every 5 to 10 years; hence, cardiology expert opinion is often needed. Preoperative cardiovascular evaluation starts with an excellent history and physical examination. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.003DOI Listing
December 2018
15 Reads

Preoperative Laboratory Testing.

Anesthesiol Clin 2018 Dec 12;36(4):493-507. Epub 2018 Oct 12.

Preoperative Assessment Clinic, Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, 9 CSB Janeway Tower, Winston-Salem, NC 27157, USA.

Obtaining routine preoperative laboratory tests increases health care costs and has been listed, by the Choosing Wisely Campaign, as one of the top 5 practices anesthesiologists should avoid. Routine testing without clinical indication is not cost-effective and could cause harm and unnecessary delays. Abnormal findings are more likely to be false positive and costly to pursue, introduce new risks, and increase anxiety for the patient. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.07.002DOI Listing
December 2018
2 Reads

Designing and Running a Preoperative Clinic.

Anesthesiol Clin 2018 Dec;36(4):479-491

Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU School of Medicine, 550 1st Avenue, TH 552, New York, NY 10016, USA.

Value in health care has been described as quality divided by cost, where quality is the sum of patient outcomes and experience. A well-run preoperative evaluation clinic (PEC) offers many opportunities to improve the value of the care delivered to patients by reducing the associated costs and improving the quality of care. Certain patient education and medical optimization strategies initiated in the PEC clinic are linked to an improvement in patients' long-term health outcomes. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S19322275183006
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http://dx.doi.org/10.1016/j.anclin.2018.07.001DOI Listing
December 2018
10 Reads

Regional Anesthesiology and Acute Pain Medicine in the Era of Value-Based Health Care.

Anesthesiol Clin 2018 Sep 27;36(3):xiii-xiv. Epub 2018 Jun 27.

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA 94304, USA. Electronic address:

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http://dx.doi.org/10.1016/j.anclin.2018.06.001DOI Listing
September 2018
6 Reads

Regional Anesthesia: What We Need to Know in the Era of Enhanced Recovery After Surgery Protocols and the Opioid Epidemic.

Authors:
Lee A Fleisher

Anesthesiol Clin 2018 Sep 15;36(3):xi-xii. Epub 2018 Jun 15.

Perelman School of Medicine at 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.2018.06.002DOI Listing
September 2018
2 Reads

What Can Regional Anesthesiology and Acute Pain Medicine Learn from "Big Data"?

Anesthesiol Clin 2018 Sep 7;36(3):467-478. Epub 2018 Jul 7.

Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Stanford University School of Medicine, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.

Demonstrating value added to patients' experience through regional anesthesiology and acute pain medicine is critical. Evidence supporting improved outcomes can be derived from prospective studies or retrospective cohort studies. Population-based studies relying on existing clinical and administrative databases are helpful when an outcome is rare and detecting a change would require studying large numbers of patients. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.04.003DOI Listing
September 2018
3 Reads

Pediatric Ambulatory Continuous Peripheral Nerve Blocks.

Anesthesiol Clin 2018 Sep 7;36(3):455-465. Epub 2018 Jul 7.

Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address:

Despite the widespread use of ambulatory continuous peripheral nerve blocks in adults, its use in children has been sporadic. Indications for the use of ambulatory continuous peripheral nerve block in children involve orthopedic procedure, where significant pain is anticipated beyond 24 hours. Techniques to place the perineural catheters in children are similar to that used in adults. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.05.003DOI Listing
September 2018
3 Reads

Regional Anesthesia and Analgesia for Acute Trauma Patients.

Anesthesiol Clin 2018 Sep 7;36(3):431-454. Epub 2018 Jul 7.

Department of Anesthesiology, Division of Trauma Anesthesiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.

Regional anesthesia for the acute trauma patient is increasing due to the growing appreciation of its benefits, development of newer techniques and equipment, and more robust training. Block procedures are expanding beyond perioperative interventions performed exclusively by anesthesiologists to paramedics on scene, emergency medicine physicians, and nurse-led services using these techniques early in trauma pain management. Special considerations and indications apply to trauma victims compared with the elective patient and must be appreciated to optimize safety and clinical outcomes. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.04.004DOI Listing
September 2018
4 Reads

Enhanced Recovery After Shoulder Arthroplasty.

Anesthesiol Clin 2018 Sep;36(3):417-430

Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles 680, Philadelphia, PA 19104, USA.

Enhanced recovery after surgery (ERAS) protocols depend on multidisciplinary care and should be peer-reviewed and data-driven. ERAS has reduced hospital length of stay and complications, simultaneously improving patient outcomes. ERAS protocol after shoulder arthroplasty features multidisciplinary collaboration among different perioperative services and multimodal analgesia with a focus on regional anesthesia. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.04.006DOI Listing
September 2018
2 Reads

Update on Selective Regional Analgesia for Hip Surgery Patients.

Anesthesiol Clin 2018 Sep 11;36(3):403-415. Epub 2018 Jul 11.

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 3801 Miranda Avenue, MC 112A, Palo Alto, CA 94304, USA; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, MC 112A, Palo Alto, CA 94304, USA.

In hip surgery, regional anesthesia offers benefits in pain management and recovery. There are a wide range of regional analgesic options; none have shown to be superior. Lumbar plexus block, femoral nerve block, and fascia iliaca block are the most supported by published literature. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.04.001DOI Listing
September 2018
27 Reads

Novel Methodologies in Regional Anesthesia for Knee Arthroplasty.

Anesthesiol Clin 2018 Sep 11;36(3):387-401. Epub 2018 Jul 11.

Department of Anesthesiology, University of California, San Diego, 200 West Arbor Drive, MC 8770, San Diego, CA 92103, USA. Electronic address:

Maximizing analgesia is critical following joint arthroplasty because postoperative pain is a major barrier to adequate physical therapy. Continuous peripheral nerve blocks have been the mainstay for acute pain management in this population; however, this and similar techniques are limited by their duration of action. Cryoneurolysis and peripheral nerve stimulation are two methodologies used for decades to treat chronic pain. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.05.002DOI Listing
September 2018
2 Reads

Updates in Enhanced Recovery Pathways for Total Knee Arthroplasty.

Anesthesiol Clin 2018 Sep 11;36(3):375-386. Epub 2018 Jul 11.

Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA. Electronic address:

Enhanced recovery after surgery (ERAS) programs for orthopedics involve a multidisciplinary approach to accelerating return to function, reducing pain, improving patient comfort and satisfaction, reducing complications from the surgical procedure, reducing hospital length of stay, and reducing costs. ERAS pathways for patients receiving total knee arthroplasty are different from those having intracavitary surgery; they are less focused on fluid homeostasis and gut motility than they are with optimizing systemic and local analgesics and providing a balance between the highest quality pain control and accelerated return to ambulation. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.04.007DOI Listing
September 2018
3 Reads

Updates on Multimodal Analgesia for Orthopedic Surgery.

Anesthesiol Clin 2018 Sep 11;36(3):361-373. Epub 2018 Jul 11.

Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Suite 8290, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA.

Pain control after orthopedic surgery is challenging. A multimodal approach provides superior analgesia with fewer side effects compared with opioids alone. This approach is particularly useful in light of the current opioid epidemic in the United States. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.05.001DOI Listing
September 2018
6 Reads

Perioperative Considerations for the Patient with Opioid Use Disorder on Buprenorphine, Methadone, or Naltrexone Maintenance Therapy.

Anesthesiol Clin 2018 Sep 11;36(3):345-359. Epub 2018 Jul 11.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA; Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.

As part of a national effort to combat the current US opioid epidemic, use of currently Food and Drug Administration-approved drugs for the treatment of opioid use disorder/opioid addiction (buprenorphine, methadone, and naltrexone) is on the rise. To provide optimal pain control and minimize the risk of relapse and overdose, providers need to have an in-depth understanding of how to manage these medications in the perioperative setting. This article reviews key principles and discusses perioperative considerations for patients with opioid use disorder on buprenorphine, methadone, or naltrexone. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.04.002DOI Listing
September 2018
2 Reads

Establishing an Acute Pain Service in Private Practice and Updates on Regional Anesthesia Billing.

Anesthesiol Clin 2018 Sep;36(3):333-344

Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA 94304, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA. Electronic address:

Acute pain management is an expanding perioperative specialty and there is a renewed focus on implementing and developing an acute pain service (APS) in nonacademic hospitals (ie, "private practice"). An anesthesiologist-led APS can improve patient care by decreasing perioperative morbidity and potentially reducing the risk of chronic postsurgical pain syndromes. Elements of a successful APS include multidisciplinary collaboration to develop perioperative pain protocols, education of health care providers and patients, and regular evaluation of patient safety and quality of care metrics. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S19322275183004
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http://dx.doi.org/10.1016/j.anclin.2018.04.005DOI Listing
September 2018
10 Reads

Integrating Academic and Private Practices: Challenges and Opportunities.

Anesthesiol Clin 2018 Jun 9;36(2):321-332. Epub 2018 Apr 9.

Department of Anesthesiology and Perioperative Medicine, UCLA Health, 757 Westwood Plaza, Suite 2331-L, Los Angeles, CA 90095-7403, USA. Electronic address:

As health care reform shifts toward value over volume, academic medical centers, known for highly specialized, high-cost care, will suffer from erosion of their traditional funding sources. Academic medical centers have undertaken mergers and partnerships with community medical centers, to maintain a more diversified, cost-effective, and competitive presence in their markets. These consolidations have seen varying results. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.01.012DOI Listing
June 2018
3 Reads

Anesthesiology's Future with Specialists in Population Health.

Authors:
Mike Schweitzer

Anesthesiol Clin 2018 Jun 9;36(2):309-320. Epub 2018 Apr 9.

Population Health, Premier Inc, PSH Learning Collaborative, Clearwater, FL, USA. Electronic address:

In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care. Engaging specialists in population health medicine is a prerequisite to be successful in improving the quality of care by reducing complications, unnecessary utilization, avoidable Emergency Department visits/readmissions, and total cost of care. Creating patient-centric, physician-lead, interdisciplinary care teams to redesign the delivery of care across the continuum of the episode of care (eg, shadow bundle) is a successful approach to commercial or Centers for Medicare and Medicaid Services value-based payments. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.01.008DOI Listing
June 2018
4 Reads

Comprehensive Acute Pain Management in the Perioperative Surgical Home.

Anesthesiol Clin 2018 Jun 7;36(2):295-307. Epub 2018 Apr 7.

Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA. Electronic address:

The careful coordination of care throughout the perioperative continuum offered by the perioperative surgical home (PSH) is important in the treatment of postoperative pain. Physician anesthesiologists have expertise in acute pain management, pharmacology, and regional and neuraxial anesthetic techniques, making them ideal leaders for managing perioperative analgesia within the PSH. Severe postoperative pain is one of many patient- and surgery-specific factors in the development of chronic postsurgical pain. Read More

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http://dx.doi.org/10.1016/j.anclin.2018.01.007DOI Listing
June 2018
4 Reads