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    655 results match your criteria Anesthesiology Clinics[Journal]

    1 OF 14

    Value-Based Care and Strategic Priorities.
    Anesthesiol Clin 2017 Dec;35(4):725-731
    Anesthesiology, Anesthesiology Administration, University of Minnesota Health, MMC 294 Mayo, 8294A (Campus Delivery Code), 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
    The anesthesia market continues to undergo disruption. Financial margins are shrinking, and buyers are demanding that anesthesia services be provided in an efficient, low-cost manner. To help anesthesiologists analyze their market, Drucker and Porter's framework of buyers, suppliers, quality, barriers to entry, substitution, and strategic priorities allows for a structured analysis. Read More

    Market Evaluation: Finances, Bundled Payments, and Accountable Care Organizations.
    Anesthesiol Clin 2017 Dec;35(4):715-724
    Division of Gastroenterology, Perelman School of Medicine, 3400 Civic Center Boulevard-14th Floor Innovation Center, Philadelphia, PA 19104, USA.
    To control costs and improve quality, changes in health care delivery and financing have emerged, resulting in shifting of financial risk to providers for the quality and cost of care, including emergence of accountable care organizations and bundled payment models. This article discusses health care financing and delivery models in the context of procedures and surgeries that happen outside of the operating room. It describes the history of health insurance, trends in ambulatory surgery centers, and new payment models that have emerged from the Affordable Care Act and the Medicare Access and Children's Health Insurance Program Reauthorization Act. Read More

    Pediatric Anesthesia Considerations for Interventional Radiology.
    Anesthesiol Clin 2017 Dec;35(4):701-714
    Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, The University of Pennsylvania, The Children's Hospital of Philadelphia, 9th Floor, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address:
    Anesthesiologists are increasingly called on to care for pediatric patients undergoing diagnostic imaging and invasive procedures in interventional radiology. These procedures are typically classified as either nonvascular or vascular, and can range from short diagnostic imaging studies or biopsies to significantly longer and more invasive intravascular procedures. Anesthesia providers must consider each child's ability to cooperate reliably during the procedure, their age, and any cognitive impairment to define the best anesthetic plan. Read More

    Interventional Pulmonology.
    Anesthesiol Clin 2017 Dec;35(4):687-699
    Department of Anesthesiology and Critical Care, University of Pennsylvania, 3400 Spruce Street, 7th Floor Ravdin Building, Philadelphia, PA 19104, USA.
    Bronchoscopy presents a unique challenge and need for collaboration between anesthesia providers and bronchoscopists. The approach to topical anesthesia, analgesia, and sedation must be customized based on complexity, duration, and setting. The bronchoscopy team must work together in each phase of the procedure to ensure patient safety and allow completion of a quality bronchoscopy. Read More

    Anesthesia for Colonoscopy and Lower Endoscopic Procedures.
    Anesthesiol Clin 2017 Dec;35(4):679-686
    Gastroenterology Division, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
    Demand for anesthesiologist-assisted sedation is expanding for gastrointestinal lower endoscopic procedures and may add to the cost of these procedures. Most lower endoscopy can be accomplished with either no, moderate, or deep sedation; general anesthesia and active airway management are rarely needed. Propofol-based sedation has advantages in terms of satisfaction and recovery over other modalities, but moderate sedation using benzodiazepines and opiates work well for low-risk patients and procedures. Read More

    Anesthesia for Routine and Advanced Upper Gastrointestinal Endoscopic Procedures.
    Anesthesiol Clin 2017 Dec;35(4):669-677
    Gastroenterology Division, University of Pennsylvania, Perelman School of Medicine, Penn Medicine, Abramson Cancer Center, Perelman Center for Advanced Medicine, South Pavilion, 7th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address:
    This article aims to detail the breadth and depth of advanced upper gastrointestinal endoscopic procedures. It will focus on sedation and airway management concerns pertaining to this emerged and emerging class of minimally invasive interventions. The article will also cover endoscopic hemostasis, endoscopic resection, stenting and Barrett eradication therapy plus endoscopic ultrasound. Read More

    Cardioversions and Transthoracic Echocardiography.
    Anesthesiol Clin 2017 Dec;35(4):655-667
    Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
    Patients with atrial fibrillation and flutter routinely require transesophageal echocardiography with cardioversion. It is not uncommon to encounter patients with reduced ejection fractions, coronary artery disease, prior cardiac surgery, or obstructive sleep apnea. The anesthesiologist must carefully evaluate the patient and any available laboratory and study findings to assess for potential complications after anesthesia. Read More

    Anesthesia in the Electrophysiology Laboratory.
    Anesthesiol Clin 2017 Dec;35(4):641-654
    Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
    The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. Read More

    Catheterization Laboratory: Structural Heart Disease, Devices, and Transcatheter Aortic Valve Replacement.
    Anesthesiol Clin 2017 Dec;35(4):627-639
    Adult Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address:
    The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. Read More

    A Radiologist's View of Tumor Ablation in the Radiology Suite.
    Anesthesiol Clin 2017 Dec;35(4):617-626
    Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
    Image-guided percutaneous, minimally invasive ablation techniques offer a wide variety of new modalities to treat tumors in some of the most medically complicated patients coming to our hospitals. The use of computed tomography, PET, ultrasound imaging, and MRI to guide radiofrequency ablation, microwave ablation, and cryoablation techniques now makes it possible to treat patients on a short stay or outpatient basis with very good immediate outcomes. This rapid expansion of new tumor ablation techniques often presents challenges for the non-operating room anesthesia team. Read More

    An Anesthesiologist's View of Tumor Ablation in the Radiology Suite.
    Anesthesiol Clin 2017 Dec;35(4):611-615
    Department of Anesthesiology, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
    The advent of radiology image-guided tumor ablation procedures has opened up a new era in minimally invasive procedures. Using CT, MRI, ultrasound, and other modalities, radiologists and surgeons can now ablate a tumor through percutaneous entry sites. What traditionally was done in an operating room via large open incisions, with multiple days in the hospital recovering, is now becoming an outpatient procedure via these new techniques. Read More

    Use of Anesthesiology Services in Radiology.
    Anesthesiol Clin 2017 Dec;35(4):601-610
    Morton Hospital, Taunton, MA, USA.
    In the setting of technological advancements in imaging and intervention with concomitant rise in the use of non-operating room anesthesia (NORA) care, it has become even more critical for anesthesiologists to be aware of the needs and limitations of interventional procedures performed outside of the operating room. This article addresses the use of NORA services from the interventional radiologist's point of view and provides specific examples of preprocedural, intraprocedural, and postprocedural care patients may need for optimal outcome. Read More

    Monitoring for Nonoperating Room Anesthesia.
    Anesthesiol Clin 2017 Dec;35(4):591-599
    Anesthesiology, Division of Pediatric Anesthesiology, Pediatric Intensive Care Unit, Children's Hospital of Wisconsin, MCW, Milwaukee, WI, USA; Pediatrics, Division of Pediatric Critical Care, Pediatric Intensive Care Unit, Children's Hospital of Wisconsin, MCW, Milwaukee, WI, USA. Electronic address:
    Procedures requiring nonoperating room anesthesia (NORA) continue to increase in quantity and complexity. The roles of anesthesiologists as members of care teams in nonoperating room locations continue to evolve. The safe provision of NORA requires strict adherence to standardized monitoring guidelines including pulse oximetry, capnography, electrocardiogram, and noninvasive blood pressure ampliflier. Read More

    Implementation and Use of Anesthesia Information Management Systems for Non-operating Room Locations.
    Anesthesiol Clin 2017 Dec;35(4):583-590
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Perioperative Research, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    Non-operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Read More

    Safety of Non-Operating Room Anesthesia: A Closed Claims Update.
    Anesthesiol Clin 2017 Dec;35(4):569-581
    Department of Anesthesiology and Pain Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356540, Seattle, WA 98195, USA.
    Malpractice claims for non-operating room anesthesia care (NORA) had a higher proportion of claims for death than claims in operating rooms (ORs). NORA claims most frequently involved monitored anesthesia care. Inadequate oxygenation/ventilation was responsible for one-third of NORA claims, often judged probably preventable by better monitoring. Read More

    Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence.
    Anesthesiol Clin 2017 Dec;35(4):559-568
    Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6th Floor Dulles Building, Philadelphia, PA 19104, USA. Electronic address:
    Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non-operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. Read More

    Demands of Integrated Care Delivery in Interventional Medicine and Anesthesiology: Interdisciplinary Teamwork and Strategy.
    Anesthesiol Clin 2017 Dec;35(4):555-558
    Department of Anesthesiology, University of Tennessee College of Medicine, UTHSC/Regional One Health, Chandler Building, Suite 600, 877 Jefferson Avenue, Memphis, TN 38103, USA.
    Evolving financial and medical constraints fueled by the increasing repertoire of nonoperating room cases and widening scope of patient comorbidities are discussed. The need to integrate finances and care approaches is detailed, and strategic suggestions for broader collaborative practice are suggested. Read More

    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

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