journal
https://read.qxmd.com/read/38705683/orthopedic-anesthesia-changes-challenges-and-choices
#1
EDITORIAL
Ashley M Shilling
No abstract text is available yet for this article.
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705682/anesthesia-for-injuries-in-athletes-and-those-of-us-who-attempt-to-be-athletes
#2
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705681/a-look-forward-and-a-look-back-the-growing-role-of-eras-protocols-in-orthopedic-surgery
#3
REVIEW
Marissa Weber, Melissa Chao, Simrat Kaur, Bryant Tran, Anis Dizdarevic
The success of enhanced recovery after surgery (ERAS) protocols in improving patient outcomes and reducing costs in general surgery are widely recognized. ERAS guidelines have now been developed in orthopedics with the following recommendations. Preoperatively, patients should be medically optimized with a focus on smoking cessation, education, and anxiety reduction. Intraoperatively, using multimodal and regional therapies like neuraxial anesthesia and peripheral nerve blocks facilitates same-day discharge...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705680/regional-anesthesia-complications-and-contraindications
#4
REVIEW
Danial Shams, Kaylyn Sachse, Nicholas Statzer, Rajnish K Gupta
Regional anesthesia has a strong role in minimizing post-operative pain, decreasing narcotic use and PONV, and, therefore, speeding discharge times. However, as with any procedure, regional anesthesia has both benefits and risks. It is important to identify the complications and contraindications related to regional anesthesia, which patient populations are at highest risk, and how to mitigate those risks to the greatest extent possible. Overall, significant complications secondary to regional anesthesia remain low...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705679/continuous-catheter-techniques
#5
JOURNAL ARTICLE
Brittany Deiling, Kenneth Mullen, Ashley M Shilling
Continuous peripheral nerve block catheters are simple in concept: percutaneously inserting a catheter adjacent to a peripheral nerve. This procedure is followed by local anesthetic infusion via the catheter that can be titrated to effect for extended anesthesia or analgesia in the perioperative period. The reported benefits of peripheral nerve catheters used in the surgical population include improved pain scores, decreased narcotic use, decreased nausea/vomiting, decreased pruritus, decreased sedation, improved sleep, and improved patient satisfaction...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705678/local-anesthetics-local-anesthetic-systemic-toxicity-last-and-liposomal-bupivacaine
#6
REVIEW
Michael O On'Gele, Sara Weintraub, Victor Qi, James Kim
Local anesthetics have played a vital role in the multimodal analgesia approach to patient care by decreasing the use of perioperative opioids, enhancing patient satisfaction, decreasing the incidence of postoperative nausea and vomiting, decreasing the length of hospital stay, and reducing the risk of chronic postsurgical pain. The opioid-reduced anesthetic management for perioperative analgesia has been largely successful with the use of local anesthetics during procedures such as peripheral nerve blocks and neuraxial analgesia...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705677/regional-anesthesia-in-the-elite-athlete
#7
REVIEW
Patrick Meyer, Kristopher Schroeder
Elite athletes are exposed to an elevated risk of musculoskeletal injury which may present a significant threat to an athlete's livelihood. The perioperative anesthetic plan of care for these injuries in the general population often incorporates regional anesthesia procedures due to several benefits. However, some concern exists regarding the potential for regional anesthesia to adversely impact functional recovery in an elite athlete who may have a lower tolerance for this risk. This article aims to review the data behind this concern, discuss strategies to improve the safety of these procedures and explore the features of consent in this patient population...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705676/safety-considerations-for-outpatient-arthroplasty
#8
REVIEW
Alberto E Ardon
Since 2018, the number of total joint arthroplasties (TJAs) performed on an outpatient basis has dramatically increased. Both surgeon and anesthesiologist should be aware of the implications for the safety of outpatient TJAs and potential patient risk factors that could alter this safety profile. Although smaller studies suggest that the risk of negative outcomes is equivalent when comparing outpatient and inpatient arthroplasty, larger database analyses suggest that, even when matched for comorbidities, patients undergoing outpatient arthroplasty may be at increased risk of surgical or medical complications...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705675/anesthesia-for-the-patient-undergoing-foot-and-ankle-surgery
#9
REVIEW
Christopher M Sharrow, Brett Elmore
Modern anesthetic management for foot and ankle surgery includes a variety of anesthesia techniques including general anesthesia, neuraxial anesthesia, or MAC in combination with peripheral nerve blocks and/or multimodal analgesic agents. The choice of techniques should be tailored to the nature of the procedure, patient comorbidities, anesthesiologist skill level, intensity of anticipated postoperative pain, and surgeon preference.
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705674/anesthesia-for-the-patient-undergoing-knee-procedures
#10
REVIEW
Grant Neely, Nicole Hollis, Cy Mozingo
Anesthesia for patients undergoing knee procedures encompasses a large patient population with significant variation in patient age, comorbidities, and type of surgery. In addition, these procedures are performed in vastly different surgical environments, including large academic hospitals, private hospitals, and out-patient surgical centers. These variabilities require a thoughtful and individualized anesthetic approach tailored toward the medical and surgical needs of each patient. This article discusses anesthetic approaches to patients with acute, subacute, and chronic knee-related pathology requiring surgery...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705673/regional-anesthesia-for-hip-arthroscopy
#11
REVIEW
Peter E Amato, Andrew J Winkelman, Grace L Forster, F Winston Gwathmey
Pain after hip arthroscopy can be severe, yet we lack a consensus method for non-narcotic analgesia. Here we describe anatomic elements of hip arthroscopy and our current understanding of the relevant sensory innervation as a prelude to the evaluation of locoregional analgesic techniques. Many regional nerve blocks and local anesthetic infiltration techniques are reviewed, including 2 newer ultrasound fascial plane blocks. Further study of targeted, motor-sparing approaches, either ultrasound-guided or under direct surgical visualization is needed...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705672/anesthesia-for-the-patient-undergoing-shoulder-surgery
#12
REVIEW
Jeffrey J Mojica, Aaron Ocker, Jaime Barrata, Eric S Schwenk
Shoulder surgery introduces important anesthesia considerations. The interscalene nerve block is considered the gold standard regional anesthetic technique and can serve as the primary anesthetic or can be used for postoperative analgesia. Phrenic nerve blockade is a limitation of the interscalene block and various phrenic-sparing strategies and techniques have been described. Patient positioning is another important anesthetic consideration and can be associated with significant hemodynamic effects and position-related injuries...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705671/regional-anesthesia-for-athletes-undergoing-upper-extremity-procedures-techniques-and-considerations
#13
REVIEW
Carole-Anne Potvin, Vivian H Y Ip
Upper extremity injuries are frequent in athletes which may require surgeries. Regional anesthesia for postoperative analgesia is important to aid recovery, and peripheral nerve blocks for surgical anesthesia enable surgeries to be performed without general anesthetics and their associated adverse effects. The relevant nerve block approaches to anesthetize the brachial plexus for elbow, wrist and hand surgeries are discussed in this article. There is very limited margin for error when performing nerve blocks and multimodal monitoring approach to reduce harm are outlined...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38705670/unique-medical-considerations-for-the-athlete-undergoing-anesthesia
#14
REVIEW
Alessandra Riccio, Ashley M Shilling
Athletes are among a unique group such that they may possess a serious underlying pathologic condition that may often go unnoticed given their high caliber of physical fitness. However, several considerations should be investigated, especially in the perioperative period, in order to minimize morbidity and mortality. Namely, cardiac pathologic condition can result in sudden death, and pulmonary pathologic condition may affect airway and respiratory management. Moreover, patients undergoing orthopedic surgery are at the highest risk for venous thromboembolism...
June 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38278598/the-evolving-landscape-of-perioperative-medicine
#15
EDITORIAL
Zdravka Zafirova, Richard D Urman
No abstract text is available yet for this article.
March 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38278597/preoperative-patient-evaluation-obtaining-the-information-we-need-to-inform-the-care-we-provide
#16
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
March 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38278596/what-s-new-in-preoperative-cardiac-testing
#17
REVIEW
Murad Elias, Vahé S Tateosian, Deborah C Richman
More than 300 million surgeries are performed annually worldwide. Patients are progressively aging and often have multiple comorbidities that put them at increased cardiovascular risk in the perioperative period. The United States published latest guidelines regarding preoperative cardiac evaluation and risk stratification for patients undergoing non-cardiac surgery in 2014. There are multiple risk stratification tools available that can help guide management. Furthermore, newer laboratory tests, such as preoperative NT-proBNP and high-sensitivity troponin assays, may aid in preventing and diagnosing perioperative myocardial injury...
March 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38278595/social-determinants-of-health-and-preoperative-care
#18
REVIEW
Mofya S Diallo, Romana Hasnain-Wynia, Thomas R Vetter
Preoperative care exists as part of perioperative continuum during which anesthesiologists and surgeons optimize patients for surgery. These multispecialty efforts are important, particularly for patients with complex medical histories and those requiring major surgery. Preoperative care improves planning and determines the clinical pathway and discharge disposition. The role of nonmedical social factors in the preoperative planning is not well described in anesthesiology. Research to improve outcomes based on social factors is not well described for anesthesiologists but could be instrumental in decreasing disparities and advancing health equity in surgical patients...
March 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38278594/value-based-health-care-in-perioperative-medicine-process-maps-and-costing-to-determine-best-practices
#19
REVIEW
David Newton, Angela M Bader
Perioperative care in the United States is largely based on current fee-for-service models. Fee-for-service models are not based on the true cost of services provided, charges do not equal costs, and reimbursement varies based on insurer. Value-based health care is defined as patient-centered outcomes over cost of providing these services. Process mapping and time-driven activity-based costing can be used to define actual cost of services provided. Outcomes after discharge can be measured, so that the overall value of care provided can be assessed and improved based on the outcomes and costs identified...
March 2024: Anesthesiology Clinics
https://read.qxmd.com/read/38278593/management-of-preoperative-anemia
#20
REVIEW
Laura Mendez-Pino, Andrés Zorrilla-Vaca, David L Hepner
Anemia is the most common modifiable risk factor for postoperative morbidity and mortality. Early identification and optimal management are key to restore iron stores and ensure its resolution before surgery. Several therapies have been proposed to treat anemia in the perioperative period, such as iron supplementation and erythropoiesis-stimulating agents, though it remains unclear which is the most optimal to improve clinical outcomes. This article summarizes the most updated evidence on perioperative management of anemia and denotes differences among the international guidelines to reflect the conflicting evidence in this field and the need for further research in specific areas...
March 2024: Anesthesiology Clinics
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