Advances in Anesthesia

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ISBN: 9781416057284 | 1416057285
Cover: Hardcover
Copyright: 12/1/2009

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Penn State College of Medicine, Hershey, PA. Topics include anesthetic management of interventional neuroradiological procedures, perioperative management of the opioid-tolerant patient, retirement planning for physicians, and regional anesthesia in trauma. For anesthesiologists.

Editorial Board	p. vii
Contributors	p. ix
Anesthetic Management of Interventional Neuroradiological Procedures
Neurovascular techniques	p. 2
Vascular access	p. 2
Imaging technology	p. 2
Embolic materials	p. 3
Anesthetic considerations	p. 3
Monitoring	p. 5
Arterial pressure	p. 5
Other systemic monitoring	p. 5
Central nervous system monitoring	p. 6
Urinary output	p. 6
Laboratory tests	p. 7
Anesthetic techniques	p. 7
Dynamic sedation	p. 7
Narcotics	p. 9
General anesthesia with tracheal intubation	p. 9
Adjuvant techniques for sedation and general anesthesia	p. 10
Anticoagulation	p. 10
Deliberate hypotension	p. 10
Flow arrest	p. 12
Deliberate hypertension	p. 12
Deliberate hypercapnia	p. 12
Radiation safety	p. 13
Management of procedural catastrophes	p. 13
Transport and postprocedural considerations	p. 14
Specific procedures	p. 14
Suuperselective angiography and therapeutic embolization of AVMs	p. 14
Embolization of spinal sord lesions	p. 15
Carotid test occlusion and therapeutic carotid occlusion	p. 16
Aneurysm ablation	p. 17
Angioplasty	p. 18
Angioplasty for atherosclerosis	p. 19
Thrombolysis for acute stroke	p. 20
Treatment of other CNS vascular malformations	p. 20
Dural AVMs	p. 20
Carotid cavernous fistulae	p. 20
Vein of galen malformation	p. 21
Intra-arterial chemotherapy and embolization of tumors	p. 23
Vertebral body compression fracture therapy	p. 23
Summary	p. 24
Acknowledgments	p. 24
Perioperative Management of the Opioid-Tolerant Patient
Nociception: a neuroanatomical review	p. 26
Tolerance and hyperalgesia	p. 27
Opioid-induced hyperalgesia: essentials of current knowledge	p. 28
Opioid-induced hyperalgesia in animal studies	p. 28
OEH in animal studies: type of pain stimulus	p. 29
OIH in animal studies: time course and dosing regimen	p. 29
OIH in animal studies: neuroanatomical structures and receptors	p. 30
Opioid-induced hyperalgesia in humans: methods and settings of evaluation	p. 32
Opioid-induced hyperalgesia in humans: chronic opiate users	p. 32
Opioid-induced hyperalgesia in humans: perioperative exposure	p. 34
Opioid-induced hyperalgesia in humans: pain testing opiate-naïve individuals following acute opiate exposure	p. 34
Multimodal analgesia	p. 35
Specific agents	p. 36
Acetaminophen	p. 36
Nonsteroidal anti-inflammatory drugs	p. 36
Gabapentinoids	p. 38
Antidepressants	p. 39
NMDA receptor antagonists	p. 40
Local anesthetics	p. 41
Converting oral and parenteral opioids	p. 42
Converting parenteral opioids to oral opioids and discharge planning	p. 45
Clinical challenges: case presentations illustrating application of pain management principles in opioid-tolerant patients	p. 47
Clinical challenge #1: The patient on oral buprenorphine or Buprenorphine-naloxone combination therapy	p. 47
Clinical challenge #2: Opioid-tolerant patient requiring total knee arthroplasty	p. 48
Clinical challenge #3: Opioid-tolerant Patient with traumatic lower extremity amputation	p. 49
Summary	p. 49
Acknowlrdgments	p. 49
Preoperative Stress Syndromes and Their Evaluation, Consultation, and Management
Pathophysiology	p. 56
Epidemiology	p. 56
Anxiety during the preanesthesia period	p. 57
Primary anxiety disorders	p. 59
Awareness under anesthesia and the development of posttraumatic stress disorder	p. 61
Differential diagnosis of anxiety states	p. 62
Medical care/psychiatric consultation	p. 63
Diet	p. 64
Medications for anxiety	p. 64
Treatment of acute preoperative anxiety	p. 68
Psychotherapy and other therapies for anxiety	p. 68
Complementary and alternative treatment of anxiety	p. 69
Summary	p. 69
Genomics: Implications for Anesthesia, Perioperative Care and Outcomes
Fundamental principles of genetic variation and impact on function	p. 74
Variation in DNA as a cause of human disease	p. 79
Technology to identify genetic variation	p. 81
Measurement of DNA variation	p. 81
Measurement of RNA variation	p. 83
Principles of study of gene-disease relationships	p. 84
A simple example of the methods used in gene-disease association studies	p. 87
What are the uses of genetic studies?	p. 89
How does genetic information alter risk classification	p. 91
Summary	p. 94
Acknowledgments	p. 94
Retirement Planning for Physicians
Tax and investment strategies	p. 97
Maximize contributions	p. 97
Make tax-free investments	p. 98
Purchase stocks	p. 98
Shift income	p. 99
Fund education	p. 99
Fund Roth individual retirement arrangement	p. 99
Distribution phase	p. 100
Case study	p. 102
Summary	p. 105
Nonopioid Adjuvants in Multimodal Therapy for Acute Perioperative Pain
Nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, and acetaminophen	p. 113
Nonselective nonsteroidal anti-Inflammatory drugs	p. 114
Aspirin	p. 114
Diclofenac	p. 116
Ketorolac	p. 116
Acetaminophen	p. 118
COX-2 inhibitors	p. 119
N-Methyl-D-aspartate receptor antagonists	p. 121
Ketamine	p. 122
Dextromethorphan	p. 123
Magnesium	p. 124
Gabapentinoids	p. 125
Gabapentin	p. 125
Pregabalin	p. 126
¿2-Adrenergic agonists	p. 127
Clonidine	p. 128
Dexmedetomidine	p. 128
Glucocorticoids	p. 129
Summary	p. 134
Evidence-Based Update and Controversies in the Treatment and Prevention of Postoperative Nausea and Vomiting
Risk factors for postoperative nausea and vomiting	p. 144
Currendy available antiemetics	p. 145
Dopamine receptor antagonists	p. 145
Anticholinergics	p. 149
Antihistamines	p. 149
Serotonin receptor antagonists	p. 150
Other antiemetic interventions	p. 150
Newer generation antiemetics	p. 151
Nk₁ receptor antagonists	p. 153
Combination therapy and the multimodal approach	p. 155
Recommendations for the prophylaxis and treatment of postoperative nausea and vomiting	p. 157
Summary	p. 157
Impact of Central Neuraxial Analgesia on the Progress of Labor
Difficulties with designing and conducting clinical trials	p. 167
The effect of neuraxial analgesia on cesarean delivery rates	p. 170
Randomized controlled trials	p. 170
Impact studies	p. 172
Timing of initiation of neuraxial analgesia	p. 173
The effect of neuraxial anesthesia on the instrumental vaginal delivery rate	p. 174
The effect of neuraxial analgesia on the duration of labor	p. 178
First stage of labor	p. 178
Second stage of labor	p. 180
Third stage of labor	p. 181
Oxytocin administration and ambulation	p. 181
Oxytocin	p. 181
Ambulation	p. 183
Summary	p. 183
Regional Anesthesia in Trauma
The consequences of trauma and the role of the anesthesiologist	p. 192
History of pain relief for the trauma patient	p. 193
Regional anesthesia in the battlefield	p. 194
Neurochemistry of nociception in trauma	p. 195
Hormone release in the trauma patient	p. 196
Benefits of regional anesthesia and analgesia on the stress response in the trauma patient	p. 196
Perioperative regional anesthesia techniques in trauma	p. 197
Central neuraxial techniques	p. 197
Use of continuous thoracic epidural analgesia for ahoracic trauma	p. 198
Paravertebral block	p. 199
Peripheral nerve blocks for the management of trauma to the extremities	p. 200
Continuous nerve blocks and multimodal analgesia	p. 201
Peripheral nerve localization techniques	p. 201
Peripheral nerve blocks of the upper extremities (and shoulder) for trauma	p. 202
Peripheral nerve blocks of the lower extremities for trauma patients	p. 203
Other regional analgesic techniques used in trauma patients	p. 205
Local anesthetics and analgesic adjuvants for regional anesthesia	p. 206
Risks of regional anesthesia in trauma	p. 208
Compartment syndrome	p. 209
Peripheral nerve injury	p. 210
Regional anesthesia in the heavily sedated or anesthetized patient	p. 212
Infection	p. 213
Coagulopathy	p. 213
Prehospital and emergency room management of adult trauma: regional anesthesia in the field	p. 214
Summary	p. 216
Index	p. 223
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Advances in Anesthesia

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