Anesthesiologist Should Research Articles

Anesthesiologist Should Have ER/ICU Experience in Their Life

Anesthesiologist Should Have ER/ICU Experience in Their Life

What Every Anesthesiologist Should Know About the Manual Resuscitation Bag.

The bag-valve-mask or the manual resuscitation bag is life-saving equipment. This article explains its construction, functioning, and limitations. This article also attempts to clarify some common misconceptions such as whether a resuscitation bag can be used to preoxygenate or provide continuous positive airway pressure or positive end-expiratory pressure and the highest percentage of oxygen that it can deliver.

Videolaryngoscopy in Airway Management: What Every Anesthesiologist Should Know!

Aim of review: The aim of this article is to convey several hotspot issues regarding the use of videolaryngoscopy (VL) in airway management that anesthesiologists are often concerned. Methods: Recent literature in the past 20 years about the use of VL in the clinical airway management were searched from the Pubmed and Cochrane databases and reviewed, in order to determine the strengths and weakness of VL and conflicting issues regarding the role of VL in airway management. Recent findings: The benefits of VL are most significant in patients with difficult airways, with an improved laryngeal view and an increased success rate of intubation. However, VL cannot give a 100% success rate and there is no specific evaluation system of difficult or failed VL as with direct laryngoscopy. Awake VL-assisted intubation is a useful alternative to awake fiberoptic intubation, but the fiberoptic bronchoscope cannot be discarded and still is gold standard tool of difficult airway management. There are several different-type VLs available and their efficacies may be different between devices due to various designs and shapes. Due to the limited number of comparative studies, however, there is inconclusive evidence to recommend which VL design is more advantageous in various clinical situations. A Macintosh-type VL allows residents to learn laryngoscopy and intubation more quickly and effectively. Given that VL has tremendous advantages, it should be used as the first-line device for all tracheal intubations. Summary: The introduction of VL has resulted in a dramatic transformation of clinical airway management and is seen as the evolutionary step in intubation technology. There are considerable disagreements over the role of VL in airway management and the need of more investigation, but VL continues to get popularity both inside and outside the operating room. With increasing use of VL in airway management, experience and skill will undoubtedly increase, and the evidence will suggest that the attempt numbers and complications of intubations may be decreased, and patient safety can be improved. (Funded by the Major Project of Zhejiang Science and Technology Fund.) Citation: Fu-Shan Xue, Ya-Yang Liu, Hui-Xian Li, Gui-Zhen Yang. Videolaryngoscopy in Airway Management: What Every Anesthesiologist Should Know! J Anesth Perioper Med 2017; 4 : x-xx. doi: 10.24015/JAPM.2017.0048 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Caring for the Amish: What Every Anesthesiologist Should Know.

The Amish are a relatively isolated group with cultural and religious customs that differ significantly from the mainstream American population. Functioning as tight-knit communities with strong conservative Christian beliefs, the Amish maintain a culture based on intentional separateness from the outside world. Key aspects of Amish life include distinct clothing and behaviors, a unique language, an agrarian lifestyle, limited formal education, nonviolence/nonaggression, and a general lack of modern technology, as exemplified by the use of the traditional horse-and-buggy. The Amish have distinct health care practices, beliefs, and goals, and because of differing genetics and lifestyle, also have a distinct constellation of health and disease characteristics. This article reviews the core beliefs, community and lifestyle, health care beliefs and practices, and health characteristics of this unique and medically challenging population. Generalizable strategies for providing culturally competent care for any such ethnically, socially, or medically unique community are presented.

Pro: A Cardiovascular Anesthesiologist Should Provide Services in the Catheterization and Electrophysiology Laboratory

THE GAMUT OF clinical practices in the realm of interventional cardiology has grown more in the past decade than perhaps any other field in medicine and continues to evolve. Significant recent advances have occurred in nonpharmacologic interventional techniques for the management of almost all cardiac arrhythmias and structural heart diseases, including valvular dysfunction, cardiomyopathy, and adult congenital heart lesions. Advances in technology and technical skills now allow increasingly complex procedures such as percutaneous valve replacements, arrhythmia ablation surgeries, and cardiac ventricular assist device insertions to be performed in even sicker patients using a catheter-based approach, thus obviating the need for open cardiothoracic surgery. 1 Vahanian A. Alfieri O.R. Al-Attar N. et al. Transcatheter valve implantation for patients with aortic stenosis: A position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 2008; 34: 1-8 Crossref PubMed Scopus (247) Google Scholar , 2 Michowitz Y. Mathuria N. Tung R. et al. Hybrid procedures for epicardial catheter ablation of ventricular tachycardia: Value of surgical access. Heart Rhythm. 2010; 7: 1635-1643 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar Newer procedures continue to show increasing success at achieving their targeted goals and enhancing the patients' quality of life. Needless to say, percutaneous or minimally invasive catheter-based procedures are here to stay, and in the next few years, interventional cardiovascular and electrophysiologic procedures (EP) likely will dominate the care of patients with cardiac or vascular disease. This changing landscape of cardiovascular medicine has presented both unique challenges with regards to patient management as well as new opportunities in advancing the practice of anesthesiologists involved in these interventional procedures, a role that can be performed most reliably and, perhaps, only by a trained cardiovascular/thoracic (CVT) anesthesiologist.

Two Cases With Cushing Syndrome: What an Anesthesiologist Should Know

Cushing syndrome is a multietiologic clinical situation, resulting in several features like obesity, hyperglycemia, hypertension, proximal muscle weakness, skin thinning, menstrual irregularities, buffalo hump, and purple striae. In perioperative period the anesthesiologist must deal with difficult ventilation and intubation, hemodynamic disturbances, volume overload and hypokalemia, glucose intolerance and diabetes, maintaining the blood cortisol level and preventing the glucocorticoid deficiency. This syndrome is quite rare and its features make these patients very difficult to the anaesthesiologist. doi:10.4021/jem5w

Two Cases With Cushing Syndrome: What an Anesthesiologist Should Know

Cushing syndrome is a multietiologic clinical situation, resulting in several features like obesity, hyperglycemia, hypertension, proximal muscle weakness, skin thinning, menstrual irregularities, buffalo hump, and purple striae. In perioperative period the anesthesiologist must deal with difficult ventilation and intubation, hemodynamic disturbances, volume overload and hypokalemia, glucose intolerance and diabetes, maintaining the blood cortisol level and preventing the glucocorticoid deficiency. This syndrome is quite rare and its features make these patients very difficult to the anaesthesiologist. J Endocrinol Metab. 2011;1(1):41-44 doi: https://doi.org/10.4021/jem5w

Pro: The General Anesthesiologist Should Be Trained and Certified in Transesophageal Echocardiography

DESPITE MONITORING OF routine hemodynamic variables, many patients develop complications of cardiovascular origin while undergoing noncardiac surgery. Not only is monitoring of routine hemodynamic variables insufficient to accurately diagnose and treat hemodynamic instability, it does not even ensure maintenance of intravascular volume. Transesophageal echocardiography (TEE) allows multiplane imaging of the myocardium, heart chambers and valves, pericardium, and great vessels and the assessment of blood flow characteristics and the timing of intracardiac events.

Infusate Contamination in Regional Anesthesia: What Every Anesthesiologist Should Know

Infection can be a devastating complication of regional anesthesia. Contaminated infusate as a cause of infection in neuraxial anesthesia or peripheral nerve blockade has rarely been reported in the literature. However, it may be an important source of morbidity, especially as increasing numbers of patients are being discharged with perineural catheters and portable pumps of local anesthetic, which may infuse for several days at home. Two important issues related to infusate contamination in regional anesthesia are that of "hang-time" and sterile compounding practices. Hang-time can be defined as the maximum length of time during which an admixture preparation (infusate) can be safely administered without risk of microbiological or chemical instability. In the United States, there are currently no national guidelines on the hang-times of regional anesthesia infusates. On the other hand, guidelines for the sterile compounding of infusions used in regional anesthesia are now established by United States Pharmacopeia and The National Formulary Chapter 797, entitled "Pharmaceutical Compounding, Sterile Preparations." These guidelines have significant implications for the anesthesiologist. In this review, we examined the available literature regarding contaminated infusate as a cause of infection in regional anesthesia, to discuss strategies for the prevention of such contamination including the appropriate hang-time for infusates, and to discuss the implications of United States Pharmacopeia and The National Formulary Chapter 797 for anesthesiologists.

Pediatric Computed Tomographic Scan with Anesthesia: What the Anesthesiologist Should Know

Pediatric Computed Tomographic Scan with Anesthesia: What the Anesthesiologist Should Know

A Matter of Life and Death: What Every Anesthesiologist Should Know About the Medical, Legal, and Ethical Aspects of Declaring Brain Death

Departments of Anesthesiology, Internal Medicine, and Biomedical History and Ethics, University of Washington, Seattle, Washington

Fetal Heart Rate Monitoring: What the Anesthesiologist Should Know

Fetal Heart Rate Monitoring: What the Anesthesiologist Should Know