Anesthesia & Analgesia's supplement for education and dialog

Can dexamethasone reduce delirium incidence after cardiac surgery?

Can dexamethasone reduce delirium incidence after cardiac surgery?

Delirium is seen in at least 50% of patients after cardiac surgery. Patients with delirium have a greater likelihood extended hospital stay, long-term cognitive impairment, and death after surgery. Cardiac surgery and cardiopulmonary bypass trigger an inflammatory response. This response may contribute to neuroinflammation, brain injury, and postoperative delirium. Steroids may decrease neuroinflammation and the […]

Proper care of patients who suffer myocardial infarction after vascular surgery

Proper care of patients who suffer myocardial infarction after vascular surgery

Postoperative myocardial infarction (MI) is a well-documented and potentially fatal complication of vascular surgery. Elevated troponin I levels can suggest a myocardial infarction even without ECG evidence. Medical management of ischemic heart disease is well understood, and involves the use of HMG-CoA reductase inhibitors (i.e., statins), antiplatelet drugs, beta-adrenergic receptor blockers, and angiotensin-converting enzyme (ACE) […]

November 2014: Anesthesia & Analgesia

November 2014: Anesthesia & Analgesia

The November issue of Anesthesia & Analgesia has just posted. Dr. Steven Shafer, editor-in-chief, Anesthesia & Analgesia: The story of Freeman Allen (Freeman Allen: Boston’s Pioneering Physician Anesthetist), one of Boston’s first physician anesthetists, serves as a springboard for discussions on the gratitude of Halifax to the citizens of Boston for assistance in a time of great […]

Drug-induced sleep endoscopy: use of an automated dosing strategy

Drug-induced sleep endoscopy: use of an automated dosing strategy

The incidence of obstructive sleep apnea is increasing. The diagnosis is typically made using overnight polysomnography in a sleep laboratory, a time consuming and expensive procedure. The standard therapy is continuous positive airway pressure at night, but this does not always work. Surgery can be performed, but requires anatomic determination of the reason for sleep […]

Keep breathing!

Keep breathing!

Awakening from inhaled anesthesia is a complicated business. Once the patient is no longer inhaling anesthetic, the concentration of anesthetic in the blood will drop as anesthetic gas is eliminated via the lungs. However, as the concentration in the blood decreases, the partial pressure in the blood will drop below the partial pressure in the […]

TEE is useful even during cardiopulmonary bypass

TEE is useful even during cardiopulmonary bypass

The cardiac anesthesiologist must constantly be on the look-out for adverse changes in physiology, and must be particularly vigilant during the transition on and off cardiopulmonary bypass. Even during bypass potential complications may arise that require acute intervention. Transesophageal echocardiography is particularly useful during bypass to watch for ventricular distension. Dr. Michael A. Fierro, Loyola […]