Those who manage the anesthetic care of children who need an arterial line know that insertion can be difficult. The pulse is felt, yet pass after pass fails to cannulate the artery. Ultrasound guidance is becoming more popular, particularly for difficult arterial cannulation. Dr. Yoshinobu Nakayama, Department of Anesthesiology and Intensive Care, Kyoto Prefectural University(…)
This issue explores the Perioperative Surgical Home (PSH). Kain and colleagues (The Perioperative Surgical Home as a Future Perioperative Practice Model) explain how the PSH works at the University of California at Irvine. Vetter and colleagues (The Perioperative Surgical Home: How Anesthesiology Can Collaboratively Achieve and Leverage the Triple Aim in Health Care) describe their(…)
Does phenylephrine cause vasoconstriction in the extracranial vasculature without a decrease in cerebral oxygenation?
To maintain cerebral perfusion during systemic hypotension, it is common clinical practice to raise blood pressure using a vasopressor. Phenylephrine is probably the most frequent choice. Concerns were raised in the past about a possible direct cerebral vasoconstrictive effect, negating the potential benefits from increased systemic blood pressure. More recent studies using transcranial Doppler have(…)
The patient experiences profound hypotension after induction: quick, what’s your differential diagnosis? Let’s also say the patient has a secundum atrial septal defect (ASD) that’s to be closed in the cardiac catheterization lab. Is your differential diagnosis any different now? Dr. Dinesh Kumar, Department of Cardiac Thoracic & Vascular Anesthesia, Sri Chitra Tirunal Institute of(…)
Noninvasive monitoring has come a long way. First there was blood pressure, followed by oximetry and end-tidal carbon dioxide. Now there are many more noninvasive blood tests, including noninvasive hemoglobin measurement, monitored continuously via spectrophotometric finger sensors (Masimo Corporation, Irvine, California, SpHb). What factors affect the accuracy of this device? Dr. Ronald D. Miller, Anesthesia(…)
Does anesthesia exposure for surgery for malignant disease affect the risk of malignancy after surgery?
Anesthetics are known to affect the immune response, yet recently in this journal it was shown that the risk of malignant disease within 5 years postoperatively could not be associated with the duration of general anesthesia and time with Bispectral Index (BIS) under 45 in patients without a history of malignancy. What about patients with(…)