Anesthesia & Analgesia's supplement for education and dialog

May 2014 Anesthesia & Analgesia

May 2014 Anesthesia & Analgesia

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?

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, and phenylephrine is probably the most frequently used drug.  Concerns were raised in the past about a possible direct cerebral vasoconstrictive effect, thus negating the potential benefits from increasing the systemic blood pressure.  More recent studies(…)

Paradoxical Air Embolism to Left Anterior Descending Artery in a Patient with ASD

Paradoxical Air Embolism to Left Anterior Descending Artery in a Patient with ASD

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 measurement of hemoglobin and the effect of perfusion

Noninvasive measurement of hemoglobin and the effect of perfusion

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?

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(…)