Mechanical ventilation in the operating room frequently includes application of positive end expiratory pressure (PEEP). This is done to improve intraoperative oxygen delivery, as well as to improve lung mechanics postoperatively. PEEP increases intrathoracic pressure, decreasing venous return, and potentially raising venous pressure. This raises potential concern that PEEP may increase bleeding, particularly in operations […]
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 […]
Office-based anesthesia is expanding. At the present time, there has not been a good review of what is needed for those who practice anesthesia in the office. Drs. Fred Shapiro, Nathan Punwani, Noah Rosenberg, Arnaldo Valedon, Rebecca Twersky and Richard Urman, from various institutions around the United States, are individuals who do both office and ambulatory surgery and […]
Anesthesiologists routinely use capnography for both general anesthesia and sedation. We consider this the standard of care for sedation. This is not the case for nonanesthesiologists (e.g., specialists and nurses) administering deep sedation. Should it be? Does capnography use prevent hypoxemia? Dr. Kim van Loon, Division of Anesthesiology Intensive Care and Emergency Medicine, University Medical […]
Are ambulatory surgery patients more hypertensive if they don’t take their ACE inhibitor on the day of surgery?
Should antihypertensives be discontinued before surgery? No. Is it harmful for those patients who take chronic angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II subtype I receptor agonists (ARBs) to stop taking the medications before surgery? Maybe. There is some evidence that if patients continue to use these drugs, on the morning of surgery they may […]
Cigarette smoking is bad, but is everything in cigarette smoke harmful? Specifically, what can be said about nicotine? Nicotine is an anti-inflammatory alkaloid. It can be protective against ulcerative colitis. It improves glucose homeostasis. Nicotine may also have therapeutic value for Parkinson’s disease management. In addition, it has antinociceptive effects. So, how does nicotine affect […]