scholarly journals Anesthesia and Analgesia in the Patient with an Unstable Shoulder

2017 ◽  
Vol 11 (1) ◽  
pp. 848-860 ◽  
Author(s):  
Ismael Acevedo Bambaren ◽  
Fernando Dominguez ◽  
Maria Elena Elias Martin ◽  
Silvia Domínguez
Keyword(s):  
Shoulder Instability ◽  
Shoulder Dislocation ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Postoperative Pain Management ◽  
Good Health ◽  
Cerebral Hypoperfusion ◽  
Nerve Blocks ◽  
Airway Control ◽  
Intraoperative Management

Introduction:The patient with an unstable shoulder represents a challenge for the anesthesiologist. Most patients will be young individuals in good health but both shoulder dislocation reduction, a procedure that is usually performed under specific analgesia in an urgent setting, and instability surgery anesthesia and postoperative management present certain peculiarities.Material and Methods:For the purpose of the article, 78 references including clinical trials and reviews were included. The review was organized considering the patient that presents an acute shoulder dislocation and the patient with chronic shoulder instability that requires surgery. In both cases the aspects like general or regional anesthesia, surgical positions and postoperative pain management were analyzed.Conclusion:The patient with an acutely dislocated shoulder is usually managed in the emergency room. Although reduction without analgesia is often performed in non-medical settings, an appropriate level of analgesia will ease the reduction procedure avoiding further complications. Intravenous analgesia and sedation is considered the gold standard but requires appropriate monitorization and airway control. Intraarticular local analgesic injection is considered also a safe and effective procedure. General anesthesia or nerve blocks can also be considered. The surgical management of the patient with shoulder instability requires a proper anesthetic management. This should start with an exhaustive preoperative evaluation that should be focused in identifying potential respiratory problems that might be complicated by local nerve blocks. Intraoperative management can be challenging, especially for patients operated in beach chair position, for the relationship with problems related to cerebral hypoperfusion, a situation related to hypotension events directly linked to patient positioning. Different nerve blocks will help attaining excellent analgesia both during and after the surgical procedure. An interescalene nerve block should be considered the best technique, but in certain cases, other blocks can be considered.

Trauma: The Burn Patient

2018 ◽  
pp. 81-86
Author(s):  
Ethan Kim ◽  
Ruchir Gupta
Keyword(s):  
Carbon Monoxide ◽  
Fluid Therapy ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Initial Assessment ◽  
Area Burned ◽  
Intraoperative Management ◽  
Parkland Formula ◽  
Burn Patient

In this chapter the essential aspects of anesthetic management of the burn patient are discussed. Subtopics include use of the Parkland formula for calculating fluid requirements, airway considerations, and carbon monoxide toxicity. The differences between first-, second-, and third-degree burns are also discussed. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Issues discussed that are related to preoperative evaluation include initial assessment, calculating percentage of body area burned, and airway evaluation. Topics related to intraoperative management include muscle relaxation, monitoring, and fluid therapy. Postoperative issues involve extubation criteria and treatment to induce muscle relaxation.

Transsphenoidal/Pituitary Surgery

2018 ◽  
Author(s):  
Vaia T. Abatzis ◽  
Edward C. Nemergut
Keyword(s):  
Pituitary Gland ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Pituitary Surgery ◽  
Anesthetic Care ◽  
Anesthetic Agents ◽  
Intraoperative Management ◽  
Transsphenoidal Pituitary Surgery ◽  
Early Diagnosis Of Diabetes

Patients with tumors of the pituitary gland represent a heterogeneous yet commonly encountered neurosurgical population. Optimal anesthetic care requires an understanding of the complex pathophysiology secondary to each patient’s endocrine disease. Although patients presenting with Cushing’s disease and acromegaly have unique manifestations of endocrine dysfunction, all patients with tumors of the pituitary gland require meticulous preoperative evaluation and screening. There are many acceptable strategies for optimal intraoperative anesthetic management; however, the selection of anesthetic agents should be tailored to facilitate surgical exposure, preserve cerebral perfusion and oxygenation, and provide for rapid emergence and neurological assessment. Postoperatively, careful monitoring of fluid balance and serum sodium is essential to the early diagnosis of diabetes insipidus (DI). DI is most often transient but can require medical therapy. A thorough understanding of the preoperative assessment, intraoperative management, and potential complications are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.

scholarly journals Repeated Anesthetic Management for a Patient With Klippel-Feil Syndrome

2014 ◽  
Vol 61 (3) ◽  
pp. 103-106 ◽  
Author(s):  
Yuri Hase ◽  
Nobuhito Kamekura ◽  
Toshiaki Fujisawa ◽  
Kazuaki Fukushima
Keyword(s):  
Airway Management ◽  
Cervical Vertebrae ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Fatal Outcome ◽  
Laryngeal Edema ◽  
Airway Control ◽  
First Choice ◽  
Surgical Airway ◽  
Preoperative Examination

Abstract Klippel-Feil syndrome (KFS) is a rare disease characterized by a classic triad comprising a short neck, a low posterior hairline, and restricted motion of the neck due to fused cervical vertebrae. We report repeated anesthetic management for orthognathic surgeries for a KFS patient with micrognathia. Because KFS can be associated with a number of other anomalies, we therefore performed a careful preoperative evaluation to exclude them. The patient had an extremely small mandible, significant retrognathia, and severe limitation of cervical mobility due to cervical vertebral fusion. As difficult intubation was predicted, awake nasal endotracheal intubation with a fiberoptic bronchoscope was our first choice for gaining control of the patient's airway. Moreover, the possibility of respiratory distress due to postoperative laryngeal edema was considered because of the surgeries on the mandible. In the operating room, tracheotomy equipment was always kept ready if a perioperative surgical airway control was required. Three orthognathic surgeries and their associated anesthetics were completed without a fatal outcome, although once the patient was transferred to the intensive care unit for precautionary postoperative airway management and observation. Careful preoperative examination and preparation for difficult airway management are important for KFS patients with micrognathia.

Extracranial-Intracranial Bypass

2018 ◽  
Author(s):  
Wael Saasouh ◽  
David E. Traul
Keyword(s):  
Cerebral Circulation ◽  
Surgical Procedure ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Management Strategies ◽  
Intracranial Bleeding ◽  
Arterial Supply ◽  
Proper Management ◽  
Intraoperative Management ◽  
Postoperative Observation

Extracranial-intracranial (EC-IC) bypass is a surgical procedure used to preserve or rescue cerebral circulation when the arterial supply is disrupted. There are several techniques of EC-IC bypass depending on the location of the anomaly and the vessels involved, the purpose being to provide a connection from a patent extracranial artery to an artery within the cranium, thus bypassing the anomalic or thrombosed portion. The mainstay of the anesthetic management of this procedure includes careful preoperative evaluation, meticulous intraoperative management, and close postoperative observation. Intracranial bleeding and hyperperfusion after the procedure are the two principal concerns, and proper management strategies should be in place for all cases.

Anesthesia for Airway Endoscopy and Micro-Laryngeal Surgery

2021 ◽  
Author(s):  
Vicki E. Modest ◽  
Paul H. Alfille
Keyword(s):  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Jet Ventilation ◽  
Control Plan ◽  
Airway Control ◽  
Laryngeal Surgery ◽  
Anesthetic Considerations ◽  
Surgical Field ◽  
Suspension Laryngoscopy ◽  
Type Of Surgery

Pre- and intra-operative anesthetic management considerations for airway endoscopy and micro-laryngeal surgery are covered in this chapter. Often presenting with critically obstructed or otherwise compromised airways, a carefully devised induction and airway control plan is essential. Unique to this type of surgery is the shared surgical field, requiring the utmost level of communication and cooperation between the surgical and anesthesia teams. Included is a discussion of ventilation options, routine and otherwise, and associated airway instrumentation such as jet ventilation catheters. Challenges of patient management during suspension laryngoscopy, are presented. Also addressed are laser basics, specific anesthetic considerations including risks and potential harms in the setting of these high-risk for fire procedures. This review contains 5 figures, 2 tables, and 40 references. Keywords: airway endoscopy, micro-laryngeal surgery, anesthetic considerations, obstructed airway, preoperative evaluation, airway intubation, laryngeal microsurgery, fire, OR

scholarly journals Actualización en el manejo anestésico del paciente obeso. ¿Lo sabemos todo?

2019 ◽  
Vol 11 (7) ◽  
pp. 2
Author(s):  
Belén Sánchez Quirós ◽  
María Asunción Pérez Herrero
Keyword(s):  
Metabolic Syndrome ◽  
Risk Factor ◽  
Difficult Intubation ◽  
Perioperative Complications ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Cardiovascular Complications ◽  
Prothrombotic State ◽  
Respiratory Complications ◽  
Intraoperative Management

 La obesidad creciente en nuestro medio es un factor de riesgo para la aparición de complicaciones perioperatorias.  Un manejo perioperatorio individualizado, teniendo en cuenta la idiosincrasia de estos pacientes es esencial para mejorar los resultados y la seguridad del procedimiento quirúrgico. Un manejo anestesico adecuado puede cambiar sustancialmente el desenlace vital de estos pacientes. ABSTRACT Anesthetic management of obese patient update. Do we know everything?  Obesity is a growing risk factor that leads to perioperative complications increase. An appropriate preoperative evaluation, intraoperative management and monitoring during the postoperative period is essential to improve safety during the surgical procedure. These patients present criteria of difficult intubation and ventilation, respiratory complications, especially the Apnea / hypopnea sleep syndrome (OSA); metabolic syndrome; prothrombotic state and cardiovascular complications. The commented article described the physiopathological characteristics and current recommendations of the anesthetic management for these patients.

scholarly journals Anesthetic management of a patient with situs inversus totalis undergoing coronary artery bypass grafting surgery: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Chigusa Nakasone ◽  
Masafumi Kanamoto ◽  
Wataru Tatsuishi ◽  
Tomonobu Abe ◽  
Shigeru Saito
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Situs Inversus ◽  
Anesthetic Management ◽  
Artery Bypass ◽  
Situs Inversus Totalis ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Intraoperative Management

Abstract Background Anesthetic management of coronary artery bypass grafting surgery (CABG) in a dextrocardia patient with situs inversus totalis is rarely encountered and seldom reported in the literature. Case presentation A 76-year-old Japanese female patient had been diagnosed with situs inversus totalis and coronary artery disease of 3 vessels, and she subsequently underwent elective CABG. A preoperative examination showed almost normal results. ECG showed right deviation with the normal lead position. In the operating room, ECG leads were applied in reverse. Pulmonary artery catheterization was performed via the left internal jugular vein. A transesophageal echocardiography (TEE) probe was introduced without difficulty. A different angle was needed to acquire the desired views because of her atypical anatomy. Conclusion Careful perioperative evaluation, intraoperative management, and inspection of multiplane angle and probe adjustments in TEE are needed for anatomically abnormal patients.

scholarly journals The Shoulder Instability: An Overview

2021 ◽  
Author(s):  
Balaji Zacharia ◽  
Arun Prakas ◽  
Subramanian Vaidyanathan ◽  
Antony Roy ◽  
Mohammed Komalam Ayyub
Keyword(s):  
Natural History ◽  
Shoulder Instability ◽  
Shoulder Joint ◽  
Shoulder Dislocation ◽  
Narrative Review ◽  
Pathological Anatomy ◽  
Dynamic Factors ◽  
History Of ◽  
Classification And Treatment

AbstractInstability of the shoulder joint is common but most of the time it is unrecognized by the treating surgeon. The symptoms can vary from subtle pain to shoulder dislocation. In many cases, there is no history of trauma. The shoulder joint is stabilized by both static and dynamic factors, and treatment is complex, with recurrence more common in young athletic individuals. Open and arthroscopic techniques of stabilization are available with specific indications for each of these methods. In this narrative review of shoulder instability, we describe the pathological anatomy, evaluation, natural history, classification, and treatment of shoulder instability.

Postoperative Pain Management

2018 ◽  
Author(s):  
Abhishek Parmar
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Clinical Information ◽  
Postoperative Pain Management ◽  
Patient Controlled Analgesia ◽  
Management Options ◽  
Nerve Blocks ◽  
Epidural Catheter Placement ◽  
Opiate Abuse ◽  
Regional Nerve Block

The aim of this review is to provide practical clinical information on modern pain management options to guide the clinician on evidence-based practices, optimizing the treatment of pain and avoiding practices that may lead to potential abuse. Postoperative pain management is an essential component of any surgeon’s practice and has clear implications for surgical outcomes, patient satisfaction, and population health. Understanding options within a multimodal approach to pain management in the acute setting is a key determinant to improving outcomes for our patients. This review discusses multimodal analgesic options, including a variety of pain medications (opiates, antiinflammatory medications, and patient-controlled analgesia) and techniques (epidural catheter placement, regional nerve blocks) to be used in tandem. Lastly, best possible practices to avoid opiate abuse are discussed. This review contains 4 figures, 5 tables, 1 video and 96 references. Key words: antiinflammatories, epidural, narcotics, patient-controlled analgesia, postoperative pain, regional nerve block

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