scholarly journals Office-Based Sedation/General Anesthesia for COPD Patients, Part II

2019 ◽  
Vol 66 (1) ◽  
pp. 44-51
Author(s):  
Kristin Chino ◽  
Steven Ganzberg ◽  
Kristopher Mendoza
Keyword(s):  
General Anesthesia ◽  
Treatment Plan ◽  
Current Treatment ◽  
Multiple Organ ◽  
Treatment Modalities ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Anxiety Control ◽  
Dental Office ◽  
Organ Systems

The safe treatment of patients with chronic obstructive pulmonary disease (COPD) in dental office office-based settings can be quite complex without a current understanding of the etiology, course, severity, and current treatment modalities of the disease. The additional concerns of providing sedation and/or general anesthesia to patients with COPD in settings outside of a hospital demand thorough investigation of individual patient presentation and realistic development of planned treatment that patients suffering from this respiratory condition can tolerate. Along with other co-morbidities, such as advanced age and potential significant cardiovascular compromise, the dental practitioner providing sedation or general anesthesia must tailor any treatment plan to address multiple organ systems and mitigate risks of precipitating acute respiratory failure from inadequate pain and/or anxiety control. Part I of this article covered the epidemiology, etiology, and pathophysiology of COPD. Patient considerations in the preoperative period were also reviewed. Part II will cover which patients are acceptable for sedation/general anesthesia in the dental office-based setting as well as sedation/general anesthesia techniques that may be considered. Postoperative care will also be reviewed.

scholarly journals Office-Based Sedation/General Anesthesia for COPD Patients, Part I

2018 ◽  
Vol 65 (4) ◽  
pp. 261-268 ◽  
Author(s):  
Kristin Chino ◽  
Steven Ganzberg ◽  
Kristopher Mendoza
Keyword(s):  
General Anesthesia ◽  
Treatment Plan ◽  
Multiple Organ ◽  
Treatment Modalities ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Anxiety Control ◽  
Copd Patients ◽  
Dental Office ◽  
Organ Systems

The safe treatment of patients with chronic obstructive pulmonary disease (COPD) in dental office–based settings can be quite complex without a current understanding of the etiology, course, severity, and treatment modalities of the disease. The additional concerns of providing sedation and/or general anesthesia to patients with COPD in settings outside of a hospital demand thorough investigation of individual patient presentation and realistic development of planned treatment that patients suffering from this respiratory condition can tolerate. Along with other comorbidities, such as advanced age and potential significant cardiovascular compromise, the dental practitioner providing sedation or general anesthesia must tailor any treatment plan to address multiple organ systems and mitigate risks of precipitating acute respiratory failure from inadequate pain and/or anxiety control. Part I of this article will cover the epidemiology, etiology, and pathophysiology of COPD. Patient evaluation in the preoperative period will also be reviewed. Part II will cover which patients are acceptable for sedation/general anesthesia in the dental office–based setting as well as sedation/general anesthesia techniques that may be considered.

“Double-Dipping”

2013 ◽  
Vol 18 (4) ◽  
pp. 6-7
Author(s):  
Stephen L. Demeter
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Multiple Organ ◽  
Organ System ◽  
The Other ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Sixth Edition ◽  
Organ Systems ◽  
Artery Disease ◽  
Single Organ

Abstract The goal of impairment assessment is to accurately estimate the loss of structure and/or function due to an injury or illness. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) sometimes provides two or more methods for rating a given condition, or, in the case of two or more impairing conditions, it may be inappropriate to rate less significant conditions if the rating for the primary impairment already takes into account the deficit(s). Either scenario offers opportunities for “double-dipping” or rating the same impairment more than once. Duplicative ratings commonly occur when two or more impairing conditions are present in a single organ system and even more often if multiple organ systems are involved. Because of methodological changes, ratings using the AMA Guides, Sixth Edition, are less susceptible to double-dipping than those from earlier editions, especially musculoskeletal ratings. To avoid duplication, the rater must look closely at all elements included in the impairment classes and determine if any similarity exists in the other organ systems or conditions rated (eg, is the patient's coronary artery disease responsible for the diminished exercise capacity, or is it the cardiomyopathy, or is it chronic obstructive pulmonary disease). When two or more conditions are present, evaluators should rate the higher or highest impairment and then eliminate, as much as possible, the influence of similar symptoms, signs, or diagnostic test abnormalities when rating the lower impairments.

scholarly journals Perioperative Optimization of Patients With Neuromuscular Disorders Undergoing Scoliosis Corrective Surgery: A Multidisciplinary Team Approach

2020 ◽  
pp. 219256822090169
Author(s):  
Fady Sedra ◽  
Roozbeh Shafafy ◽  
Ahmed-Ramadan Sadek ◽  
Syed Aftab ◽  
Alexander Montgomery ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Neuromuscular Disorders ◽  
Multiple Organ ◽  
Neuromuscular Scoliosis ◽  
High Rate ◽  
Wound Complications ◽  
Team Approach ◽  
Corrective Surgery ◽  
Organ Systems ◽  
Respiratory Management

Study Design: Narrative review. Objective: The high rate of complications associated with the surgical management of neuromuscular spinal deformities is well documented in the literature. This is attributed to attenuated protective physiological responses in multiple organ systems. Methods: Review and synthesis of the literature pertaining to optimization of patients with neuromuscular scoliosis undergoing surgery. Our institutional practice in the perioperative assessment and management of neuromuscular scoliosis is also described along with a clinical vignette. Results: Respiratory complications are the most common to occur following surgery for neuromuscular disorders. Other categories include gastrointestinal, cardiac, genitourinary, blood loss, and wound complications. A multidisciplinary approach is required for perioperative optimization of these patients and numerous strategies are described, including respiratory management. Conclusion: Perioperative optimization for patients with neuromuscular disorders undergoing corrective surgery for spinal deformity is multifaceted and complex. It requires a multidisciplinary evidence-based approach. Preadmission of patients in advance of surgery for assessment and optimization may be required in certain instances to identify key concerns and formulate a tailored treatment plan.

scholarly journals Anesthesia and Respiratory Disorders

2019 ◽  
Author(s):  
Pranav Bansal ◽  
Mayuri Gupta ◽  
Ishrat Yousuf
Keyword(s):  
Carbon Dioxide ◽  
Chronic Obstructive Pulmonary Disease ◽  
Laparoscopic Cholecystectomy ◽  
Oxygen Saturation ◽  
General Anesthesia ◽  
Endotracheal Tube ◽  
Chronic Obstructive ◽  
Oral Antibiotics ◽  
Obstructive Pulmonary Disease ◽  
The Past

A 56- year old male patient, chronic smoker for the past 30 years, is known case of chronic obstructive pulmonary disease. pre-operative stabilization with inhaled bronchodilators, oral antibiotics and mucolytics the patient is posted for laparoscopic cholecystectomy. After induction of general anesthesia and securing airway with endotracheal tube, the surgery is started. After insufflation of abdomen with carbon-dioxide, the oxygen saturation falls and ventilation becomes difficult as judged by difficulty in pressing reservoir bag in Bain’s circuit.

scholarly journals Hemophagocytic Lymphohistiocytosis: A Life Threatening Cytopenic Condition

2021 ◽  
Vol 15 (2) ◽  
pp. 98-102
Author(s):  
Suranjit Kumar Saha ◽  
MM Shahin Ul Islam ◽  
Nasir Uddin Ahmed ◽  
Prativa Saha
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Clinical Manifestations ◽  
Specific Treatment ◽  
Gene Mutations ◽  
Multiple Organ ◽  
Treatment Modalities ◽  
Hematopoietic Stem ◽  
Organ Systems ◽  
Life Threatening ◽  
Poor Outcomes

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder that occurs in many underlying conditions in all age. This is characterized by unbridled activation of cytotoxic T lymphocytes, natural killer (NK) cells and macrophages resulting in raised cytokine level. Those cytokines and immune mediated injury occur in multiple organ systems. It may be primary and secondary. Primary HLH is familial, childhood presentation and associated with gene mutations. Secondary HLH is acquired, adulthood presentation that occurs in infections, malignancies inflammatory and autoimmune diseases etc. Clinical manifestations include fever, splenomegaly, lymphadenopathy, neurologic dysfunction, coagulopathy, features of sepsis etc. Laboratory investigation includes cytopenias, hypertriglyceridemia, hyperferritinemia, abnormal liver function, hemophagocytosis, and diminished NKcell activity. Treatment modalities include immunosuppressive, immunomodulatory agents, cytostatic drugs, T-cell antibodies, anticytokine agents and hematopoietic stem cell transplantation (HSCT). Besides those, aggressive supportive care combined with specific treatment of the precipitating factor can produce better outcome. With treatment more than 50% of children who undergo transplant survive, but adults have quite poor outcomes even with aggressive management. Faridpur Med. Coll. J. 2020;15(2): 98-102

scholarly journals Somatotypes trajectories during adulthood and their association with COPD phenotypes

2020 ◽  
Vol 6 (3) ◽  
pp. 00122-2020
Author(s):  
Miguel J. Divo ◽  
Marta Marin Oto ◽  
Ciro Casanova Macario ◽  
Carlos Cabrera Lopez ◽  
Juan P. de-Torres ◽  
...  
Keyword(s):  
Early Adulthood ◽  
Airflow Obstruction ◽  
Forced Expiratory Volume ◽  
Multiple Organ ◽  
Airflow Limitation ◽  
Initial Increase ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Continuous Increase ◽  
Copd Patients

RationaleChronic obstructive pulmonary disease (COPD) comprises distinct phenotypes, all characterised by airflow limitation.ObjectivesWe hypothesised that somatotype changes – as a surrogate of adiposity – from early adulthood follow different trajectories to reach distinct phenotypes.MethodsUsing the validated Stunkard's Pictogram, 356 COPD patients chose the somatotype that best reflects their current body build and those at ages 18, 30, 40 and 50 years. An unbiased group-based trajectory modelling was used to determine somatotype trajectories. We then compared the current COPD-related clinical and phenotypic characteristics of subjects belonging to each trajectory.Measurements and main resultsAt 18 years of age, 88% of the participants described having a lean or medium somatotype (estimated body mass index (BMI) between 19 and 23 kg·m−2) while the other 12% a heavier somatotype (estimated BMI between 25 and 27 kg·m−2). From age 18 onwards, five distinct trajectories were observed. Four of them demonstrating a continuous increase in adiposity throughout adulthood with the exception of one, where the initial increase was followed by loss of adiposity after age 40. Patients with this trajectory were primarily females with low BMI and DLCO (diffusing capacity of the lung for carbon monoxide). A persistently lean trajectory was seen in 14% of the cohort. This group had significantly lower forced expiratory volume in 1 s (FEV1), DLCO, more emphysema and a worse BODE (BMI, airflow obstruction, dyspnoea and exercise capacity) score thus resembling the multiple organ loss of tissue (MOLT) phenotype.ConclusionsCOPD patients have distinct somatotype trajectories throughout adulthood. Those with the MOLT phenotype maintain a lean trajectory throughout life. Smoking subjects with this lean phenotype in early adulthood deserve particular attention as they seem to develop more severe COPD.

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