Advances in Anesthesia RSS feed: Articles in Press. Each year, Advances in Anesthesia brings you the best current thinking from the preeminent practitioners in your field. A distinguished editorial board identifies current areas of major progress and controversy and invites specialists to contribute original articles on these topics. These insightful overviews bring concepts to a clinical level and explore their everyday impact on patient care. Volume 28 Highlights (coming Fall 2010) Suggamadex in Other Countries An Update on PCOD Anesthesia for the Transplant Patient for Non-transplant Surgery Unusual Infectious Agents and Anesthesia Herbal Medications and Nutraceuticals: Perioperative Considerations Modern Understanding of Mechanical Ventilation in Normal and Diseased Lung Biomarkers: Understanding, Progress, and Implications in the Perioperative Period Physician Performance Measures and Professional Practice Evaluation Ultrasound-Guided Central Venous Cannulation Perioperative Implication of Obstructive Sleep Apnea Thoracolumbar-Paravertebral Post-Dural Puncture Headache Lipid Emulsion Editor-in-Chief: Thomas M. McLoughlin, Jr., MD Associate Editors: Joel O. Johnson, MD, PhD and Francis V. Salinas, MD http://www.advancesinanesthesia.com//inpress?rss=yesElsevier Inc.en © 2006 Elsevier Inc. All rights reserved. Advances in Anesthesia0737-61462011-06-10 © 2006 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.advancesinanesthesia.com/article/PIIS0737614606000025/abstract?rss=yesAnesthesia for nonobstetric surgery in patients who are pregnant presents unique challenges and concerns for anesthesiologists. Each year in the United States, more than 75,000 women undergo nonobstetric surgery during pregnancy . The maternal physiologic adaptation to pregnancy alters the volume of distribution, amount of free unbound drug, sensitivity to anesthetics, maternal oxygen consumption, risk for aspiration, blood pressure and cardiac output in the supine position, risk for thrombosis and embolism, and the function of all other organ systems. In addition, anesthesiologists have a second unseen patient, the fetus, who also may be affected directly or indirectly by an anesthetic administered to the mother. This article reviews the implications of pregnancy on anesthetic management by presenting and analyzing the management of five patients undergoing various surgical procedures during pregnancy.Anesthetic Considerations for Nonobstetric Surgery During Pregnancy - Corrected ProofHoward H. Bernstein, Jerome You10.1016/j.aan.2006.06.001Advances in Anesthesia (2011)2011-06-10Advances in Anesthesia2011-06-10http://www.advancesinanesthesia.com/article/PIIS0737614606000037/abstract?rss=yesIt is estimated that between 500,000 and 2 million thromboembolic events occur annually in the United States , including deep venous thromboses, myocardial infarctions, thromboembolic strokes, and pulmonary emboli. Although major thrombi often can be lysed with fibrinolytic agents or sometimes can be removed surgically, pharmacologic prevention of thrombus formation in susceptible patients and high-risk situations is clearly preferable. Thus, anticoagulants and antiplatelet agents play a critical role in preventing thrombus formation associated with a variety of disease states, pathologic processes, and clinical situations (eg, thrombus formation on a prosthetic heart valve or in the left atrium of a patient who has atrial fibrillation; deep venous thrombosis [DVT] in the perioperative period after hip arthroplasty or knee replacement).Present and Future Anticoagulants - Corrected ProofMarc E. Stone, Linda Shore-Lesserson10.1016/j.aan.2006.06.002Advances in Anesthesia (2011)2011-06-10Advances in Anesthesia2011-06-10http://www.advancesinanesthesia.com/article/PIIS0737614606000049/abstract?rss=yesThe invention of the light bulb by Thomas Edison in 1879 heralded a new era of productivity for society, providing the means for continuous operation. Today, approximately 15% of America's full-time workforce has a rotating work-shift schedule, with close to 8% engaged in evening and night-shift work . Maintaining the health, safety, and economy of modern society requires 24/7 availability of services, such as health care, law enforcement, and transportation. This situation is analogous to the one that anesthesia providers face when delivering quality care to patients at all hours. The uninterrupted nature of that work presents unusual physiologic demands to individuals called on to provide such services in a safe manner. Humans have a genetically determined need for sleep and programmed circadian patterns that dictate levels of alertness and performance. This delicate system of sleep-wake physiology evolved over millions of years; thus, it is no wonder that since Edison's time, modern society faces challenges when attempting to oppose it.Fatigue in Anesthesia—the Impact on Patient and Provider Safety: Update on Work-Hour Limitations - Corrected ProofMichael D. Nevarez, Steven K. Howard10.1016/j.aan.2006.06.003Advances in Anesthesia (2011)2011-06-10Advances in Anesthesia2011-06-10http://www.advancesinanesthesia.com/article/PIIS0737614606000050/abstract?rss=yesIn October 2004 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) published a sentinel event alert, “Preventing and managing the impact of anesthesia awareness” . JCAHO has been issuing sentinel event alerts with varying degrees of impact on anesthesia care providers since 1998, but none of the previous issues had generated the water cooler buzz in anesthesiology departments like that of the 2004 alert, coming as it did with a wave of increasing media and public attention to the problem of unintended intraoperative awareness during general anesthesia. At the same time the American Society of Anesthesiologists (ASA) had commissioned a task force to review the problem of intraoperative awareness, with specific attention to the role of brain function monitoring for its prevention. Their “Practice Advisory for Intraoperative Awareness and Brain Function Monitoring” was approved for publication in October 2005. There is controversy within the anesthesia community as to whether this level of attention is disproportionate to the frequency of the occurrence of this anesthetic complication or whether it focuses needed attention and research on an under-recognized problem with significant sequelae.Update on Unintended Intraoperative Awareness - Corrected ProofChristopher D. Kent, Karen B. Domino10.1016/j.aan.2006.06.004Advances in Anesthesia (2011)2011-06-10Advances in Anesthesia2011-06-10http://www.advancesinanesthesia.com/article/PIIS0737614606000062/abstract?rss=yesIncreasing numbers of awake intracranial procedures are being performed for various reasons. The author reviews anesthetic care for patients undergoing these complicated procedures. The goal of neuroanesthesiologists during these procedures is to facilitate safe, effective, pain-free surgery while maximizing patient comfort. The patient outcome goal is to control the neurologic problem and have minimal or no new postoperative deficit. The indications, contraindications, and preoperative planning and preparation of the patient and medical team for awake craniotomy are reviewed. The perioperative events for which patients must be deeply sedated and when they must be wide awake, yet comfortable, for the testing and resection of a lesion or placement of a stimulator are described. The major intraoperative difficulties that arise during many of these procedures and possible remedies are described. Pharmacologic options for sedation and analgesia are reviewed, as are medications that are contraindicated. Throughout the article there is a plea for continuous vigilance, building rapport with and communicating with patients, surgeons, and persons who are performing the intraoperative testing and monitoring—from preoperative evaluation through the procedure and postoperative course. Finally, the author stresses that anesthesiologists must carefully review and re-evaluate the surgeon's expectations, patient selection, monitoring requirements, and alternative plans well in advance of the operation.Anesthesia for Awake Intracranial Procedures - Corrected ProofHeidi M. Koenig10.1016/j.aan.2006.06.005Advances in Anesthesia (2011)2011-06-10Advances in Anesthesia2011-06-10http://www.advancesinanesthesia.com/article/PIIS0737614606000074/abstract?rss=yesThe development of new health care technologies continues at a rapid pace in the United States . These new technologies have resulted in more and more diagnostic and therapeutic procedures outside of the operating room. For example, between 1998 and 2001, use of MRI by Medicare enrollees increased 16% per year . To accomplish these procedures in an expeditious and safe manner, patients must be immobile. This requirement for immobility to get clear images and the need for analgesia for painful interventional procedures has led to the increased need for sedation, analgesia, and general anesthesia outside of the operating room. Cooperative adults can tolerate many of these procedures without any sedation, but babies and infants and older children and adults with behavior or movement disorders cannot be immobile for these procedures.Anesthesia for Sites Outside the Operating Room - Corrected ProofAlice L. Landrum10.1016/j.aan.2006.06.006Advances in Anesthesia (2011)2011-06-10Advances in Anesthesia2011-06-10http://www.advancesinanesthesia.com/article/PIIS0737614606000086/abstract?rss=yesDexmedetomidine (Precedex) is a highly selective, potent alpha-2 adrenergic receptor agonist. It has sedative, analgesic, and anxiolytic properties with, amazingly, no effect on the respiratory rate. Dexmedetomidine binds alpha-2 receptors eight times more avidly than does clonidine and is shorter acting. Its mechanism of action includes stimulation of receptors in the locus ceruleus to provide sedation and in the spinal cord to enhance analgesia.Off-Label Uses of Dexmedetomidine - Corrected ProofKeyuri Popat, Ronaldo Purugganan, Imrana Malik10.1016/j.aan.2006.06.007Advances in Anesthesia (2011)2011-06-10Advances in Anesthesia2011-06-10http://www.advancesinanesthesia.com/article/PIIS0737614606000098/abstract?rss=yesThe American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.Since its founding in 1905, the society's achievements have made it an important voice in American medicine and the foremost advocate for all patients who require anesthesia or relief from pain.As physicians, anesthesiologists are responsible for administering anesthesia to relieve pain and for managing vital life functions, including breathing, heart rhythm and blood pressure, during surgery. After surgery, they maintain the patient in a comfortable state during the recovery, and are involved in the provision of critical care medicine in the intensive care unit. ASA mission statementDiversity and Disparities in Health and Health Care: Why it Matters to Anesthesiology - Corrected ProofJennifer Thomas-Goering, Carmen R. Green10.1016/j.aan.2006.06.008Advances in Anesthesia (2011)2011-06-10Advances in Anesthesia2011-06-10http://www.advancesinanesthesia.com/article/PIIS0737614606000104/abstract?rss=yesThe face of cardiac surgery is changing and, with it, the face of cardiac anesthesia. A glance at almost any operating room schedule confirms that cardiac surgical volume is down. Patients rarely present for coronary surgery without a prior percutaneous intervention, if not the “full metal jacket” of stents down the entire left anterior descending artery. Lipid-lowering therapy, statins, lifestyle modification, and better control of hypertension and diabetes all have contributed to the decline in the number of patients presenting for coronary artery bypass grafting (CABG). In general, outcomes of percutaneous interventions are comparable with surgery . One response to this trend is a decline in interest in cardiac surgery among American graduates . Another is the incorporation of percutaneous techniques into the curriculum of surgical training programs. Finally, the move to less invasive operative techniques, which cause less pain and allow faster return to normal functioning, has been in full swing for some time. Valvular disease, congenital defects, and arrhythmias all currently are addressed with percutaneous and minimally invasive techniques.Anesthesia for Robotic Heart Surgery - Corrected ProofSteven Haddy, Mark Cunningham10.1016/j.aan.2006.06.009Advances in Anesthesia (2011)2011-06-10Advances in Anesthesia2011-06-10