Associate Editors vii
Contributors ix
Preface xix
Thomas M. McLoughlin Jr, Francis V. Salinas, and Laurence C. Torsher
Postoperative Sleep Disturbances: Understanding and Emerging Therapies 1
David R. Hillman
Introduction 1
Normal sleep 2
The nature of sleep 2
Sleep architecture 3
Physiologic changes during sleep 3
Normal sleep requirements 4
Causes of inadequate sleep 4
General 4
Effects of hospitalization, illness, surgery, and anesthesia on sleep 6
Consequences of inadequate sleep 8
General 8
Effects of disturbed sleep on health, well-being, recovery from illness, and surgery 8
Hospitalization risks with preexisting sleep disorders 11
Obstructive sleep apnea 11
Sleep hypoventilation 12
Insomnia 13
Restless legs syndrome/periodic limb movement disorder 13
Parasomnias 13
Narcolepsy 14
Addressing the problem 14
Hospital environment 14
Psychological well-being 15
Drug and other therapies 15
Preexisting sleep disorders 15
Summary 17
Hypothermia: Update on Risks and Therapeutic and Prophylactic Applications 25
Miguel A. Cobas and Arnaldo Vera-Arroyo
Historic reference 25
The use of hypothermia after cardiac arrest 26
Physiology of hypothermia 26
Pathophysiology of cardiac arrest 26
Clinical applications of hypothermia for cardiac arrest 27
Intrahospital cardiac arrest 30
The use of hypothermia in traumatic brain injury 32
Hypothermia for spinal cord injury 36
Hypothermia in other neurologic entities 37
Methods and practical aspects of cooling 38
Practical aspects of cooling 39
Complications of hypothermia 40
Summary and take-home points: is it still cool to be cold? 41
Challenges in the Perioperative Care of Adolescents 47
Lana M. Volz and Bridget L. Muldowney
Physical and emotional development of adolescents 48
Consent and assent of the adolescent patient 50
Implications of pregnancy testing in the female adolescent 51
Adolescent mental health and psychotropic medications 53
Anxiety and depression 53
Attention deficit/hyperactivity disorder 54
Perioperative serotonin syndrome 56
Trends and perioperative implications of adolescent substance abuse 57
Summary 61
Obstetric Hemorrhage: Prevention, Recognition, and Treatment 65
Jason Papazian and Rachel M. Kacmar
Introduction and epidemiology 65
Bleeding risk assessment in pregnancy and specific causes 66
Uterine atony 66
Uterine inversion 68
Retained products of conception 69
Genital tract trauma 69
Uterine rupture 69
Placenta previa 70
Invasive placentation 71
Surgical complications 72
Placental abruption 72
Coagulopathy 73
Patients who refuse transfusion 73
Preparation and anticipation for peripartum hemorrhage 74
System/institutional preparation 74
Patient preparation/optimization 75
Response to peripartum hemorrhage 76
Blood loss estimation and measurement 76
Maternal early warning systems 77
Laboratory analysis 77
Peripartum hemorrhage protocols 78
Blood product transfusion 80
Pharmacologic treatment options 82
Uterotonics 82
Antifibrinolytics 84
Recombinant factor VII 84
Prothrombin complex concentrate 85
Recombinant thrombomodulin 85
Desmopressin 85
Physiologic homeostasis 85
Interventional radiology and arterial embolization 86
Summary 86
Advances in the Anesthetic Management of Solid Organ Transplantation 95
Christopher L. Wray
Introduction 95
Anesthesia for kidney transplantation 96
End-stage renal disease 97
Preoperative evaluation for kidney transplantation 98
Preoperative cardiac evaluation 98
Day of surgery 99
Intraoperative management 100
Postoperative management 101
Anesthesia for liver transplantation 102
Organ allocation 103
End-stage liver disease 104
Cirrhotic cardiomyopathy 104
Coronary artery disease 105
Portopulmonary hypertension 106
Hepatopulmonary syndrome 106
Preoperative evaluation for liver transplantation 107
Day of surgery 111
Intraoperative management 112
Postoperative management 114
Extracorporeal Membrane Oxygenation 119
Stephen A. Esper
Introduction 119
Types of extracorporeal membrane oxygenation circuits 120
Indications and epidemiology for extracorporeal membrane oxygenation 123
Complications 125
Patient-related complications 127
Anticoagulation-related complications 129
Device-related complications 130
Coagulation and anticoagulation considerations 132
Bleeding and transfusion 135
What happens when extracorporeal membrane oxygenation comes to the operating room? 136
Quadratus Lumborum Blocks 145
Hesham Elsharkawy
Introduction 145
Anatomy 146
Mechanism of local anesthetic spread 147
Points of injection, nomenclature 150
Lateral quadratus lumborum block 151
Posterior quadratus lumborum block 151
Anterior quadratus lumborum block (transmuscular quadratus lumborum) 151
The subcostal paramedian oblique sagittal transmuscular quadratus lumborum block 151
Patient positioning and equipment selection 152
Ultrasound transducer 152
Patient position 152
Clinical pearls 153
Dose and volume of local anesthetic 153
Indications 154
Continuous quadratus lumborum blockade 154
Quadratus lumborum block in the anticoagulated patient 154
Supporting evidence 154
Summary 155
Complications of Allogeneic Blood Product Administration, with Emphasis on Transfusion-Related Acute Lung Injury and Transfusion-Associated Circulatory Overload 159
Tamara Friedman, Mazyar Javidroozi, Gregg Lobel, and Aryeh Shander
Introduction 160
Transfusion-related acute lung injury 161
Definition 161
Underlying mechanism and pathology 163
Risk factors 163
Epidemiology 164
Consequences of transfusion-related acute lung injury 165
Treatment and management strategies 165
Transfusion-associated circulatory overload 166
Definition 166
Underlying mechanisms and risk factors 167
Epidemiology 168
Consequences of transfusion-associated circulatory overload 169
Treatment and management strategies 169
Summary 170
Practical Management of the Opioid-Tolerant Patient in the Perioperative Surgical Home 175
John-Paul J. Pozek, Stephen F. Goldberg, Jaime L. Baratta, and Eric S. Schwenk
Introduction 175
The perioperative surgical home 176
Opioids 176
Opioid tolerance 177
Opioid-induced hyperalgesia 177
Preoperative assessment 177
Opioid agonist therapy 179
Intraoperative management 179
Ketamine 182
Magnesium 183
Lidocaine 183
Alpha-2 agonists 184
Regional anesthesia and analgesia 184
Postoperative management 185
Multimodal analgesia 185
Postoperative oral analgesics and restarting home medications 186
The role of acute pain management services in the perioperative surgical home 187
Summary 187
Practical Management of a Regional Anesthesia-Driven Acute Pain Service 191
Stephen F. Goldberg, John-Paul J. Pozek, Eric S. Schwenk, Jaime L. Baratta, David H. Beausang, and Andrew K. Wong
Introduction 191
Structure of an acute pain service 192
Acute pain nurses and protocol-driven care 193
Using multimodal analgesia 195
Neuraxial analgesia 196
Epidural side effects and complications 196
The role of an acute pain management service in epidural management 197
Continuous peripheral nerve blocks 199
Peripheral nerve block complications and side effects 200
Monitoring for Falls 203
The Role of Additives in Perineural Analgesia 204
Choosing a Perineural Catheter Infusion Pump 204
Managing an Ambulatory Catheter Service 205
Summary 207
Update on Perioperative Pulmonary Embolism Management: A Decision Support Tool to Aid in Diagnosis and Treatment 213
Alan M. Smeltz, Lavinia M. Kolarczyk, and Robert S. Isaak
Video content accompanies this article at http://www.advancesinanesthesia.com.
Introduction 214
Risk factors 214
Classification of pulmonary embolism 216
Diagnosis 216
Clinical Diagnosis 216
Imaging 217
Treatment 219
Anticoagulation 219
Systemic thrombolysis 220
Catheter-directed thrombolysis 221
Embolectomy 222
Percutaneous embolectomy 223
Surgical embolectomy 223
Venous-arterial extracorporeal membrane oxygenation 223
Bringing it all together 224
Summary 226
Acknowledgments 226
