Front Matter| Volume 35, ISSUE 1, Pxiii-xviii, 2017


        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
         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