Latest Updates

Local Anesthetics for Neuraxial and Regional Techniques

Krystina Geiger, PharmD, BCPS, BCCCP, Michael J Schontz, PharmD, BCPS, BCCCP
    • Cardiovascular and neurologic adverse effects can amount from local anesthetic systemic toxicity (LAST). The most current recommendations include lipid emulsion therapy as a standard of care for when the patient becomes hemodynamically unstable due to LAST.
    • Liposomal bupivacaine is a delayed release formulation of standard bupivacaine and the most recent local anesthetic with a novel delivery system. This may present a gateway for advancement of new formulations and new approaches to regional techniques.
    • Enhanced recovery after surgery protocols are becoming more common in the surgical world. Local anesthetics will be playing a role in the reduction of opiate consumption and opiate-related side effects. Additionally, mitigation of opiate prescriptions may assist with the reduction of illicit opiate drug use.

Management of Cystic Neoplasms of the Pancreas

Daniel E Abbott, MD, Adam M Awe, BS, Walker A Julliard, MD, Victoria R Rendell, MD, Sean M Ronnekleiv-Kelly, MD, Sharon M Weber, MD, Emily R Winslow, MD
    • Updated guidelines for pancreatic cyst management have recently been released, including the 2018 European Consensus Guidelines, the 2017 American College of Radiology Guidance, and the 2016 Revisions to the International Consensus Guidelines.
    • Epithelial histologic subtypes of intraductal papillary mucinous neoplasms have been shown to have important implications for prognosis.
    • Pancreatic cyst fluid analysis for DNA biomarkers has shown promise for cyst diagnosis and detection of malignancy in the PANDA clinical trial and other studies although utility in clinical practice has not been demonstrated.
    • A multidisciplinary team at Johns Hopkins Hospital published details of their multidisciplinary pancreatic cyst clinic outcomes, the first of its kind reported in the literature.

Esophagus

Emmanuel M. Gabriel, MD, PhD, Steven N Hochwald, MD, FACS

    Screening Prostate-Specific Antigen and Early Detection

    Matthew R Cooperberg, MD, MPH
      • The evidence is increasingly clear that early detection of higher risk prostate cancers based on prostate-specific antigen (PSA) testing reduces prostate cancer mortality but at the cost of overdiagnosis and potential overtreatment of low-risk disease.
      • The best way to implement PSA testing likely involves early baseline assessment and infrequent repeat testing for the majority of men with low baseline PSA.
      • Shared decision-making around PSA testing can be relatively straightforward and should focus on the fact that the purpose of screening is early identification of potentially lethal disease. The man should understand, ideally before a PSA test and certainly before a biopsy, that low-risk disease, if identified, does not require immediate treatment in most cases.

    Parasomnias

    KyoungBin Im, MD, MS
      • NREM parasomnias have a common underlying pathophysiology with varying clinical manifestations.
      • NREM parasomnias are often secondary to sleep deprivation and other primary sleep disorders.
      • Sleep-related eating disorders are strongly associated with zolpidem, especially when given to patient with restless legs syndrome.
      • REM sleep behavior disorder (RBD) diagnosis is based on the history (dream enactment) and the evidence of REM without atonia from polysomnogram.
      • RBD is considered precursor of neurodegenerative diseases such as Parkinson diseases, Lewy body disease, and synucleinopathy.

    Management of Dyslipidemia

    John D. Brunzell, MD, FACP, R Alan Failor, MD
      • 2018 Diabetes Canada Clinical Practice Guidelines Expert Committee: Dyslipidemia.
      • 2017 Dyslipidemia: Current Therapies and Guidelines for Treatment.
      • 2017 American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease.

    Endocrine

    Ashok R Shaha, MD, FACS, Rebecca Tuttle, MD

      Management of Dyslipidemia

      John D. Brunzell, MD, FACP, R Alan Failor, MD
        • 2018 Diabetes Canada Clinical Practice Guidelines Expert Committee: Dyslipidemia.
        • 2017 Dyslipidemia: Current Therapies and Guidelines for Treatment.
        • 2017 American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease.
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