- Response to chemoradiation should be assessed for up to 26 weeks, provided there is no evidence of progression.
- Varying regimens for chemoradiation, including capecitabine, as an alternative to 5-fluorouracil and the introduction of intensity-modulated radiation therapy
- Nivolumab as a potential second- or third-line treatment in refractory metastatic squamous cell carcinoma
Latest Updates
- Blood pressure management is essential in spinal injury management: IV Crystalloid, blood products and/or norepinephrine should be used to maintain SBP >90 mmHg and MAP between 85-90 mm Hg
- Intravenous steroid administration may be considered in the first 8 hours after blunt spinal cord injury in consultation with a spinal specialist and with patient and/or family understanding the risks and benefits.
- If required, surgical intervention within 24 hours of injury is associated with improved long-term outcomes in spinal cord injury.
- The use of suggamadex versus traditional neuromuscular blockade reversal may lead to improved postoperative pulmonary outcomes in obese patients.
- The advent and use of less fat-soluble volatile anesthetics, such as desflurane, leads to faster emergence and return of airway reflexes and may improve postoperative pulmonary outcomes in the obese patient.
- Creation of obesity-specific perioperative guidelines from the Society of Bariatric Anesthesia
- Creation of specific operative equipment to assist with the transportation and positioning of obese patients
- Blood pressure management is essential in spinal injury management: IV Crystalloid, blood products and/or norepinephrine should be used to maintain SBP >90 mmHg and MAP between 85-90 mm Hg
- Intravenous steroid administration may be considered in the first 8 hours after blunt spinal cord injury in consultation with a spinal specialist and with patient and/or family understanding the risks and benefits.
- If required, surgical intervention within 24 hours of injury is associated with improved long-term outcomes in spinal cord injury.
Anesthesia for Common Cardiac Lesions
- Management of cardiopulmonary bypass has improved with ultrafiltration.
- Neuromonitoring including cerebral oximetry is becoming routine in cardiac surgery.
- Transesophageal echocardiography is a great tool for the diagnosis and evaluation of pre- and post- surgical procedures.
Surgical Management of Fecal Incontinence
- MRI defecography is obtained in real time as patient passes contrast during defecation. It is a noninvasive functional test, which can reveal anatomic defects including rectocele and rectal prolapse, the structure of surrounding pelvic organs and sphincter muscle anatomy. It is superior to endoanal ultrasonography in visualizing sphincter atrophy, which correlates with poor outcomes after sphincteroplasty, and can significantly influence surgical approach in patients who are operative candidates.
- Sacral nerve stimulation (SNS) has been shown to have excellent results in terms of improvement in fecal incontinence in up to 90% of patients and achievement of complete continence in 1/3 of patients after multiple years of follow-up. Additionally, SNS improves fecal incontinence in patients with external sphincter tears, pudendal neuropathy and preceding sphincteroplasty. Because of these encouraging results, SNS is becoming the first-line surgical therapy for patient’s refractory to medical management. As SNS has gained traction, some colorectal surgeons proceed directly to the first stage of SNS placement as a combined diagnostic and therapeutic modality.
- The Fenix system is an implantable device consisting of a ring of magnetized titanium beads that help keep the sphincter closed during defecation and can be forced open by bearing down during normal defecation. This device is currently under investigation, comparing its effectiveness with SNS in a large multicenter randomized controlled trial.
- Response to chemoradiation should be assessed for up to 26 weeks, provided there is no evidence of progression.
- Varying regimens for chemoradiation, including capecitabine, as an alternative to 5-fluorouracil and the introduction of intensity-modulated radiation therapy
- Nivolumab as a potential second- or third-line treatment in refractory metastatic squamous cell carcinoma
Management of Drug Interactions between Anti-infective and Common Anesthetics
- Rocuronium-induced neuromuscular blockade is potentiated by a synergistic effect of gentamicin and clindamycin, which may delay recovery.
- Penicillins form a complex with sugammadex, which may interfere with the therapeutically intended sugammadex-rocuronium complex.
- Ondansetron can decrease the analgesic efficacy of acetaminophen at high doses.
- Anesthesiologists are positioned to manage interactions between anesthetic agents and antimicrobials in the operating room.
