What's New | Decker

Updating consensus guideline recommendations up to January 2016
Adding a duplex scan image showing a deep vein thrombosis (DVT) in the diagnosis section
Adding a computed tomographic (CT) scan showing a pulmonary embolism (PE)
Showing the various types of approved inferior vena cava filters
Adding five separate flow-chart figures depicting a stepwise management algorithm for the evaluation and treatment of DVT and PE
Adding a section on catheter-associated upper extremity thrombosis
Adding a section on extended prophylaxis, the use of non–vitamin K antagonists, updates on stockings
Writing five new multiple-choice questions based on the review

Many iatrogenic withdrawal syndromes have been identified, the most common of which is opioid or benzodiazepine withdrawal. Generally speaking, the approach to treating opioid and/or benzodiazepine withdrawal is to provide enough medication to saturate target receptors, followed by a period of gradual dose reduction to allow the body to return to a state of homeostasis.
The Neonatal Abstinence Score (NAS) was designed to assess withdrawal symptoms in infants with multiple drug exposure during pregnancy. Because the NAS was validated in infants, it is not applicable in older children with iatrogenic withdrawal. In recent years, withdrawal assessment tools for pediatrics have been developed for iatrogenic withdrawal to provide an objective assessment of withdrawal.
There have been no randomized clinical trials that have compared the efficacy of various weaning strategies. However, a recent multicenter clinical trial, named the RESTORE trial, examined the effects of a standardized sedation protocol in pediatric intensive care units.

Members of the European Organisation for Research and Treatment of Cancer–Invasive Fungal Infection Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group formed a consensus committee to develop standard definitions for invasive fungal infections for clinical research.
The development of standardized methodology for antifungal susceptibility testing is another recent advance in the laboratory evaluation of Aspergillus species. Although azole resistance by Aspergillus species is unusual, patients exposed chronically to antifungal triazoles have been reported to have refractory infection caused by isolates with elevated minimum inhibitory concentrations.
Fusarium and Scedosporium species are increasingly common causes of infections in surgical patients, especially in recipients of stem cell or organ transplants.

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.

In a 2015 population-based, cross-sectional study conducted by the United Kingdom Obstetric Surveillance System on women requiring massive postpartum transfusion for PPH, uterine atony was found to be responsible 40% of the time. Atony represents a large proportion of cases of PPH, and its incidence is on the rise. Over recent years, we have observed a significant rise in the rate of PPH attributed to uterine atony not only in the United States but also worldwide.
Originally described in 1997, the B-Lynch compression suture is an effective and easily used tool for the management of PPH. This technique involves placing brace sutures over the fundus of the uterus to apply ongoing compression of the uterus.
The correct ratio of packed red blood cells to fresh frozen plasma to platelets in the setting of obstetrical hemorrhage remains controversial. Most experts advocate for a 1:1:1 ratio in the setting of active bleeding, whereas others advocate for 6:4:1 or 2:1 (with platelets to be given after the first 4:2).

To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
Recent progress in management ofheart failure in postoperative and traumatic patients

Contemporary understanding of ventricular mechanics with identification of the structure and function of the ventricular myocardial band
Detailed description of the anatomic proximity of cardiac structures and how knowledge of this proximity helps prevent intraoperative complications and damage to critical cardiac structures
Comprehensive description of aortic root anatomy and mechanics and application of how this anatomy dictates performance of transcatheter aortic valve replacement

Vascular System