Latest Updates

Cardiac Patients for Non-Cardiac Surgeries

    • Improved survival of patients with congenital heart disease requires all anesthesiologists to be familiar with basic pathophysiological concepts and long term problems after repair or palliation of heart defects.
    • Complex congenital heart defects are nowadays often managed with staged palliations and multiple interventions in the cardiac catheterization laboratory. A thorough understanding of the physiological implications for each of these stages is important for a safe anesthetic management.
    • Minimal invasive surgical techniques can have major implications for patients with single ventricle physiology.
    • Recent advances in the treatment of pulmonary arterial hypertension and heart transplantations will increase the number of imaging studies and interventions for surveillance and therapy adjustments.   

Noncandidal Fungal Infections

    • 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.

Cardiovascular Drugs

    • Pulmonary hypertension can be treated with single or combination therapy employing calcium channel blockers, phosphodiesterase inhibitors, guanylate cyclase stimulators, endothelin receptor antagonists, and prostanoids.
    • Levosimendan is a calcium sensitizer used to treat cardiogenic shock and right heart failure.
    • Clevidipine is an ultra-rapid acting calcium channel blocker used for perioperative hypertension management in cardiovascular and vascular diseases, neurosurgery, and surgery for pheochromocytoma.

Management of Drug Interactions between Anti-infectives 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.

Acute Liver Failure

Constantine J Karvellas, MD, SM, FRCPC, R. Todd Stravitz, MD, FACP, FACG, FAASLD
    • Improved intensive care management of patients with acute liver failure (ALF) has decreased the incidence of cerebral edema/intracranial hypertension
    • High-volume plasma exchange improves overall survival in patients with ALF
    • Improved understanding of the abnormalities of global hemostasis in patients with ALF
    • Improved sanitation and mass vaccination has decreased the incidence of ALF due to hepatotrophic viruses

Acute Liver Failure

Constantine J Karvellas, MD, SM, FRCPC, R. Todd Stravitz, MD, FACP, FACG, FAASLD
    • Improved intensive care management of patients with acute liver failure (ALF) has decreased the incidence of cerebral edema/intracranial hypertension
    • High-volume plasma exchange improves overall survival in patients with ALF
    • Improved understanding of the abnormalities of global hemostasis in patients with ALF
    • Improved sanitation and mass vaccination has decreased the incidence of ALF due to hepatotrophic viruses

Acute Liver Failure

Constantine J Karvellas, MD, SM, FRCPC, R. Todd Stravitz, MD, FACP, FACG, FAASLD
    • Improved intensive care management of patients with acute liver failure (ALF) has decreased the incidence of cerebral edema/intracranial hypertension
    • High-volume plasma exchange improves overall survival in patients with ALF
    • Improved understanding of the abnormalities of global hemostasis in patients with ALF
    • Improved sanitation and mass vaccination has decreased the incidence of ALF due to hepatotrophic viruses

Injuries to the Upper Urogenital Tract

    • Most grade III and IV injuries, including those with devitalized parenchymal fragments and urinary extravasation, are managed nonoperatively
    • Angioembolization of persistent or delayed kidney bleeding (pseudoaneurysm) obviates the need for exploration in a majority of cases
    • A high index of suspicion is necessary to diagnose a ureteral injury to prevent late complications such as urinoma, sepsis, and nephrectomy
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