The Mount Sinai journal of medicine, New York
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Endovascular aortic repair is a new alternative to conventional surgical techniques. A variety of devices available for endovascular aortic repair are discussed and the outcomes after repair are reviewed. Anesthetic considerations during endovascular repair are dictated by the device being used, as well as the site of device deployment. ⋯ Patients undergoing repair of thoracic aortic pathology may be candidates for perioperative transesophageal echocardiographic monitoring. Since a subgroup of these patients may be at risk for postoperative paraplegia, aggressive spinal cord protection should be considered. Patients with large aneurysms may be at risk for "post-implantation syndrome," which is characterized by hyperpyrexia, hypotension, and coagulopathy.
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Approximately two-thirds of all women in the United States receive analgesia for labor and delivery. The ideal labor analgesic technique would confer complete pain relief without side effects to either the mother or the neonate. ⋯ Modern obstetric analgesia techniques and medications come close to achieving these goals. The following article will review current labor analgesia techniques and medications used during labor and delivery.
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Airway management is a critical component of modern anesthetic care. Advances in airway management, as well as the recent history of airway management teaching at The Mount Sinai Hospital, are reviewed.
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There has been growing interest in defining and measuring outcomes for cardiac surgical patients. Outcomes measures have been used in many hospitals as tools for measuring the quality of care, although it is difficult to infer from them how care might be improved. Traditionally, the major outcome endpoints used in cardiac surgery have been the 30-day mortality and morbidity rates. ⋯ By using outcome prediction tools and making conclusions based on preoperative risk factor information, surgeons and anesthesiologists are able to make better decisions about treatment strategies. Additionally, operating room and intensive care unit personnel can use these data to schedule cases and allocate resources more efficiently. These data are also very important for hospital administrators and insurance providers.
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Review
The open lung concept of alveolar recruitment can improve outcome in respiratory failure and ARDS.
Respiratory failure is a common finding in the ICU and in the management of complex cases in the operating room. Over the last ten years, it has become clear that modes of mechanical ventilation and lung recruitment may play a role both in cytokine modulation and patient outcome. Early lung recruitment and alveolar stabilization may play a very important role in the management of patients with respiratory failure and adult respiratory distress syndrome (ARDS). ⋯ This technique not only improves oxygenation, but also affects surfactant function and cytokine modulation. The open lung concept is physiologically based on the Law of Laplace. Adhering to the principles of the open lung concept, pressure-controlled ventilation may improve patient outcome by reducing the extent of irreversible structural damage to the lungs caused by mechanical ventilation.