Anesthesiology clinics
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Anesthesiology clinics · Sep 2020
ReviewPediatric Anesthesia Outside the Operating Room: Safety and Systems.
Anesthesia care performed outside the operating room is a growing area of pediatric anesthesia practice. The anesthesiology team expects to care for children in diverse locations, which include diagnostic and interventional radiology, gastroenterology and pulmonary endoscopy suites, radiation oncology sites, and the cardiac catheterization laboratory. To provide safe, high-quality care the anesthesiologist working in these environments must understand the unique environmental, logistical, and perioperative considerations and risks involved with each remote location. This 2-part review provides an overview of safety and system considerations in pediatric nonoperating room anesthesia before describing in more detail considerations for particular remote anesthetizing locations.
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Anesthesiology clinics · Sep 2020
ReviewSustainability in the Operating Room: Reducing Our Impact on the Planet.
Climate change will be the defining health crisis of the twenty-first century, and environmental health is directly linked with human health. The health sector should lead the sustainability effort by greening itself and reducing its ecological footprint to improve global health and the health of the planet. Anesthesiology has an oversized role in production of greenhouse gases and waste, and thus its impact on affecting change is also oversized. Decreasing the waste of volatile anesthetic agents, medications, and anesthesia equipment is a powerful start to the many sustainability changes needed in health care.
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Anesthesiology clinics · Sep 2020
ReviewUsing Electroencephalography (EEG) to Guide Propofol and Sevoflurane Dosing in Pediatric Anesthesia.
Sevoflurane and propofol-based anesthetics are dosed according to vital signs, movement, and expired sevoflurane concentrations, which do not assess the anesthetic state of the brain and, therefore, risk underdose and overdose. Electroencephalography (EEG) measures cortical brain activity and can assess hypnotic depth, a key component of the anesthetic state. Application of sevoflurane and propofol pharmacology along with EEG parameters can more precisely guide dosing to achieve the desired anesthetic state for an individual pediatric patient. This article reviews the principles underlying EEG use for sevoflurane and propofol dosing in pediatric anesthesia and offers case examples to illustrate their use in individual patients.
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The focus of this article is noncardiac surgery in the adult with congenital heart disease (CHD). The purpose is to provide the general and pediatric anesthesiologist with a basic overview of the most common congenital cardiac lesions, their long-term sequelae, and expected perioperative concerns during noncardiac surgery. Because of the very heterogeneous nature of CHD, it is difficult to make a single article a comprehensive guide for every lesion and its associated perioperative concerns. The authors hope to provide those who are not specifically trained in congenital cardiac anesthesia the basic principles and a greater understanding of each defect.
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Disaster medicine refers to situations in which the need to care for patients outweighs the available resources. It is imperative for anesthesiologists to be involved at a leadership level in mass casualty/disaster preparedness planning. ⋯ Terror events and natural disasters can differ significantly in anesthesia preparedness. Resiliency is an important aspect of the recovery phase that decreases psychological damage in the aftermath of a mass casualty event.