Case 15. Outpatient Anesthesia fro Carpal Tunnel Release
Case Files: Anesthesiology 学习笔记(65)腕管松解术的门诊麻醉1.
Case Files: Anesthesiology 学习笔记(66)腕管松解术的门诊麻醉2.
Case Files: Anesthesiology 学习笔记(67)腕管松解术的门诊麻醉3.
Case Files: Anesthesiology 学习笔记(68)腕管松解术的门诊麻醉4.
Clinical Pearls
1. Tourniquet discomfort defines the duration for which an i.v. regional technique is effective.
2. Local anesthetic toxicity is a significant risk in the setting of tourniquet failure. Standard monitors should always be applied and the anesthesiologist must remain vigilant during this anesthetic.
3. Benzodiazepines such as midazolam are used to treat local anesthetic toxicity.
Case 16. Preoperative Assessment of the Patient with Heart Disease
Case Files: Anesthesiology 学习笔记(69)心脏病人的术前评估1.
Case Files: Anesthesiology 学习笔记(70)心脏病人的术前评估2.
Clinical Pearls
1. Cardiac complications are the leading cause of perioperative morbidity and mortality in the perioperative setting.
2. Major clinical risk factors include acute coronary syndromes, decompensated heart failure, clinically siginificant arrythmias, and severe valvular disease.
3. Intermediate-risk predictors include ischemic heart disease, compensated or prior heart failure, cerebrovascular disease, diabetes mellitus that requires insulin therapy, and renal insufficiency (serum creatin level ＞2 mg/dL).
4. Exercise capacity remains an important determinant of perioperative risk.
5. Elective major vascular surgery remains the type of surgery with the highest associated risk.
Case 17. Severe Aortic Stenosis for Non-cardiac Surgery
Case Files: Anesthesiology 学习笔记(71)严重主动脉狭窄患者的非心脏手术1.
Case Files: Anesthesiology 学习笔记(72)严重主动脉狭窄患者的非心脏手术2.
Case Files: Anesthesiology 学习笔记(73)严重主动脉狭窄患者的非心脏手术3.
Case Files: Anesthesiology 学习笔记(74)严重主动脉狭窄患者的非心脏手术4.
Case Files: Anesthesiology 学习笔记(75)严重主动脉狭窄患者的非心脏手术5.
Case Files: Anesthesiology 学习笔记(76)严重主动脉狭窄患者的非心脏手术6.
Clinical Pearls
1. The hemodynamic goals for managing patients with aortic stenosis include maintaining sinus rhythm, a normal to high preload, normal to high SVR, and slow heart rate. As long as these goals are met, anesthesia can be maintained with many different techniques.
2. Alpha agonists such as phenylephrine are the treatment of choice for hypotension.
3. With severe aortic stenosis, ventricular relaxation and compliance are altered necessitating higher left ventricular filling pressures. Congestive failure and pulmonary edema may result.
Case 18. Anesthetic Management of Abdominal Aortic Aneurysm
Case Files: Anesthesiology 学习笔记(77)腹主动脉瘤患者的麻醉管理1.
Case Files: Anesthesiology 学习笔记(78)腹主动脉瘤患者的麻醉管理2.
Case Files: Anesthesiology 学习笔记(79)腹主动脉瘤患者的麻醉管理3.
Case Files: Anesthesiology 学习笔记(80)腹主动脉瘤患者的麻醉管理4.
Case Files: Anesthesiology 学习笔记(81)腹主动脉瘤患者的麻醉管理5.
Clinical Pearls
1. Because of its lower morbidity, an endovascular (as opposed to open) approach to aortic aneurysm repair has expanded the population of patients with AAA who are candidates for surgical treatment.
2. Patients that present for AAA, whether by open technique or by stent, often have other comorbidities such as hypertension, diabetes, and cardiac disease which significantly impact anesthetic management.
3. Invasive monitoring such as arterial blood pressure and central venous pressure provide valuable information such as the “beat-to-beat” arterial pressure, volume status, and cardiac functionality both in the operating room and intensive care unit. In the setting of AAA repair, the benefits of invasive monitoring far outweigh the attendant risks.
4. AAA repair is a moderate-to high-riskprocedure that carries the possibilities of complications such as myocardial infarction and stroke in the perioperative period.
Case 19. Automatic Implantable Cardiovertor Defibrillator
Case Files: Anesthesiology 学习笔记(82)自动植入式心律转复除颤器1.
Case Files: Anesthesiology 学习笔记(83)自动植入式心律转复除颤器2.
Case Files: Anesthesiology 学习笔记(84)自动植入式心律转复除颤器3.
Case Files: Anesthesiology 学习笔记(85)自动植入式心律转复除颤器4.
Clinical Pearls
1. The preoperative evaluation of a patient with an AICD includes an evaluation and optimization of the underlying heart disease and left ventricular function as well as determination that the AICD is functioning well.
2. The perioperative monitoring of such a patient is mainly guided by the degree of left ventricular function, and the type of surgery.
3. The AICD is deactivated prior to the procedure and reactivated afterwards.
4. An external cardiac defibrillator should always be available in the operating room, with the external defibrillator pads in place so that an effective cardioversion or defibrillation can be performed without interfering with the surgical field.
5. Any electromagnetic force can interfere the functioning of the AICD.
6. It is essential to monitor patients with an AICD continuously in the postoperative period until the vital signs are stable.
Case 20.Pulmonary Hypertension
Case Files: Anesthesiology 学习笔记(86)肺动脉高压1.
Case Files: Anesthesiology 学习笔记(87)肺动脉高压2.
Case Files: Anesthesiology 学习笔记(88)肺动脉高压3.
Clinical Pearls
1. Patients with pulmonary hypertension may have considerable cardiac dysfunction and have increased risk of heart failure with hemodynamic alterations.
2. Patients with pulmonary hypertension require a comprehensive preoperative evaluation which identifies the severity of the disease and baseline cardiac function, and assures that the patient's condition is optimized prior to surgery.
3. Both anesthetic and surgical techniques can worsen pulmonary hypertension and precipitate heart failure.
4. The perioperative management of patients with pulmonary hypertension is critical to the reduction of cardiopulmonary complications and improvement of outcomes.
合辑来啦 case files: Anesthesiology-case 10-14
合辑来啦 case files: Anesthesiology-case 6-9
联系客服
