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Author: Barbara M. Rogers, MD, MBOE, FASA ASA Monitor May 2023, Vol. 87, 17. For the average anesthesiologist, the thought of working on the OB “floor” brings either delight or terror. The schizophrenic nature of the day – from routine labor epidurals and scheduled cesarean sections, to stat life-threatening emergencies – can lead to exhaustion and […]
Read MoreAuthor: Bennett K. Pract Pain Manag. 2023 May/June;22(3). In early 2020, PPM covered the rapid rise of non-opioid pain policies across the nation, as legislatures and insurers had begun focusing intensely on policies that encouraged, incentivized, and even mandated the use of alternatives to opioid therapy for the treatment of pain. Three years on, policymakers at all levels […]
Read MoreAuthors: Nikhil Kumar, M.D. et al Anesthesiology April 2023. The accompanying images demonstrate the presence of the distal end of a chest tube in the tracheal lumen just above the carina. These images are from a patient who developed coughing and massive air leak after chest tube placement. Inadvertent tracheal injury during chest tube placement […]
Read MoreAuthors: P J Devereaux et al N Engl J Med. 2022 May 26;386(21):1986-1997 Background: Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding. Methods: We conducted a trial involving patients undergoing noncardiac surgery. Patients were randomly assigned to receive tranexamic acid (1-g intravenous bolus) or […]
Read MoreAuthors: Christine Jette, MD, FASA et al ASA Monitor April 2023, Vol. 87, 10–12. Safe access to pediatric surgery and anesthesia care in rural America is critical to having an equitable health care system. The American College of Surgeons (ACS) Children’s Surgery Verification (CSV) Quality Improvement Program provides standards defining “the resources believed necessary to achieve […]
Read MoreAuthor: Amarquaye W. Pract Pain Manag. 2023 May/June;23(3). When a patient asks about beginning methadone therapy for CRPS, clinical pharmacist William Amarquaye advises on administration, titration, side effects, and interactions. Patient Scenario: Patient Prescribed Methadone for CRPS The Patient Patient Bob* called our pharmacy inquiring about a new prescription for methadone that he was placed […]
Read MoreAUTHORS: James, Leslie A. BA et al Anesthesia & Analgesia 128(6):p 1279-1285, June 2019. | BACKGROUND: Frailty, a state of decreased physiological reserve, is strongly associated with perioperative mortality in older adults. However, the mechanism by which frailty is associated with mortality is not yet understood. Autonomic dysfunction in the form of decreased intraoperative hemodynamic variability has […]
Read MoreAuthors: Matthew D McEvoy et al Perioper Med (Lond) 2020 Nov 23;9(1):35. Background: Recent literature has demonstrated that hemodynamic instability in the intraoperative period places patients at risk of poor outcomes. Furthermore, recent studies have reported that stroke volume optimization and protocolized hemodynamic management may improve perioperative outcomes, especially surgical site infection (SSI), in certain high-risk […]
Read MoreAuthors: Andres Zorrilla-Vaca et al AM Surg 2021 Aug;87(8):1189-1195. Introduction: Goal-directed fluid therapy (GDFT) has increasingly been utilized in major surgery as a key component to ensure fluid optimization and adequate tissue perfusion, showing improvements in the rate of morbidity and mortality under conventional care. It is unclear if patients derive similar benefit as part of […]
Read MoreAuthors: Yaras R, Bettinger J Pract Pain Manage. 2023 MayJune:23(2). The following hypothetical case is intended to reflect the changes in the CDC opioid prescribing guidelines (see full background).¹ Below is a step-by-step guide through the management of “legacy” patients on chronic opioid medications. See our separate case on initiating opioid therapy under the new guidelines. Patient’s Medical and Psychiatric […]
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