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Overview

Advances in Anesthesia by Carol L. Lake MD, MBA, MPH

The distinguished editorial board chooses topics that are most critical and clinically relevant to improving patient care. Invited experts write original, comprehensive articles, summarizing the vital changes and critical issues, and give both the practitioner and student fresh, thorough viewpoints on the topic's significance.

Product Details

ISBN-13: 9781416032953
Publisher: Elsevier Health Sciences
Publication date: 12/30/2006
Series: Advances Series , #24
Pages: 240
Product dimensions: 6.10(w) x 9.10(h) x 0.70(d)

Table of Contents

Associate Editors     vii
Contributors     ix
Health Care Resource Management: An Introduction and the Role of the Anesthesiologist   Thomas F. Rahlfs   Ronaldo Purugganan   Lisa McMillian
The flow of product     1
Distinction of capital equipment versus supplies     2
Inventory management     2
Control and management of inventory     2
Inventory control     3
Inventory management     4
Inventory valuation     5
Inventory receiving and distribution     5
Inventory storage     7
Inventory standardization     7
The decision process of procuring equipment     8
Value analysis     9
Return on investment analysis     12
Group purchasing organizations and integrated delivery networks     13
Appendix 1     14
Glossary of terms     14
Automated Anesthesia   Thomas M. Hemmerling
But what about the way drugs are administered?     19
So what is the status in developing automated anesthesia?     20
Monitoring display     20
Closed-loop administration of drugs in anesthesia     23
Target controlled infusion systems     26
Automatic anesthesia record keeping     28
Simulators in anesthesia     28
Personal digital assistant-technological development and use in anesthesia     31
Summary     32
In the near future     32
Further down the road     35
Advances in Transfusion Medicine   Debra Nordmeyer   John E. Forestner   Michael H. Wall
Red blood cell transfusion     41
Compatibility testing     43
Risks associated with conventional red blood cell transfusions     45
Transfusion reactions     45
Delayed transfusion reactions     47
Metabolic complications of transfusions     48
Alternatives to allogeneic blood transfusion     48
Blood conservation strategies     48
Preoperative autologous blood donation     49
Transfusion of non-red blood cell components     51
Plasma-fresh-frozen plasma, fresh-thawed plasma     51
Platelets     52
Cryoprecipitate     53
Recombinant factor VIIa     53
Prothrombin complex concentrate     54
Massive transfusion protocols     54
Perioperative Considerations for the Morbidly Obese Patient   Wanda M. Popescu   Jeffrey J. Schwartz
Epidemiology and public health issues     59
Pathophysiology of obesity     60
Comorbidities associated with obesity     61
Endocrine system     61
Cardiovascular system     61
Immune and coagulation system alterations associated with obesity     63
Respiratory system     63
Gastrointestinal system     64
Musculoskeletal system     64
Nervous system     65
Treatment of obesity     65
Nonpharmacologic treatment     65
Medical therapy     65
Surgical therapy     65
Anesthetic management     66
Preoperative evaluation     66
Intraoperative management     68
Postoperative management     74
Impact of Obesity in Pediatric Anesthesia   Carole Lin
Defining pediatric obesity     79
Etiology of pediatric obesity     82
Physiology of pediatric obesity     83
Respiratory     83
Cardiac     85
Diabetes     86
Hepatic     86
Endocrinology     87
Neurology     87
Psychology      87
Musculoskeletal     87
Anesthesia care of obese pediatric patients     87
Preoperative workup     88
Preoperative management     88
Postoperative considerations     93
Specific surgical techniques     94
Summary     94
Should Nonanesthesia Providers Be Administering Propofol?   Klaus Kjaer   Anand Patel
Benzodiazepines and opioids     105
Propofol     105
The gastroenterologist's perspective     106
Technical performance     106
Performance of complex procedures     107
Recovery time     107
Cost     108
Safety     109
The patient's perspective     110
Comfort during procedure     111
Quality of recovery     111
Cost     113
The anesthesiologist's perspective     113
Effects of propofol     113
Levels of sedation     114
Cost     114
Designing the optimal sedation plan     114
Procedural factors     116
Patient factors     116
The optimal setting     117
Implementation     117
Preprocedure evaluation     117
Monitoring     117
Recovery room care     118
Who should administer propofol for endoscopy?     118
Statements     118
Data     119
Summary     119
Challenges in Practice Management   Joanne Conroy   Kevin Barry
Understanding and delivering value     127
Creating value in anesthesia     128
Getting a seat at the table     128
Understanding one's competitiveness     128
Current compensation formulas and future compensation formulas to reward value     129
Incentives     130
Total compensation beyond salary...keeping the workforce     131
Practice structure and alignment around value     133
Billing compliance     133
Customer service and throughput     134
Competing on quality     134
Partnering     136
Stipends     137
Exclusive contracts     137
Summary     139
Advances in Pediatric Pain Management   Kim-Phuong T. Nguyen   Nancy L. Glass
Pain assessment     144
Individual variation in requirements for pain medication     145
Multimodal analgesia      145
Preemptive analgesia in children     146
Oral pain medications     147
Acetaminophen     147
Nonsteroidal anti-inflammatory drugs     148
Combination agents     150
Oral opiates     150
Parenteral opiate and opioid therapy     151
Morphine     151
Fentanyl     151
Hydromorphone     151
Remifentanil     153
Methadone     153
Patient-controlled analgesic therapy     154
Continuous opioid infusions     156
Other routes of administration for opioid agents     156
Other analgesic agents and adjuncts     158
Ketorolac     158
Ketamine     159
Tramadol     159
Gabapentin     160
Alpha-2 agonists     161
Lidocaine     162
Regional anesthetic blocks in children     163
Safety of regional block in children under general anesthesia     163
Single-shot caudal epidural block     163
Adjuncts to caudal block in children-to add or not to add?     164
Opioids     165
Clonidine     165
Ketamine      166
Midazolam     166
Neostigmine     166
Continuous epidural analgesia     167
Confirming epidural catheter placement     167
Confirmation by radiography     169
Ultrasound-guided placement of epidural catheters     169
Electrocardiographic guidance     170
Tsui test     170
Local anesthetics in epidurals     171
Spinal analgesia in the preterm and young infant     172
Use of ultrasound in peripheral nerve blocks     175
Managing side effects and complications of analgesia     177
Side effect management     177
Respiratory depression     177
Local anesthetic toxicity     177
Summary     178
The Use of Ultrasound in Regional Anesthesia   James Benonis   Stuart A. Grant
General principles     189
Specific equipment for anesthesia     190
Probes     190
Machine: portable versus cart-based     190
Probe covers, gel, and infection control     190
Technique of ultrasound-guided nerve block: general principles     190
Upper extremity nerve block     191
Interscalene     192
Supraclavicular      193
Infraclavicular     195
Axillary     195
Lower extremity     197
Lumbar plexus     197
Femoral     197
Sciatic     198
Subgluteal     198
Popliteal     199
Saphenous     199
Neuraxial and paravertebral     200
Abdominal wall     200
Iliohypogastric/ilioinguinal nerve block     200
Transversus abdominus block     201
Outocome studies     201
Summary     202
Airway Management Devices and Approaches   Anh-Thuy Nguyen   Keyuri Popat
Patient assessment     205
Supraglottic airway devices     205
Laryngeal mask airway     205
The Cobra Perilaryngeal Airway     211
The Streamlined Liner of the Pharynx Airway     211
The Chou Airway     211
The esophageal tracheal Combitube     212
Intubation aids     213
Patient preparation     213
Types of intubation aids     215
Fiberoptic bronchoscopy     215
Optical stylets     218
Newer devices     219
Rigid laryngoscopes      220
Other airway techniques     223
Retrograde intubation     223
Percutaneous transtracheal jet ventilation     223
Cricothyrotomy     224
Tracheostomy     225
Airway exchange catheters     226
Summary     231
Index     233

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