Surgical Pain Control With Ropivacaine by Atomized Delivery (Spray): A Randomized Controlled Trial.

Study Objective: To investigate the role of intraoperative atomized intraperitoneal ropivacaine (AIR) as an adjuvant to anesthetic agents at the time of minimally invasive pelvic surgery.

Design: Double-blind, randomized controlled trial.

Classification: Randomized controlled trial (Canadian Task Force classification I).

Overcoming Challenges in the Management of Critical Events During Cardiopulmonary Bypass.

Critical events during cardiopulmonary bypass (CPB) can challenge the most experienced perfusionists, anesthesiologists, and surgeons and can potentially lead to devastating outcomes. Much of the challenge of troubleshooting these events requires a key understanding of these situations and a well-defined strategy for early recognition and treatment. Adverse situations may be anticipated prior to going on CPB.

Neuroanesthesia.

Neuroanesthesia is a subspecialty area of anesthesia that deals with the complex relationships of anesthetic medications, neurosurgical procedures, and the critical care issues that surround the management of these patients. In this chapter we will focus on a brief overview of the key features associated with the management of patients undergoing neurosurgical procedures, including a review of hemodynamic/neurologic effects of anesthetic agents, neurophysiologic monitoring, and unique medical complications associated with these procedures. For successful patient outcomes, multidisciplinary approaches and effective team communications are essential in these high-intensity environments.

Blood product storage: does age really matter?

Red blood cell transfusion therapy has been used with the ultimate goal of enhancing oxygen delivery to vital organs and tissue beds, thus enhancing cellular function. Red blood cell transfusion therapy is also a long-standing practice, and since the 1950s it has only grown in utilization, especially within the United States. Recently, transfusion therapy has come under increased scrutiny with a desire to develop evidence-based therapeutic guidelines that not only decrease undue risk to the patient but also decrease the overutilization of this high-cost, low-availability product.

Severe acidosis during laparoscopic repair of pelvic organ prolapse and incontinence.

The creation and maintenance of a carbon dioxide pneumoperitoneum to allow a laparoscopic approach to surgery for pelvic organ prolapse has been associated with hypercapnea and respiratory acidosis. We present a case report of a 68-year-old patient who developed severe acidosis during a robotic-assisted laparoscopic sacrocolpopexy and discuss a practical approach to surgical and anesthetic decision making.

Teaching professionalism during anesthesiology training.

Recently, there has been a focus on the teaching of professionalism in postgraduate medical education. Many discussions and studies have been performed to help in teaching professionalism and in the evaluation of the effectiveness of this teaching process. Unfortunately, many anesthesiologists are unaware of the literature and the discussions that have taken place.

Standard anesthetic technique for middle ear surgical procedures: a comparison of desflurane and sevoflurane.

Objective: This study was designed to compare desflurane and sevoflurane anesthesia for middle ear microsurgery.

Study Design: One hundred healthy adults undergoing middle ear surgery were assigned to receive either desflurane or sevoflurane as their anesthetic. Intraoperative hemodynamics and BIS numbers were recorded.

Antiphospholipid antibodies before and after liver transplantation.

Objective: The aim of this study was to determine whether liver transplantation of patients with antiphospholipid antibodies (APA) is 1) adversely affected with vascular thrombosis and 2) whether such antibodies persist post transplantation.

Methods: Twelve patients with APA awaiting transplant were identified and characterized biochemically and immunologically. Each had the level of APA determined using commercially available enzyme-linked immunoassay kits before, during, and after liver transplantation.

Liver transplantation for fulminant hepatic failure.

The etiology and prognosis of individuals with various forms of fulminant hepatic failure are reviewed. Special techniques of clinical management and decision making as to when and to whom to transplant in cases of fulminant hepatic failure are reviewed.