Decision Support in Medicine

HIV patients

What should the Anesthesiologist Should Know Prior to the Operative Procedure Background Human immunodeficiency virus (HIV), the causative viral organism of acquired immunodeficiency syndrome (AIDS), was first recognized over 20 years ago, and has since infected approximately 50 million people worldwide. In the United States, there are between 850,000 to 1 million cases of HIV/AIDS,…

Surgical treatment of pericardial disease

What the Anesthesiologist Should Know before the Operative Procedure The pericardium has two layers, the visceral layer, which covers the heart and the origin of the great vessels. The parietal layer is reflected off the visceral layer and is a thin layer of fibro-elastic tissue that forms a sac around the heart and separates the…

Pelvic laparoscopy

What the Anesthesiologist Should Know before the Operative Procedure Pelvic laparoscopy may be done by gynecologists, obstetricians, urologists or colon and rectal surgeons. Sometimes it may also be performed by transplant surgeons working on the urinary bladder after kidney or pancreas transplants draining into the bladder. It will be important to know if the patient…

The Thrombophilic Parturient (e.g., LMWH)

What the Anesthesiologist Should Know before the Operative Procedure Pregnancy induces a hypercoagulable state. While the incidence of thromboembolic complications in the peripartum period is low, they remain a major cause of maternal morbidity and mortality. In most cases, the risks associated with administering anticoagulation therapy are greater than those of the hypercoagulable state associated…

Antepartum and Postpartum Hemorrhage – Prediction and Management

What the Anesthesiologist Should Know before the Operative Procedure Obstetric hemorrhage accounts for 25% to 30% of all maternal deaths worldwide and causes death in underdeveloped countries at a rate 100 times that in developed countries. Most deaths are due to postpartum hemorrhage. In developed countries, postpartum hemorrhage is the leading cause of major maternal…

Ophthalmic Surgery – General Considerations

What the Anesthesiologist Should Know before the Operative Procedure As a group, patients undergoing ophthalmic surgery have a low risk of developing perioperative cardiac complications, but frequently have associated medical conditions associated with the extremes of age. Nitrous oxide (N2O) can increase intraocular pressure and cause blindness in patients who recently had a medical gas…

Mediastinal masses

What the Anesthesiologist Should Know before the Operative Procedure Mediastinal masses can be anterior, middle, or posterior in their location. In general, anterior mediastinal masses (lymphomas, thymomas, germ cell tumors, metastatic lesions, and thyroid masses) are problematic due to compression of both airway and vascular structures. Middle (bronchogenic cysts, granulomas, and lymphomas) and posterior mediastinal…

Thyroidectomy – Procedures

What the Anesthesiologist Should Know before the Operative Procedure Disorders of the thyroid gland usually involve some swelling or increase in thyroidal tissue. Surgery is typically superficial and in some cases can be performed under regional or local anesthesia by experienced surgeons. The thyroid gland can become massive and sternotomy may be required to extirpate…

Amputation of the Leg, Above the Knee and Below the Knee

What the Anesthesiologist Should Know before the Operative Procedure Patients present for amputations of the lower extremity for a variety of reasons, including, but not limited to, infection, vascular compromise, tumors, and trauma. The underlying reason for the amputation should be elucidated, if it is not obvious. The primary reason that the amputation is required…

Pulmonary Thromboendarterectomy

What the Anesthesiologist Should Know before the Operative Procedure Pulmonary thromboendarterectomy (PTE) is the surgical therapy for chronic thromboembolic pulmonary hypertension (CTEPH), which is defined as pulmonary hypertension (mean pulmonary artery pressure >25 mmHg) that persists for at least 6 months after an episode of pulmonary embolism. At experienced centers, PTE has a perioperative mortality…

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