Key Points ▪ Anesthesiologists rely extensively on physiologic signals and anesthetic dosing strategies to infer and to track states of the brain and central nervous system under general anesthesia. ▪ Heart rate and systemic arterial blood pressure changes are the…
Key Points ▪ There are four key principles of intraoperative neurologic monitoring. ▪ The pathway at risk during the surgical procedure must be amenable to monitoring. ▪ The monitor must provide reliable and reproducible data. ▪ If evidence of injury…
▪ Identify the type of cardiovascular implantable electronic device (CIED) (pacemaker, transvenous defibrillator, subcutaneous defibrillator), as well as the generator manufacturer and model of the CIED. ▪ Contact the physician or clinic managing the patient’s CIED in the preoperative period…
Key Points ▪ Perioperative applications of transesophageal echocardiography (TEE) include monitoring, diagnosis, and procedural guidance. The role of TEE in cardiac surgery, noncardiac surgery, interventional procedures, and critical care continues to evolve. ▪ In noncardiac surgery, intraoperative TEE serves as…
Key Points ▪ Monitoring of the electrocardiogram (ECG) provides continuous monitoring of heart rate, identification of arrhythmias and conduction abnormalities, and detection of myocardial ischemia. ▪ Accurate and reliable ECG monitoring requires attention to lead placement and selection, choice of…
Key Points ▪ Malignant hyperthermia (MH) is a pharmacogenetic disorder inherited primarily in an autosomal dominant pattern. ▪ MH susceptibility is linked to 230 mutations in the skeletal muscle ryanodine receptor (RyR1) and four mutations in the calcium voltage-gated channel…
Key Points ▪ Patient positioning is a major responsibility that requires the cooperation of the entire surgical team. ▪ Many patient positions that are used for surgery result in undesirable physiologic consequences including significant cardiovascular and respiratory compromise. Anesthetic agents…
Key Points ▪ Herbal medication use has increased dramatically in the overall population and particularly in preoperative patients. ▪ Patients might not volunteer information unless they are queried specifically about herbal medication use. ▪ Although many commonly used herbs have…
Key Points ▪ The history and physical examination most accurately predict the risks of anesthesia and the likelihood of required changes in monitoring or therapy. ▪ For diabetic patients, end-organ dysfunction and the degree of glucose control in the perioperative…
Key Points ▪ The anesthesia preoperative evaluation, which is the clinical foundation for guiding perioperative patient management, reduces perioperative morbidity and enhances patient outcome. ▪ The fundamental purpose of preoperative evaluation is to obtain pertinent information regarding the patient’s medical…