Developmental physiology describes the bodily changes that take place during early development. Anesthesiologists must be familiar with these changes as they pertain to the different organ systems. Developmental pharmacology describes the changes in pharmacokinetics and pharmacodynamics during early life. In…
We begin this journey into the magical world of pediatric anesthesia by describing fetal cardiopulmonary physiology and the physiologic changes that occur during birth. Knowledge of these changes is important for understanding the pathophysiologic conditions that occur in neonates when…
Key Points 1. Major adverse cardiac events (MACEs) are relatively common in patients undergoing noncardiac surgical procedures. The incidence of perioperative myocardial infarction (PMI) is about 0.9%. However, a larger percentage of patients experiences a perioperative increase in cardiac troponins…
Key Points 1. Cerebrovascular accidents are some of the most significant perioperative complications because they increase long-term disability, hospital length of stay, and mortality. 2. Recent stroke is associated with a 1.8-fold increased risk of death in noncardiac surgery. 3.…
Key Points 1. The postanesthesia care unit (PACU) is a specialized unit designed to monitor for early postanesthesia and surgical adverse events. 2. Early cardiac decline after noncardiac surgery requires prompt evaluation, early intervention, and cardiologist consultation for advanced care.…
Key Points 1. The costs of healthcare are escalating. Goal-directed fluid therapy (GDT) and multimodal pain relief are ways to control cost while improving quality. 2. GDT is an integral part of enhanced recovery programs (ERPs), as is multimodal pain…
Key Points 1. The rate of maternal heart disease is increasing and complicates up to 4% of pregnancies. It is a leading cause of maternal, fetal, and neonatal morbidity and mortality. 2. The diagnosis of new cardiovascular disease during pregnancy…
Key Points 1. Cardiomyopathy and ischemic coronary artery disease are the most common cardiac conditions in liver transplant candidates. 2. There are no clear recommendations for the assessment of cardiac status before liver transplantation, but each patient must be individually…
Key Points 1. Cardiac patients presenting for emergency noncardiac surgery have higher risk for perioperative morbidity and mortality. Emergency surgeries are associated with two to five times the risk of major adverse cardiac events compared with elective procedures. Preoperative evaluation…
Key Points 1. Tachyarrhythmias result from one of three mechanisms (reentry, automaticity, and triggered activity), with reentry being the mechanism most commonly treated in the electrophysiology (EP) laboratory. 2. Anesthetic agents influence cardiac conduction and arrhythmogenesis and can adversely affect…