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How Should We Prepare the Patient With a Pacemaker/Implantable Cardioverter-Defibrillator?

INTRODUCTION Battery-operated pacemakers (PMs) revolutionized the treatment of fatal electrical conduction abnormalities in 1958, just a few years after the invention of the transistor. With the maturation of this technology, PMs were designed to also provide atrioventricular synchronization, improve the quality of life for the chronotropically incompetent patient, and prevent and treat atrial fibrillation. The development of implantable cardioverter-defibrillators (ICDs), capable of antitachycardia pacing (ATP) and…

Should Preoperative Brain Natriuretic Peptide (BNP) Be Measured Routinely?

INTRODUCTION In addition to its contractile function, the heart is also considered an endocrine organ capable of producing two natriuretic peptide hormones, atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). Both hormones cause increased renal excretion of water and solute in response to plasma volume overload and hyperosmolality. A variety of pathophysiologic stressors are also known to stimulate BNP release, with myocardial ischemia and cardiomyocyte…

Is Routine Preoperative Pregnancy Testing Necessary?

INTRODUCTION Surgery on a pregnant woman raises several novel concerns. These include the effect of surgery and anesthesia on the developing fetus and the potential to trigger preterm labor. The hazards to the fetus could come from teratogenic effects of drugs administered during the perioperative period or, in a more advanced pregnancy, alterations in uteroplacental blood flow and maternal hypoxia and acidosis. It is reported that up to 15% of…

Update on Preprocedure Testing

CHAPTER OUTLINE Introduction Options/Therapies Evidence Preoperative Radiologic Studies Preoperative Pulmonary Function Testing Preoperative Urine Analyses and Culture Preoperative Coagulation Studies Preoperative Hematocrit and Complete Blood Count Preoperative Serum Chemistry and Glucose Urine Toxicology Screen Electrocardiogram Pregnancy Testing Controversies/Areas of Uncertainty Guidelines INTRODUCTION High-quality preprocedure assessment requires evidence-based risk assessment and management in a setting of efficiency and cost containment. Preprocedure testing should be targeted such that…

How Should We Identify Patients at Risk for Postoperative Neurocognitive Disorder?

INTRODUCTION Postoperative neurocognitive disorder (PND) is a term recently proposed to describe a number of situations that occur up to 1 year after surgery and anesthesia; it aligns with other descriptions of neurocognitive disorders in the Diagnostic and Statistical Manual for Mental Disorders fifth edition (DMS-5) diagnostic criteria. These include emergence excitation or delirium, postoperative delirium (POD), delayed neurocognitive recovery, and postoperative mild or major neurocognitive…

Reducing Risk for Perioperative Stroke

INTRODUCTION Although strokes can and do occur at any age, the incidence of stroke doubles with every decade after the age of 45 years, with three-fourths of all strokes in the United States occurring in people over the age of 65 years. People over 65 represented 13.1% of the population in the year 2010 but are expected to grow to be 20.6% of the population by…

Should Patients With Stable Coronary Artery Disease Undergo Prophylactic Revascularization Before Noncardiac Surgery?

INTRODUCTION The preoperative assessment of a patient in need of elective noncardiac surgery is often a difficult task. There has been enormous controversy regarding the appropriate strategy for diagnosing and managing coronary artery disease (CAD) before elective noncardiac surgery because of the paucity of clinical trial data. Overall, elective surgical procedures in a population of general medical patients are associated with a very low risk for…

Which Patient Should Have a Preoperative Cardiac Evaluation (Stress Test)?

INTRODUCTION Preoperative cardiovascular risk assessment attempts to prospectively identify at-risk patients and allows targeted management to reduce perioperative cardiac complications. These complications include both “demand” events, in which perioperative stress increases myocardial oxygen requirements to a level that cannot be met because of fixed obstructive coronary artery disease (CAD) or low perfusion pressure, and true “acute coronary syndromes” (ACS) with occlusive plaque rupture, likely due, in…

Is a Preoperative Screening Clinic Cost-Effective?

Chaper Outline Introduction Preoperative Assessment Settings Consultations Collaborative Care Brain Health Frailty Preoperative Anemia Chronic Pain and Surgery Shared Decision Making Operating Room Cancellations Areas of Uncertainty INTRODUCTION Preoperative clinic visits have been shown to improve patient satisfaction, reduce unnecessary testing and consultation, and decrease length of hospital stay and in-hospital mortality postoperatively. Optimization of a patient’s medical condition before surgery has also been shown to…

Evidence-Based Practice Parameters: The Approach of the American Society of Anesthesiologists

INTRODUCTION Practice parameters are “strategies for patient management developed by the profession to assist physicians in clinical decision making.” The evidence-based practice parameters of the American Society of Anesthesiologists (ASA) include practice guidelines and practice advisories. Although both types of guidance employ similar approaches and methodologies, the evidence base supporting recommendations in practice advisories is limited in quantity, quality, and consistency. This chapter focuses on practice…

Biostatistics

Introduction to Biostatistics Most of the researchers of medical sciences feel that mathematics in general and statistics in particular are an excessive and difficult task. In biomedical research, knowledge of statistics is mandatory and is an integral part of the research. In the era of evidence-based medicine, the practice of designing and conducting biomedical observations and experiments, presenting the data accruing therefrom, and interpreting the results,…

Quality of Life and Health-Related Issues

Introduction Acute and chronic diseases with a relapsing and remitting course often produce a substantial impact on the function and the quality of life (QOL). One of the important outcome measures after a serious illness or its treatment has been the length of survival. As medical and surgical advances have led to better treatment of existing diseases, many patients are living longer and the ultimate goal…

Palliative Care to Neurological and Neurosurgical Patients

Introduction Palliative care to neurological and neurosurgical patients presents many challenges. The needs of patients and their families varies according to the stages of neurological and neurosurgical illness. In the acute phase, there is need for specialist care, whereas in chronic survivors, it is more to be focused on rehabilitation, with supportive care structured around the needs and problems of the patients and family members. Neurological…

Universal Precautions in the Intensive Care Unit

Introduction Nosocomial infections, or health care–associated infections (HCAI), are a global problem. The Centers for Disease Control and Prevention (CDC) reported 1.7 million HCAI cases in the United States in 2007. During the past decade reliable success in HCAI prevention was achieved for bloodstream infections only. A cardinally opposite situation is observed for other kinds of HCAI, and the rates of sepsis are increasing annually by…

Sterilization and Disinfection

Background Sterilization and disinfection are the basic components of hospital infection control activities. Every day, a number of hospitals are performing various surgical procedures. Even more number of invasive procedures are being performed in different health care facilities. The medical device or the surgical instrument that comes in contact with the sterile tissue or the mucus membrane of the patient during the various processes is associated…

Pharmacogenomics

Introduction Central to the practice of anesthesiology is the goal of safety and maximal efficacy for every individual patient. The challenge is that patients can have a range of responses to anesthetic drugs both beneficial and adverse. Potential causes for this variability include disease state, age, nutritional status, organ dysfunction, drug–drug interactions, and other comorbidities. While the basic pharmacologic principles of pharmacokinetics (PK) and pharmacodynamics (PD)…

Stem Cell Therapy

Stems cells have been recognized as a wonder drug as they provided a ray of hope to diseases where mankind had become hopeless. Thus ever since they were put to test for scientific evidence of response, more and more research has been done in the field. This has included both experimental research and clinical research. The 21st century belongs to regeneration medicine and stem cells. This…

Recent Advances in Neuroanesthesiology

Introduction Perioperative neuroscience is a very dynamic field due to ongoing research, clinical innovations, and technological developments. In this chapter, we review some of the major recurring themes, innovative findings, and prevalent topics associated with advances in the field of neuroanesthesiology. Endovascular Treatment of Stroke and Perioperative Stroke Ischemic stroke is one of the leading causes of morbidity and mortality worldwide. Treatment of ischemic stroke may…

Translational Research

Introduction This chapter begins with a description of the evolution of the term “translational research.” Then, the authors describe the current state of translational research, reasons for the results of basic research not leading to good results in clinical research, and steps that should be taken by drug researchers to be successful. Translational research has recently become popular, but it has not been clearly understood and…

Evidence-Based Practice of Neuroanesthesia

Introduction It was in the year 1992 that evidence-based practice (EBP) was formally introduced into clinical practice. The first EBP was started in medicine as evidence-based medicine (EBM) and later spread to other fields such as nursing, psychology, education, and library sciences. EBP involves conscientious decision making, which is based on the best available evidence as well as preferences and patient characteristics. EBP got its reputation…