ADVANCES IN Anesthesia CONTENTS VOLUME 32 2014 Associate Editors vii Contributors ix Introduction xix Practical Understanding of Hemostasis and Approach to the Bleeding Patient in the Operating Room 1 Albert Pierce and Jean-Francois Pittet Introduction 1 Classical coagulation cascade 2 Observation leading to discovery 2 Beyond the waterfall/cascade 3 Regulation 3 Endothelial roles in regulation 3 Importance of the endothelial glycocalyx 5 Continued evolution of our understanding 5 Trauma/inflammation/coagulopathy 5 Immune response to injury 5 A mechanism of tissue injury induced inflammation 6 Importance of trauma-induced coagulopathy 7 Management goals 8 Newer models of treatment for trauma resuscitation 8 Identification of the need for massive transfusion 8 Two models of resuscitation 9 Point-of-care coagulation testing 10 How viscoelastic tests help 11 Normal thromboelastography/rotational thromboelastometry 11 Abnormal thromboelastography/rotational thromboelastometry 11 Platelet testing 12 Platelet mapping 12 Impedance aggregometry 12 Fibrinolysis testing 13 Role of traditional coagulation tests 13 A combined approach to resuscitation 13 Damage-control resuscitation in nontrauma patients 14 Surgical hemorrhage as trauma-induced bleeding 14 Coagulopathy 14 Predicting hemorrhage 14 Blood conservation 15 Coagulation testing for perioperative massive hemorrhage 15 Trigger of massive transfusion protocol 15 xiii
Application of damage-control resuscitation methods to nontrauma patients 15 Summary 18 Update on Perioperative Myocardial Injury and Infarction: Definitions, Diagnosis, Biomarkers, Implications, and Approach to Care in the Perioperative Period 23 Gregory A. Nuttall, William C. Oliver Jr, and Charanjit S. Rihal Introduction 23 Definitions 24 Diagnosis 24 Biomarkers 25 Risk factors 26 Approach to care 27 Implications 31 Summary 33 Shoulder Surgery in the Beach Chair Position: Current Anesthetic Concepts and Controversies in Hemodynamic Management and Cerebral Perfusion 37 Rohini Kotha and Steven L. Orebaugh Introduction 38 History/Utility of beach chair position 38 Management goals for anesthesia in beach chair position 38 General considerations 38 Position-related considerations 39 Anesthetic-related considerations 39 Pathophysiology of cerebral blood flow in beach chair position 40 Clinical outcomes 46 Beach chair position versus supine 46 Type of anesthesia and mode of ventilation 48 Epidemiologic outcomes 51 Monitoring cerebral perfusion 52 Preventative strategies 53 Summary 53 Recommendations 54 Anesthesia for Endoscopic Procedures: The New Frontier 59 John E. Tetzlaff, John Vargo, and Walter Maurer xiv Introduction 60 Gastrointestinal endoscopic procedures 60 Esophagogastroduodenoscopy 60 Colonoscopy 61 Endoscopic retrograde cholangiopancreatography 61 Endoscopic ultrasonography 62
Deep endoscopy 63 Endoscopic mucosal resection 64 Esophageal ablation therapy 64 Chromoendoscopy 65 Endoscopic dilation and stenting 65 Enteric feeding tubes 65 Sedation for advanced endoscopic procedures 66 The future 67 Natural orifice transluminal endoscopic surgery 67 Transgastric necrosectomy of the pancreas 67 Cholangioscopy 68 Endoscopic bariatric procedures 68 Endoscopic treatment of postoperative leaks and fistula 68 Anesthesia and Upper and Lower Airway Management for Advanced Diagnostic and Therapeutic Bronchoscopy 71 Basem Abdelmalak, Sonali Sethi, and Thomas R. Gildea Introduction 72 Advanced diagnostic bronchoscopy 72 Endobronchial optical advanced diagnostic techniques 72 Endobronchial ultrasonography 73 Electromagnetic navigation bronchoscopy 74 Advanced therapeutic bronchoscopy 74 Central airway obstruction 74 Other examples of therapeutic bronchoscopic procedures 77 Endobronchial treatment of severe asthma 77 Anesthetic considerations and management 78 Preoperative assessment 78 Type of anesthetic 78 Anesthetic adjuvants 79 Airway control and fresh gas flow 80 Rigid bronchoscopy and anesthesia 82 Complex bronchoscopic procedures 83 Postanesthesia care 85 Complications 85 Summary 85 Advances in Perioperative Pulmonary Protection Strategies 89 J. Kyle Bohman and Daryl J. Kor Introduction 89 Risk factors and causes of postoperative pulmonary complications 90 Risk factors for postoperative pulmonary complications 90 Causes of perioperative respiratory impairment 91 General prevention strategies 93 Smoking cessation 94 Mechanical ventilation strategies 94 Pulmonary hygiene 96 xv
Anesthetic and analgesic techniques 98 Prevention of gastric-to-pulmonary aspiration 99 Management of intravenous fluids 100 Preventing transfusion-related acute lung injury 101 Avoiding hyperoxia 101 Management of neuromuscular blockade reversal 102 Postoperative pulse oximetry 102 Minimizing perioperative sedation 103 Prevention of ventilator-associated pneumonia 103 Population-specific prevention strategies 103 Obstructive lung disease 103 Obstructive sleep apnea and obesity 105 Intrathoracic procedures 105 Specialized care of acute respiratory distress syndrome and refractory hypoxemia 107 Preoperative evaluation 107 Obstructive lung disease 107 Obstructive sleep apnea 107 Preoperative pulmonary function testing 108 Preoperative evaluation before lung resection 108 Summary 108 Perioperative Frailty: Definitions, Evaluation, Implications for Management, Impact on Outcomes After Anesthesia 119 Sheila Ryan Barnett Introduction 119 Why study frailty? 120 Defining frailty 120 Pathophysiology 120 Identifying frailty 121 Clinical phenotype 122 Deficit accumulation 122 The role of the comprehensive geriatric assessment 123 Strength and gait speed 125 Sarcopenia 125 Cardiovascular disease and frailty 126 Preoperative identification of vulnerable patients 126 Anesthesia and the frail patient 126 Prehabilitation and enhanced recovery after surgery programs 128 Summary 128 Liposomal Bupivacaine: Its Role in Regional Anesthesia and Postoperative Analgesia 133 Brian M. Ilfeld xvi Introduction 133 Liposomes 134 Liposome local anesthetic 135
Potential toxicity 136 Exparel 136 Pharmacokinetics 137 Pharmacodynamics: wound infiltration 137 Adverse events 138 Epidural administration 139 Peripheral nerve blocks 140 Transversus abdominis plane blocks 140 Femoral nerve blocks 141 Surgical subjects 142 Potential implications 144 Potential disadvantages 144 Knowledge gaps and future research 145 Summary 145 Ultrasound Guidance for Central Neuraxial Anesthesia and Analgesia 149 James Edward Johnson, Anahi Perlas, and Ki Jinn Chin Introduction 149 Anatomy and sonoanatomy of the lumbar spine 150 Parasagittal oblique view 151 Parasagittal views of the articular processes and transverse processes 152 Transverse midline interlaminar view 153 Transverse midline spinous process view 153 Recommended preprocedural scanning technique in the lumbar spine 153 Strategies in subjects with poor-quality views 155 Anatomy and sonoanatomy of the thoracic spine 156 Parasagittal oblique view of the midthoracic spine 157 Transverse midline view of the midthoracic spine 157 Recommended preprocedural scanning technique in the thoracic spine 158 The clinical application of neuraxial ultrasound scan 159 Identification of specific intervertebral levels 159 Measuring depth to the epidural or intrathecal space 161 Improving the clinical efficacy of neuraxial blockade 162 Improving technical performance of neuraxial blockade 163 Predicting the ease of performance of neuraxial blockade 165 Reducing the risk of adverse outcomes 165 Acquiring competency in neuraxial ultrasound scan 165 The learning curve in neuraxial ultrasound scan 165 Training strategies in neuraxial ultrasound scan 166 Real-time ultrasound-guided neuraxial block 166 Summary 167 Perioperative Management of the Patient with Diabetes 171 Timothy B. Curry and Daniel R. Brown Introduction 171 Background 171 Classification of diabetes 172 xvii
Diagnosis 174 Treatment of diabetes 174 Perioperative management goals 175 Prehospital evaluation, management and education 175 Perioperative glycemic control strategies for patients with diabetes 180 Discharge and follow-up 184 Special considerations 184 Summary 185 Anesthetic Care of Septic Patients 191 R. Eliot Fagley Introduction 191 Preoperative evaluation 192 Induction of anesthesia 194 Monitoring and maintenance of anesthesia 196 Emergence 200 Summary 200 Advances in Spinal Cord Protection from Perioperative Ischemic Injury 205 Philip E.F. Roman, Ashanpreet S. Grewal, Bradley S. Taylor, and Alina M. Grigore Introduction 206 Anatomy and physiology of the spinal cord 206 Molecular mechanism of spinal neuronal injury 209 Operative techniques for spinal cord preservation 210 Indications 212 Repair of descending thoracic aortic aneurysm 212 Thoracoabdominal aortic aneurysm 213 Thoracic endovascular aortic repair 214 Nonoperative techniques for spinal cord protection 215 Risk of injury 215 Hemodynamic monitoring 216 Intraoperative neuromonitoring 217 Cerebrospinal fluid drainage 221 Hypothermia 221 Pharmacologic interventions 222 Perioperative diagnosis of spinal cord injury 223 Treatment of spinal cord ischemia 224 Postoperative care 224 Outcomes 226 Open versus endovascular 226 Descending thoracic aortic aneurysms 227 Type B dissections 228 Ruptured aneurysms 229 Summary 230 Index 237 xviii