Skyscape Web Viewer : Yao & Artusio's Anesthesiology: Problem-Oriented Patient Management : Main Index

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Postoperative nausea and vomiting (PONV) Acupuncture Ambulatory Surgery B.1. What is an enhanced recovery after surgery (ERAS) program? What are the core tenets of these programs? B.11. What is an enhanced recovery after surgery (ERAS) protocol, and how would you apply it in the outpatient setting? B.15. Is there any way to rapidly antagonize a profound nondepolarizing block? B.5. Would you premedicate this patient? C.5. What is your plan for maintenance of anesthesia? What other medications might you want to give? C.8. What components of ERAS are applied in the intraoperative phase of the care of patients undergoing CRS? D.3. What is the incidence of postoperative nausea and vomiting (PONV)? D.3. What would you do before tracheal extubation of this patient? Metoclopramide Robotic-Assisted Laparoscopic Surgery
See Tonsillectomy, hemorrhage after A.5. What is the incidence of post-tonsillectomy hemorrhage? A.6. What are the risk factors for post-tonsillectomy hemorrhage? Does age matter? A.7. Describe the morbidity and mortality of post-tonsillectomy hemorrhage. D.1. Is postoperative management in the pediatric intensive care unit (PICU) indicated? If this was an uncomplicated adenotonsillectomy, what are the suggested criteria for planned admission? Post-Tonsillectomy Hemorrhage See Tonsillectomy, hemorrhage after
Posture A.11. What are the clinical manifestations of epiglottitis? A.12. Define neutral and critical temperatures. What are these values in the preterm neonate, in the term neonate, and in the adult? Discuss temperature regulation in the neonate. A.2. What are the determinants of intraocular pressure (IOP) under normal circumstances? What is the normal range? What was the expected IOP in this patient's injured eye? A.5. What are the risk factors for low back pain? A.6. What are the potential sources of pain in the spine? Asthma and Chronic Obstructive Pulmonary Disease B.1. What are the noninterventional treatments available? B.4. What are the options for patient positioning during posterior fossa surgery? B.7. How are FRC and CC affected by age and posture? How are they affected by general anesthesia? C.11. What is the effect on cardiopulmonary, renal, and central nervous system (CNS) functions of excessive absorption of irrigation solution during TURP? C.4. How would you maintain the patient's body temperature?
Potassium levels A.4. What is the mechanism of action of succinylcholine, and how is it metabolized? What are the side effects of succinylcholine? B.1. How should this patient be evaluated? C.19. What intraoperative signs suggest that the hepatic graft is working? C.2. What are the considerations for induction of anesthesia? C.8. How would you approach diuretic therapy? C.9. What laboratory tests should be ordered during the resuscitation of this patient?
PPH
See Pacemakers, permanent (PPMs) A.1. What are the indications for permanent pacemakers (PPMs)? A.12. What are the usual lifespans of PPMs and implantable cardioverter-defibrillators (ICDs)? A.13. What is a leadless PPM? How does it work? A.14. What is an ICD? How does it work? What is a subcutaneous ICD? A.2. What is sick sinus syndrome? What is chronotropic incompetence? A.6. How many modes of pacing are available in modern PPMs? How do they work? What is the difference between DDD pacing and DDI pacing? A.7. The patient was mechanically hyperventilated during surgery, and her pacemaker gradually increased her heart rate. Is the pacemaker malfunctioning? A.9. What are the indications for, and complications associated with, AV sequential PPMs? B.7. Would you recommend reprogramming this device to asynchronously pace before surgery? What would you recommend regarding the ICD functions of the device? Cardiac Implantable Electronic Devices See Pacemakers, permanent (PPMs)
See Dabigatran A.3. Does the patient's atrial fibrillation need to be addressed prior to surgery, and if so, how? B.1. What is dabigatran (Pradaxa)? How is its effect measured? How far in advance of elective surgery should it be stopped? Can its effect be reversed? Nerve Blocks of the Lower Extremity
Prazosin A.14. What is the mechanism of action of the major antihypertensive drugs? B.14. What is the pharmacologic management of CRPS? B.2. How do you pharmacologically prepare the patient with a pheochromocytoma for surgery?
Prednisone A.7. What treatments are available for a patient with MG? Asthma and Chronic Obstructive Pulmonary Disease B.15. The patient was on 20 mg of prednisone per day for 5 days as part of the treatment of an asthma exacerbation 3 months ago. He is currently not on corticosteroids. Should the patient receive "stress-dose" corticosteroids? B.3. How are routine medications and immunosuppressive medications managed in the perioperative period? B.3. What are the preoperative concerns of induction immunotherapy and neoadjuvant chemotherapy? D.10. How would you manage this patient in the intensive care unit? D.2. What are immunosuppressive agents, and how do they affect anesthetic care? Dexamethasone
Preeclampsia
Pregnancy
Prematurity
Preterm birth A.16. What tests and/or interventions can improve neonatal outcome of a preterm birth? A.5. What is the incidence of placenta previa, and what are the associated conditions? B.1. What would you discuss with this patient preoperatively? Are any additional medical consultations warranted? C.8. What is the impact of nonobstetric surgery on maternal mortality, birth defects, and fetal loss? What factors influence it? Dexamethasone Magnesium Placenta Previa/Placenta Accreta Spectrum
Preterm infants
Procaine B.11. What factors determine the onset, potency, and duration of local anesthetic block? C.2. What is the systemic toxicity of local anesthetics?
Propofol
Prostate gland
Prothrombin complex concentrate (PCC) B.1. What is dabigatran (Pradaxa)? How is its effect measured? How far in advance of elective surgery should it be stopped? Can its effect be reversed? C.9. Two hours later, estimated blood loss (EBL) is approximately 2 L and the patient has been resuscitated with 3 units of packed red blood cells (pRBCs), 229 mL intraoperative cell salvage (cell saver), and 500 mL albumin in addition to 4 L crystalloid. The surgeon says the field is still "oozy" and there is ongoing blood loss. What are your concerns for resuscitation moving forward? How will you guide your resuscitation? Traumatic Brain Injury (TBI)
See Postreperfusion syndrome (PRS) A.5. What other conditions are associated with orofacial clefts? C.10. What hemodynamic changes are expected after removal of vascular clamps? What is postreperfusion syndrome?
See Polysomnography (PSG) A.1. What medical problems exist with this patient? The patient asks you if he is "high risk." What is the evidence? Is surgical therapy a safe and viable alternative for this patient? A.4. How is OSA diagnosed? What is a sleep study or polysomnography? How are the results obtained from polysomnography used to grade the severity of OSA? What are the subtypes of OSA? Are there genetic disorders with a predisposition to OSA? What is the role of OSA screening tests in the preoperative setting? Morbid Obesity, Obstructive Sleep Apnea, and Bariatric Anesthesia
PS
See Posttetanic count (PTC) B.10. What is the posttetanic count (PTC)? B.8. What are the effects of succinylcholine on ICP? What is the significance of the effect, if any? Postoperative Residual Neuromuscular Weakness and Prolonged Apnea
See Personal Therapy Manager (PTM) C.6. What is a Personal Therapy Manager (PTM), and what role does it play in neuraxial pain relief? Cancer Pain
PT
Pulmonary artery catheterization C.2. What various monitors are available for myocardial ischemia? Is a pulmonary artery catheter (PAC) helpful in determining the occurrence of ischemia? C.3. What additional monitors would you employ? C.4. Should the patient have a PA catheter placed before induction? C.4. Would you place invasive monitors such as a central venous catheter (CVC), pulmonary artery catheter (PAC), and/or an intra-arterial catheter? G.2. What is the adjunctive medical therapy for ARDS?
Pulmonary artery hypertension (PAH)
Pulmonary artery pressure A.5. Draw the pressure/time curves for the LV, left atrium (LA), pulmonary artery (PA), and aorta for a normal patient and for patients with each of the four valvular lesions. A.5. How do you make a diagnosis of right-to-left shunting through a patent ductus arteriosus? A.6. Describe the cardiovascular physiology of patients with end-stage liver disease (ESLD). A.6. What is Pickwickian syndrome? What is obesity hypoventilation syndrome (OHS)? Describe the pathogenesis of severe OSA. C.1. How would you monitor this patient? C.23. How would you recognize a CO2 embolism during laparoscopy? How does this differ from an air embolism? Why should N2O be discontinued during suspected embolization? Will N2O increase the size of CO2 emboli? C.3. Would you monitor for venous air embolism (VAE)? What are the monitoring options? C.5. What hemodynamic changes are frequently associated with opening the pericardial space? C.6. What monitors and devices would you apply to the patient? Why? C.8. How would you deal with problems related to clamping of the pulmonary artery? C.9. How would you manage fluid therapy for patients with hypertension?
Pulmonary atresia A.1. What is TOF? A.10. What definitive surgical procedures are available for treating patients with TOF/PS? A.11. What palliative and definitive surgical procedures are available for patients with TOF with pulmonary atresia? A.2. What are the associated cardiovascular defects in 22q11 deletion syndrome? A.4. What is the pathophysiology of TOF with pulmonary atresia? A.6. What is a "pink Tet"? aminosalicylate Sodium B.2. Which other abnormalities need to be considered in this patient? Prostaglandin Tetralogy of Fallot
Pulmonary capillary wedge pressure (PCWP) Abdominal Aortic Aneurysm Repair C.4. What is the pathophysiology of aortic clamping and unclamping? C.7. What are the hemodynamic changes of aortic cross-clamp placement? What efforts can be made to minimize these changes both before and during cross-clamping? If the patient develops ST-segment depressions with a rising pulmonary capillary wedge pressure (PCWP) during cross-clamp, what maneuvers should be taken? Nicardipine Nitroglycerin
Pulmonary edema