Special considerations: Alzheimer’s disease
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Geriatric Neuroanesthesia, 2019
Outpatient drug therapy for alleviating some of the memory problems associated with AD is a new and changing field. Increasingly, patients on either the N-methyl-D-aspartate receptor (NMDA) antagonist, memantine, or one of the three acetylcholinesterase inhibitors, galantamine, rivastigmine, and donepezil, are presenting for surgery. No specific interactions with common anesthetic drugs have been discovered, and a comprehensive review of these drugs in anesthesiology practice has not been undertaken. The acetylcholinesterase inhibitors are associated with signs of increased cholinergic signaling in the periphery: vomiting and nausea. In the case of galantamine, bradycardia is also possible (44). It has been suggested that donepezil be used more routinely in the post-anesthesia care unit (PACU) to aid in recovery as an attempt to remedy a potential anticholinergic cause, either by undiagnosed dementia or as a consequence of administering drugs known to contribute to anticholinergic situations perioperatively (e.g., diphenhydramine) (45).
Misuse, Recreational Use, and Addiction in Relation to Prescription Medicines
Ornella Corazza, Andres Roman-Urrestarazu in Handbook of Novel Psychoactive Substances, 2018
The strong potential of recreational use and addiction of medications used in the anaesthesia environment (i.e., propofol, ketamine, barbiturates, benzodiazepines, and opiates) has raised the issue of the particular risk of developing an addiction disorder among anaesthesiologists (Bryson & Silverstein, 2008). A review of 1,000 treated physicians conducted by Talbott in 1987 suggested that addiction disorders are more common among anaesthesiologists than among other health professionals (Talbott, Gallegos, Wilson, & Porter, 1987). A survey of 126 academic anaesthesiology training programs carried out in 2008 reported that 22% of the departments had recorded at least one incident of inhalational anaesthetic misuse (Hernandez & Nelson, 2010). A 2007 e-mail survey of 126 academic anaesthesiology training programs noted an incidence of propofol misuse of 10/10,000 anaesthesia providers per decade (Hernandez & Nelson, 2010). Because of the unique condition of being in strong proximity to highly addictive agents in the work environment, there is a consensus in considering anaesthesiologists as a particularly at risk population for the development of addiction disorders who would benefit from specific monitoring and prevention approaches (Bryson & Silverstein, 2008).
Anesthesia Incidents and Accidents
Marilyn Sue Bogner in Misadventures in Health Care, 2003
Anesthesia residents, individuals who, after completing 4 years of medical school and a 1-year internship, are pursuing further training in the medical specialty of anesthesiology, work an average of 73 hours per week including night and weekend responsibilities (Howard, Healzer, & Gaba, 1997). Some work weeks may exceed 100 hours. Many fully trained practicing physicians similarly work extended hours. When on call, anesthesiologists typically work 24-hour shifts, often without sleep. Unlike many other medical specialties, anesthesiology has fostered a culture that discourages providing clinical care after a night on call in which there was acute sleep loss. In spite of this, private practice anesthesiologists often provide care for a short list of identified routine surgical cases the morning after they have worked the preceding day and night. Even a single night of sleep loss, as when on call, produces appreciable fatigue and sleepiness, a depressed mood, and reduced motivation to perform that could lead to an adverse incident (Weinger & Ancoli-Israel, 2002).
Who can do this procedure? Using entrustable professional activities to determine curriculum and entrustment in anesthesiology – An international survey
Published in Medical Teacher, 2022
Christoph S. Burkhart, Salome Dell-Kuster, Claire Touchie
What about anesthesiology? In anesthesiology, many procedures and tasks are time-critical and may be life-saving if done correctly and in a timely fashion. However, in inexperienced hands, these procedures or skills may be immediately life-threatening. Sometimes, you do not have the time to hesitate and you absolutely have to know who can do what in order to provide timely and appropriate care to the patient. The question of who is allowed to do what procedure or task with how much supervision seems to be neatly addressed by EPAs. Examples of EPAs in anesthesiology include resuscitation of a trauma patient in the trauma bay, insertion of a central line, epidural analgesia for labor, handover of a patient to the postanesthesia care unit, and postoperative care or pain management after specific procedures (Wisman-Zwarter et al. 2016; Moll-Khosrawi et al. 2020).
Intraoperative hypotension and its organ-related consequences in hypertensive subjects undergoing abdominal surgery: a cohort study
Published in Blood Pressure, 2021
Szymon Czajka, Zbigniew Putowski, Łukasz J. Krzych
In this cohort study we screened 590 consecutive patients who underwent abdominal surgery between 1 October 2018 and 15 July 2019 in a university hospital. Organ retrieval surgery (n = 11), re-operations (n = 24), procedures performed under local anaesthesia and under monitored anaesthesia care (n = 33), and those classified as immediate according to the NCEPOD Classification of Intervention [10] (n = 14) were excluded. The flow chart describing study group selection is presented in Figure 1. Demographic and clinical data were recorded, including sex, age, weigh, height, comorbidities and their pharmacological treatment, according to the ICD 10 coding [11]. Body mass index (BMI) and Charlson Comorbidity Index (CCI) were subsequently calculated. The type and duration of anaesthesia as well as the type, duration and urgency of surgery were recorded [12]. Perioperative risk was assessed based on individual patient’s risk, according to the American Society of Anaesthesiology (ASA) physical status (PS) classification [13], and procedural risk, according to the European Society of Cardiology and European Society of Anaesthesiology recommendations [14]. Primary arterial hypertension was diagnosed based on medical records. The ongoing antihypertensive therapy was evaluated.
Sedation in cardiac arrhythmias management
Published in Expert Review of Cardiovascular Therapy, 2018
Federico Guerra, Giulia Stronati, Alessandro Capucci
Sedative and anesthetic drugs are commonly used both in the electrophysiology lab and in the emergency setting for arrhythmia-related issues.Electrical cardioversion is a common procedure requiring deep sedation in order to avoid pain and discomfort related to shock discharge. While anesthesiology support is traditionally recommended, many different approaches are possible in order to reach the same level of safety while cutting time-related issues and healthcare costs.Many procedures currently performed in an electrophysiology lab only require local anesthesia. However, deep sedation or even general anesthesia can become a requirement in many cases, such as complex substrate or pace-mapping ablation, subcutaneous device positioning, and unconventional cardiac anatomies. In these cases, the line between a safe cardiologist-directed sedation and the need for anesthesiology support is often quite thin, and many controversies exist related to the pros and cons of both strategies.Sedative drugs present anti-arrhythmic properties and can be administered to stop supraventricular and ventricular arrhythmias, atrial fibrillation, and electrical storm. On the other hand, some sedatives such as propofol could potentially prevent arrhythmia inducibility, making the ablation procedure unfeasible.
Related Knowledge Centers
- Anesthesia
- Nurse Anesthetist
- Pain Management
- Surgery
- Perioperative Medicine
- Intensive Care Medicine
- Physician
- Operating Theater
- Intensive Care Unit
- Injection