https://wikianesthesia.org/w/api.php?action=feedcontributions&feedformat=atom&user=Nicholascorcoran 2026-05-03T11:16:10Z User contributions MediaWiki 1.37.1 https://wikianesthesia.org/w/index.php?title=PACU_Post_Anesthesia_Care_Unit&diff=17129 2025-03-24T11:58:22Z

<p>Nicholascorcoran: created page</p> <hr /> <div>Guidelines for Resident Experience in the Post-Anesthesia Care Unit<br /> <br /> ACGME Requirements<br /> <br /> <br /> '''&lt;u&gt;Transfer of Care&lt;/u&gt;'''<br /> <br /> At the end of procedures requiring anesthesia services, the care for each patient must be transferred to an appropriate setting for immediate postoperative management. The transition of care from the anesthesia provider must include an assessment of the patient’s readiness for transfer to a post anesthesia environment. Upon transfer, the anesthesia provider must provide a verbal report that includes a description of the patient’s preoperative medical history and physical exam, intraoperative course including the surgical procedure and anesthetic management, and anticipated postoperative issues. The report should be directly communicated to the personnel who will assume responsibility for the patient’s care, including, but not limited to nursing and anesthesia providers. <br /> <br /> <br /> '''&lt;u&gt;Anesthesiology Resident Participation in Postoperative Care&lt;/u&gt;'''<br /> <br /> Most patients undergoing anesthesia and surgery will be transferred to Post Anesthesia Care Unit (PACU) for immediate postoperative management. In order to gain experience in the immediate postoperative care of surgical patients, each anesthesia resident should have a formal rotation in the PACU. During this rotation, anesthesiology residents will be assigned to the PACU and must directly manage postoperative patients, with emphasis on pain management, hemodynamic evaluation and management, airway emergencies that occur during the PACU stay and other clinical situations that arise in the immediate postoperative period. Whenever feasible, the anesthesia resident should be present at the time of arrival of the patient into the PACU, should receive a verbal report about the patient and should review relevant records, including the anesthesia record. <br /> <br /> The PACU rotation should emphasize immediate post-anesthesia and postoperative care issues. Resident responsibilities may also include participation in emergency resuscitation and other emergency care within the hospital and participation in a rapid response team. These additional responsibilities should not compromise patient care within the PACU. <br /> <br /> The PACU rotation should include didactic lectures and case discussions related to immediate postoperative care needs, clinical assessment and patient management. Residents should gain an understanding about postoperative care needs and resource utilization, patient triage and bed allocation. Appropriate supervision should be provided by faculty knowledgeable about postoperative management who are available for assistance and/or consultation at any time.<br /> <br /> <br /> '''&lt;u&gt;PACU Discharge&lt;/u&gt;'''<br /> <br /> The anesthesiology resident, under appropriate supervision must determine if patients fulfill PACU discharge criteria and confirm that the transfer will be to a hospital unit with appropriate resources and staff to provide necessary postoperative care. At the time of discharge from PACU, the resident should communicate significant postoperative events and/or concerns to the providers assuming care for the patient.<br /> <br /> <br /> '''&lt;u&gt;Other Postoperative Care Experiences&lt;/u&gt;''' <br /> <br /> The anesthesiology resident should participate in the transition of care from various anesthetizing locations to inpatient settings and home care. As part of the postoperative experience, all residents must develop the skills to assess patient needs, identify the most appropriate site for further postoperative care, and ensure safe and timely transfers of care to other providers. The resident should develop skills at communication of patient needs and coordination of care between the medical staff, nursing staff and other providers. Appropriate medical records shall be kept during the PACU period.<br /> <br /> <br /> <br /> https://static1.squarespace.com/static/5e6d2ea8ff954d5b7b122439/t/61f85993eb7e9f2bb6858fcc/1718141350030/ASA+Standards+for+Post+Anesthesia+Care.pdf</div>

Nicholascorcoran https://wikianesthesia.org/w/index.php?title=Table_of_contents&diff=16541 2024-06-27T18:04:29Z

<p>Nicholascorcoran: </p> <hr /> <div>The '''table of contents''' is a non-comprehensive list of articles the editors of WikiAnesthesia feel should exist and will continuously evolve as the site grows from contributions from the anesthesia community.<br /> <br /> Links which are '''&lt;span style=&quot;color:#337AB7&quot;&gt;blue&lt;/span&gt;''' already exist on the wiki (but would surely benefit from additions and revisions). Links which are '''&lt;span style=&quot;color:#9B1B2F&quot;&gt;red&lt;/span&gt;''' do not currently exist as articles on the site. Articles may exist in more than one location in the table of contents.<br /> <br /> Please see our '''[[WikiAnesthesia:Author guide|author guide]]''' for instructions on how to start editing content on the site.<br /> <br /> If you add a new article which is not currently listed but has a natural place in the table of contents, please edit this list to include it. We kindly ask that you do not make major changes to the table of contents before running it by an [{{fullurl:Special:ListUsers|group=editor}} editor] first.<br /> =[[:Category:Surgical procedures|Surgical procedures]]=<br /> <br /> ==[[:Category:Cardiac surgery|Cardiac surgery]]==<br /> *[[Aortic procedures]]<br /> **[[Aortic aneurysm repair|Aortic aneurysm repair (AAA)]]<br /> **[[Aortoplasty for supravalvular stenosis]]<br /> **[[Repair of aortic aneurysm with graft]]<br /> *[[Circulatory assist procedures]]<br /> **[[Cardiopulmonary bypass|Cardiopulmonary bypass (CPB)]]<br /> **[[Extracorporeal membrane oxygenation|Extracorporeal membrane oxygenation (ECMO)]]<br /> **[[Insertion of ventricular assist device]] (Redirects: [[LVAD]], [[RVAD]], [[BiVAD]])<br /> **[[Insertion of permanently implantable aortic counterpulsation ventricular assist device|Insertion of permanently implantable aortic counterpulsation ventricular assist device (VAD)]]<br /> **[[Insertion of percutaneous ventricular assist device|Insertion of percutaneous ventricular assist device (pVAD)]]<br /> **[[Implantation of total replacement heart system]]<br /> *[[Electrophysiology procedures]]<br /> **[[Insertion of pacemaker or ICD]]<br /> **[[Intracardiac catheter ablation for the treatment of arrhythmia]]<br /> **[[Loop recorder implantation]]<br /> *[[Myocardial procedures]]<br /> **[[Excision of intracardiac tumor]]<br /> **[[Ventriculomyotomy]]<br /> **[[Ventricular aneurysmectomy]]<br /> *[[Cardiac revascularization procedures]]<br /> **[[Coronary artery bypass graft|Coronary artery bypass graft (CABG)]]<br /> **[[Off-pump and minimally invasive coronary artery bypass grafting|Off-pump and minimally invasive coronary artery bypass grafting (OPCAB)]]<br /> **[[Percutaneous transluminal coronary angioplasty|Percutaneous transluminal coronary angioplasty (PTCA)]]<br /> **[[Transmyocardial laser revascularization]]<br /> **[[Coronary endarterectomy]]<br /> *[[Pericardial procedures]]<br /> **[[Pericardiocentesis]]<br /> **[[Pericardiectomy]]<br /> *[[Septal procedures]]<br /> **[[Septal myectomy/myotomy]]<br /> **[[Transcatheter closure of ASD or VSD]]<br /> **[[Open repair of ASD or VSD]]<br /> *Transplant procedures<br /> **[[Heart transplant]]<br /> **[[Heart-lung transplant]]<br /> **[[Lung transplant]] (Redirect: [[BOLT]])<br /> *[[Valvular procedures]]<br /> **[[Transcatheter aortic valve replacement|Transcatheter aortic valve replacement (TAVR)]]<br /> **[[Transcatheter mitral valve replacement|Transcatheter mitral valve replacement (TMVR)]]<br /> **[[Aortic valve repair or replacement|Aortic valve repair or replacement (AVR)]]<br /> **[[Mitral valve repair or replacement|Mitral valve repair or replacement (MVR)]]<br /> **[[Tricuspid valve repair or replacement]]<br /> **[[Percutaneous balloon valvuloplasty]]<br /> <br /> ==[[:Category:General surgery|General surgery]]==<br /> *[[Biliary tract surgery]]<br /> **[[Cholecystectomy]]<br /> **[[Excision of bile duct tumor]]<br /> **[[Choledochal cyst excision or anastomosis]]<br /> **[[Percutaneous transhepatic biliary drainage]]<br /> **[[Percutaneous transhepatic cholangiography]]<br /> **[[Endoscopic retrograde cholangiopancreatography]]<br /> *[[Breast surgery]]<br /> **[[Mastectomy]]<br /> **[[Breast biopsy]]<br /> **[[Breast lumpectomy]]<br /> **[[Sentinel lymph node biopsy]]<br /> *[[Colorectal surgery]]<br /> **[[Anorectal surgery]]<br /> ***[[Hemorrhoidectomy]]<br /> ***[[Lateral internal sphincterotomy]]<br /> ***[[Incision and drainage of perianal abscess]]<br /> ***[[High resolution anoscopy|High resolution anoscopy (HRA)]]<br /> ***[[Sacral nerve stimulation for fecal incontinence]]<br /> **[[Colectomy]]<br /> **[[Pelvic exenteration]]<br /> **[[Proctectomy]]<br /> **[[Rectal prolapse surgery]]<br /> ***[[Mucosal sleeve resection|Mucosal sleeve resection (Delorme Procedure)]]<br /> ***[[Perineal rectosigmoidectomy]]<br /> ***[[Rectopexy]]<br /> *[[Endocrine surgery]]<br /> **[[Adrenalectomy]]<br /> ***[[Excision of pheochromocytoma]]<br /> **[[Thyroidectomy]]<br /> **[[Parathyroidectomy]]<br /> *[[Esophageal surgery]]<br /> **[[Cervical esophagostomy]]<br /> **[[Esophagectomy]]<br /> ***[[Thoracoabdominal esophagectomy]]<br /> ***[[Minimally invasive esophagectomy]]<br /> ***[[Transhiatal esophagectomy]]<br /> ***[[Ivor Lewis esophagectomy]]<br /> ***[[McKeown esophagectomy]]<br /> **[[Esophageal diverticulectomy]]<br /> ***[[Zenker's divericulectomy]]<br /> **[[Esophagomyotomy]]<br /> ***[[Heller myotomy]]<br /> **[[Esophagastric fundoplication]]<br /> ***[[Nissen fundoplication]]<br /> ***[[Belsey Mark fundoplication]]<br /> **[[Surgical repair of esophageal perforation or rupture]]<br /> *[[Hepatic surgery]]<br /> **[[Hepatic resection]]<br /> **[[Hepatorrhaphy]]<br /> **[[Liver transplant]]<br /> ***[[Veno-Venous Bypass]]<br /> *[[Intestinal surgery]] <br /> **[[Appendectomy]]<br /> **[[Closure of enteric fistula]]<br /> **[[Duodenotomy]]<br /> **[[Enterolysis procedure|Enterolysis procedure (Lysis of adhesions)]]<br /> **[[Inguinal hernia repair]]<br /> **[[Meckel's diverticulectomy]]<br /> **[[Ostomy procedure]]<br /> **[[Small bowel resection]]<br /> **[[Ventral hernia repair]]<br /> *[[Pancreatic surgery]]<br /> **[[Pancreatectomy]]<br /> **[[Pancreaticoduodenectomy|Pancreaticoduodenectomy (Whipple procedure)]]<br /> *[[Splenic surgery]]<br /> **[[Splenectomy]]<br /> **[[Splenorrhaphy|Splenorrhaphy (Repair of ruptured spleen)]]<br /> *[[Stomach surgery]]<br /> **[[Gastric resection|Gastric resection (Gastrectomy)]]<br /> **[[Percutaneous endoscopic gastrostomy|Percutaneous endoscopic gastrostomy (PEG)]]<br /> **[[Gastric or duodenal perforation repair]]<br /> **[[Bariatric surgery]]<br /> ***[[Gastric bypass surgery]]<br /> ****[[Roux-en-Y gastric bypass]]<br /> ****[[Biliopancreatic diversion with duodenal switch|Biliopancreatic diversion with duodenal switch (BPD/DS)]]<br /> ***[[Gastric restrictive surgery]]<br /> ****[[Laparoscopic adjustable gastric banding]]<br /> ****[[Open vertical sleeve gastrectomy]]<br /> *[[Trauma surgery]]<br /> *[[Hyperthermic intraperitoneal chemotherapy surgery|Hyperthermic intraperitoneal chemotherapy surgery (HIPEC)]]<br /> <br /> ==[[:Category:Interventional radiology procedures|Interventional radiology procedures]]==<br /> *[[Superior vena cava recanalization]]<br /> <br /> ==[[:Category:Oral and maxillofacial surgery|Oral and maxillofacial surgery]]==<br /> *[[Dental extraction]]<br /> <br /> ==[[:Category:Neurosurgery|Neurosurgery]]==<br /> *[[Functional neurosurgery]]<br /> **[[Deep brain stimulation lead placement]]<br /> **[[Percutaneous trigeminal rhizotomy]]<br /> **[[Vagus nerve stimulation|Vagus nerve stimulation (VNS)]]<br /> **[[Responsive neurostimulation|Responsive neurostimulation (RNS)]]<br /> *[[Intracranial neurosurgery]]<br /> **[[Awake craniotomy|Awake craniotomy]]<br /> **[[Bifrontal craniotomy for CSF leak]]<br /> **[[Craniocervical decompression]]<br /> **[[Craniotomy for cerebral embolectomy]]<br /> **[[Craniotomy for decompression of cranial nerves]]<br /> **[[Craniotomy for extracranial-intracranial revascularization|Craniotomy for extracranial-intracranial revascularization (EC-IC bypass)]]<br /> **[[Craniotomy for intracranial aneurysm]]<br /> **[[Craniotomy for intracranial vascular malformations]]<br /> **[[Craniotomy for resection of epileptogenic focus]]<br /> **[[Craniotomy for trauma]]<br /> **[[Craniotomy for tumor resection]]<br /> **[[Transphenoidal resection of pituitary tumor]]<br /> *[[Spinal neurosurgery]]<br /> **[[Anterior cervical spine surgery]]<br /> **[[Posterior cervical spine surgery]]<br /> **[[Anterior thoracic spine surgery]]<br /> **[[Posterior thoracic spine surgery]]<br /> **[[Anterior lumbar/lumbosacral spine surgery]]<br /> **[[Posterior lumbar/lumbosacral spine surgery]]<br /> *[[CSF aspiration, diversion, or shunt procedures]]<br /> **[[Ventriculocisternostomy|Ventriculocisternostomy (Torkildsen shunt)]]<br /> **[[Ventriculoperitoneal shunt|Ventriculoperitoneal shunt (VP shunt)]]<br /> **[[Ventriculoatrial shunt|Ventriculoatrial shunt (VA shunt)]]<br /> *[[Carotid endarterectomy|Carotid endarterectomy (CEA)]]<br /> *Neuro interventional radiology procedures<br /> **[[Cerebral angiogram]]<br /> <br /> ==[[:Category:Obstetric and gynecologic surgery|Obstetric and gynecologic surgery]]==<br /> *[[Cesarean section]]<br /> *[[Dilation and curettage|Dilation and curettage (D&amp;C)]]<br /> *[[Endometrial ablation]]<br /> *[[Hysterectomy|Hysterectomy (TAH)]]<br /> *[[Hysteroscopy]]<br /> *[[Myomectomy|Myomectomy (Fibroidectomy)]]<br /> *[[Oophorectomy|Oophorectomy (BSO)]]<br /> *[[Ovarian torsion surgery]]<br /> *[[Pelvic exenteration]]<br /> *[[Tubal ligation]]<br /> *[[Vaginectomy]]<br /> <br /> ==[[:Category:Ophthalmology|Ophthalmology]]==<br /> *[[Cataract surgery|Cataract surgery]]<br /> *[[Corneal transplant]]<br /> *[[Traveculectomy]]<br /> *[[Ectropion repair]]<br /> *[[Entropion repair]]<br /> *[[Ptosis repair]]<br /> *[[Eyelid reconstruction]]<br /> *[[Pterygium excision]]<br /> *[[Repair of ruptured of lacerated globe]]<br /> *[[Dacryocystorhinostomy|Dacryocystorhinostomy (DCR)]]<br /> *[[Enucleation]]<br /> *[[Orbitotomy]]<br /> <br /> ==[[:Category:Orthopedic surgery|Orthopedic surgery]]==<br /> *[[Foot and ankle surgery]]<br /> *[[Hand surgery]]<br /> **[[Hand or digit replantation]]<br /> **[[Carpal tunnel release]]<br /> **[[Fixation of fractures and dislocations of the wrist and hand]]<br /> **[[Wrist arthroscopy]]<br /> **[[Darrach procedure]]<br /> **[[Arthrodesis of the wrist]]<br /> **[[Excision of ganglion of the wrist]]<br /> **[[Palmar and digital fasciectomy]]<br /> **[[Repair of laceracted nerves/tendons of the hand]]<br /> *[[Hip surgery]]<br /> **[[Hip arthroplasty|Hip arthroplasty (THA)]]<br /> *[[Lower leg surgery]]<br /> **[[Open reduction and interal fixation of the tibial plateau fracture]]<br /> *[[Joint replacement surgery]]<br /> **[[Hip arthroplasty|Hip arthroplasty (THA)]]<br /> **[[Knee arthroplasty|Knee arthroplasty (TKA)]]<br /> **[[Shoulder arthroplasty|Shoulder arthroplasty (TSA)]]<br /> *[[Knee surgery]]<br /> **[[Knee arthroplasty|Knee arthroplasty (TKA)]]<br /> *[[Orthopedic oncology surgery]]<br /> *[[Shoulder surgery]]<br /> **[[Shoulder arthroplasty|Shoulder arthroplasty (TSA)]]<br /> *[[Spine surgery]]<br /> *[[Sports surgery]]<br /> <br /> ==[[:Category:Otolaryngology|Otolaryngology]]==<br /> *Airway procedures<br /> **[[Bronchoscopy]]<br /> **[[Deep extubation]]<br /> **[[Laryngoscopy]]<br /> *[[Ear, audiovestibular, and temporal bone procedures]]<br /> **[[Cochlear implant surgery]]<br /> **[[Tympanoplasty and/or mastoidectomy]]<br /> *[[Esophageal surgery]]<br /> **[[Esophageal diverticulectomy]]<br /> **[[Esophagoscopy]]<br /> *[[Jaw surgery]]<br /> **[[Maxillary and mandibular osteotomy]]<br /> **[[Temporomandibular joint surgery]]<br /> *[[Pharyngeal surgery]]<br /> **[[Glossectomy]]<br /> **[[Tonsillectomy and/or adenoidectomy]]<br /> *[[Nasal surgery]]<br /> **[[Rhinectomy]]<br /> **[[Rhinoplasty and/or septoplasty]]<br /> *[[Neck surgery]]<br /> **[[Brachial cleft cyst excision]]<br /> **[[Cricothyroidotomy]]<br /> **[[Laryngectomy]]<br /> **[[Laryngoplasty]]<br /> **[[Lymph node biopsy]]<br /> **[[Platysmaplasty|Platysmaplasty (Neck lift)]]<br /> **[[Submandibular gland excision]]<br /> **[[Thyroid radiofrequency ablation]]<br /> **[[Tracheal resection]]<br /> **[[Tracheotomy]]<br /> *[[Salivary and parotid surgery]]<br /> **[[Parotidectomy]]<br /> *[[Sinus surgery]]<br /> **[[Functional endoscopic sinus surgery|Functional endoscopic sinus surgery (FESS)]]<br /> **[[Maxillectomy]]<br /> <br /> ==[[:Category:Pediatric surgery|Pediatric surgery]]==<br /> *[[Pediatric cardiac surgery]]<br /> **[[Anastomosis of pulmonary artery to aorta]] (Redirects: [[Damus-Kaye-Stan procedure]])<br /> **[[Ascending aorta to pulmonary artery shunt]] (Redirects: [[Waterson shunt]])<br /> **[[Banding of pulmonary artery]]<br /> **[[Descending aorta to pulmonary artery shunt]] (Redirects: [[Potts-Smith shunt]])<br /> **[[Excision of coarctation of aorta]]<br /> **[[Repair of pulmonary venous stenosis]]<br /> **[[Repair of anomalous pulmonary venous return]]<br /> **[[Repair of hypoplastic or interrupted aortic arch]]<br /> **[[Repair of transposition of the great arteries]]<br /> **[[Repair of truncus arteriosus]] (Redirects: [[Rastelli procedure]])<br /> **[[Repair of patent ductus arteriosus]]<br /> **[[Subclavian to pulmonary artery shunt]] (Redirects: [[Blalock-Taussig shunt]])<br /> **[[Superior vena cava to pulmonary artery]] (Redirects: [[Glenn procedure]])<br /> **Transcatheter Pulmonary Valve Implantation <br /> **Cardiac Catheterization <br /> *[[Pyloromyotomy]]<br /> *[[Repair of tracheoesophageal fistula (TEF)]]<br /> *[[Pediatric neurosurgery]]<br /> *[[Pediatric otorhinolaryngology]]<br /> **[[Myringotomy for ear tubes]]<br /> *[[Pediatric urology]]<br /> **[[Circumcision]]<br /> **[[Orchiopexy]]<br /> **[[Meatoplasty]]<br /> **[[Bladder exstrophy repair]]<br /> **[[Hypospadias repair]]<br /> <br /> ==[[:Category:Plastic and reconstructive surgery|Plastic and reconstructive surgery]]==<br /> *[[Burn surgery]]<br /> **[[Burn wound debridement]]<br /> **[[Burn wound skin grafting]]<br /> **[[Burn wound scar revision]]<br /> **[[Laser treatment for burn scar]]<br /> *[[Panniculectomy]]<br /> *[[Platysmaplasty|Platysmaplasty (Neck lift)]]<br /> <br /> ==[[:Category:Thoracic surgery|Thoracic surgery]]==<br /> *[[Bronchopulmonary lavage]]<br /> *[[Chest wall resection]]<br /> *[[Diaphragmatic plication]]<br /> *[[Drainage of empyema]]<br /> *[[Endobronchial ultrasound-guided transbronchial needle aspiration]] (Redirects: [[EBUS-TBNA]])<br /> *[[Lobectomy]] (Redirects: [[Wedge resection]])<br /> *[[Lung volume reduction surgery]]<br /> *[[Mediastinal tumor resection]]<br /> *[[Mediastinoscopy]]<br /> *[[Surgery for pleural mesothelioma|Pleural mesothelioma]]<br /> *[[Pneumonectomy]]<br /> *[[Repair of pectus excavatum or carinatum]]<br /> *[[Thoracoplasty]]<br /> *[[Thymectomy]]<br /> *[[Tracheal resection]]<br /> *[[Video-assisted thoracoscopic surgery]] (Redirects: [[VATS]])<br /> <br /> ==[[:Category:Vascular surgery|Vascular surgery]]==<br /> *[[Arteriovenous access for hemodialysis]]<br /> *[[Carotid endarterectomy|Carotid endarterectomy (CEA)]]<br /> *[[Endovascular aortic repair|Endovascular aortic repair (TEVAR)]]<br /> *[[Infrainguinal arterial bypass]]<br /> *[[Lumbar sympathectomy]]<br /> *[[Permanent vascular access]]<br /> *[[Thoracic outlet syndrome surgery]]<br /> *[[Transjugular intrahepatic portosystemic shunts|Transjugular intrahepatic portosystemic shunts (TIPS)]]<br /> *[[Varicose vein stripping and ablation]]<br /> *[[Femoral artery endarterectomy]]<br /> <br /> ==[[:Category:Urology|Urology]]==<br /> *[[Brachytherapy]]<br /> *[[Circumcision]]<br /> *[[Cystectomy]]<br /> *[[Cystoscopy]]<br /> *[[Hypospadias repair]]<br /> *[[Kidney transplant]]<br /> *[[Lithotripsy]]<br /> *[[Nephrectomy]]<br /> *[[Nephrostomy]]<br /> *[[Orchiectomy]]<br /> *[[Penectomy]]<br /> *[[Percutaneous nephrolithotomy or nephrolithotripsy]]<br /> *[[Prostatectomy|Prostatectomy (TURP)]]<br /> *[[Pelvic exenteration]]<br /> *[[Suprapubic cystostomy]]<br /> *[[Transurethral resection of bladder tumor|Transurethral resection of bladder tumor (TURBT)]]<br /> <br /> ==[[:Category:Out-of-operating room procedures|Out-of-operating room procedures]]==<br /> *[[Cardioversion]]<br /> *[[Electroconvulsive therapy|Electroconvulsive therapy (ECT)]]<br /> *[[Gastroenterology procedures]]<br /> **[[Endoscopic retrograde cholangiopancreatography|Endoscopic retrograde cholangiopancreatography (ERCP)]]<br /> **[[Colonoscopy]]<br /> **[[Upper GI endoscopy|Upper GI endoscopy (EGD)]]<br /> <br /> =[[Airway management]]=<br /> *[[Airway anatomy]]<br /> *[[Airway assessment]]<br /> *[[Aspiration under anesthesia]]<br /> *[[Cormack-Lehane grading system]]<br /> *[[Deep extubation]]<br /> *[[Difficult airway algorithm]]<br /> *[[Endobronchial intubation]] (Redirects: [[Mainstem intubation]])<br /> *[[Mallampati score]]<br /> *[[One-lung ventilation]]<br /> **[[Bronchial blocker]]<br /> **[[Double-lumen endotracheal tube]]<br /> *[[Pediatric airway management]]<br /> *[[Preoxygenation]]<br /> *[[Transtracheal ventilation]]<br /> <br /> ==[[Airway equipment]]==<br /> *[[Bougie]]<br /> *[[Breathing circuits]] (Redirects: [[Ayre's T-piece]], [[Bain system]], [[Jackson-Rees]], [[Lack system]], [[Magill system]], [[Mapleson A]], [[Mapleson B]], [[Mapleson C]], [[Mapleson D]], [[Mapleson E]], [[Mapleson F]], [[Waters bag]])<br /> *[[Bronchial blocker]]<br /> *Endotracheal tubes<br /> **[[Double-lumen endotracheal tube]] (Redirects: [[DLT]], [[Double-lumen endobronchial tube]])<br /> **[[Endotracheal tube]] (Redirects: [[ETT]])<br /> **[[Electromyographic endotracheal tube]] (Redirects: [[EMG ETT]], [[NIM EMG ETT]])<br /> **[[Laser-resistant endotracheal tube]] (Redirects: [[Laser ETT]])<br /> **[[Microlaryngeal endotracheal tube]] (Redirects: [[Microlaryngoscopy tube]], [[MLT]])<br /> **[[Reinforced endotracheal tube]] (Redirects: [[Armored endotracheal tube]], [[Wire-reinforced endotracheal tube]])<br /> **[[Ring-Adair-Elwyn endotracheal tube]] (Redirects: [[Nasal RAE ETT]], [[Oral RAE ETT]], [[RAE ETT]])<br /> *Laryngoscope blades<br /> **[[Macintosh laryngoscope blade]] (Redirects: [[MAC]])<br /> **[[Miller laryngoscope blade]] (Redirects: [[Miller]])<br /> **[[Wis-Hipple laryngoscope blade]] (Redirects: [[Miller]])<br /> *[[Lighted stylet]] (Redirects: [[Lightwand]])<br /> *[[Magill forceps]]<br /> *Noninvasive ventilation<br /> **[[Bag valve mask]] (Redirects: [[Ambu bag]], [[BVM]])<br /> **[[Nasal cannula]]<br /> **[[Non-rebreather mask]]<br /> **[[High-flow nasal cannula]] (Redirects: [[HFNC]])<br /> *Supraglottic airways<br /> **[[Combitube]] (Redirects: [[Esophageal-tracheal double-lumen tube]])<br /> **[[Laryngeal tube]] (Redirects: [[King LT]])<br /> **[[Nasopharyngeal airway]] (Redirects: [[Nasal airway]])<br /> **[[Oropharyngeal airway]] (Redirects: [[Oral airway]])<br /> **Laryngeal mask airways<br /> ***[[Laryngeal mask airway]] (Redirects: [[LMA]])<br /> ***[[LMA Fastrach]] (Redirects: [[Intubating LMA]])<br /> ***[[LMA ProSeal]]<br /> ***[[LMA Unique]]<br /> ***[[LMA Supreme]]<br /> ***[[I-gel LMA]] (Redirects: [[IGel LMA]])<br /> *[[Video laryngoscopes]]<br /> **[[C-Mac]]<br /> **[[Glidescope]]<br /> *[[Yankauer suction tip]]<br /> <br /> ==[[:Category:Airway procedures|Airway procedures]]==<br /> *[[Cricothyrotomy]] (Redirects: [[Cric]], [[Crike]], [[Thyrocricotomy]], [[Cricothyroidotomy]], [[Needle cricothyrotomy]])<br /> *[[Endotracheal intubation]] (Redirects: [[Intubation]])<br /> **[[Asleep fiberoptic intubation]]<br /> **[[Awake fiberoptic intubation]]<br /> **[[Nasal intubation]]<br /> **[[Oral intubation]]<br /> **[[Retrograde intubation]]<br /> *[[Laryngoscopy]]<br /> **[[Direct laryngoscopy]] (Redirects: [[DL]])<br /> **[[Indirect laryngoscopy]] (Redirects: [[Fiberoptic laryngoscopy]], [[VL]], [[Video laryngoscopy]])<br /> *[[Tracheotomy]] (Redirects: [[Tracheostomy]])<br /> <br /> =Anatomy and physiology=<br /> *[[Acid-base homeostasis]]<br /> *[[Cerebral physiology]]<br /> *[[Consciousness]]<br /> *[[Cardiovascular anatomy and physiology]]<br /> *[[Gastrointestinal physiology]]<br /> *[[Hematology]]<br /> * [[Hepatic physiology]]<br /> * [[Renal physiology]]<br /> * [[Respiratory physiology]]<br /> <br /> = [[:Category:Comorbidities|Comorbidities]] =<br /> <br /> == [[Acid-base disorders]] ==<br /> * [[Metabolic acidosis]] (Redirects: [[Anion gap metabolic acidosis]], [[Diabetic ketoacidosis]], [[DKA]], [[High anion gap metabolic acidosis]], [[Hyperchloremic acidosis]], [[Ketoacidosis]], [[Lactic acidosis]], [[Nongap metabolic acidosis]], [[Normal anion gap metabolic acidosis]], [[Renal tubular acidosis]], [[RTA]])<br /> * [[Metabolic alkalosis]] (Redirects: [[Contraction alkalosis]])<br /> * [[Respiratory acidosis]]<br /> * [[Respiratory alkalosis]]<br /> <br /> == Cardiovascular disorders ==<br /> * [[Acute coronary syndrome]] (Redirects: [[MI]], [[Myocardial infarction]], [[Myocardial ischemia]], [[Unstable angina]])<br /> * [[Angina pectoris]] (Redirects: [[Prinzmetal's angina]], [[Stable angina]])<br /> * [[Aortic aneurysm]]<br /> * [[Aortic dissection]] (Redirects: [[Type A dissection]], [[Type B dissection]])<br /> * [[Aortic rupture]]<br /> * [[Arteriovenous malformation]] (Redirects: [[AVM]], [[Cerebral arteriovenous malformation]], [[Cerebral AVM]])<br /> * [[Brugada syndrome]]<br /> * [[Cardiac arrhythmias]]<br /> ** [[Asystole]]<br /> ** [[Atrial fibrillation]] (Redirects: [[Afib]])<br /> ** [[Atrial flutter]] (Redirects: [[Aflutter]])<br /> ** [[Bradycardia]] (Redirects: [[Sinus bradycardia]])<br /> ** [[Drug-induced QT prolongation]] (Redirects: [[QT prolongation]])<br /> ** [[Junctional rhythm]]<br /> ** [[Long QT syndrome]] (Redirects: [[Romano-Ward syndrome]])<br /> ** [[Pulseless electrical activity]] (Redirects: [[PEA]])<br /> ** [[Sick sinus syndrome]] (Redirects: [[Tachycardia-bradycardia syndrome]])<br /> ** [[Ventricular fibrillation]]<br /> ** [[Wandering atrial pacemaker]]<br /> ** [[Wolff-Parkinson-White syndrome]] (Redirects: [[WPW]])<br /> ** [[Heart block]] (Redirects: [[Atrioventricular block]], [[AV block]], [[SA block]], [[Sinoatrial block]])<br /> *** [[Bundle branch block]] (Redirects: [[Bifascicular block]])<br /> **** [[Left anterior fascicular block]] (Redirects: [[LAFB]])<br /> **** [[Left bundle branch block]] (Redirects: [[LBBB]])<br /> **** [[Left posterior fascicular block]] (Redirects: [[LPFB]])<br /> **** [[Right bundle branch block]] (Redirects: [[RBBB]])<br /> *** [[First-degree atrioventricular block]] (Redirects: [[1st-degree atrioventricular block]])<br /> *** [[Second-degree atrioventricular block]] (Redirects: [[2nd-degree atrioventricular block]], [[Mobitz I]], [[Mobitz II]], [[Wenckebach block]])<br /> *** [[Third-degree atrioventricular block]] (Redirects: [[3rd-degree atrioventricular block]], [[Complete heart block]], [[Trifascicular block]])<br /> ** [[Premature contraction]]<br /> *** [[Premature atrial contraction]] (Redirects: [[PAC]])<br /> *** [[Premature junctional contraction]] (Redirects: [[PJC]])<br /> *** [[Premature ventricular contraction]] (Redirects: [[PVC]])<br /> ** [[Tachycardia]]<br /> *** [[Supraventricular tachycardia]] (Redirects: [[SVT]])<br /> **** [[Atrioventricular reentrant tachycardia]] (Redirects: [[AVRT]])<br /> **** [[AV-nodal reentrant tachycardia]] (Redirects: [[AVNRT]])<br /> **** [[Multifocal atrial tachycardia]]<br /> **** [[Sinus tachycardia]]<br /> *** [[Ventricular tachycardia]]<br /> * [[Cardiac tamponade]]<br /> * [[Cardiomyopathy]]<br /> ** [[Arrhythmogenic cardiomyopathy]]<br /> ** [[Dilated cardiomyopathy]]<br /> ** [[Hypertrophic cardiomyopathy]] (Redirects: [[HOCM]])<br /> ** [[Restrictive cardiomyopathy]]<br /> ** [[Takotsubo cardiomyopathy]] (Redirects: [[Broken heart syndrome]], [[Stress cardiomyopathy]])<br /> ** [[Tachycardia-induced cardiomyopathy]]<br /> * Cardiomegaly<br /> ** [[Left atrial enlargement]] (Redirects: [[LAE]])<br /> ** [[Left ventricular hypertrophy]] (Redirects: [[LVH]])<br /> ** [[Right atrial enlargement]] (Redirects: [[RAE]])<br /> ** [[Right ventricular hypertrophy]] (Redirects: [[RVH]])<br /> * [[Congenital heart defects]]<br /> ** [[Absent pulmonary valve syndrome]]<br /> ** [[Aortopulmonary septal defects]]<br /> *** [[Aortopulmonary window]]<br /> *** [[Double outlet right ventricle]] (Redirects: [[DORV]])<br /> *** [[Persistent truncus arteriosus]] (Redirects: [[PTA]])<br /> *** [[Taussig-Bing syndrome]]<br /> *** [[Transposition of the great vessels]] (Redirects: [[d-TGA]], [[dextro-Transposition of the great arteries]], [[l-TGA]], [[levo-Transposition of the great arteries]], [[TGA]], [[TGV]])<br /> ** [[Atrial septal defect]] (Redirects: [[ASD]], [[Sinus venosus atrial septal defect]])<br /> ** [[Atrioventricular septal defect]] (Redirects: [[Atrioventricular canal defect]], [[Endocardial cushion defect]], [[AVSD]], [[Ostium primum atrial septal defect]])<br /> ** [[Bicuspid aortic valve]]<br /> ** [[Cor triatriatum]]<br /> ** [[Coronary artery anomaly]] (Redirects: [[AAOCA]], [[Anomalous aortic origin of a coronary artery]])<br /> ** [[Crisscross heart]]<br /> ** [[Dextrocardia]]<br /> ** [[Ebstein's anomaly]]<br /> ** [[Hypoplastic left heart syndrome]]<br /> ** [[Hypoplastic right heart syndrome]] (Redirects: [[Uhl anomaly]])<br /> ** [[Lutembacher's syndrome]]<br /> ** [[Tetralogy of Fallot]]<br /> ** [[Ventricular inversion]]<br /> ** [[Ventricular septal defect]] (Redirects: [[VSD]])<br /> * [[Congenital vascular malformations]]<br /> ** [[Aberrant subclavian artery]]<br /> ** [[Anomalous pulmonary venous connection]] (Redirects: [[Partial anomalous pulmonary venous connection]], [[Scimitar syndrome]], [[Total anomalous pulmonary venous connection]])<br /> ** [[Aneurysm of sinus of Valsalva]]<br /> ** [[Coarctation of the aorta]]<br /> ** [[Congenital stenosis of vena cava]]<br /> ** [[Double aortic arch]]<br /> ** [[Interrupted aortic arch]]<br /> ** [[Overriding aorta]]<br /> ** [[Patent ductus arteriosus]] (Redirects: [[PDA]])<br /> ** [[Persistent left superior vena cava]]<br /> ** [[Pulmonary atresia]]<br /> ** [[Right-sided aortic arch]]<br /> ** [[Stenosis of pulmonary artery]]<br /> ** [[Vascular ring]]<br /> * [[Coronary artery disease]] (Redirects: [[CAD]])<br /> * [[Coronary steal syndrome]] (Redirects: [[Cardiac steal syndrome]])<br /> * [[Endocarditis]] (Redirects: [[Acute bacterial endocarditis]], [[Infective endocarditis]], [[Nonbacterial thrombotic endocarditis]], [[Subacute bacterial endocarditis]])<br /> * [[Heart failure]] (Redirects: [[Biventricular heart failure]], [[CHF]], [[Congestive heart failure]], [[Left-sided heart failure]], [[Right-sided heart failure]])<br /> ** [[Heart failure with reduced ejection fraction]] (Redirects: [[HFrEF]], [[Systolic heart failure]])<br /> ** [[Heart failure with preserved ejection fraction]] (Redirects: [[HFpEF]], [[Diastolic dysfunction]], [[Diastolic heart failure]])<br /> ** [[Pulmonary heart disease]]<br /> * [[Gestational hypertension]]<br /> * [[Hypertension (comorbidity)]] (Redirects: [[Essential hypertension]], [[HTN]])<br /> * [[Pericardial effusion]]<br /> * [[Pericarditis]]<br /> * [[Peripheral artery disease]] (Redirects: [[PAD]])<br /> * [[Pulmonary embolism]] (Redirects: [[PE]])<br /> * [[Pulmonary heart disease]] (Redirects: [[Cor pulmonale]])<br /> * [[Pulmonary hypertension]] (Redirects: [[PAH]], [[PH]], [[Pulmonary arterial hypertension]])<br /> * [[Shock]]<br /> ** [[Cardiogenic shock]]<br /> ** [[Obstructive shock]]<br /> ** [[Distributive shock]] (Redirects: [[Septic shock]])<br /> * [[Valvular heart disease]]<br /> ** [[Aortic stenosis]]<br /> ** [[Aortic regurgitation]]<br /> ** [[Mitral stenosis]]<br /> ** [[Mitral regurgitation]]<br /> ** [[Mitral valve prolapse]] (Redirects: [[MVP]])<br /> ** [[Pulmonary valve stenosis]]<br /> ** [[Pulmonary valve regurgitation]] (Redirects: [[Pulmonary valve insufficiency]])<br /> ** [[Tricuspid stenosis]] (Redirects: [[TS]])<br /> ** [[Tricuspid regurgitation]]<br /> <br /> == Cerebrovascular disorders ==<br /> * [[Anterior spinal artery syndrome]] (Redirects: [[Beck's syndrome]])<br /> * [[Carotid artery stenosis]]<br /> * [[Moyamoya disease]]<br /> * [[Epidural hematoma]]<br /> * [[Intracranial aneurysm]] (Redirects: [[Berry aneurysm]], [[Saccular aneurysm]])<br /> * [[Intracranial hemorrhage]] (Redirects: [[Intracerebral hemorrhage]], [[Intraparenchymal hemorrhage]], [[Intraventricular hemorrhage]], [[SAH]], [[Subarachnoid hemorrhage]])<br /> * [[Stroke]] (Redirects: [[Cerebral infarction]], [[Cerebrovascular accident]], [[CVA]], [[Hemorrhagic stroke]], [[Ischemic stroke]])<br /> * [[Subdural hematoma]] (Redirects: [[SDH]])<br /> * [[Vertebrobasilar insufficiency]] (Redirects: [[Subclavian steal syndrome]], [[VBI]])<br /> <br /> == Electrolyte disorders ==<br /> * [[Hypercalcemia]]<br /> * [[Hyperkalemia]]<br /> * [[Hypernatremia]]<br /> * [[Hypocalcemia]]<br /> * [[Hypokalemia]]<br /> * [[Hyponatremia]] (Redirects: [[Hypotonic hyponatremia]], [[Isotonic hyponatremia]])<br /> <br /> == Endocrine disorders ==<br /> * [[Acromegaly]]<br /> * [[Adrenal insufficiency]] (Redirects: [[Addison's disease]])<br /> * [[Carcinoid syndrome]]<br /> * [[Congenital adrenal hyperplasia]]<br /> * [[Cushing's syndrome]]<br /> * [[Diabetes insipidus]]<br /> * [[Diabetes mellitus]]<br /> ** [[Gestational diabetes]]<br /> ** [[Type 1 diabetes]] (Redirects: [[DM1]], [[T1D]])<br /> ** [[Type 2 diabetes]] (Redirects: [[DM2]], [[T2D]])<br /> * [[Hyperaldosteronism]] (Redirects: [[Bartter syndrome]], [[Conn syndrome]])<br /> * [[Hyperlipidemia]] (Redirects: [[HLD]])<br /> * [[Hyperparathyroidism]]<br /> * [[Hyperthyroidism]] (Redirects: [[Graves' disease]], [[Thyrotoxicosis]])<br /> * [[Hypoaldosteronism]]<br /> * [[Hypoparathyroidism]]<br /> * [[Hypothyroidism]] (Redirects: [[Cretinism]], [[Euthyroid sick syndrome]], [[Hashimoto's thyroiditis]], [[Myxedema]])<br /> * [[Kallmann syndrome]]<br /> * [[Multiple endocrine neoplasia]] (Redirects: [[Sipple syndrome]], [[Wagenmann-Froboese syndrome]], [[Wermer syndrome]])<br /> * [[Obesity]]<br /> * [[Pheochromocytoma]]<br /> * [[Porphyria]] (Redirects: [[Acute intermittent porphyria]], [[AIP]])<br /> * [[Serotonin syndrome]]<br /> * [[Syndrome of inappropriate antidiuretic hormone secretion]] (Redirects: [[SIADH]])<br /> <br /> == Gastrointestinal disorders ==<br /> * [[Acute liver failure]] (Redirects: [[ALF]], [[Fulminant hepatic failure]], [[Hepatic encephalopathy]])<br /> * [[Chronic liver disease]]<br /> ** [[Cirrhosis]] (Redirects: [[Chronic liver failure]])<br /> ** [[Hepatocellular carcinoma]]<br /> * [[Gastroesophageal reflux disease]] (Redirects: [[Acid reflux]], [[GERD]], [[Heartburn]])<br /> * [[Hepatitis]]<br /> * [[Pyloric stenosis]]<br /> <br /> == Genetic disorders ==<br /> * [[Amyloidosis]]<br /> * [[Andersen-Tawil syndrome]]<br /> * [[Antithrombin III deficiency]]<br /> * [[Arrhythmogenic cardiomyopathy]]<br /> * [[Bartter syndrome]]<br /> * [[Bernard-Soulier syndrome]]<br /> * [[Brugada syndrome]]<br /> * [[Congenital adrenal hyperplasia]]<br /> * [[Congenital afibrinogenemia]]<br /> * [[Crouzon syndrome]]<br /> * [[Cystic fibrosis]] (Redirects: [[CF]])<br /> * [[Down syndrome]] (Redirects: [[Trisomy 21]])<br /> * [[Dysfibrinogenemia]]<br /> * [[Edwards syndrome]] (Redirects: [[Trisomy 18]])<br /> * [[Ehlers-Danlos syndromes]] (Redirects: [[EDS]])<br /> * [[Epidermolysis bullosa]] (Redirects: [[EB]])<br /> * [[Fabry disease]]<br /> * [[Factor V Leiden]]<br /> * [[Fanconi syndrome]]<br /> * [[Friedreich's ataxia]]<br /> * [[Gitelman syndrome]]<br /> * [[Glanzmann's thrombasthenia]]<br /> * [[Glycogen storage disease]] (Redirects: [[Aldolase A deficiency]], [[Andersen disease]], [[Cori's disease]], [[Forbes' disease]], [[Hers' disease]], [[McArdle disease]], [[Pompe disease]], [[Tarui's disease]], [[von Gierke's disease]])<br /> * [[Gray platelet syndrome]]<br /> * [[Hemophilia]]<br /> * [[Hereditary hemorrhagic telangiectasia]] (Redirects: [[HHT]], [[Osler-Weber-Rendu syndrome]])<br /> * [[Hermansky-Pudlak syndrome]]<br /> * [[Huntington's disease]]<br /> * [[Hypoprothrombinemia]]<br /> * [[Hypertrophic cardiomyopathy]]<br /> * [[Jervell and Lange-Nielsen syndrome]]<br /> * [[Kallmann syndrome]]<br /> * [[Klippel-Feil syndrome]]<br /> * [[Liddle's syndrome]]<br /> * [[Long QT syndrome]]<br /> * [[Marfan syndrome]]<br /> * [[May-Hegglin anomaly]]<br /> * [[Multiple endocrine neoplasia]]<br /> * [[Noonan syndrome]]<br /> * [[Pierre Robin sequence]]<br /> * [[Protein C deficiency]]<br /> * [[Protein S deficiency]]<br /> * [[Loeys-Dietz syndrome]]<br /> * [[Muscular dystrophy]] (Redirects: [[Becker muscular dystrophy]], [[Duchenne muscular dystrophy]], [[Limb-girdle muscular dystrophy]], [[Myotonic muscular dystrophy]])<br /> * [[Neurofibromatosis]]<br /> * [[Mucopolysaccharidosis]] (Redirects: [[Hunter syndrome]], [[Hurler syndrome]], [[Maroteaux-Lamy syndrome]], [[Morquio syndrome]], [[Natowicz syndrome]], [[Sanfilippo syndrome]], [[Scheie syndrome]], [[Sly syndrome]])<br /> * [[Sickle cell disease]]<br /> * [[Timothy syndrome]]<br /> * [[Treacher Collins syndrome]]<br /> * [[VACTERL association]]<br /> * [[von Willebrand disease]]<br /> <br /> == Head and neck disorders ==<br /> * [[Epiglottitis]]<br /> * [[Laryngomalacia]]<br /> * [[Laryngotracheal stenosis]]<br /> * [[Pharyngeal abscess]] (Redirects: [[Peritonsillar abscess]], [[Retropharyngeal abscess]])<br /> * [[Pharyngitis]] (Redirects: [[Strep throat]], [[Tonsillitis]])<br /> <br /> == Hematologic disorders ==<br /> * [[Coagulopathies]]<br /> ** [[Disseminated intravascular coagulation]] (Redirects: [[DIC]], [[Purpura fulminans]])<br /> ** Hypercoagulable disorders<br /> *** [[Antiphospholipid syndrome]] (Redirects: [[APLS]], [[APS]])<br /> *** [[Antithrombin III deficiency]] (Redirects: [[ATIII deficiency]])<br /> *** [[Essential thrombocythemia]]<br /> *** [[Factor V Leiden]]<br /> *** [[Protein C deficiency]]<br /> *** [[Protein S deficiency]]<br /> ** Hypocoagulable disorders<br /> *** [[Evans syndrome]]<br /> *** [[Bernard-Soulier syndrome]]<br /> *** [[Congenital afibrinogenemia]]<br /> *** [[Dysfibrinogenemia]]<br /> *** [[Glanzmann's thrombasthenia]]<br /> *** [[Gray platelet syndrome]]<br /> *** [[Hemophilia]] (Redirects: [[Factor IX deficiency]], [[Factor VII deficiency]], [[Factor VIII deficiency]], [[Factor X deficiency]], [[Factor XI deficiency]], [[Factor XII deficiency]], [[Factor XIII deficiency]], [[Haemophilia]], [[Hemophilia A]], [[Hemophilia B]], [[Hemophilia C]])<br /> *** [[Heparin-induced thrombocytopenia]] (Redirects: [[HIT]], [[HITT]])<br /> *** [[Hermansky-Pudlak syndrome]]<br /> *** [[Hypoprothrombinemia]]<br /> *** [[Thrombocytopenic purpura]] (Redirects: [[Idiopathic thrombocytopenic purpura]], [[ITP]], [[Thrombotic Thrombocytopenic purpura]], [[TTP]], [[Upshaw–Schulman syndrome]])<br /> *** [[May-Hegglin anomaly]]<br /> *** [[von Willebrand disease]] (Redirects: [[vWD]])<br /> <br /> == Mediastinal disorders ==<br /> * [[Mediastinal mass]]<br /> * [[Mediastinitis]]<br /> * [[Pneumomediastinum]] (Redirects: [[Mediastinal emphysema]])<br /> <br /> == Musculoskeletal disorders ==<br /> * Congenital musculoskeletal disorders<br /> ** [[Craniosynostosis]]<br /> ** [[Down syndrome]]<br /> ** [[Goldenhar syndrome]]<br /> ** [[Klippel-Feil syndrome]] (Redirects: [[KFS]])<br /> ** [[Pierre Robin sequence]] (Redirects: [[PRS]])<br /> ** [[Treacher Collins syndrome]] (Redirects: [[TCS]])<br /> <br /> == [[Neonatal emergencies]] ==<br /> * [[Abdominal wall defects]]<br /> ** [[Gastroschisis]]<br /> ** [[Omphalocele]]<br /> * [[Choanal atresia]]<br /> * [[Congenital diaphragmatic hernia]]<br /> * [[Esophageal atresia]]<br /> * [[Intestinal obstruction]]<br /> ** [[Congenital aganglionic megacolon]] (Redirects: [[Hirschsprung's disease]])<br /> ** [[Intestinal atresia]]<br /> ** [[Intestinal malrotation]] (Redirects: [[Volvulus]]<br /> ** [[Meconium ileus]]<br /> * [[Necrotizing enterocolitis]] (Redirects: [[NEC]])<br /> * [[Pyloric stenosis]]<br /> * [[Spina bifida]]<br /> * [[Tracheoesophageal fistula]]<br /> <br /> == Neurologic disorders ==<br /> * [[Amyotrophic lateral sclerosis]] (Redirects: [[ALS]])<br /> * [[Autonomic dysreflexia]]<br /> * [[Chronic pain (comorbidity)]]<br /> * [[Dementia]]<br /> * [[Dysautonomia]]<br /> * [[Essential tremor]]<br /> * [[Huntington's disease]]<br /> * [[Multiple sclerosis]]<br /> * [[Myasthenia gravis]]<br /> * [[Parkinson's disease]]<br /> * [[Seizures]] (Redirects: [[Epilepsy]])<br /> * [[Stroke]]<br /> <br /> == Obstetric disorders==<br /> * [[Amniotic fluid embolism]] (Redirects: [[AFE]])<br /> * [[Ectopic pregnancy]]<br /> * [[Fetal distress]]<br /> * [[Gestational hypertension]]<br /> * [[Gestational diabetes]]<br /> *[[Nonobstetric Surgery During Pregnancy]]<br /> * [[Nuchal cord]]<br /> * [[HELLP syndrome]]<br /> * [[Obstetrical bleeding]]<br /> * [[Placenta accreta spectrum]] (Redirects: [[Accreta]], [[Increta]], [[Percreta]], [[Placenta accreta]], [[Placenta increta]], [[Placenta percreta]])<br /> * [[Umbilical cord prolapse]]<br /> * [[Uterine rupture]]<br /> * [[Vasa previa]]<br /> <br /> == Psychiatric disorders ==<br /> * [[Generalized Anxiety disorder]] (Redirects: [[Anxiety]], [[GAD]])<br /> * [[Major depressive disorder]] (Redirects: [[Depression]], [[MDD]])<br /> * [[Substance abuse]] (Redirects: [[Drug abuse]])<br /> <br /> == Pulmonary disorders ==<br /> * [[Acute respiratory distress syndrome]] (Redirect: [[ARDS]])<br /> * [[Asthma]]<br /> * [[Atelectasis]]<br /> * [[Chronic obstructive pulmonary disease]] (Redirects: [[COPD]])<br /> * [[Cystic fibrosis]]<br /> * [[Lung cancer]]<br /> * [[Obstructive sleep apnea]] (Redirects: [[OSA]])<br /> * [[Pleural effusion]]<br /> * [[Pneumonia]]<br /> * [[Pneumothorax]]<br /> * [[Pulmonary edema]]<br /> * [[Pulmonary embolism]] (Redirects: [[PE]])<br /> * [[Pulmonary hypertension]]<br /> * [[Severe acute respiratory syndrome coronavirus 2]] (Redirects: [[Coronavirus]], [[COVID-19]], [[SARS-CoV-2]])<br /> <br /> == Renal disorders ==<br /> * [[Acute renal failure]]<br /> * [[Bartter syndrome]]<br /> * [[Diabetes insipidus]]<br /> * [[Chronic kidney disease]] (Redirects: [[CKD]])<br /> * [[Fanconi syndrome]]<br /> * [[Gitelman syndrome]]<br /> * [[Liddle's syndrome]]<br /> * [[Uremia]]<br /> <br /> =Perioperative management=<br /> *[[Enhanced recovery after surgery|Enhanced recovery after surgery (ERAS)]]<br /> *[[Perioperative prevention of chronic pain]]<br /> *[[Perioperative visual loss]]<br /> ==Preoperative management==<br /> *[[Preoperative patient assessment]]<br /> *[[Preoperative medication management|Preoperative medication management]]<br /> *[[NPO guidelines]]<br /> ==Postoperative management==<br /> *[[Postoperative pain management]]<br /> ===Postoperative complications===<br /> *[[Dental injury]]<br /> *[[Intraoperative awareness]]<br /> *[[Postoperative nausea and vomiting|Postoperative nausea and vomiting (PONV)]]<br /> *[[Residual neuromuscular blockade]]<br /> <br /> =Intraoperative emergencies=<br /> *[[Acute coronary syndrome]] (Redirects: [[MI]], [[Myocardial infarction]], [[Myocardial ischemia]])<br /> *[[Amniotic fluid embolism]] (Redirects: [[AFE]])<br /> *[[Anaphylaxis]]<br /> *[[Asystole]]<br /> *[[Bradycardia (intraoperative emergency)]]<br /> *[[Bronchospasm]]<br /> *[[Cardiac arrest]]<br /> *[[Delayed emergence]]<br /> *[[Difficult airway algorithm]]<br /> *[[Fire (intraoperative emergency)]] (Redirects: [[Airway fire]])<br /> *[[Hypertension (intraoperative emergency)]]<br /> *[[Hypotension (intraoperative emergency)]]<br /> *[[Hypoxemia (intraoperative emergency)]]<br /> *[[Laryngospasm]]<br /> *[[Local anesthetic systemic toxicity]] (Redirects: [[LAST]])<br /> *[[Malignant Hyperthermia]]<br /> *[[Oxygen failure]]<br /> *[[Pneumothorax]]<br /> *[[Power failure]]<br /> *[[Total spinal anesthesia]]<br /> *[[Transfusion reaction]]<br /> *[[Pulseless electrical activity]] (Redirects: [[PEA arrest]])<br /> *[[Supraventricular tachycardia (intraoperative emergency)]] (Redirects: [[SVT (intraoperative emergency)]])<br /> *[[Venous air embolism]] (Redirects: [[VAE]])<br /> *[[Ventricular fibrillation]] (Redirects: [[VF]], [[Vfib]])<br /> *[[Ventricular tachycardia]] (Redirects: [[Monomorphic ventricular tachycardia]], [[Polymorphic ventricular tachycardia]], [[Torsades de pointes]], [[VT]], [[Vtach]])<br /> <br /> =Intraoperative monitoring=<br /> *[[Arterial blood pressure]] (Redirects: [[ABP]])<br /> *[[Capnography]] (Redirects: [[End-tidal CO2]], [[EtCO2]])<br /> *[[Central venous pressure]] (Redirects: [[CVP]])<br /> *[[Cerebral oximetry]] (Redirects: [[ScO2]])<br /> *[[Core temperature]]<br /> *[[Echocardiography]]<br /> **[[Transesophageal echocardiography]] (Redirects: [[TEE]])<br /> **[[Transthoracic echocardiography]] (Redirects: [[TTE]])<br /> *[[Electrocardiography]] (Redirects: [[5-lead electrocardiogram]], [[ECG]])<br /> *[[Electroencephalography]] (Redirects: [[BIS]], [[Bispectral index]], [[EEG]], [[Entropy monitoring]], [[Patient state index]], [[PSI]], [[SedLine]], [[Spectral edge frequency]])<br /> *[[Intracranial pressure]] (Redirects: [[ICP]])<br /> *[[Neuromonitoring]]<br /> **[[Brainstem auditory evoked potentials]] (Redirects: [[BAEPs]])<br /> **[[Motor evoked potentials]] (Redirects: [[MEPs]])<br /> **[[Somatosensory evoked potentials]] (Redirects: [[SSEPs]])<br /> **[[Visual evoked potentials]] (Redirects: [[VEPs]])<br /> *[[Pleth variability index]] (Redirects: [[PVI]])<br /> *[[Pulse oximetry]] (Redirects: [[Plethysmography]], [[SpO2]])<br /> *[[Pulse pressure variation]] (Redirects: [[PPV]])<br /> *[[Precordial doppler]]<br /> *[[Pulmonary artery pressure]] (Redirects: [[PAP]])<br /> *[[Peripheral IV]] (Redirects: [[IV]], [[Large bore IV]], [[PIV]])<br /> *[[Urine output]] (Redirects: [[UOP]])<br /> <br /> = Neuraxial and regional anesthesia =<br /> * [[Local anesthetics]]<br /> * [[Local anesthetic adjuvants]]<br /> * [[Local anesthetic toxicity]] (Redirects: [[LAST]])<br /> <br /> ==[[Neuraxial anesthesia]]==<br /> *[[Caudal anesthesia]]<br /> *[[Combined spinal-epidural anesthesia]] (Redirects: [[CSE]])<br /> *[[Epidural anesthesia]] (Redirects: [[Epidural]])<br /> **[[Lumbar epidural]]<br /> **[[Thoracic epidural]]<br /> *[[Post-dural-puncture headache]] (Redirects: [[PDPH]])<br /> *[[Spinal anesthesia]] (Redirects: [[Spinal]])<br /> *[[Total spinal anesthesia]]<br /> *Ultrasound-guided neuraxial<br /> <br /> == [[Regional anesthesia]] ==<br /> * [[Bier block]]<br /> * [[Local anesthetics]]<br /> * [[Local anesthetic adjuvants]]<br /> <br /> === [[Head and neck nerve blocks]] ===<br /> * [[Blocks for awake tracheal intubation]]<br /> * [[Cervical plexus block]]<br /> * [[Scalp block]]<br /> <br /> === [[Upper extremity nerve blocks]] ===<br /> * [[Blocks at the elbow]]<br /> * [[Brachial plexus blocks]]<br /> ** [[Interscalene block]]<br /> ** [[Supraclavicular block]]<br /> ** [[Infraclavicular block]]<br /> ** [[Axillary block]]<br /> * [[Digital block]]<br /> * [[Wrist block]]<br /> <br /> === [[Thoracic and abdominal wall blocks]] ===<br /> * [[Intercostal nerve block]]<br /> * [[Pectoralis nerve block]]<br /> * [[Quadratus lumborum block]] (Redirects: [[QL block]])<br /> * [[Serratus plane block]]<br /> * [[Transversus abdominis plane block]] (Redirects: [[TAP block]])<br /> * [[Truncal block]] (Redirects: [[Iliohypogastric nerve block]], [[Ilioinguinal nerve block]], [[Rectus sheath block]])<br /> <br /> === [[Lower extremity nerve blocks]] ===<br /> * [[Ankle block]]<br /> * [[Fascia iliaca block]]<br /> * [[Femoral nerve block]]<br /> * [[Lumbar plexus block]]<br /> * [[Obturator nerve block]]<br /> * [[Popliteal nerve block]]<br /> * [[Saphenous nerve block]]<br /> * [[Sciatic nerve block]]<br /> <br /> = Pharmacology =<br /> * [[Equianalgesic]] (Redirects: [[MME]], [[Morphine milligram equivalent]])<br /> * [[Pharmacodynamics]]<br /> * [[Pharmacokinetics]]<br /> ** [[Blood-gas partition coefficient]]<br /> ** [[Context sensitive half-life]]<br /> ** [[Drug metabolism]]<br /> ** [[Elimination]]<br /> ** [[Ion trapping]]<br /> ** [[Redistribution]]<br /> *[[Pharmacogenetics and pharmacogenomics]]<br /> **[[Pharmacogenetics and pharmacogenomics#Definitions and history|Definitions and history]]<br /> **[[Pharmacogenetics and pharmacogenomics#Therapeutic class concerns|Therapeutic class concerns]]<br /> **[[Pharmacogenetics and pharmacogenomics#Pediatric considerations|Pediatric considerations]]<br /> **[[Pharmacogenetics and pharmacogenomics#Clinical implications and cost|Clinical implications and costs]]<br /> **[[Pharmacogenetics and pharmacogenomics#Terminology|Terminology]]<br /> <br /> == Drug reference ==<br /> === Acetylcholinesterase inhibitors ===<br /> * [[Edrophonium]]<br /> * [[Neostigmine]] (Redirects: [[Bloxiverz]])<br /> * [[Physostigmine]]<br /> <br /> === [[Adrenergic receptor modulators]] ===<br /> Redirects: [[Alpha agonists]], [[Alpha antagonists]], [[Beta agonists]]<br /> * Alpha-1 agonists<br /> ** [[Ephedrine]]<br /> ** [[Epinephrine]] (Redirects: [[Adrenaline]])<br /> ** [[Norepinephrine]] (Redirects: [[Noradrenaline]])<br /> ** [[Phenylephrine]] (Redirects: [[Neosynephrine]])<br /> * Alpha-1 antagonists<br /> ** [[Labetalol]]<br /> ** [[Phenoxybenzamine]]<br /> ** [[Phentolamine]]<br /> * Alpha-2 agonists<br /> ** [[Clonidine]] (Redirects: [[Catapres]])<br /> ** [[Dexmedetomidine]] (Redirects: [[Precedex]])<br /> * Beta agonists<br /> ** Beta-1 selective agonists<br /> *** [[Dobutamine]]<br /> ** [[Ephedrine]]<br /> ** [[Epinephrine]]<br /> ** [[Isoprenaline]] (Redirects: [[Isoproterenol]])<br /> ** [[Norepinephrine]]<br /> * [[Beta blockers]] (Redirects: [[Beta antagonists]])<br /> ** Beta-1 selective antagonists<br /> *** [[Esmolol]] (Redirects: [[Brevibloc]])<br /> *** [[Metoprolol]]<br /> ** [[Labetalol]]<br /> <br /> === [[Analgesics]] ===<br /> * [[Acetaminophen]] (Redirects: [[Tylenol]])<br /> * [[Analgesic adjuvants]]<br /> ** [[Gabapentin]] (Redirects: [[Neurontin]])<br /> ** [[Ketamine]]<br /> ** [[Lidocaine]]<br /> ** [[Pregabalin]] (Redirects: [[Lyrica]])<br /> * [[Nonsteroidal anti-inflammatory drugs]] (Redirects: [[NSAIDs]])<br /> ** [[Aspirin]] (Redirects: [[Acetylsalicylic acid]])<br /> ** [[Celecoxib]] (Redirects: [[Celebrex]])<br /> ** [[Ibuprofen]]<br /> ** [[Ketorolac]] (Redirects: [[Toradol]])<br /> * [[Opioid analgesics]]<br /> ** 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[[Metoprolol]]<br /> * Positive chronotropes<br /> ** [[Atropine]]<br /> ** [[Dobutamine]]<br /> ** [[Dopamine]]<br /> ** [[Ephedrine]]<br /> ** [[Epinephrine]]<br /> ** [[Glycopyrrolate]]<br /> ** [[Isoprenaline]]<br /> ** [[Milrinone]]<br /> ** [[Norepinephrine]]<br /> <br /> * Electrolytes<br /> ** [[Calcium chloride]]<br /> ** [[Calcium gluconate]]<br /> ** [[Magnesium sulfate]]<br /> ** [[Potassium chloride]]<br /> <br /> === Diuretics ===<br /> <br /> * [[Furosemide]]<br /> * [[Mannitol]]<br /> <br /> === [[General anesthetics]] ===<br /> * [[Inhalational anesthestics]] (Redirects: [[Volatile anesthetics]])<br /> ** [[Chloroethane]] (Redirects: [[Ethyl chloride]])<br /> ** [[Chloroform]]<br /> ** [[Cyclopropane]]<br /> ** [[Desflurane]] (Redirects: [[Suprane]])<br /> ** [[Diethyl ether]] (Redirects: [[Ether]])<br /> ** [[Enflurane]]<br /> ** [[Halothane]] (Redirects: [[Fluothane]])<br /> ** [[Isoflurane]] (Redirects: [[Forane]])<br /> ** [[Methoxyflurane]]<br /> ** [[Nitrous oxide]]<br /> ** [[Sevoflurane]] (Redirects: [[Ultane]])<br /> ** [[Xenon]]<br /> * [[Intravenous anesthetics]]<br /> ** [[Etomidate]] (Redirects: [[Amidate]])<br /> ** [[Ketamine]] (Redirects: [[Esketamine]], [[Ketalar]])<br /> ** [[Methohexital]] (Redirects: [[Brevital]])<br /> ** [[Propofol]] (Redirects: [[Diprivan]])<br /> ** [[Thiopental]] (Redirects: [[Sodium pentothal]])<br /> <br /> === Imaging dyes ===<br /> * [[Fluorescein]]<br /> * [[Indocyanine green]]<br /> * [[Methylene blue]] (Redirects: [[Methylthioninium chloride]])<br /> <br /> === [[Inodilators]] ===<br /> * [[Dobutamine]]<br /> * [[Milrinone]] (Redirects: [[Primacor]])<br /> <br /> === [[Inotropes]] ===<br /> Redirects: [[Negative inotropes]], [[Positive inotropes]]<br /> * Negative inotropes<br /> ** [[Beta blockers]]<br /> * Positive inotropes<br /> ** [[Calcium chloride]]<br /> ** [[Calcium gluconate]]<br /> ** [[Dobutamine]]<br /> ** [[Dopamine]]<br /> ** [[Ephedrine]]<br /> ** [[Epinephrine]]<br /> ** [[Isoprenaline]]<br /> ** [[Milrinone]]<br /> ** [[Norepinephrine]]<br /> <br /> === [[Intravenous fluids]] ===<br /> * [[Albumin]]<br /> * [[Hetastarch]] (Redirects: [[Hydroxyethyl starch]])<br /> * [[Intravenous sugar solution]] (Redirects: [[D5]], [[D50]], [[D5W]], [[D5NS]], [[D5LR]])<br /> * [[Normal saline]] (Redirects: [[NS]])<br /> * [[Lactated Ringer's]] (Redirects: [[LR]])<br /> * [[Normosol]]<br /> * [[Plasma-lyte]]<br /> * [[Sodium bicarbonate]]<br /> <br /> === [[Local anesthetics]] ===<br /> * [[Benzocaine]]<br /> * [[Bupivacaine]] (Redirects: [[Marcaine]])<br /> * [[Chloroprocaine]] (Redirects: [[Nesacaine]])<br /> * [[Procaine]] (Redirects: [[Novocain]], [[Novocaine]])<br /> * [[Lidocaine]] (Redirects: [[Xylocaine]])<br /> * [[Mepivacaine]] (Redirects: [[Carbocaine]])<br /> * [[Ropivacaine]] (Redirects: [[Naropin]])<br /> * [[Tetracaine]]<br /> <br /> === [[Local anesthetic adjuvants]] ===<br /> * [[Clonidine]]<br /> * [[Epinephrine]]<br /> * [[Fentanyl]]<br /> * [[Hydromorphone]]<br /> * [[Ketamine]]<br /> * [[Midazolam]]<br /> * [[Morphine]]<br /> * [[Neostigmine]]<br /> * [[Sufentanil]]<br /> * [[Sodium bicarbonate]]<br /> <br /> === [[Neuromuscular blockers]] ===<br /> * [[Cisatracurium]] (Redirects: [[Nimbex]])<br /> * [[Mivacurium]]<br /> * [[Rocuronium]] (Redirects: [[Zemuron]])<br /> * [[Succinylcholine]] (Redirects: [[Anectine]])<br /> * [[Vecuronium]]<br /> <br /> === [[Opioids]] ===<br /> * [[Opioid analgesics]]<br /> ** Opium alkaloids and derivatives<br /> *** [[Buprenorphine]] (Redirects: [[Subutex]])<br /> *** [[Codeine]]<br /> *** [[Hydrocodone]] (Redirects: [[Vicodin]])<br /> *** [[Hydromorphone]] (Redirects: [[Dilaudid]])<br /> *** [[Morphine]]<br /> *** [[Oxycodone]] (Redirects: [[Oxycontin]], [[Roxicodone]])<br /> ** Synthetic opioids<br /> *** [[Alfentanil]] (Redirects: [[Alfenta]])<br /> *** [[Fentanyl]] (Redirects: [[Sublimaze]])<br /> *** [[Methadone]]<br /> *** [[Meperidine]] (Redirects: [[Demerol]], [[Pethidine]])<br /> *** [[Remifentanil]] (Redirects: [[Ultiva]])<br /> *** [[Sufentanil]] (Redirects: [[Sufenta]])<br /> ** [[Tramadol]] (Redirects: [[Ultram]])<br /> * Opioid antagonists<br /> ** [[Naloxone]] (Redirects: [[Narcan]])<br /> ** [[Naltrexone]]<br /> * [[Buprenorphine/naltrexone]] (Redirects: [[Suboxone]])<br /> <br /> === [[Sedative hypnotics]] ===<br /> * [[Dexmedetomidine]]<br /> * [[Etomidate]]<br /> * [[Ketamine]]<br /> * [[Methohexital]]<br /> * [[Midazolam]]<br /> * [[Propofol]]<br /> * [[Thiopental]]<br /> <br /> === Steroids ===<br /> * [[Dexamethasone]] (Redirects: [[Decadron]])<br /> * [[Hydrocortisone]]<br /> <br /> === [[Uterotonics]] ===<br /> * [[Carboprost]] (Redirects: [[Hemabate]])<br /> * [[Methylergometrine]] (Redirects: [[Methergine]], [[Methylergonovine]])<br /> * [[Misoprostol]] (Redirects: [[Cytotec]])<br /> * [[Oxytocin]] (Redirects: [[Pitocin]])<br /> <br /> === [[Vasodilators]] ===<br /> * Calcium channel blockers<br /> ** [[Clevidipine]] (Redirects: [[Cleviprex]])<br /> ** [[Nicardipine]] (Redirects: [[Cardene]])<br /> ** [[Nimodipine]] (Redirects: [[Nimotop]])<br /> * Nitrovasodilators<br /> ** [[Nitric oxide]] (Redirects: [[NO]])<br /> ** [[Nitroglycerin]]<br /> ** [[Nitroprusside]] (Redirects: [[Nipride]], [[SNP]], [[Sodium nitroprusside]])<br /> * Pulmonary vasodilators<br /> ** [[Nitric oxide]] (Redirects: [[NO]])<br /> ** [[Epoprostenol]] (Redirects: [[Flolan]], [[Prostacyclin]], [[Prostaglandin I2]])<br /> * [[Dobutamine]]<br /> * [[Fenoldopam]] (Redirects: [[Corlopam]])<br /> * [[Hydralazine]]<br /> * [[Milrinone]]<br /> * [[Sildenafil]] (Redirects: [[Revatio]], [[Viagra]])<br /> <br /> === [[Vasoconstrictors]] ===<br /> * [[Ephedrine]]<br /> * [[Epinephrine]]<br /> * [[Phenylephrine]]<br /> * [[Norepinephrine]]<br /> * [[Dopamine]]<br /> * [[Vasopressin]] (Redirects: [[Vasostrict]])<br /> <br /> === Other drugs ===<br /> * [[Octreotide]]<br /> <br /> =[[:Category:Transfusion medicine|Transfusion medicine]]=<br /> ==[[:Category:Blood products|Blood products]]==<br /> *[[Packed red blood cells|Packed red blood cells (pRBCs)]]<br /> *[[Fresh frozen plasma|Fresh frozen plasma (FFP)]]<br /> *[[Platelets]]<br /> *[[Cryoprecipitate]]<br /> *Whole blood<br /> *Blood salvage (&quot;Cell Saver&quot;)<br /> <br /> =Procedures in anesthesia=<br /> *[[Airway procedures]]<br /> *[[Neuraxial anesthesia]]<br /> *[[Regional anesthesia]]<br /> *Vascular access procedures<br /> **[[Arterial line]]<br /> **Central line<br /> ***[[Central venous catheter|Central venous catheter (CVC)]]<br /> ***[[Introducer sheath|Introducer sheath (Cordis)]]<br /> ***[[Peripherally inserted central catheter|Peripherally inserted central catheter (PICC)]]<br /> **[[Peripheral IV|Peripheral IV (PIV)]]<br /> **Midline Catheter<br /> **[[Microintroducer]]<br /> **[[Rapid infusion catheter|Rapid infusion catheter (RIC)]]<br /> <br /> =[[Subspecialties in anesthesia]]=<br /> *[[Cardiothoracic anesthesia]]<br /> *[[Critical care medicine]]<br /> *[[Neuroanesthesia]]<br /> *[[Obstetric anesthesia]]<br /> *[[Pain medicine]]<br /> *[[Pediatric anesthesia]]<br /> *[[Pediatric cardiac anesthesia]]<br /> *[[Perioperative medicine]]<br /> *[[Regional anesthesia and acute pain]]<br /> *[[Transplant anesthesia]]</div>

Nicholascorcoran https://wikianesthesia.org/w/index.php?title=Nonobstetric_Surgery_During_Pregnancy&diff=16540 2024-06-27T18:02:31Z

<p>Nicholascorcoran: Final edits</p> <hr /> <div>{{Infobox comorbidity<br /> | anesthetic_relevance = Medium<br /> | anesthetic_management = Nonobstetric anesthesia and surgery in pregnant women involves managing surgical procedures and anesthesia administration with specific considerations for both maternal and fetal safety.<br /> A complete discussion with patient, surgeon and obstetrician about timing, urgency and intraoperative monitoring is important.<br /> | specialty = Anesthesiology, Obstetric Anesthesiology<br /> | image = <br /> }}<br /> <br /> Nonobstetric anesthesia and surgery in pregnant women involves managing surgical procedures and anesthesia administration with specific considerations for both maternal and fetal safety. It's crucial due to the complexity of balancing the health needs of the pregnant patient with minimizing potential risks to the developing fetus. This topic underscores the importance of specialized medical care and interdisciplinary collaboration to ensure optimal outcomes for both mother and child during nonobstetric surgical interventions.<br /> <br /> == Surgical Considerations ==<br /> <br /> === Timing of Surgery ===<br /> Emergency surgery, which is urgently needed, should be performed irrespective of the trimester of pregnancy. <br /> <br /> Nonurgent surgeries, such as cholecystectomy for recurrent biliary obstruction without infection, are typically scheduled during the second trimester whenever feasible. <br /> <br /> According to societal guidelines, elective surgeries that are not urgent should generally be postponed until after delivery.<br /> <br /> ==== Rationale ====<br /> It's advisable to limit fetal exposure to surgery and medications during the first trimester of pregnancy, particularly during organogenesis, due to the inconclusive certainty surrounding the safety of many drugs in pregnancy. Additionally, caution is warranted because common adverse outcomes in the first trimester, such as miscarriage, vaginal bleeding, or fetal structural anomalies, could mistakenly be attributed to surgery and anesthesia without clear alternative causes.<br /> <br /> == Anesthetic implications ==<br /> <br /> === Preoperative optimization ===<br /> Pregnant patients needing surgery should undergo preoperative evaluation akin to nonpregnant patients. This involves documenting medical and obstetric history comprehensively, alongside a detailed airway assessment during physical examination. Additional laboratory tests should be conducted based on the patient's medical conditions and the planned surgery; however, uncomplicated pregnancies typically do not necessitate extra preoperative testing.<br /> <br /> ==== Preoperative aspiration mitigation ====<br /> Based on the anatomic and hormonal changes that occur, pregnant patients may be at increased risk of aspiration during induction of (or emergence from) general anesthesia, especially in cases of difficult or failed intubation when mask ventilation may be required. The risk of aspiration may be reduced by preoperative fasting and use of pharmacologic prophylaxis. However, no specific intervention has been shown to improve clinical outcomes, and decision to administer prophylaxis should be individualized. &lt;ref&gt;{{Cite journal|last=Paranjothy|first=Shantini|last2=Griffiths|first2=James D.|last3=Broughton|first3=Hannah K.|last4=Gyte|first4=Gillian Ml|last5=Brown|first5=Heather C.|last6=Thomas|first6=Jane|date=2010-01-20|title=Interventions at caesarean section for reducing the risk of aspiration pneumonitis|url=https://pubmed.ncbi.nlm.nih.gov/20091567|journal=The Cochrane Database of Systematic Reviews|issue=1|pages=CD004943|doi=10.1002/14651858.CD004943.pub3|issn=1469-493X|pmc=4063196|pmid=20091567}}&lt;/ref&gt; <br /> <br /> === Intraoperative management ===<br /> <br /> ==== Fetal Monitoring ====<br /> One purpose of fetal monitoring is to identify concerning changes in the fetal heart rate (FHR) that may be influenced by reversible maternal factors not detectable through maternal monitoring alone. Even slight decreases in maternal blood pressure, oxygen levels, or uteroplacental blood flow can potentially affect fetal well-being. Interventions may include administering intravenous fluids, increasing oxygen levels, administering medications to raise maternal blood pressure, or adjusting maternal positioning. However, interpreting FHR patterns can be challenging during general anesthesia, as there is typically a decrease in beat-to-beat variability. Moreover, not all nonobstetric surgeries can be paused to facilitate emergency cesarean delivery, thus the exact benefit to the fetus remains uncertain.<br /> <br /> ===== When to perform =====<br /> The decision to perform intra-operative monitoring should be a group decision between the Patient, Attending Surgeon, Anesthesiologist, and Obstetrician. It should be based on factors such as gestational age, type of surgery, and available resources. It should be recognized that in certain situations: specific surgeries, anesthetics or medications may need to be given that can have negative effects on the FHR, but the ability to stop, pause of reverse the effects may not be possible to facilitate an emergency cesarean delivery. <br /> <br /> Society Guidelines recommend continuous monitoring of FHR in all viable fetuses (greater than 23 to 24 weeks of gestation) throughout surgery. The can be done via electronic FHR monitor or Doppler ultrasound. This is not always technically feasible due to positioning, type of surgery and location. At a minimum the FHR should be monitored preoperatively an post operatively for a period of time regardless of the gestational age. It should be recognized continuous FHR monitoring has not been shown conclusively to improve fetal outcome in women under general anesthesia.<br /> <br /> If the decision is made to perform Intraoperative, qualified personnel are required to be available to monitor and interpret the FHR throughout the surgery. This must be an obstetrician or clinician experienced in reading and evaluation FHR strips and under almost no circumstances should be the Anesthesiologist directing the patients anesthetic. If continuous monitoring is performed after 23 to 24 weeks gestation, Appropriate resources should be immediately available, including and obstetrician or clinician capable of performing an emergency C-Section. <br /> <br /> === Positioning ===<br /> Beyond 18 to 20 weeks of gestation, patients should be positioned with a 15 to 30 degree left lateral tilt when supine, to reduce aortocaval compression and cardiovascular compromise. The efficacy and need for left uterine displacement (LUD) for healthy parturients at cesarean delivery have been questioned. However, the preponderance of evidence suggests that LUD should be used for nonobstetric surgery.<br /> <br /> LUD can be accomplished by tilting the operating table or by placing a wedge under the patient's right hip. Most operations can be successfully performed with LUD. If LUD compromises surgery and the supine level position is required, blood pressure may fall and should be maintained with intravenous (IV) fluid and vasopressor therapy.<br /> <br /> === Postoperative management ===<br /> <br /> ==== Maternal monitoring ====<br /> Similar to any postoperative monitoring, close monitoring of the airway and respiratory system is essential during the recovery from anesthesia, as significant anesthetic complications can arise during emergence or shortly after surgery. See other specific Post Anesthesia General Adult Recovery texts<br /> <br /> ==== Fetal assessment ====<br /> The FHR should be monitored in the recovery room, intermittently for previable fetuses, and continuously for the viable fetus. Uterine activity should also be monitored in cases in which the fetus is viable, as contractions are most likely to occur proximate to the procedure and as any tocolytic effect of general anesthetics wears off<br /> <br /> ==== Left Uterine Displacement ====<br /> Left lateral position or uterine displacement should be maintained until the patient is fully awake, alert, and able to adjust her own position.<br /> <br /> ==== Postoperative pain control ====<br /> A multimodal analgesia should be used for postoperative pain control for all patients. This should include nonpharmacologic methods of pain control, acetaminophen, regional anesthesia techniques, and local anesthetic infiltration. Opioids should be used on an as-needed basis. <br /> <br /> Nonsteroidal anti-inflammatory drugs (NSAIDs) should not be used routinely during pregnancy (particularly in the early first and late third trimesters) because of potential fetal effects.<br /> <br /> == Pathophysiology ==<br /> <br /> === Physiological Changes of Pregnancy ===<br /> <br /> ==== Cardiovascular ====<br /> Cardiac output (CO) rises significantly during normal pregnancy. CO reaches approximately 35 percent above baseline by the end of the first trimester, and plateaus at approximately 50 percent above baseline at 30 to 32 weeks gestation when patients are maintained in the left lateral decubitus position. At term, the supine position can reduce CO by 25 to 30 percent compared with left lateral decubitus position, due to compression of the inferior vena cava by the gravid uterus. In a subset of patients, this caval compression can produce significant maternal hypotension, labeled &quot;supine hypotensive syndrome.&quot; &lt;ref name=&quot;:0&quot;&gt;{{Cite web|title=UpToDate|url=https://www.uptodate.com/contents/anesthesia-for-nonobstetric-surgery-during-pregnancy?sectionName=Postoperative+care&amp;topicRef=121990&amp;anchor=H24&amp;source=see_link#H24|access-date=2024-06-27|website=www.uptodate.com}}&lt;/ref&gt;<br /> <br /> ==== Pulmonary ====<br /> Starting in the first trimester, resting minute ventilation increases, counterintuitively due to increased Tidal Volume not Respiratory Rate, up to nearly 1.5x pre-pregnancy MV by term. Thus pregnancy is associated with a compensated respiratory alkalosis, with pH = 7.42 to 7.44 and partial pressure of carbon dioxide (PaCO2) = 28 to 32 mmHg. Progesterone stimulates this increase in ventilation and causes the common dyspnea symptoms in pregnant women. <br /> <br /> With growing uterine size there is a compensatory decrease in FRC. Beyond 20 weeks of gestation there is a noticeable 20 percent FRC decrease<br /> <br /> Oxygen consumption is increased by 20 percent.<br /> <br /> ==== Hematologic ====<br /> There is an increase in plasma volume compared to red cell mass causing a concentration decrease in hemoglobin, known as physiologic anemia of pregnancy or a dilutional anemia. normal hemoglobin may be as low as 11 g/dL by the end of the first trimester and approximately 10.5 g/dL in the second trimester. &lt;ref&gt;{{Cite journal|date=2021-08-01|title=Anemia in Pregnancy: ACOG Practice Bulletin, Number 233|url=https://pubmed.ncbi.nlm.nih.gov/34293770|journal=Obstetrics and Gynecology|volume=138|issue=2|pages=e55–e64|doi=10.1097/AOG.0000000000004477|issn=1873-233X|pmid=34293770}}&lt;/ref&gt;<br /> <br /> Pregnancy creates a relatively hypercoagulable state, which persists into the postpartum period primarily due to an increase in concentrations of the vitamin K-dependent clotting factors and type 1 and 2 plasminogen activator inhibitor, and decreases in levels of free protein S, the cofactor of the endogenous anticoagulant activated protein C. Return to baseline thromboembolic risk generally occurs after 12 weeks postpartum. &lt;ref name=&quot;:0&quot; /&gt;<br /> <br /> ==== Gastrointestinal ====<br /> Gastroesophageal reflux in pregnancy is associated with a decreased lower esophageal sphincter tone throughout pregnancy and an increase in intraabdominal pressure due to the enlarging uterus. 40 to 85 percent of women describe being symptomatic during pregnancy. Gastric emptying is normal during pregnancy. Gastric acid secretion is unchanged or decreased in pregnant women.<br /> <br /> For this reason women are considered a Full Stomach during preoperative considerations of anesthesia and for endotracheal intubation and Rapid sequence intubation considerations.<br /> <br /> ==== Sensitivity to anesthetic medications ====<br /> The physiologic changes of pregnancy alter sensitivity to many anesthetic medications and may affect drug metabolism. Minimum alveolar concentration is reduced for volatile anesthetics during pregnancy &lt;ref&gt;{{Cite journal|last=Gin|first=T.|last2=Chan|first2=M. T.|date=1994-10|title=Decreased minimum alveolar concentration of isoflurane in pregnant humans|url=https://pubmed.ncbi.nlm.nih.gov/7943833|journal=Anesthesiology|volume=81|issue=4|pages=829–832|doi=10.1097/00000542-199410000-00009|issn=0003-3022|pmid=7943833}}&lt;/ref&gt;<br /> <br /> === Effects of Anesthetics of the Fetus and the Pregnancy ===<br /> There is no compelling evidence that any specific anesthetic agent is teratogenic in humans or that a specific anesthetic-related medication should be avoided during the perioperative care of a pregnant patient. See Other Pages for specific advice and information on the developing fetus. Briefly: <br /> <br /> === Fetal brain development ===<br /> Laboratory and animal studies, including studies in nonhuman primates, have reported histologic changes of the brain and adverse neurodevelopmental effects after exposure to most anesthetics during periods of rapid brain development. Human clinical studies involving young children have reported mixed results, although the most robust studies are reassuring that a single anesthetic exposure does not adversely affect neurodevelopment &lt;ref&gt;{{Cite journal|last=Sun|first=Lena S.|last2=Li|first2=Guohua|last3=Miller|first3=Tonya L. K.|last4=Salorio|first4=Cynthia|last5=Byrne|first5=Mary W.|last6=Bellinger|first6=David C.|last7=Ing|first7=Caleb|last8=Park|first8=Raymond|last9=Radcliffe|first9=Jerilynn|last10=Hays|first10=Stephen R.|last11=DiMaggio|first11=Charles J.|date=2016-06-07|title=Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood|url=https://pubmed.ncbi.nlm.nih.gov/27272582|journal=JAMA|volume=315|issue=21|pages=2312–2320|doi=10.1001/jama.2016.6967|issn=1538-3598|pmc=5316422|pmid=27272582}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal|last=McCann|first=Mary Ellen|last2=de Graaff|first2=Jurgen C.|last3=Dorris|first3=Liam|last4=Disma|first4=Nicola|last5=Withington|first5=Davinia|last6=Bell|first6=Graham|last7=Grobler|first7=Anneke|last8=Stargatt|first8=Robyn|last9=Hunt|first9=Rodney W.|last10=Sheppard|first10=Suzette J.|last11=Marmor|first11=Jacki|date=2019-02-16|title=Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial|url=https://pubmed.ncbi.nlm.nih.gov/30782342|journal=Lancet (London, England)|volume=393|issue=10172|pages=664–677|doi=10.1016/S0140-6736(18)32485-1|issn=1474-547X|pmc=6500739|pmid=30782342}}&lt;/ref&gt;<br /> <br /> In 2016, the US Food and Drug Administration (FDA) announced warnings about potential risks of negative effects on the developing brain from administration of anesthetics and sedative drugs to third trimester pregnant women and children under age three, especially for repeated exposures or procedures lasting more than three hours. The FDA recommends that health care providers discuss with pregnant patients the benefits, risks, and appropriate timing of surgery requiring anesthesia that will take longer than three hours. However, the degree of risk remains unclear.<br /> <br /> === Teratogenicity ===<br /> Theoretically, any medication could be teratogenic if given in a high enough dose, for a long enough duration of time, and at precisely the right time of development. Although many drugs used in anesthesia have been associated with teratogenic effects in animal studies, such findings are extremely difficult to extrapolate to humans due to interspecies variation and the high dose of agents used in the animal studies. Some medications, such as opioids, have been associated with congenital malformations when used chronically throughout pregnancy. In contrast, the use of all anesthetic medications in the perioperative setting in clinically relevant doses and concentrations has not been associated with teratogenicity.<br /> <br /> ===== Benzodiazepines =====<br /> Some early reports suggested that diazepam use in early pregnancy may be associated with cleft palate. Subsequent studies have failed to demonstrate this association or a definite risk of other anomalies, although a small increase in risk could not be excluded. Benzodiazepines that are commonly used in the perioperative setting (eg, midazolam) have never been associated with congenital malformations.&lt;ref name=&quot;:0&quot; /&gt; These are however frequently avoided clinically in these cases. <br /> <br /> ===== Nitrous oxide =====<br /> Nitrous oxide has been shown to be a weak teratogen in animal models. Because of its effect of inhibiting methionine synthetase and impairing DNA production, there is concern about nitrous oxide use during pregnancy, particularly in the first trimester during organogenesis. However, no human study has shown any increase in the rate of congenital malformations with nitrous oxide use. This includes a study of over 2000 women who underwent surgery in the first trimester, most with the use of nitrous oxide&lt;ref&gt;{{Cite journal|last=Mazze|first=R. I.|last2=Källén|first2=B.|date=1989-11|title=Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases|url=https://pubmed.ncbi.nlm.nih.gov/2589435|journal=American Journal of Obstetrics and Gynecology|volume=161|issue=5|pages=1178–1185|doi=10.1016/0002-9378(89)90659-5|issn=0002-9378|pmid=2589435}}&lt;/ref&gt;. Despite this reassuring evidence, it is clinically frequent to avoid nitrous oxide during the first trimester if there are reasonable alternatives.<br /> <br /> == Medications ==<br /> Of the clinically relevant medications, All medications cross the Uterine/Placenta barrier except (Heparin, Insulin, Glycopyrrolate, NDNMB, Succinylcholine). Known by the mnemonic (He Is Going Nowhere Soon). <br /> <br /> ==== Induction agents ====<br /> The selection of the anesthesia induction agent (eg, propofol, ketamine, etomidate) should be based on patient factors and provider preference. No agents has been clearly shown to be teratogenic or to have adverse effects on human brain development. Propofol is the preferred induction agent for routine induction in otherwise healthy pregnant patients.<br /> <br /> Pregnant patients may be more sensitive to the effects of neuromuscular blocking agents (NMBAs) than nonpregnant patients. As for all patients who receive NMBAs, at a minimum, neuromuscular monitoring with peripheral nerve stimulation should be used to guide dosing and recovery from neuromuscular block in pregnant patients. Quantitative measurements are preferable to qualitative, if possible. <br /> <br /> ==== Succinylcholine ====<br /> The duration of action of succinylcholine is unpredictable in pregnant patients, though this is usually of no clinical significance. This is due to 2 factors: the decrease in pseudocholinesterase, which metabolizes succinylcholine, is reduced during pregnancy, and the increase in the volume of distribution causing a lower plasma level for a given dose. <br /> <br /> ==== Nondepolarizing NMBAs ====<br /> The initial dose of nondepolarizing NMBA should be based on ideal body weight and further doses should be based on neuromuscular monitoring. <br /> <br /> ==== Maintenance anesthetics ====<br /> Choice of maintenance anesthetic agents should be based on the considerations that apply to nonpregnant patients, as none of the standard anesthetic agents have been proven teratogenic or to have relatively increased adverse effects on human brain development. All general anesthetic drugs cross the placenta and may result in minimal or absent FHR variability<br /> <br /> A systematic review of four studies including 155 pregnant women undergoing nonobstetric surgery reported minimal or absent FHR variability in most tracings and a decrease in FHR baseline of 10 to 25 beats per minute for women under general anesthesia. Additional criteria are necessary to identify non-reassuring fetal heart rate (FHR) patterns, such as persistent tachycardia without maternal fever, recurrent or prolonged FHR decelerations, repeated late decelerations, or a sinusoidal pattern. Before determining that an FHR tracing warrants emergency delivery, potential drug-induced causes should be ruled out. For instance, opioids and magnesium sulfate can reduce heart rate variability, butorphanol may produce a sinusoidal pattern, and beta blockers and atropine can elevate the FHR. The presence of moderate variability and/or FHR accelerations effectively rules out metabolic acidemia.<br /> <br /> Pregnant patients have an increased sensitivity to potent inhaled anesthetics, seen as a decrease in the Minimum Alveolar Concentration (MAC). Several studies have reported up to a 30 percent reduction in the minimum alveolar concentration for isoflurane starting in early pregnancy &lt;ref&gt;{{Cite journal|last=Gin|first=T.|last2=Chan|first2=M. T.|date=1994-10|title=Decreased minimum alveolar concentration of isoflurane in pregnant humans|url=https://pubmed.ncbi.nlm.nih.gov/7943833|journal=Anesthesiology|volume=81|issue=4|pages=829–832|doi=10.1097/00000542-199410000-00009|issn=0003-3022|pmid=7943833}}&lt;/ref&gt;, compared with nonpregnant patients. In contrast, a small study found no difference in the electroencephalographic measures of anesthetic effect between pregnant patients during cesarean delivery and gynecologic patients &lt;ref&gt;{{Cite journal|last=Ueyama|first=Hiroshi|last2=Hagihira|first2=Satoshi|last3=Takashina|first3=Masaki|last4=Nakae|first4=Aya|last5=Mashimo|first5=Takashi|date=2010-09|title=Pregnancy does not enhance volatile anesthetic sensitivity on the brain: an electroencephalographic analysis study|url=https://pubmed.ncbi.nlm.nih.gov/20693882|journal=Anesthesiology|volume=113|issue=3|pages=577–584|doi=10.1097/ALN.0b013e3181e4f508|issn=1528-1175|pmid=20693882}}&lt;/ref&gt;.<br /> <br /> Potent inhalation agents decrease uterine tone during the operative procedure. This is overall advantageous, particularly for abdominal procedures in the second and third trimester, as it may reduce the incidence of pre-term contractions and pre-term labor. However, in the event of emergency delivery, higher doses of uterotonic agents may be required (eg, oxytocin, methylergonovine, carboprost tromethamine) for patients who are receiving these inhalation agents than patients who have neuraxial anesthesia. <br /> <br /> Inhaled nitrous oxide (either alone or as a 50 percent mixture with oxygen) has no effect on uterine tone, maternal hemodynamic status, or FHR variability. See above for recommendation of developing fetus.<br /> <br /> ==== Neuromuscular Blocking Reversal ====<br /> <br /> ===== Sugammadex =====<br /> Used to reverse the effects of neuromuscular blocking agents. <br /> <br /> Sugammadex has a mechanism of action that encapsulates progesterone and reduces free progesterone levels in pharmacologic simulation studies &lt;ref&gt;{{Cite journal|last=Et|first=Tayfun|last2=Topal|first2=Ahmet|last3=Erol|first3=Atilla|last4=Tavlan|first4=Aybars|last5=Kılıçaslan|first5=Alper|last6=Uzun|first6=Sema Tuncer|date=2015-04|title=The Effects of Sugammadex on Progesterone Levels in Pregnant Rats|url=https://pubmed.ncbi.nlm.nih.gov/26167346|journal=Balkan Medical Journal|volume=32|issue=2|pages=203–207|doi=10.5152/balkanmedj.2015.15502|issn=2146-3123|pmc=4432702|pmid=26167346}}&lt;/ref&gt;. This effect could be consequential, since progesterone is required for endometrial decidualization and uterine growth early in pregnancy, and myometrial quiescence and cervical structural integrity later in pregnancy. There is insufficient evidence to conclude that sugammadex is safe during pregnancy, and the decision to use sugammadex should be individualized until more evidence on hormonal and teratogenic effects is available.<br /> <br /> At this time the Society of Obstetric Anesthesia and Perinatology has recommended avoiding routine sugammadex use during pregnancy, and instead recommends other reversal agents<br /> <br /> ===== Neostigmine and Atropine =====<br /> Used to revere the effects of neuromuscular blocking agents.<br /> <br /> Neostigmine reverses the effects of neuromuscular blocking agents by inhibiting acetylcholinesterase, thereby increasing the availability of acetylcholine at the neuromuscular junction and facilitating muscle contraction. However, it can lead to side effects such as bradycardia due to increased cholinergic activity<br /> <br /> Atropine is often co-administered with neostigmine to counteract its cholinergic effects, including bradycardia, by blocking muscarinic receptors and preventing excessive parasympathetic stimulation. This combination helps maintain a balanced autonomic response during recovery from anesthesia<br /> <br /> Glycopyrrolate is not typically used in pregnant patients because it crosses the placenta poorly, resulting in limited effectiveness in the fetus. This could lead to fatal bradycardia in the fetus due to unopposed actions of the neostigmine. Therefore, alternative medications such as atropine are preferred. <br /> <br /> ==== Antibiotics ====<br /> Whether antibiotic prophylaxis is required depends on the particular procedure being performed.<br /> <br /> Safe antibiotic options for pregnant women include cephalosporins, penicillins, erythromycin (excluding estolate), azithromycin, and clindamycin due to their favorable safety profiles. Aminoglycosides are generally safe but pose risks of fetal and maternal ototoxicity and nephrotoxicity.<br /> <br /> ==== Thromboprophylaxis ====<br /> The hypercoagulable state of pregnancy increases the risk of a thromboembolic event in the postsurgical period<br /> <br /> Pneumatic compression devices should be used or considered for all surgeries <br /> <br /> Tailor the decision to administer pharmacological prophylaxis according to the anticipated scope and duration of the procedure, as well as the patient's risk factors for venous thrombosis, including factors related to pregnancy (such as thrombophilia, prolonged immobilization, previous venous thrombosis, malignancy, diabetes mellitus, varicose veins, paralysis, maternal age, or obesity).<br /> <br /> ==== Glucocorticoid administration ====<br /> Administration of a course of antenatal glucocorticoids 24 to 48 hours prior to surgery for patients between 24 and 34 weeks of gestation can reduce perinatal morbidity/mortality if preterm birth occurs.<br /> <br /> The decision to give glucocorticoids, and potentially delay surgery for 24 to 48 hours, must balance the urgency of the surgery with the obstetrician's estimate of the risk of preterm birth because of the underlying disease or the planned procedure.<br /> <br /> == References ==<br /> <br /> [[Category:Comorbidities]]</div>

Nicholascorcoran https://wikianesthesia.org/w/index.php?title=Nonobstetric_Surgery_During_Pregnancy&diff=16539 2024-06-27T17:11:15Z

<p>Nicholascorcoran: continued upates</p> <hr /> <div>{{Infobox comorbidity<br /> | anesthetic_relevance = Medium<br /> | anesthetic_management = Nonobstetric anesthesia and surgery in pregnant women involves managing surgical procedures and anesthesia administration with specific considerations for both maternal and fetal safety.<br /> A complete discussion with patient, surgeon and obstetrician about timing, urgency and intraoperative monitoring is important.<br /> | specialty = Anesthesiology, Obstetric Anesthesiology<br /> | image = <br /> }}<br /> <br /> Nonobstetric anesthesia and surgery in pregnant women involves managing surgical procedures and anesthesia administration with specific considerations for both maternal and fetal safety. It's crucial due to the complexity of balancing the health needs of the pregnant patient with minimizing potential risks to the developing fetus. This topic underscores the importance of specialized medical care and interdisciplinary collaboration to ensure optimal outcomes for both mother and child during nonobstetric surgical interventions.<br /> <br /> == Surgical Considerations ==<br /> <br /> === Timing of Surgery ===<br /> Emergency surgery, which is urgently needed, should be performed irrespective of the trimester of pregnancy. <br /> <br /> Nonurgent surgeries, such as cholecystectomy for recurrent biliary obstruction without infection, are typically scheduled during the second trimester whenever feasible. <br /> <br /> According to societal guidelines, elective surgeries that are not urgent should generally be postponed until after delivery.<br /> <br /> ==== Rationale ====<br /> It's advisable to limit fetal exposure to surgery and medications during the first trimester of pregnancy, particularly during organogenesis, due to the inconclusive certainty surrounding the safety of many drugs in pregnancy. Additionally, caution is warranted because common adverse outcomes in the first trimester, such as miscarriage, vaginal bleeding, or fetal structural anomalies, could mistakenly be attributed to surgery and anesthesia without clear alternative causes.<br /> <br /> == Anesthetic implications&lt;!-- Briefly summarize the anesthetic implications of this comorbidity. --&gt; ==<br /> <br /> === Preoperative optimization&lt;!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --&gt; ===<br /> Pregnant patients needing surgery should undergo preoperative evaluation akin to nonpregnant patients. This involves documenting medical and obstetric history comprehensively, alongside a detailed airway assessment during physical examination. Additional laboratory tests should be conducted based on the patient's medical conditions and the planned surgery; however, uncomplicated pregnancies typically do not necessitate extra preoperative testing.<br /> <br /> === Preoperative aspiration mitigation ===<br /> Based on the anatomic and hormonal changes that occur, pregnant patients may be at increased risk of aspiration during induction of (or emergence from) general anesthesia, especially in cases of difficult or failed intubation when mask ventilation may be required. The risk of aspiration may be reduced by preoperative fasting and use of pharmacologic prophylaxis. However, no specific intervention has been shown to improve clinical outcomes, and decision to administer prophylaxis should be individualized. <br /> <br /> === Intraoperative management&lt;!-- Describe how this comorbidity may influence intraoperative management. --&gt; ===<br /> <br /> ==== Fetal Monitoring ====<br /> One purpose of fetal monitoring is to identify concerning changes in the fetal heart rate (FHR) that may be influenced by reversible maternal factors not detectable through maternal monitoring alone. Even slight decreases in maternal blood pressure, oxygen levels, or uteroplacental blood flow can potentially affect fetal well-being. Interventions may include administering intravenous fluids, increasing oxygen levels, administering medications to raise maternal blood pressure, or adjusting maternal positioning. However, interpreting FHR patterns can be challenging during general anesthesia, as there is typically a decrease in beat-to-beat variability. Moreover, not all nonobstetric surgeries can be paused to facilitate emergency cesarean delivery, thus the exact benefit to the fetus remains uncertain.<br /> <br /> ===== When to perform =====<br /> The decision to perform intra-operative monitoring should be a group decision between the Patient, Attending Surgeon, Anesthesiologist, and Obstetrician. It should be based on factors such as gestational age, type of surgery, and available resources. It should be recognized that in certain situations: specific surgeries, anesthetics or medications may need to be given that can have negative effects on the FHR, but the ability to stop, pause of reverse the effects may not be possible to facilitate an emergency cesarean delivery. <br /> <br /> Society Guidelines recommend continuous monitoring of FHR in all viable fetuses (greater than 23 to 24 weeks of gestation) throughout surgery. The can be done via electronic FHR monitor or Doppler ultrasound. This is not always technically feasible due to positioning, type of surgery and location. At a minimum the FHR should be monitored preoperatively an post operatively for a period of time regardless of the gestational age. It should be recognized continuous FHR monitoring has not been shown conclusively to improve fetal outcome in women under general anesthesia.<br /> <br /> If the decision is made to perform Intraoperative, qualified personnel are required to be available to monitor and interpret the FHR throughout the surgery. This must be an obstetrician or clinician experienced in reading and evaluation FHR strips and under almost no circumstances should be the Anesthesiologist directing the patients anesthetic. If continuous monitoring is performed after 23 to 24 weeks gestation, Appropriate resources should be immediately available, including and obstetrician or clinician capable of performing an emergency C-Section. <br /> <br /> === Medications ===<br /> <br /> ==== General Anesthetics ====<br /> All general anesthetic drugs cross the placenta and may result in minimal or absent FHR variability<br /> <br /> A systematic review of four studies including 155 pregnant women undergoing nonobstetric surgery reported minimal or absent FHR variability in most tracings and a decrease in FHR baseline of 10 to 25 beats per minute for women under general anesthesia <br /> <br /> Additional criteria are necessary to identify non-reassuring fetal heart rate (FHR) patterns, such as persistent tachycardia without maternal fever, recurrent or prolonged FHR decelerations, repeated late decelerations, or a sinusoidal pattern. Before determining that an FHR tracing warrants emergency delivery, potential drug-induced causes should be ruled out. For instance, opioids and magnesium sulfate can reduce heart rate variability, butorphanol may produce a sinusoidal pattern, and beta blockers and atropine can elevate the FHR. The presence of moderate variability and/or FHR accelerations effectively rules out metabolic acidemia.<br /> <br /> ==== Antibiotics ====<br /> Whether antibiotic prophylaxis is required depends on the particular procedure being performed.<br /> <br /> Safe antibiotic options for pregnant women include cephalosporins, penicillins, erythromycin (excluding estolate), azithromycin, and clindamycin due to their favorable safety profiles. Aminoglycosides are generally safe but pose risks of fetal and maternal ototoxicity and nephrotoxicity.<br /> <br /> ==== Thromboprophylaxis ====<br /> The hypercoagulable state of pregnancy increases the risk of a thromboembolic event in the postsurgical period<br /> <br /> Pneumatic compression devices should be used or considered for all surgeries <br /> <br /> Tailor the decision to administer pharmacological prophylaxis according to the anticipated scope and duration of the procedure, as well as the patient's risk factors for venous thrombosis, including factors related to pregnancy (such as thrombophilia, prolonged immobilization, previous venous thrombosis, malignancy, diabetes mellitus, varicose veins, paralysis, maternal age, or obesity).<br /> <br /> ==== Glucocorticoid administration ====<br /> Administration of a course of antenatal glucocorticoids 24 to 48 hours prior to surgery for patients between 24 and 34 weeks of gestation can reduce perinatal morbidity/mortality if preterm birth occurs.<br /> <br /> The decision to give glucocorticoids, and potentially delay surgery for 24 to 48 hours, must balance the urgency of the surgery with the obstetrician's estimate of the risk of preterm birth because of the underlying disease or the planned procedure.<br /> <br /> === Postoperative management&lt;!-- Describe how this comorbidity may influence postoperative management. --&gt; ===<br /> <br /> ==== Maternal monitoring ====<br /> Similar to any postoperative monitoring, close monitoring of the airway and respiratory system is essential during the recovery from anesthesia, as significant anesthetic complications can arise during emergence or shortly after surgery. See other specific Post Anesthesia General Adult Recovery texts<br /> <br /> ==== Fetal assessment ====<br /> The FHR should be monitored in the recovery room, intermittently for previable fetuses, and continuously for the viable fetus. Uterine activity should also be monitored in cases in which the fetus is viable, as contractions are most likely to occur proximate to the procedure and as any tocolytic effect of general anesthetics wears off<br /> <br /> ==== Left Uterine Displacement ====<br /> Left lateral position or uterine displacement should be maintained until the patient is fully awake, alert, and able to adjust her own position.<br /> <br /> ==== Postoperative pain control ====<br /> A multimodal analgesia should be used for postoperative pain control for all patients. This should include nonpharmacologic methods of pain control, acetaminophen, regional anesthesia techniques, and local anesthetic infiltration. Opioids should be used on an as-needed basis. <br /> <br /> Nonsteroidal anti-inflammatory drugs (NSAIDs) should not be used routinely during pregnancy (particularly in the early first and late third trimesters) because of potential fetal effects.<br /> <br /> == Pathophysiology&lt;!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --&gt; ==<br /> <br /> === PHYSIOLOGIC CHANGES OF PREGNANCY ===<br /> <br /> ==== Cardiovascular ====<br /> Cardiac output (CO) rises significantly during normal pregnancy. CO reaches approximately 35 percent above baseline by the end of the first trimester, and plateaus at approximately 50 percent above baseline at 30 to 32 weeks gestation when patients are maintained in the left lateral decubitus position. At term, the supine position can reduce CO by 25 to 30 percent compared with left lateral decubitus position, due to compression of the inferior vena cava by the gravid uterus. In a subset of patients, this caval compression can produce significant maternal hypotension, labeled &quot;supine hypotensive syndrome.&quot; &lt;ref name=&quot;:0&quot;&gt;{{Cite web|title=UpToDate|url=https://www.uptodate.com/contents/anesthesia-for-nonobstetric-surgery-during-pregnancy?sectionName=Postoperative+care&amp;topicRef=121990&amp;anchor=H24&amp;source=see_link#H24|access-date=2024-06-27|website=www.uptodate.com}}&lt;/ref&gt;<br /> <br /> ==== Pulmonary ====<br /> Starting in the first trimester, resting minute ventilation increases, counterintuitively due to increased Tidal Volume not Respiratory Rate, up to nearly 1.5x pre-pregnancy MV by term. Thus pregnancy is associated with a compensated respiratory alkalosis, with pH = 7.42 to 7.44 and partial pressure of carbon dioxide (PaCO2) = 28 to 32 mmHg. Progesterone stimulates this increase in ventilation and causes the common dyspnea symptoms in pregnant women. <br /> <br /> With growing uterine size there is a compensatory decrease in FRC. Beyond 20weeks of gestation there is a noticeable 20 percent FRC decrease<br /> <br /> Oxygen consumption is increased by 20 percent<br /> <br /> ==== Hematologic ====<br /> There is an increase in plasma volume compared to red cell mass causing a concentration decrease in hemoglobin, known as physiologic anemia of pregnancy or a dilutional anemia. normal hemoglobin may be as low as 11 g/dL by the end of the first trimester and approximately 10.5 g/dL in the second trimester. &lt;ref&gt;{{Cite journal|date=2021-08-01|title=Anemia in Pregnancy: ACOG Practice Bulletin, Number 233|url=https://pubmed.ncbi.nlm.nih.gov/34293770|journal=Obstetrics and Gynecology|volume=138|issue=2|pages=e55–e64|doi=10.1097/AOG.0000000000004477|issn=1873-233X|pmid=34293770}}&lt;/ref&gt;<br /> <br /> Pregnancy creates a relatively hypercoagulable state, which persists into the postpartum period primarily due to an increase in concentrations of the vitamin K-dependent clotting factors and type 1 and 2 plasminogen activator inhibitor, and decreases in levels of free protein S, the cofactor of the endogenous anticoagulant activated protein C. Return to baseline thromboembolic risk generally occurs after 12 weeks postpartum. &lt;ref name=&quot;:0&quot; /&gt;<br /> <br /> ==== Gastrointestinal ====<br /> Gastroesophageal reflux in pregnancy is associated with a decreased lower esophageal sphincter tone throughout pregnancy and an increase in intraabdominal pressure due to the enlarging uterus. 40 to 85 percent of women describe being symptomatic during pregnancy. Gastric emptying is normal during pregnancy. Gastric acid secretion is unchanged or decreased in pregnant women<br /> <br /> For this reason women are considered a Full Stomach during preoperative considerations of anesthesia and for endotracheal intubation and Rapid sequence intubation considerations,<br /> <br /> ==== Sensitivity to anesthetic medications ====<br /> The physiologic changes of pregnancy alter sensitivity to many anesthetic medications and may affect drug metabolism. Minimum alveolar concentration is reduced for volatile anesthetics during pregnancy &lt;ref&gt;{{Cite journal|last=Gin|first=T.|last2=Chan|first2=M. T.|date=1994-10|title=Decreased minimum alveolar concentration of isoflurane in pregnant humans|url=https://pubmed.ncbi.nlm.nih.gov/7943833|journal=Anesthesiology|volume=81|issue=4|pages=829–832|doi=10.1097/00000542-199410000-00009|issn=0003-3022|pmid=7943833}}&lt;/ref&gt;<br /> <br /> === EFFECTS OF ANESTHETICS ON THE FETUS AND THE PREGNANCY ===<br /> There is no compelling evidence that any specific anesthetic agent is teratogenic in humans or that a specific anesthetic-related medication should be avoided during the perioperative care of a pregnant patient. <br /> <br /> See Other Pages for specific advice and information on the developing fetus<br /> <br /> In Brief<br /> <br /> === Fetal brain development ===<br /> Laboratory and animal studies, including studies in nonhuman primates, have reported histologic changes of the brain and adverse neurodevelopmental effects after exposure to most anesthetics during periods of rapid brain development. Human clinical studies involving young children have reported mixed results, although the most robust studies are reassuring that a single anesthetic exposure does not adversely affect neurodevelopment &lt;ref&gt;{{Cite journal|last=Sun|first=Lena S.|last2=Li|first2=Guohua|last3=Miller|first3=Tonya L. K.|last4=Salorio|first4=Cynthia|last5=Byrne|first5=Mary W.|last6=Bellinger|first6=David C.|last7=Ing|first7=Caleb|last8=Park|first8=Raymond|last9=Radcliffe|first9=Jerilynn|last10=Hays|first10=Stephen R.|last11=DiMaggio|first11=Charles J.|date=2016-06-07|title=Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood|url=https://pubmed.ncbi.nlm.nih.gov/27272582|journal=JAMA|volume=315|issue=21|pages=2312–2320|doi=10.1001/jama.2016.6967|issn=1538-3598|pmc=5316422|pmid=27272582}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal|last=McCann|first=Mary Ellen|last2=de Graaff|first2=Jurgen C.|last3=Dorris|first3=Liam|last4=Disma|first4=Nicola|last5=Withington|first5=Davinia|last6=Bell|first6=Graham|last7=Grobler|first7=Anneke|last8=Stargatt|first8=Robyn|last9=Hunt|first9=Rodney W.|last10=Sheppard|first10=Suzette J.|last11=Marmor|first11=Jacki|date=2019-02-16|title=Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial|url=https://pubmed.ncbi.nlm.nih.gov/30782342|journal=Lancet (London, England)|volume=393|issue=10172|pages=664–677|doi=10.1016/S0140-6736(18)32485-1|issn=1474-547X|pmc=6500739|pmid=30782342}}&lt;/ref&gt;<br /> <br /> In 2016, the US Food and Drug Administration (FDA) announced warnings about potential risks of negative effects on the developing brain from administration of anesthetics and sedative drugs to third trimester pregnant women and children under age three, especially for repeated exposures or procedures lasting more than three hours. The FDA recommends that health care providers discuss with pregnant patients the benefits, risks, and appropriate timing of surgery requiring anesthesia that will take longer than three hours. However, the degree of risk remains unclear.<br /> <br /> === Teratogenicity ===<br /> Theoretically, any medication could be teratogenic if given in a high enough dose, for a long enough duration of time, and at precisely the right time of development. Although many drugs used in anesthesia have been associated with teratogenic effects in animal studies, such findings are extremely difficult to extrapolate to humans due to interspecies variation and the high dose of agents used in the animal studies. Some medications, such as opioids, have been associated with congenital malformations when used chronically throughout pregnancy. In contrast, the use of all anesthetic medications in the perioperative setting in clinically relevant doses and concentrations has not been associated with teratogenicity.<br /> <br /> ===== Benzodiazepines =====<br /> Some early reports suggested that diazepam use in early pregnancy may be associated with cleft palate. Subsequent studies have failed to demonstrate this association or a definite risk of other anomalies, although a small increase in risk could not be excluded. Benzodiazepines that are commonly used in the perioperative setting (eg, midazolam) have never been associated with congenital malformations.&lt;ref name=&quot;:0&quot; /&gt; These are however frequently avoided clinically in these cases. <br /> <br /> ===== Nitrous oxide =====<br /> Nitrous oxide has been shown to be a weak teratogen in animal models. Because of its effect of inhibiting methionine synthetase and impairing DNA production, there is concern about nitrous oxide use during pregnancy, particularly in the first trimester during organogenesis. However, no human study has shown any increase in the rate of congenital malformations with nitrous oxide use. This includes a study of over 2000 women who underwent surgery in the first trimester, most with the use of nitrous oxide&lt;ref&gt;{{Cite journal|last=Mazze|first=R. I.|last2=Källén|first2=B.|date=1989-11|title=Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases|url=https://pubmed.ncbi.nlm.nih.gov/2589435|journal=American Journal of Obstetrics and Gynecology|volume=161|issue=5|pages=1178–1185|doi=10.1016/0002-9378(89)90659-5|issn=0002-9378|pmid=2589435}}&lt;/ref&gt;. Despite this reassuring evidence, it is clinically frequent to avoid nitrous oxide during the first trimester if there are reasonable alternatives.<br /> <br /> == Treatment&lt;!-- Summarize the treatment of this comorbidity. Add subsections as needed. --&gt; ==<br /> <br /> === Medication&lt;!-- Describe medications used to manage this comorbidity. --&gt; ===<br /> <br /> <br /> <br /> The possible exception to this is sugammadex, which is administered to reverse neuromuscular blocking agents. Sugammadex encapsulates progesterone and reduces free progesterone levels in pharmacologic simulation studies [4]. This effect could be consequential, since progesterone is required for endometrial decidualization and uterine growth early in pregnancy, and myometrial quiescence and cervical structural integrity later in pregnancy (see &quot;Progesterone supplementation to reduce the risk of spontaneous preterm labor and birth&quot;, section on 'Rationale for progesterone supplementation').<br /> <br /> While the results of animal studies of miscarriage and teratogenicity of sugammadex are mixed [5,6], studies in humans have not reported complications. Although total numbers are insufficient to conclude that sugammadex is safe during pregnancy, there is a growing body of evidence of its efficacy and safety for nonobstetric surgery [7-9]. Thus, while the decision to use sugammadex should be individualized until more evidence on hormonal and teratogenic effects is available, the Society of Obstetric Anesthesia and Perinatology has recommended avoiding routine sugammadex use during pregnancy, and instead using other reversal agents [10]. (See &quot;Clinical use of neuromuscular blocking agents in anesthesia&quot;, section on 'Reversal of neuromuscular block'.)<br /> <br /> === Surgery&lt;!-- Describe surgical procedures used to treat this comorbidity. --&gt; ===<br /> <br /> === Prognosis&lt;!-- Describe the prognosis of this comorbidity --&gt; ===<br /> <br /> == Epidemiology&lt;!-- Describe the epidemiology of this comorbidity --&gt; ==<br /> <br /> == References ==<br /> <br /> [[Category:Comorbidities]]</div>

Nicholascorcoran https://wikianesthesia.org/w/index.php?title=Nonobstetric_Surgery_During_Pregnancy&diff=16538 2024-06-27T15:51:34Z

<p>Nicholascorcoran: Created the page</p> <hr /> <div>{{Infobox comorbidity<br /> | anesthetic_relevance = Medium<br /> | anesthetic_management = Nonobstetric anesthesia and surgery in pregnant women involves managing surgical procedures and anesthesia administration with specific considerations for both maternal and fetal safety.<br /> A complete discussion with patient, surgeon and obstetrician about timing, urgency and intraoperative monitoring is important.<br /> | specialty = Anesthesiology, Obstetric Anesthesiology<br /> | image = <br /> }}<br /> <br /> Nonobstetric anesthesia and surgery in pregnant women involves managing surgical procedures and anesthesia administration with specific considerations for both maternal and fetal safety. It's crucial due to the complexity of balancing the health needs of the pregnant patient with minimizing potential risks to the developing fetus. This topic underscores the importance of specialized medical care and interdisciplinary collaboration to ensure optimal outcomes for both mother and child during nonobstetric surgical interventions.<br /> <br /> == Surgical Considerations ==<br /> <br /> === Timing of Surgery ===<br /> Emergency surgery, which is urgently needed, should be performed irrespective of the trimester of pregnancy. <br /> <br /> Nonurgent surgeries, such as cholecystectomy for recurrent biliary obstruction without infection, are typically scheduled during the second trimester whenever feasible. <br /> <br /> According to societal guidelines, elective surgeries that are not urgent should generally be postponed until after delivery.<br /> <br /> ==== Rationale ====<br /> It's advisable to limit fetal exposure to surgery and medications during the first trimester of pregnancy, particularly during organogenesis, due to the inconclusive certainty surrounding the safety of many drugs in pregnancy. Additionally, caution is warranted because common adverse outcomes in the first trimester, such as miscarriage, vaginal bleeding, or fetal structural anomalies, could mistakenly be attributed to surgery and anesthesia without clear alternative causes.<br /> <br /> == Anesthetic implications&lt;!-- Briefly summarize the anesthetic implications of this comorbidity. --&gt; ==<br /> <br /> === Preoperative optimization&lt;!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --&gt; ===<br /> Pregnant patients needing surgery should undergo preoperative evaluation akin to nonpregnant patients. This involves documenting medical and obstetric history comprehensively, alongside a detailed airway assessment during physical examination. Additional laboratory tests should be conducted based on the patient's medical conditions and the planned surgery; however, uncomplicated pregnancies typically do not necessitate extra preoperative testing.<br /> <br /> === Intraoperative management&lt;!-- Describe how this comorbidity may influence intraoperative management. --&gt; ===<br /> <br /> ==== Fetal Monitoring ====<br /> One purpose of fetal monitoring is to identify concerning changes in the fetal heart rate (FHR) that may be influenced by reversible maternal factors not detectable through maternal monitoring alone. Even slight decreases in maternal blood pressure, oxygen levels, or uteroplacental blood flow can potentially affect fetal well-being. Interventions may include administering intravenous fluids, increasing oxygen levels, administering medications to raise maternal blood pressure, or adjusting maternal positioning. However, interpreting FHR patterns can be challenging during general anesthesia, as there is typically a decrease in beat-to-beat variability. Moreover, not all nonobstetric surgeries can be paused to facilitate emergency cesarean delivery, thus the exact benefit to the fetus remains uncertain.<br /> <br /> ===== When to perform =====<br /> The decision to perform intra-operative monitoring should be a group decision between the Patient, Attending Surgeon, Anesthesiologist, and Obstetrician. It should be based on factors such as gestational age, type of surgery, and available resources. It should be recognized that in certain situations: specific surgeries, anesthetics or medications may need to be given that can have negative effects on the FHR, but the ability to stop, pause of reverse the effects may not be possible to facilitate an emergency cesarean delivery. <br /> <br /> Society Guidelines recommend continuous monitoring of FHR in all viable fetuses (greater than 23 to 24 weeks of gestation) throughout surgery. The can be done via electronic FHR monitor or Doppler ultrasound. This is not always technically feasible due to positioning, type of surgery and location. At a minimum the FHR should be monitored preoperatively an post operatively for a period of time regardless of the gestational age. It should be recognized continuous FHR monitoring has not been shown conclusively to improve fetal outcome in women under general anesthesia.<br /> <br /> If the decision is made to perform Intraoperative, qualified personnel are required to be available to monitor and interpret the FHR throughout the surgery. This must be an obstetrician or clinician experienced in reading and evaluation FHR strips and under almost no circumstances should be the Anesthesiologist directing the patients anesthetic. If continuous monitoring is performed after 23 to 24 weeks gestation, Appropriate resources should be immediately available, including and obstetrician or clinician capable of performing an emergency C-Section. <br /> <br /> === Medications ===<br /> <br /> ==== General Anesthetics ====<br /> All general anesthetic drugs cross the placenta and may result in minimal or absent FHR variability<br /> <br /> A systematic review of four studies including 155 pregnant women undergoing nonobstetric surgery reported minimal or absent FHR variability in most tracings and a decrease in FHR baseline of 10 to 25 beats per minute for women under general anesthesia <br /> <br /> Additional criteria are necessary to identify non-reassuring fetal heart rate (FHR) patterns, such as persistent tachycardia without maternal fever, recurrent or prolonged FHR decelerations, repeated late decelerations, or a sinusoidal pattern. Before determining that an FHR tracing warrants emergency delivery, potential drug-induced causes should be ruled out. For instance, opioids and magnesium sulfate can reduce heart rate variability, butorphanol may produce a sinusoidal pattern, and beta blockers and atropine can elevate the FHR. The presence of moderate variability and/or FHR accelerations effectively rules out metabolic acidemia.<br /> <br /> ==== Antibiotics ====<br /> Whether antibiotic prophylaxis is required depends on the particular procedure being performed.<br /> <br /> Safe antibiotic options for pregnant women include cephalosporins, penicillins, erythromycin (excluding estolate), azithromycin, and clindamycin due to their favorable safety profiles. Aminoglycosides are generally safe but pose risks of fetal and maternal ototoxicity and nephrotoxicity.<br /> <br /> ==== Thromboprophylaxis ====<br /> The hypercoagulable state of pregnancy increases the risk of a thromboembolic event in the postsurgical period<br /> <br /> Pneumatic compression devices should be used or considered for all surgeries <br /> <br /> Tailor the decision to administer pharmacological prophylaxis according to the anticipated scope and duration of the procedure, as well as the patient's risk factors for venous thrombosis, including factors related to pregnancy (such as thrombophilia, prolonged immobilization, previous venous thrombosis, malignancy, diabetes mellitus, varicose veins, paralysis, maternal age, or obesity).<br /> <br /> ==== Glucocorticoid administration ====<br /> Administration of a course of antenatal glucocorticoids 24 to 48 hours prior to surgery for patients between 24 and 34 weeks of gestation can reduce perinatal morbidity/mortality if preterm birth occurs.<br /> <br /> The decision to give glucocorticoids, and potentially delay surgery for 24 to 48 hours, must balance the urgency of the surgery with the obstetrician's estimate of the risk of preterm birth because of the underlying disease or the planned procedure.<br /> <br /> === Postoperative management&lt;!-- Describe how this comorbidity may influence postoperative management. --&gt; ===<br /> <br /> ==== Maternal monitoring ====<br /> Similar to any postoperative monitoring, close monitoring of the airway and respiratory system is essential during the recovery from anesthesia, as significant anesthetic complications can arise during emergence or shortly after surgery. See other specific Post Anesthesia General Adult Recovery texts<br /> <br /> ==== Fetal assessment ====<br /> The FHR should be monitored in the recovery room, intermittently for previable fetuses, and continuously for the viable fetus. Uterine activity should also be monitored in cases in which the fetus is viable, as contractions are most likely to occur proximate to the procedure and as any tocolytic effect of general anesthetics wears off<br /> <br /> ==== Left Uterine Displacement ====<br /> Left lateral position or uterine displacement should be maintained until the patient is fully awake, alert, and able to adjust her own position.<br /> <br /> ==== Postoperative pain control ====<br /> A multimodal analgesia should be used for postoperative pain control for all patients. This should include nonpharmacologic methods of pain control, acetaminophen, regional anesthesia techniques, and local anesthetic infiltration. Opioids should be used on an as-needed basis. <br /> <br /> Nonsteroidal anti-inflammatory drugs (NSAIDs) should not be used routinely during pregnancy (particularly in the early first and late third trimesters) because of potential fetal effects.<br /> <br /> == Related surgical procedures&lt;!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --&gt; ==<br /> <br /> == Pathophysiology&lt;!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --&gt; ==<br /> <br /> == Signs and symptoms&lt;!-- Describe the signs and symptoms of this comorbidity. --&gt; ==<br /> <br /> == Diagnosis&lt;!-- Describe how this comorbidity is diagnosed. --&gt; ==<br /> <br /> == Treatment&lt;!-- Summarize the treatment of this comorbidity. Add subsections as needed. --&gt; ==<br /> <br /> === Medication&lt;!-- Describe medications used to manage this comorbidity. --&gt; ===<br /> <br /> === Surgery&lt;!-- Describe surgical procedures used to treat this comorbidity. --&gt; ===<br /> <br /> === Prognosis&lt;!-- Describe the prognosis of this comorbidity --&gt; ===<br /> <br /> == Epidemiology&lt;!-- Describe the epidemiology of this comorbidity --&gt; ==<br /> <br /> == References ==<br /> <br /> [[Category:Comorbidities]]</div>

Nicholascorcoran https://wikianesthesia.org/w/index.php?title=Heart_transplant&diff=16140 2024-01-30T17:36:44Z

<p>Nicholascorcoran: Small changes just to start this procedure</p> <hr /> <div>{{Infobox surgical procedure<br /> | anesthesia_type = <br /> | airway = <br /> | lines_access = <br /> | monitors = <br /> | considerations_preoperative = <br /> | considerations_intraoperative = <br /> | considerations_postoperative = <br /> }}<br /> <br /> Provide a brief summary of this surgical procedure and its indications here.<br /> <br /> == Preoperative management ==<br /> <br /> === Patient evaluation&lt;!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --&gt; ===<br /> {| class=&quot;wikitable&quot;<br /> |+<br /> !System<br /> !Considerations<br /> |-<br /> |Neurologic<br /> |<br /> |-<br /> |Cardiovascular<br /> |<br /> |-<br /> |Pulmonary<br /> |<br /> |-<br /> |Gastrointestinal<br /> |<br /> |-<br /> |Hematologic<br /> |<br /> |-<br /> |Renal<br /> |<br /> |-<br /> |Endocrine<br /> |<br /> |-<br /> |Other<br /> |<br /> |}<br /> <br /> === Labs and studies&lt;!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --&gt; ===<br /> <br /> === Operating room setup&lt;!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --&gt; ===<br /> <br /> === Patient preparation and premedication&lt;!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --&gt; ===<br /> <br /> === Regional and neuraxial techniques&lt;!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --&gt; ===<br /> <br /> == Intraoperative management ==<br /> All are General Recommendations and Considerations. Your comfortability, Surgeons, and hospital policies and practices will dictate the plan. <br /> <br /> === Monitoring and access&lt;!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --&gt; ===<br /> Large bore IV (18-gauge) placed in Pre-op. Can use this IV line to go to induce anesthesia and give pre-op medications. <br /> <br /> '''Arterial Access:'''<br /> <br /> Awake vs asleep Arterial Line, typically a radial arterial line. Surgeons may elect to place femoral arterial lines as well.<br /> <br /> '''Vascular Access:'''<br /> <br /> Once asleep: additional large bore access should be obtained: there is variation in practice here:<br /> <br /> * Double Stick right Internal Jugular<br /> ** Cordis 8.5F for large volume resuscitation and blood products<br /> ** Single or double lumen 16g Central line for infusions<br /> * Single Stick RIJ<br /> ** Cordis 8.5F or 9F<br /> ** 14 G or 16 G peripheral IV's <br /> * Consider Triple stick, RIC line and additional access, especially for redo-sternotomy cases <br /> <br /> '''Central monitoring:'''<br /> <br /> * CVP monitoring <br /> * Swan-ganz catheter placement is not unusual <br /> ** Occasionally may be placed after induction but left at only 20cm until the new heart is placed in the chest then floated into the Pulmonary Artery. <br /> ** Can be used to measure Cardiac Output and Cardiac index via Thermodilution <br /> <br /> === Induction and airway management&lt;!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --&gt; ===<br /> <br /> === Positioning&lt;!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --&gt; ===<br /> Typically Supine with bilateral Arms tucked at the side. <br /> <br /> === Maintenance and surgical considerations&lt;!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --&gt; ===<br /> <br /> === Emergence&lt;!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --&gt; ===<br /> <br /> == Postoperative management ==<br /> <br /> === Disposition&lt;!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --&gt; ===<br /> <br /> === Pain management&lt;!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --&gt; ===<br /> <br /> === Potential complications&lt;!-- List and/or describe any potential postoperative complications for this case. --&gt; ===<br /> <br /> == Procedure variants&lt;!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the &quot;Ω&quot; tool in the editor). --&gt; ==<br /> <br /> {| class=&quot;wikitable wikitable-horizontal-scroll&quot;<br /> |+<br /> !<br /> !Variant 1<br /> !Variant 2<br /> |-<br /> |Unique considerations<br /> |<br /> |<br /> |-<br /> |Position<br /> |<br /> |<br /> |-<br /> |Surgical time<br /> |<br /> |<br /> |-<br /> |EBL<br /> |<br /> |<br /> |-<br /> |Postoperative disposition<br /> |<br /> |<br /> |-<br /> |Pain management<br /> |<br /> |<br /> |-<br /> |Potential complications<br /> |<br /> |<br /> |}<br /> <br /> == References ==<br /> <br /> [[Category:Surgical procedures]]</div>

Nicholascorcoran