Julie R. McSwain

Characteristics and intraoperative treatments associated with head and neck free tissue transfer complications and failures.

Objective To investigate the association between perioperative patient characteristics and treatment modalities (eg, vasopressor use and volume of fluid administration) with complications and failure rates in patients undergoing head and neck free tissue transfer (FTT). Study Design A retrospective review of medical records. Setting Perioperative hospitalization for head and neck FTT at 1 tertiary care medical center between January 1, 2009, and October 31, 2011. Subjects and Methods Consecutive patients (N = 235) who underwent head and neck FTT. Demographic, patient characteristic, and intraoperative data were extracted from medical records. Complication and failure rates within the first 30 days were collected Results In a multivariate analysis controlling for age, sex, ethnicity, reason for receiving flap, and type and volume of fluid given, perioperative complication was significantly associated with surgical blood loss (P = .019; 95% confidence interval [CI], 1.01-1.16), while the rate of intraoperative fluid administration did not reach statistical significance (P = .06; 95% CI, 0.99-1.28). In a univariate analysis, FTT failure was significantly associated with reason for surgery (odds ratio, 5.40; P = .03; 95% CI, 1.69-17.3) and preoperative diagnosis of coronary artery disease (odds ratio, 3.60; P = .03; 95% CI, 1.16-11.2). Intraoperative vasopressor administration was not associated with either FTT complication or failure rate. Conclusions FTT complications were associated with surgical blood loss but not the use of vasoactive drugs. For patients undergoing FTT, judicious monitoring of blood loss may help stratify the risk of complication and failure.

Intraoperative goal-directed hemodynamic management in free tissue transfer for head and neck cancer

The purpose of this study was to determine the effect of algorithmic physiologic management on patients undergoing head and neck free tissue transfer and reconstruction.

Anesthesia for Common Nonoperating Room Procedures in the Geriatric Patient

Growth in geriatric procedures and the increasing need for sedation in elderly patients both inside the operating room and in remote locations (nonoperating room anesthesia, or NORA) has grown considerably in recent years. In addition, older patients are more sensitive to anesthetics. When compared to younger patients, older patients have more complications such as hypoxia, hypotension, cardiac events, aspiration, agitation and confusion. Because of this, sedation with short-acting agents at lower doses is often preferable. Positioning, monitoring, administration of anesthetic medications, and communication become even more challenging in an unfamiliar and often dark environment. In this chapter, perioperative anesthetic and sedation strategies are examined for gastrointestinal endoscopy, ECT treatment, and cataract surgery in the elderly. While these procedures are generally low risk, specific geriatric care considerations are required.

Geriatric Anesthesiology: Where Have We Been and Where Are We Going?

Geriatric anesthesiology is an emerging, important area more narrowly focused on the art, science, pharmacology, and physiology pertaining to the elderly surgical population. Geriatric medical care has evolved from an empiric discipline in the 1950s and 1960s to a largely evidence-based practice today. This introductory chapter presents some of the foundational concepts of geriatrics and a general approach to caring for geriatric patients presenting for surgery. The burgeoning elderly population has some very specific implications for anesthesiologists which are outlined in this chapter but covered extensively in more detail throughout the textbook. Finally, the history of geriatric anesthesia and educational concerns and opportunities related specifically to geriatric anesthesia are briefly described.

Neuraxial hypothermia incidence misinterpreted

We readwith interest the recent systematic review by Shaw et al. [1] and applaud the authors for discussing the prevalence of perioperative hypothermia in patients receiving neuraxial anesthetics. However, we have concerns that they have inaccurately interpreted the data of a 2017 publication by Frisch et al. [2] examining hypothermia in patients undergoing total hip and knee arthroplasty, a population that often receives neuraxial anesthesia. When describing the Frisk et al. study, the Shaw et al. publication states that “those receiving neuraxial anesthesia were more likely to be hypothermic than those receiving general anesthesia (52% vs. 48%, p b 0.001).” This is, in fact, not accurate. Table 2 within the Frisch et al. study does list that 52% of hypothermic patients had regional anesthesia; however, the vastmajority of patients received regional anesthesia over general anesthesia (64% vs. 36%, respectively). Thus, 457 patients out of 1541 patients in the regional anesthetic group developed hypothermia (30%), compared to 430 patients out of 856 patients in the general anesthetic group (50%). In calculating an odds ratio, we estimate that patients who received general anesthesia had 2.4 times the odds of developing hypothermia relative to patients who received regional anesthesia (p b 0.001, 95% CI: 2.01–2.84). We emphatically agree that hypothermia does occur in patients receiving neuraxial anesthesia, and it is a potentially modifiable variable to study in this

Hip Hemiarthroplasty in Two Patients with Severe Aortic Stenosis: Ethical Questions from an Anesthesiologist's Perspective.

As the population ages, geriatric patients with preexisting cardiac disease are presenting for noncardiac surgery in escalating numbers. The decision to proceed with surgery in such patients often is multifactorial. With this in mind, we describe 2 patients with severe aortic stenosis who required hip operations: one urgent and one elective. Both patients had different anesthetic plans and did well intraoperatively. However, both patients died postoperatively because of their comorbidities. Although published guidelines are sparse, we hope this report will increase awareness and discussion about caring for geriatric patients with severe aortic stenosis.