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Anaesthesiology

This category is dedicated to the advancement of research in all topics related to Anaesthesia and Intensive Care.

Gallbladder Removal Through the Mouth Causes Few Adverse Effects

Surgeons from the Legacy Health System in Portland, Oregon, and Northwestern University in Chicago, Illinois, reported on the first 7 transgastric natural orifice transluminal surgery (NOTES) cholecystectomies ever performed on humans here at the Society of American Gastrointestinal and Endoscopic Surgeons 2008 Annual Scientific Session and Postgraduate Course.

Read more: Gallbladder Removal Through the Mouth Causes Few Adverse Effects

New Protocol Reduces Risk for Thromboembolism

Rates of venous thromboembolism (VTE) dropped significantly at a large university medical center thanks to a new protocol that identifies high-risk patients, according to findings presented here at Hospital Medicine 2008, the annual meeting of the Society of Hospital Medicine.

Read more: New Protocol Reduces Risk for Thromboembolism

Cauterizing Arteries in Laparoscopic Cholecystectomy Can Be Both Unnecessary and Dangerous

Almost since the inception of laparoscopic cholecystectomy, surgeons have been employing devices that concentrate electrical or vibrational energy to heat and thereby cauterize arteries. However, for more than 7 years, Brij Agarwal, MD, MBBS, MS, and colleagues have been avoiding the use of these energy devices. Dr. Agarwal is a senior surgeon at Sir Ganga Ram Hospital in New Delhi, one of India's leading hospitals.

Read more: Cauterizing Arteries in Laparoscopic Cholecystectomy Can Be Both Unnecessary and Dangerous

Laparoscopic Liver Resection

  • Written by Edgar J. Figueredo, MD; Raymond S. Yeung, MD
  • Category: Anaesthesiology

Introduction

Laparoscopic surgery of the liver can be traced to wedge liver biopsies performed as part of a laparoscopic staging procedure for lymphoma.[1] The first laparoscopic nonanatomic resection of a focal nodular hyperplasia (FNH) was reported by Gagner and colleagues[2] in 1992, and this was followed by the first report of laparoscopic anatomic liver resection in 1996.[3] Since this time, improvements in laparoscopic devices have significantly extended the surgeon's ability to perform these procedures safely, as reflected in recent publications.[4]

A multidisciplinary Liver Tumor Clinic at the University of Washington Medical Center has been involved in the care of more than 1500 patients with benign and malignant liver tumors since 1996, with more than 200 open resections and an equal number of laparoscopic radiofrequency ablations in the experience of the senior author. We have recently started a program in laparoscopic liver resection.

Read more: Laparoscopic Liver Resection

Congress passes “skinny” Medicare payment bill and averts SGR cut through June 2008

Unable to reach consensus on a meaningful Medicare reform package, Congressional leaders and the Bush Administration have cobbled together a last–minute, barebones package to temporarily avert the 10% across-the-board Medicare physician payment cut scheduled to take effect on January 1, 2008.  President Bush is expected to sign the bill into law soon.

Read more: Congress passes “skinny” Medicare payment bill and averts SGR cut through June 2008

Noninvasive Positive Pressure Ventilation Improves Hypercapnia in Cystic Fibrosis

Nocturnal noninvasive positive pressure ventilation (NIV) reduces hypercapnia, improves symptoms, and increases exercise capacity in patients with cystic fibrosis (CF), according to a report in the January issue of Thorax.

Read more: Noninvasive Positive Pressure Ventilation Improves Hypercapnia in Cystic Fibrosis

Opioid and Nonopioid Therapies for the Management of Pain

Lynn R. Webster, MD, FACPM, FASAM     
Introduction
The evolving need of pain patients for safe, effective analgesia is driving research into new therapeutic modalities and fresh approaches to familiar treatments. Innovation, involving both opioid and nonopioid pain therapies, dominated discussion at the 23rd Annual Meeting of the American Academy of Pain Medicine held February 7-10 in New Orleans, Louisiana. Because some patients fail to achieve a good outcome with opioid therapy, nonopioid medications and interventions are receiving greater research attention. Opioids are also the subject of new exploration, most of this directed toward separating desired analgesia from unwanted side effects such as euphoria, tolerance, abuse risk, and constipation.

Read more: Opioid and Nonopioid Therapies for the Management of Pain

Guidelines for Perioperative Cardiovascular Evaluation for Patients Considering Noncardiac Surgery

The American College of Cardiology (ACC) and American Heart Association (AHA) have issued a new guideline (last published in 2002) on the perioperative cardiovascular evaluation for patients considering noncardiac surgery. The new algorithm is simpler and gives clinicians more latitude in individualizing decisions, but does not apply to patients who require emergency surgery or who have active cardiac problems that require urgent intervention (such as unstable coronary syndromes, decompensated heart failure, arrhythmias, or valvular disease). Some highlights of the new guideline include the recommendations on non-invasive stress testing prior to noncardiac surgery which include:
Testing is not useful for patients undergoing low risk surgery, or for patients undergoing intermediate risk surgery with no clinical risk factors.

Read more: Guidelines for Perioperative Cardiovascular Evaluation for Patients Considering Noncardiac Surgery

Changing the Paradigm of Anticoagulation Management

Dr. AncellDr. Ansell
Interview: Jack Ansell, MD
Professor of Medicine
Boston University School of Medicine
Vice Chairman for Clinical Affairs
Department of Medicine
Boston University Medical Center
Boston, Massachusetts

Medscape had the opportunity to discuss laboratory and office-based anticoagulation monitoring with Jack Ansell, MD, Professor of Medicine, Boston University School of Medicine, and Vice Chairman for Clinical Affairs, Department of Medicine, Boston University Medical Center in Boston, Massachusetts. Dr. Ansell is the founder and past president of the Anticoagulation Forum.

Read more: Changing the Paradigm of Anticoagulation Management

Fatal Cardiac Tamponade as a Result of a Peripherally Inserted Central Venous Catheter

Fatal Cardiac Tamponade as a Result of a Peripherally Inserted Central Venous Catheter: A Case Report and Review of the Literature

R. M. L'E. Orme; M. M. McSwiney; R. F. O. Chamberlain-Webber
Abstract and Introduction
Abstract

We present a case of fatal cardiac tamponade that occurred in association with a peripherally inserted central catheter (PICC) inserted from the right antecubital fossa. Migration of the catheter from the right atrium within 24 h of insertion lead to the administration of a potassium-enriched sodium chloride solution into the pericardial space with the development of ST-segment elevation and progression to pulseless electrical activity and, subsequently, ventricular fibrillation.

Read more: Fatal Cardiac Tamponade as a Result of a Peripherally Inserted Central Venous Catheter

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