Περιγραφή
In recent years anesthesiologists have developed a more active role in the entire peri-operative period-from the decision for surgery, through recovery, discharge and beyond. In addition, the core training curriculum of anesthesiology has changed significantly to now include many non-operating room anesthesia rotations.General anesthesiology texts include varying degrees of perioperative management information, and a few titles are devoted specifically to the area. However, none combines a problem-based approach with review questions and answers with explanations.
Following the format of the Anesthesiology Problem-Based Learning Approach series, each chapter in Perioperative Medicine describes a specific condition or situation and a virtual case presented through a series of questions and answers. With 48 chapters covering a broad array of conundrums encountered in clinical perioperative medicine, the text focuses on preoperative optimization of patients with different comorbidities, such as coronary artery disease, heart failure, chronic obstructive pulmonary disease, obstructive sleep apnea, diabetes mellitus, cirrhosis, substance use disorder, and anemia. Sections on how to choose preoperative tests, medication management, and handling ethical issues, like informed consent, DNR, and uncomfortable conversations with patients, are discussed in detail.
Perioperative Medicine: A Problem-Based Learning Approach provides an up-to-date compendium of topics commonly presenting in daily practice and serves as a unique learning opportunity for the busy perioperative clinician approaching a new case and for clinicians in training who need to learn the basics.
Περιεχόμενα
General
1. This patient has 17 allergies – including “general anesthesia”
2. Choosing a preoperative process
3. Perioperative surgical home care model – utopia or bureaucracy
Preoperative Assessment
4. Choosing wisely: how to advise the patient on preoperative testing
5. My 79 year old patient for right inguinal hernia repair has no labs on file
6. Medication management – Drug eluting stent 2 months ago
7. Medication management – Substance use disorder
8. Indications for preoperative C-spine imaging for elective procedures
9. Prehabilitation before total hip replacement
10. Cardiopulmonary exercise testing (CPET)
Age
11. Ex-premie for interval hernia repair at 11 weeks
12. Geriatric assessment – “the get up and go, got up and left”
Organ Systems
Cardiac
13. AHA guidelines application
14. Perioperative atrial fibrillation and anticoagulation management
15. Severe aortic stenosis – candidate for a surgicenter?
16. Does your cataract surgeon know you were admitted for heart failure last week?
17. Echo shows elevated pulmonary artery pressure
Pulmonary
18. COPD – still smoking, still wheezing
19. Severe OSA in the ambulatory setting
20. Covid-19
Gastrointestinal
21. Cirrhosis and truly elective major surgery
Neurological
22. Patient has seizures and needs “clearance”
23. Clinical Application of Perioperative Brain Health
24. Restrictive lung disease from Parkinson’s disease rigidity – is it real?
25. 56 year old with a recent CVA for elective surgery – how soon is too soon?
Renal
26. Avoiding exacerbation of chronic kidney disease
Hematology
27. Preoperative anemia management – evaluation and treatment
28. Prolonged PTT in a healthy patient
Endocrine
29. Elevated glucose on admission fingerstick – how high can we go?
30. Pheochromocytoma and MEN syndromes
Other Comorbidities
31. Pregnant patient for non-obstetric surgery
32. Older primigravida with twin pregnancy for elective cesarean delivery
33. Shoulder replacement in patient who had a heart – lung transplant
Surgical Considerations
34. Minimally invasive surgery and other elements of enhanced recovery protocol
35. Blood conservation
Ethics & Shared Decision making
36. When DNR stands in the OR
37. Informed consent – do we really do this correctly?
38. Can I refuse to anesthetize this patient?
39. Difficult conversations
Miscellaneous
40. Non-verbal autistic 30 year old for full mouth dental rehabilitation with MH
41. Patient with AAA with implanted spinal cord (neuro) stimulator
42. Patient with pacemaker dependent ICD for renal cryoablation
43. My friend’s son requests surgery for gynecomastia – caused by the drugs he uses for bodybuilding
44. Perioperative care of the cancer patient
PACU
45. Discharge criteria in developmentally disabled patient with OSA
46. My patient is twitching like a fish out of water
47. My patient in the PACU is not making any sense
48. The HR monitor is alarming in the PACU
