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1
Preston, Flanigan D., ed. Perioperative assessment in vascular surgery. New York: Dekker, 1987.
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Shils, Jay L., Sepehr Sani, Ryan Kochanski, Mena Kerolus y Jeffrey E. Arle. Recording Techniques Related to Deep Brain Stimulation for Movement Disorders and Responsive Stimulation for Epilepsy. Editado por Donald L. Schomer y Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0038.
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Neuromodulation therapies are now common treatments for a variety of medically refractory disorders, including movement disorders and epilepsy. While surgical techniques for each disorder vary, electricity is used by both for relieving symptoms. During stereotactic placement of the stimulating electrode, either deep brain stimulation electrodes or cortical strip electrodes, intraoperative neurophysiology is used to localize the target structure. This physiology includes single-unit recordings, neurostimulation evoked response evaluation, and intracranial electroencephalography (EEG) to ensure the electrode leads are in the optimal location. Because the functional target for the responsive neurostimulator is more easily visualized on preoperative magnetic resonance imaging, intraoperative physiology is used more as a confirmatory tool, in contrast to the more functional localization-based use during electrode placement for movement disorders. This chapter discusses surgical placement of the electrodes for each procedure and the physiological guidance methodology used to place the leads in the optimal location.
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Abatzis, Vaia T. y Edward C. Nemergut. Transsphenoidal/Pituitary Surgery. Editado por David E. Traul y Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0004.
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Patients with tumors of the pituitary gland represent a heterogeneous yet commonly encountered neurosurgical population. Optimal anesthetic care requires an understanding of the complex pathophysiology secondary to each patient’s endocrine disease. Although patients presenting with Cushing’s disease and acromegaly have unique manifestations of endocrine dysfunction, all patients with tumors of the pituitary gland require meticulous preoperative evaluation and screening. There are many acceptable strategies for optimal intraoperative anesthetic management; however, the selection of anesthetic agents should be tailored to facilitate surgical exposure, preserve cerebral perfusion and oxygenation, and provide for rapid emergence and neurological assessment. Postoperatively, careful monitoring of fluid balance and serum sodium is essential to the early diagnosis of diabetes insipidus (DI). DI is most often transient but can require medical therapy. A thorough understanding of the preoperative assessment, intraoperative management, and potential complications are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.
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Cleary, Georgia y David Spalton. Cataract. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199237593.003.0006.
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The chapter begins by discussing lens anatomy and embryology, before covering the key areas of clinical knowledge, namely acquired cataract, clinical evaluation of acquired cataract, treatment for acquired cataract, intraoperative complications of cataract surgery, infectious postoperative complications of cataract surgery, non-infectious postoperative complications of cataract surgery, congenital cataract, management of congenital cataract, and lens dislocation. Practical skills are then covered, including biometry, local anaesthesia, operating microscope and phacodynamics, intraocular lenses, and Nd:YAG laser capsulotomy. The chapter concludes with three case-based discussions, on age-related cataract, postoperative endophthalmitis, and posterior capsular opacification.
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Flachskampf, Frank A., Mauro Pepi y Silvia Gianstefani. Transoesophageal echocardiography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0006.
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Transoesophageal echocardiography (TOE) is a standard echocardiographic technique which uses the oesophagus and upper stomach as echo windows on the heart and thoracic vessels via an endoscopic probe. It is indicated when transthoracic echocardiography is unable or unlikely to answer the clinical question. Typical indications where TOE has a proven superiority include diagnosis of left atrial thrombi, especially in the appendage, morphological evaluation of atrial septal defect, infective endocarditis, mitral valve disease, aortic and prosthetic valves, aortic diseases, and intraoperative monitoring of cardiac surgery or interventions. Indications, technique, typical views, and information to obtain in specific scenarios are presented.
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Starker, Elizabeth Q., Staci N. Allen y Debnath Chatterjee. Anesthesia for Adolescent Bariatric Surgery. Editado por Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi y Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0064.
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The growing epidemic of childhood obesity has resulted in an increasing number of obese children presenting for a wide range of surgical procedures. Bariatric surgery is gaining popularity as a valid treatment option in severely obese adolescents in whom life style interventions are not successful. The perioperative management of these patients pose several anesthetic challenges. The role of the anesthesiologist in the multidisciplinary model is outlined in this chapter. A case-based approach focuses on the preoperative evaluation, intraoperative anesthetic considerations, appropriate drug dosing, and recommended strategies for postoperative monitoring and analgesia. Common complications encountered during these procedures are also discussed.
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Chen, Martin y Muoi Trinh. Cardiogenic Shock. Editado por Matthew D. McEvoy y Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0010.
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Heart failure and cardiogenic shock are important causes of perioperative morbidity and mortality that require prompt recognition prior to the institution of specialized monitoring and treatment, including the consideration of circulatory assist devices. Patients at risk for perioperative heart failure require special consideration with respect to preoperative evaluation, medical optimization prior to proceeding with surgery, and monitoring throughout the perioperative period. The intraoperative and postoperative management need to be carefully planned in order to avoid the development of acute decompensated heart failure and cardiogenic shock. This chapter reviews the perioperative assessment and management of heart failure patients as well as the management of perioperative cardiogenic shock.
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Burgart, Alyssa M. y Louise K. Furukawa. Perioperative Care of Patients with Epidermolysis Bullosa. Editado por Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi y Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0065.
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Inherited epidermolysis bullosa comprises a group of rare, serious conditions affecting multiple organ systems. While generally referred to as a dermatologic condition, any organ with an epithelial surface is affected, leading to serious extracutaneous manifestations. These have wide-ranging implications for anesthetic management, including airway management, vascular access, skin protection, and effective pain control. A successful and safe patient experience requires thoughtful evaluation, communication with a multidisciplinary team, anesthetic planning, intraoperative management, and postoperative care. The scenario in this chapter takes readers through a series of questions to enhance their understanding of the disease and how to address common anesthetic problems. Particular attention is paid to suggested monitor modification.
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Saasouh, Wael y David E. Traul. Extracranial-Intracranial Bypass. Editado por David E. Traul y Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0010.
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Extracranial-intracranial (EC-IC) bypass is a surgical procedure used to preserve or rescue cerebral circulation when the arterial supply is disrupted. There are several techniques of EC-IC bypass depending on the location of the anomaly and the vessels involved, the purpose being to provide a connection from a patent extracranial artery to an artery within the cranium, thus bypassing the anomalic or thrombosed portion. The mainstay of the anesthetic management of this procedure includes careful preoperative evaluation, meticulous intraoperative management, and close postoperative observation. Intracranial bleeding and hyperperfusion after the procedure are the two principal concerns, and proper management strategies should be in place for all cases.
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Koht, Antoun y Tod B. Sloan. Neurophysiologic Monitoring. Editado por David E. Traul y Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0028.
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Intraoperative neurophysiologic monitoring is used for monitoring and mapping of neurological structures during surgery and procedures where the neurological structures are at risk. Among the most commonly used techniques are electrophysiologic techniques, which include spontaneous and evoked electromyography, somatosensory evoked potentials, motor evoked potentials, electroencephalography, and auditory brainstem responses. These methods differ in their responses to anesthesia and in their clinical contribution to monitoring because of differing anatomy. Their use in spinal corrective surgery highlights the role of the anesthesiologist during cases when these techniques are utilized. Optimization of anesthesia, position, and physiology provide better monitoring conditions, enhance signal evaluation, and may lead to better neurological outcome.
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Cleary, Georgia y Allon Barsam. Cataract. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199672516.003.0003.
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This chapter focuses on cataract, which is the pathological opacification of the crystalline lens. Cataract is an important cause of visual impairment and blindness worldwide, in both developed and developing countries. Fortunately, acquired cataract is a reversible cause of visual impairment and, in developed countries, cataract surgery is the most commonly performed elective surgical procedure. This chapter outlines lens anatomy and embryology, along with clinical knowledge areas that include acquired cataract (clinical evaluation and treatment), intraoperative and post-operative (infectious and non-infectious) complications of cataract surgery, and lens dislocation. Practical skills, including biometry, local anaesthesia, implantation of intraocular lenses, and Nd:YAG laser capsulotomy, are also discussed.
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Burbano-Vera, Nelson y Annette Y. Schure. Pediatric Heart Transplantation. Editado por Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi y Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0013.
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Pediatric heart transplantation is a well-established treatment for complex congenital heart defects or severe heart failure in children of all ages. Sophisticated bridging therapies (ventricular assist devices, home inotropic support, etc.) and improved survival rates have increased the likelihood for pediatric anesthesiologists to encounter patients on the waiting list or at various times after heart transplantation, not only in the cardiac catheterization suite or the operating rooms but also for other diagnostic studies or noncardiac surgery. A thorough understanding of indications, altered physiology, and specific challenges is essential for the safe anesthetic management of these patients. This chapter highlights important steps during the preoperative evaluation, typical intraoperative problems, and management strategies for pediatric heart transplant patients.
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Sharma, Deepak y Julia Metzner. Nontraumatic Intracranial Hemorrhage. Editado por Matthew D. McEvoy y Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0062.
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Nontraumatic subarachnoid, intraventricular, or intraparenchymal hemorrhage can be caused by either rupture of an aneurysm or arteriovenous malformation or by coagulopathy, hypertension, or vasculitis. Pituitary apoplexy results from spontaneous hemorrhage or infarction into a pituitary tumor. Additionally, anesthesiologists must be prepared to manage intraoperative bleeding during craniotomies. Successful management of nontraumatic intracranial hemorrhage requires (1) careful preoperative evaluation and preparation considering extracranial manifestations of intracranial bleeding; (2) administration of balanced anesthesia to facilitate surgical exposure and neurophysiological monitoring; (3) maintenance of cerebral perfusion by preserving circulating volume, judicious use of blood product transfusion and vasopressors, and avoidance of excessive hyperventilation; and, when possible, (4) providing timely emergence from anesthesia to allow neurological assessment. Close communication between the surgical and anesthesia teams is critical for optimizing the potential for good patient outcomes.
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Howell, Valerie L., Margaret M. Collins y Lauryn R. Rochlen. Anesthesia for Posterior Fossa Mass. Editado por David E. Traul y Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0002.
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Lesions of the posterior fossa provide challenges for both anesthesiologists and surgeons due to this intracranial cavity’s rigid boundaries, minimal compliance, and vital neuronal contents. Common surgeries in the posterior fossa include excision of tumors, correction of congenital and acquired craniovertebral junction anomalies, and relief of pressure on the brainstem. Symptoms can present acutely and are most commonly due to compression of brain components, obstruction of cerebrospinal fluid, or increased intracranial pressure. Careful planning of the anesthetic is important to prevent exacerbation of preexisting symptoms or pathology, optimize the surgical resection, and aid in the quick diagnosis of postoperative complications. A variety of complications may occur in the perioperative period, many of which are unique to the posterior fossa or surgical approach. Anesthetic management focuses on prevention of common complications, maintenance of hemodynamic stability, facilitation of intraoperative neurophysiologic monitoring. and early postoperative neurologic evaluation through timely emergence.
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Mills, Kerry R., ed. Oxford Textbook of Clinical Neurophysiology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.001.0001.
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The Oxford Textbook of Clinical Neurophysiology provides a comprehensive account from world experts of the modern practice of the specialty. It deals with the full range of techniques giving the underpinning basic science and clinical use. The importance of clinical skills, as well as technical expertise are emphasized. Section I reviews the physiology of nerve, muscle, and cortex, and the digital techniques used to study them. Section II discusses the techniques for nerve conduction, electromyography (EMG), electroencephalography (EEG), magnetoencephalography, evoked potentials, and transcranial magnetic stimulation, including axonal excitability measurement, reflex studies, sleep studies pelvic floor neurophysiology and intracranial EEG. Section III reviews focal and generalized neuropathy, nerve, root, and plexus lesions, neuromuscular junction disorders, muscle disease, paediatric conditions, neurodegenerations, such as amyotrophic lateral sclerosis and EMG-guided botulinum toxin therapy. Section IV reviews generalized and focal epilepsy, status epilepticus, coma, presurgical evaluation for epilepsy, syncope, paediatric conditions, sleep disorders and intraoperative monitoring. This title incudes video content and is written for trainees and trainers in clinical neurophysiology.
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Rubin, Devon I. y Jasper R. Daube. Clinical Neurophysiology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190259631.001.0001.
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Clinical neurophysiologic testing is an important component of evaluating patients with complaints that may be attributed to diseases of the central or peripheral nervous system. This classic volume in the Contemporary Neurology Series covers the basic concepts underlying each of the testing techniques and provides comprehensive descriptions of the methods and wide range of electrophysiologic testing available for patients with epilepsy, neuromuscular diseases, movement disorders, demyelinating diseases, sleep disorders, autonomic disorders and those undergoing orthopedic and neurosurgical procedures. This text details the role of each study, the interpretation of findings, and their application clinical problems. This text describes the multiple diagnostic procedures for diverse diseases of the neuromuscular system, including: electroencephalography (EEG); electromyography and nerve conduction studies; single fiber EMG; polysomnography; surface EMG patterns, blood pressure, pulse, sweat measures; vestibular function testing; deep brain stimulator physiology; and intraoperative monitoring. It is a practical textbook for neurologists, physiatrists and clinical neurophysiologists in clinical or research practice or in training. Key features of the new edition include fully updated chapters to reflect new research and techniques in clinical neurophysiology; updated images illustrating key elements of techniques and basic concepts; case examples for practical application.