Journal of Clinical Anesthesia and Intensive Care

The protection of health care workers from nosocomial infection is a paramount consideration in the current pandemic involving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Not only is prevention of viral transmission the most effective means to lessen the public health impact of coronavirus disease 2019 (COVID-19), but also both quarantine and illness – that disproportionately affect health care workers – have devastating effects on the ability of hospitals to adequately care for increased patient loads.

As the soft tissue- air interface is virtually impenetrable to ultrasound, its utility for evaluating lung pathologies was historically thought to be unfeasible [1]. However, the observation of different artifacts and novel research into their interpretations has helped transform this dogma and develop lung ultrasound as a valuable diagnostic tool in pulmonary diseases.

Gastrointestinal endoscopic procedure is routinely utilized for diagnosis and treatment of gastrointestinal abnormalities. The optimal positioning for this procedure is to offer the best operative access while minimizing potential risk to the patient. Changing the patient's position could improve the probabilities of successful endoscopy. However, each position carries some degrees of risk and this is applied in each procedure. Commonly approved positions include lateral, prone and supine. This article addresses the common patient positions used for gastrointestinal endoscopic procedures.

Many drugs are effective systemically, but slow onset of non-intravenous routes of administration may limit their clinical utility. While anesthesiologists usually have intravenous (IV) access for drug delivery, other healthcare professionals in less controlled situations such as acute crises in the emergency room, critical care settings, or urgent needs in the community, may need non-invasive drug delivery [1].

We read with great interest the paper published by Jiang et al. [1]. They illustrated a case of cesarean scar molar pregnancy in which the patient complained of vaginal bleeding and amenorrhea, and the concentration of human chorionic gonadotropin (HCG) increased abnormally and eventually recovered following comprehensive therapy including suction evacuation, uterine arterial embolization (UAE), and chemotherapy. 

Multiple sclerosis (MS) is central nervous system (CNS) based disease. It is a chronic inflammatory demyelinating disease [1]. The main causes for MS are genetic and environmental factors. It is a disease of young people (median age of onset is around 28 years) but is lifetime and is often disabling; 50% of patients need a cane to walk 15 years after disease onset; and Worldwide more than 2.5 Million persons are affected.

Enhanced recovery after surgery (ERAS) is a comprehensive care protocol that incorporates evidence-based practices to achieve the most optimal postoperative outcomes, safe on-time discharge, and surgical cost efficiency. ERAS protocols have been adapted for specialty-specific needs and implemented by a variety of surgical disciplines including thoracic surgery.

U.S. health care spending grew 4.6 percent in 2018, reaching $3.6 trillion or $11,172 per person. For comparison, Switzerland the country with the second highest healthcare expenditure in the Organization for Economic Cooperation and Development (OECD) spent $7,280 per person.

Acute pain is defined as an unpleasant sensory and emotional experience associated with, or resembling actual or potential tissue damage as a result of a surgical procedure, physical trauma, or as a consequence of a medical condition [1]. The prevalence of moderate-severe pain, defined as pain which significantly interferes with daily living activities, ranges between 27% and 66% in hospitalized pediatric patients and remains inconsistent even in those institutions with excellent resources and good reputations [2,3].

Thyroid storm is a rare but potentially life-threatening form of thyrotoxicosis. The presence of excessive thyroid hormones leads to toxic direct and indirect effects on the cardiovascular system resulting in entity known as thyrotoxicosis-induced cardiomyopathy (TCM).

The craniovertebral junction is unique and the most complex of the axial skeleton in multiple aspects; embryology, anatomy, pathology and kinematics. A surgical physiological approach to management of its abnormalities was instituted at the University of Iowa Hospitals & Clinics (UIHC) in 1977 and has been the accepted treatment algorithm worldwide.

The purpose of this document is to provide a unique white paper on the use of different anesthetic drugs and the key clinical pearls for ensuring patient safety in humans. This paper is designed to be a convenient guide that can be placed in work rooms for residents and medical school trainees to improve their learning and to provide reminders about drug-drug interactions.

Awake fiberoptic intubation remains the safest approach to managing the Difficult Airway. It is a difficult, multi-step procedure that can be time-consuming if not performed frequently. Primitive cough and gag reflexes can be challenging to block quickly with topical anesthetics.

The COVID-19 pandemic presents unprecedented challenges for anesthesia professionals and their surgical patients. Beyond managing infection risk, positive COVID-19 surgical patients add additional challenges to their perioperative care, where its perioperative risk are superimposed onto an already baseline anesthesia risk in real-time with an unknown and unpredictable fashion.

Anesthesia and surgical interventions may induce cognitive impairments, such as postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) [1]. These dysfunctions particularly affect the elderly population [2] and increase morbidity and mortality thus representing a major burden for the healthcare system [1].

While opioids remain our most potent analgesics in the management of pain, the many potential harms of prescription opioids have become increasingly clear. Despite the analgesic benefits for people with acute and chronic pain [1], opioid therapy (especially long-term opioid treatment) can result in significant problems such as opioid misuse, the development of opioid use disorder, and overdose. Some authors report that up to 20-30% of patients in primary and tertiary care settings who are maintained on long-term opioid therapy misuse opioids (i.e., use them in a manner other than how the opioids are prescribed) [2,3]. Misuse of opioids can cause or exacerbate additional health problems in people with chronic pain [1,4], and in fact, roughly 10% of patients prescribed long-term opioid therapy may develop an opioid use disorder (OUD), although prevalence varies between studies depending on differences in methodology and operational definitions [3]. 

Aortic aneurysm rupture is typically the failure of the aortic wall to withstand the tension placed upon it by a patient’s blood pressure. Along with clinical judgement and an assessment of signs and symptoms, a computed topography angiogram (CTA) is amongst the first line of diagnostic studies having 87-94% sensitivity for rupture. Therefore, while the possibility of a CTA not catching an aortic rupture is present, the chance is very low. Usually a missed or delayed diagnosis for this type of pathology is catastrophic resulting in patient death. We present the case report of a 68-year-old male with a contained aortic rupture that was initially missed on CTA.

The case study describes a rare and maybe fatal consequence of coronary stent infection (CSI), with an emphasis on the rise in occurrence over the last decade [1]. In order to enhance patient outcomes, the authors stress the need for early recognition and proper medical and surgical management. Coronary artery disease (CAD) is a serious global health concern, with an estimated 126 million people worldwide suffering from it. In addition, CAD caused millions of fatalities in 2017 [2].

Historically, the management of complex aortopathies was limited to open surgical repair, which carries a heightened risk of mortality and morbidity in elderly and comorbid patients [1]. In recent years, advancements in the management of complex aortic arch and descending thoracoabdominal aortic pathologies have increased treatment options for frail and elderly patients unamenable to conventional open repair. Among these, hybrid arch repair (HAR) with simultaneous or staged thoracic endovascular repair (TEVAR) has emerged as a viable option for this population.

Background: Maternal hemorrhage represents the most prevalent complication and primary cause of mortality during childbirth. Extensive studies have elucidated noteworthy correlations between ABO blood type and cardiovascular disease risk in both genders. Notably, individuals with blood type O exhibit a substantial variation in the formation of the platelet plug on vascular lesions, accompanied by a reduction in von Willebrand factor.