The American Society of Anesthesiologists (ASA)

Video-Assisted Thoracic Surgery

Performing thoracic surgery in non-mechanically ventilated patients requires extremely careful anesthetic management basically due to two physiological phenomena: Pendelluft and mediastinal shift (9). During the surgery, the nonoperated hemithorax receives a flow of inspiratory gas not

Anesthesiology, 2010

The 2010 Journal Symposium will highlight up-andcoming and noteworthy concepts in anesthesia research and clinical practice. Anesthesiologists have generally considered their work done and successful if patients were well a day or two after surgery. However, there is increasing evidence that perioperative management has the potential to influence patient outcomes weeks, months, and perhaps even years after surgery. This symposium will explore aspects of anesthetic care most likely to be associated with alterations in long-term outcome.

Anesthesia Progress, 2018

Cardiac arrest in the operating room and procedural areas has a spectrum of causes (eg, hypovolemia, gas embolism, and hyperkalemia) that are not directly reflected in the standard advanced cardiac life support (ACLS) recommendations. Rapid, appropriate evaluation and management of these causes require modification of the traditional algorithms. These events are almost always witnessed, are frequently known, and involve rescuer providers with knowledge of the patient and the procedure. In such a setting, there can be formulation of a differential diagnosis and a direct intervention that treats the likely underlying cause, resulting in concurrent resolution of the crisis. Similarly, periprocedural cardiac arrest (PPCA) can arise from other causes not addressed in the ACLS algorithms (eg, malignant hyperthermia, massive trauma, and local anesthetic toxicity). Formulation of an appropriate differential diagnosis and rapid, targeted interventions are critical for good patient outcomes. There is a growing body of literature describing the incidence, causes, treatment, and outcomes of PPCA. These narrative review articles provide expanded algorithms that incorporate both published evidence and expert opinion to aid the practicing anesthesiologist in addressing these crises. Comment: These narrative reviews were written to bridge the gap between traditional ACLS, which is targeted toward managing cardiac arrest in the community, and cardiac arrest in the operating room. The spectrum of causes of circulatory crisis and cardiac arrest in surgery may be different than anywhere else inside or outside of the hospital. For example, vagal responses to surgical manipulation, vagotonic anesthetics, anesthesia-induced sympatholysis, and neuraxial

Brazilian Journal of Anesthesiology, 2010

Background and objectives: Perioperative hypoxemia is common in cardiac surgeries, and atelectasis is the main cause. Besides, we can mention extracorporeal circulation (ECC), dissection of internal thoracic arteries, and previous clinical status of the patient among others as its causes. The present study elaborated an anonymous questionnaire to observe ventilatory strategies for hypoxemia in cardiac surgeries adopted by five thousand anesthesiologists all over the country. Methods: Questionnaires were sent via e-mail for five thousand anesthesiologists in Brazil. Results: Out of the questionnaires sent, 81 valid responses were received. Among the answers, 65 (80%) anesthesiologists use volume-controlled ventilation (VCV), while 16 (20%) prefer pressure-controlled ventilation (PCV). The tidal volume (Vt) used is lower than 10 mL.kg-1 , for 46 (61%) versus 20 (30%) who adopt a Vt greater than 10 mL.kg-1. Forty-seven (58%) use PEEP and 15 (21%) use FiO 2 above 60%. In the case of intraoperative hypoxemia, 20.9% increase or introduce PEEP, 70.3% increase the FiO 2 , 19.7% use alveolar recruitment maneuvers, 13.5% increase the tidal volume, and 20.9% check for the presence of failures in the anesthesia equipment. Responses were sent from 15 states. Conclusions: The conducts described in the questionnaires are compatible with those of the international literature. Adjusting the questionnaires format and the way to approach anesthesiologists, new studies could be undertaken.

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2012

Anesthesiology is on the cusp of an important transformation. To meet the growing demand for greater patient throughput, more efficient use of resources, and improved perioperative outcomes, the profession is adopting a new mandate. The goal this new mandate is to oversee perioperative clinical care-from preoperative assessment until discharge-and seamlessly integrate clinical and scientific discovery. The following three stories illustrate how this new mandate is being adopted. The first two address clinical care and research. The third is a tale from my own laboratory that illustrates the dynamic interplay between bench research and clinical practice. This notion of anesthesiologists providing comprehensive perioperative care founded on scientific discovery is not new but the time has come for this new mandate to be broadly implemented. Story 1: Rising to the challenge The extraordinary Canadian physician who convinced me that my life's work would be anesthesiology was Dr. Vincent Hughes (Fig. 1). Sadly, Dr. Hughes passed away unexpectedly in May 2011. I met Dr. Hughes in 1980 while working as a medical student at St. Jude Hospital in Vieux Fort, St. Lucia. Several days before I arrived in St. Lucia, the island was ravaged by Hurricane Allen, a category 5 storm. With winds of up to 300 kmÁhr-1 , the hurricane devastated the Caribbean region (Fig. 2), and the small town of Vieux Fort was particularly hard hit. The destruction was overwhelming: villages were destroyed, the death toll was high, and dead livestock contaminated the rivers that supplied water to the towns. St. Jude Hospital, which serves the entire southern region of St. Lucia, was severely damaged (Fig. 3). Airports and seaports were closed, and most of the country was left without power. The British Navy had moored a ship, the HMS Glasgow, in Vieux Fort harbour. The marines had established a command centre in the hospital cafeteria and were slowly opening the roads and transporting the injured back to St. Jude Hospital. At the time of my arrival, Dr. Hughes, a Canadian-trained anesthesiologist, was the only doctor available to treat the injured at the hospital. He rose to the challenge and worked tirelessly for several weeks. Each morning, he administered anesthesia in the operating rooms. From there, he went to the outpatient clinic to assist where needed and then wandered the wards to help in whatever way he could. On the pediatric wards, he started intravenous fluid therapy if required. On the surgical wards, he assisted the visiting surgeons, many of whom were unaccustomed to working in such limited medical facilities. After completing his clinical duties, he