WIN ANAESTHESIA

  Airway Response Teams Last updated:  05/08/2024 Key Points Emergency airway management (EAM) has a significant complication rate when performed outside the operating room. A team-based multidisciplinary approach is ideal for emergency airway management. Implementing an airway response team (ART) may help reduce morbidity, mortality, and significant complication rates in patients requiring EAM. Challenges of Emergency Airway Management  1 Critically ill patients in the hospital frequently require EAM. Despite advances in airway management and technology, the complication rate from EAM outside the operating room exceeds 45%. 1 Adverse events surrounding EAM are often multifactorial, including inconsistent communication among hospital staff, lack of defined roles during events, and provider unfamiliarity with techniques and equipment. Possible complications include hypoxemia leading to hypoxic brain injury, hypercarbia, alterations in blood pressure, temporomandibular join...

Cerebral Palsy Last updated:  05/15/2024 Key Points Patients with cerebral palsy (CP) often have developmental delays along with other comorbidities, including gastroesophageal reflux disease (GERD), chronic aspiration, immobility/contractures, pulmonary conditions, and epilepsy. Anesthetic issues commonly seen in patients with CP can include temperature control, challenges with positioning due to contractures, analgesic considerations, respiratory considerations, bleeding, varied developmental ability, and medication dosing variability. Additional postoperative challenges may include evaluation and effective pain management, spasticity, temperature control, and return to respiratory and neurological baseline. What is Cerebral Palsy? CP is a heterogeneous group of disorders with permanent motor dysfunction that affects muscle tone, posture, and/or movement. The incidence of CP is as high as 3.4 per 1,000 live births in pre-perinatal diagnoses for low- and middle-income countries. A...

Anesthesia for Patients with Liver Disease Last updated:  05/08/2024 Hemodynamic Stability Patients with hepatic dysfunction are at risk for circulatory instability; thus, maintaining hemodynamic stability is crucial. Invasive arterial blood pressure monitoring may be necessary to guide fluid management and vasopressor support, depending on the patient’s disease severity and the extent of the intended procedure. TEE may be a useful adjunct to assess cardiac function in patients with advanced liver disease. 2 Coagulation Management Coagulopathies should be assessed and addressed by using blood products such as fresh frozen plasma, cryoprecipitate, and platelets. The use of desmopressin should be considered to enhance platelet function. Depending on the extent of bleeding during the procedure, the clinician may consider the use of plasma-derived and recombinant clotting factor concentrates (e.g., fibrinogen concentrate, prothrombin complex concentrate, recombinant activated clotting ...