This issue of Anesthesiology Clinics covers essential topics in the post anesthesia care unit. Management of pain, delirium, acute renal failure, arrhythmias, and several post anesthesia complications are covered. Both adult and pediatric issues are addressed.

This issue of Anesthesiology Clinics covers the latest updates in thoracic anesthesia written by the world-leading experts on the topic. Procedurally-focused articles cover best practices in anesthestic management of one-lung ventilation, airway stenting, esophagectomy, mediastinal biopsies, postthoracotomy atrial fibrillation, and more. Achieve the best outcomes and reduce risks and complications in your thoracic anesthesia practice.

This issue of Anesthesiology Clinics brings the reader up to date on the most important advances in surgical palliative care for anesthesiology intensivists. Topics covered include recent trends and developments, palliative care of patients on high doses of narcotics, trauma in the surgical ICU, care of family in the surgical ICU, communication skills in palliative surgery, surgical palliative care in Haiti, and much more.

This cutting-edge issue of Anesthesiology Clinics is divided into two sections.? The first covers topics in perioperative clinical information systems (IS), including the following.? The anatomy of an anesthesia information management system; vendor and market landscape; impact of lexicons on adoption of an IS; clinical research using an IS, real-time alerts and reminders using an IS; shortcomings and challenges of IS adoption; creating a real return-on-investment for IS implementation (life after HITECH); Quality improvement using automated data sources and reporting; and opportunities and challenges of implementing an enterprise IS in the OR.? Section 2 is devoted to computers and covers the following topics.? Advanced integrated real-time clinical displays; enhancing point-of-care vigilance using computers; and computers in perioperative simulation and education.

In this issue of Anesthesiology Clinics, Guest Editors Pratik Panharipande and Wesley Ely look at modern sedation techniques in the critically ill. Topics include pharmacology of commonly used analgesics and sedatives in the ICU (including benzodiazepines, propofol, and opioids); pharmacology of sedative-analgesic agents (including dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists); lessons learned from international surveys of current sedation practices; protocolized and target-based sedation and analgesia in the ICU; sedation and weaning from mechanical ventilation, linking spontaneous awakening trials and spontaneous breathing trials to improve patient outcomes; altering ICU sedation paradigms to improve patient outcomes; sedation and sleep disturbances; sedation and immunomodulation; pharmacoeconomics of sedation; prevention and treatment of adult and pediatric delirium; and cognitive functioning, mental health and quality of life in ICU survivors.

This issue brings the anesthesiologist up to date on current essential topics in regional analgesia and acute pain management, including the latest state-of-the-art techniques and drugs.? Subjects covered include prevention and treatment of local anesthetic systemic and neurotoxicity; complications of RA and pain management (medicolegal issues including anticoagulation, infection, etc.); assessment and treatment of post block neurologic injury (history, physical, investigations, EMG, NCS); new ultrasound guided techniques for peripheral nerve blocks and evidence based outcome review; emerging techniques and drugs for neuraxial and paravertebral blocks; local infiltration analgesia (for a variety of surgical procedures, wound infusions, infusion devices); continuous PNB in hospital and at home; recent advances in multimodal analgesia (new drugs & strategies, such as capsaisin, long acting opioid and local anesthetics); challenges in acute pain management (including the opioid tolerant patient, patients with comorbidities such as MS, DM and renal failure); economics and practice management issues associated with acute pain management; pediatric pain management; new concepts of acute pain management (including strategies to prevent chronic pain, opioid induced hyperalgesia, and more).

Ongoing improvement in the quality of patient care is essential to all anesthesia practices. This issue of Anesthesiology Clinics provides solid foundation and guidance in how to improve outcomes, as it covers the following topics. An overview of QI structures and initiatives is presented, focusing on the relevance to anesthesiology. A practical guide on how to implement a QI program is provided. Quality measurement approaches and issues, including the use of databases and risk adjustment are also examined. How to use simulation and other cutting-edge technology to improve quality in the OR is provided. Issues in multidisciplinary education and enhanced communication are explored. Recommendations for fostering a culture of safety are provided. How real-time support and decision-making can improve performance on quality process measures are examined. Clinical topics including bariatrics, geriatrics and decreasing perioperative delirium, and pain management are covered, as well as issues about end-of-life care.

This book is a comprehensive guide to clinical anaesthesia for practitioners and trainees. Divided into eleven sections, the text begins with a general overview, followed by discussion on anaesthesia delivery systems, monitoring, and equipment. A complete section is dedicated to different drugs used in anaesthesia. The next section covers anaesthesia for different types of surgeries in various body systems. The remaining chapters detail more subspecialty-specific anaesthesia including cardiac, obstetric, neuro, paediatric, transplant, and regional. The book concludes with a section on postoperative care. Authored by highly experienced experts in the field, the text is further enhanced by illustrations and figures to assist learning. Key points Comprehensive guide to clinical anaesthesia for practitioners and trainees Covers numerous types of anaesthesia for different surgeries and body systems Includes sections on pharmacology and postoperative care Highly experienced, expert author team

Foreword by Walter J. Freeman.

The induction of unconsciousness using anesthetic agents demonstrates that the cerebral cortex can operate in two very different behavioral modes: alert and responsive vs. unaware and quiescent. But the states of wakefulness and sleep are not single-neuron properties---they emerge as bulk properties of cooperating populations of neurons, with the switchover between states being similar to the physical change of phase observed when water freezes or ice melts. Some brain-state transitions, such as sleep cycling, anesthetic induction, epileptic seizure, are obvious and detected readily with a few EEG electrodes; others, such as the emergence of gamma rhythms during cognition, or the ultra-slow BOLD rhythms of relaxed free-association, are much more subtle. The unifying theme of this book is the notion that all of these bulk changes in brain behavior can be treated as phase transitions between distinct brain states.

Modeling Phase Transitions in the Brain contains chapter contributions from leading researchers who apply state-space methods, network models, and biophysically-motivated continuum approaches to investigate a range of neuroscientifically relevant problems that include analysis of nonstationary EEG time-series; network topologies that limit epileptic spreading; saddle--node bifurcations for anesthesia, sleep-cycling, and the wake--sleep switch; prediction of dynamical and noise-induced spatiotemporal instabilities underlying BOLD, alpha-, and gamma-band Hopf oscillations, gap-junction-moderated Turing structures, and Hopf-Turing interactions leading to cortical waves.

This issue brings the anesthesiologist up to date on current essential topics in anesthesia for otolaryngologic surgery, covering the newest cutting-edge procedures.? Topics covered include functional vocal cord surgery; functional endoscopic sinus surgery & skull base surgery; pediatric and adult laryngeal/tracheal surgery; jet ventilation; middle ear; neuromonitoring; transoral robotic surgery; lasur surgery and fire hazards in ENT; office-based procedures; applications of ultrasound in ENT (nerve blocks & airway assessment); LMAs for surgery procedures in head and neck; and anesthesia, OSA, and upper airway collapsibility.

One of the anesthesiologist's greatest challenges is managing high-risk patients with acute or severe conditions.? This issue brings the anesthesiologist up to date on the most important and latest approaches to management of the sickest of patients.? Topics covered include managing the patient with sepsis or septic shock; anesthetic considerations for patients in respiratory failure; anesthetic concerns in patients presenting with renal failure; perioperative management of patients with liver failure; management of acute coronary syndrome in the OR; intraoperative concerns in patients presenting with sever aortic stenosis, aortic insufficiency, mitral regurgitation, or mitral stenosis; intraoperative management of patients with cardiac tamponade; anesthetic concerns in trauma victims requiring operative intervention; patients presenting with acute toxin indigestion; anesthetic concerns in patients with known neurologic insufficiency; management of endocrine insufficiency in the OR; and management of patients with mediastinal mass or tracheal stenosis.

This issue brings the anesthesiologist up to date on current essential topics in ambulatory anesthesia.? Topics covered include obstructive sleep apnea, pediatric ambulatory anesthesia, supraglottic airway devices, issues in office-based ambulatory anesthesia, complex sedation, the role of regional anesthesia in the ambulatory environment, regional catheters, postoperative pain management for the ambulatory patient, and updates on PONV and PDNV.? Authors also explore the questions of how much testing should be done, how to make yourself ASC desirable to patients and surgeons, and more.

Guest Editor Dane Nichols, MD, has assembled a panel of experts focusing on Hemodynamic Support in Septic Shock. Topics include: Oxygen Delivery and Consumption: A Macro-Circulatory Perspective; Mean Arterial Pressure: Therapeutic Goals and Pharmacologic Support, Mechanisms; Detection and Potential Management of Microcirculatory Disturbances; Detection of Hypoxia at the Cellular Level; Type A & B Lactic Acidosis: Recognition, Kinetics, and Associated Prognosis; Venous blood gases: What Can They Tell Us About the State of the Circulation; Noninvasive Assessment of Cardiac Preload and Performance through CO2 Rebreathing/ETCO2 Monitoring.

This issue of Anesthesiology Clinics prepares the anesthesiologist for the most challenging problems he will face with geriatric patients. Topics covered include delirium, postoperative cognitive dysfunction, fat embolism during hip replacement, Parkinson's disease and deep brain stimulator placement, diastolic dysfunction, atrial fibrillation, delayed arousal, severe atrial stenosis, multiple medications, informed consent and the ethical management of the older patient, dead bowel, acute perioperative beta-blockade in the older patient, urinary retention, and anesthetic care for patients with skin breakdown.

This issue of Anesthesiology Clinics covers the most cutting-edge topics in pediatric anesthesia that every practitioner must know to stay current in this changing field. Topics covered include new devices for difficult pediatric airway, the use of ultrasound in pediatric regional anesthesia, new concepts in treatment of pediatric traumatic brain injury, acute pain management, neurotoxicity of anesthetics in the developing brain, current thought on intraoperative awareness in children, current concepts on managing sepsis in children, the fontan patient, sedating the child with congenital heart disease, management of children with hemoglobinopathies, and current strategies for blood conservation in pediatric anesthesia.

This issue brings together leading specialists from diverse fields including multiple subspecialties of anesthesiology, as well as surgery, cardiology, oncology, neurology, hospital medicine, endocrinology, and others. A multidisciplinary approach is essential to patient safety and optimal outcomes, so this valuable and unique monograph brings the anesthesiologist up to date on current integrated methods of preoperative assessment, consultation, and patient preparation for surgery. Article topics include preoperative evaluation and prep of the patient for cardiac surgery; noncardiac surgery in the patient with heart disease; identification and evaluation of the patient with lung disease; surgery on the patient with endocrine dysfunction; obesity, metabolic syndrome, and the surgical patient; surgery in a patient with liver disease; surgery in the patient with renal dysfunction; anemia in the preoperative patient; perioperative anticoagulant management; preop prep of the surgical patient with neurologic disease; and emergency and urgent surgery.

Hemoglobin-based Oxygen Carriers is an exciting and evolving alternative to blood transfusion. This issue explores its potential with topics on: "HBOCs from Human or Bovine Hemoglobin," "Comparison of HBOCs to Stored Human Red Blood Cells," "HBOCs and Tissue Oxygenation," "HBOCs: Role in surgery, resuscitation or hemorrhagic shock?" and more!

In this issue, Guest Editors Pratik Panharipande and Wesley Ely look at modern Sedation techniques in the critically ill. Topics include: "Pharmacology of commonly used sedatives and analgesics in the ICU," "Pharmacology of newer agents for sedation and analgesia in the critically ill," "Current sedation practices: lessons learned from recent international surveys," "Sedation and Immunomodulation," "Sedation and sleep disturbances in the ICU," and more!

For an anesthesiologist, though the challenge of managing an obstetric patient can be very satisfying and rewarding, it can also be extremely difficult given the potential for serious harm to the fetus and mother. For routine care, it is important to understand the risks and benefits of many practices to provide patients with informed decisions and the most satisfying experiences. There are also many less-usual patients and situations, however, that challenge the anesthesiologist's skills significantly. This issue of the Anesthesiology Clinics presents the most up-to-date information on both of these categories, and is written by an outstanding group of experienced clinicians from all over the world. Topics including high-risk analysis, use of simulators for training, major hemorrhage, off-labor-floor consultation, depth of anesthesia monitoring, pharmaceuticals, use of vasopressors, neurological infections after neuroaxial anesthesia, airway management, the HIV patient, ultrasound, and others.

This issue of the Anesthesiology Clinics provides essential updates for the anesthesiologist who performs procedures outside the operating room. All-important financial considerations are covered, including Medicare payments; and full costing versus differential costing, or "smoothing.? Practice parameters are covered. Each specialty is addressed from the point of view of both a specialist and an anesthesiologist, including cardiology (EP and catheterization), gastroenterology (Endoscopy), and radiology (interventional). Transitional priorities are also covered, including consultation, pre-procedure patient assessment, patient safety, monitoring, and new ICU practices.

Decision making regarding fluid volume loading, fluid restriction, or administration of vasoactive drugs may vary among physicians, depending solely upon their clinical experience in the absence of evidence-based measurement. The initial distribution volume of glucose (IDVG) is believed to be clinically relevant as a marker of cardiovascular and fluid management in critically ill patients without a significant modification of glucose metabolism. This book covers all aspects of IDVG measurement, including the basic concept, its relationship with other fluid volumes, and the clinical application of this technique in the intensive care unit based on both the authors studies and their clinical experience with more than 4000 IDVG determinations. When the concept of IDVG is properly understood and its measurement is then performed routinely, daily fluid and cardiovascular management in critically ill patients can be improved based on evidence-based measurement."

Perioperative care is the care that is given before and after surgery. This textbook is a complete guide to the anaesthetic and critical care management of patients undergoing complex surgeries in all organ systems of the body. Topics cover all age groups - neonates, children, and adults. Divided into 11 sections, the book begins with a general overview of critical care in the perioperative period discussing airway management, pain, fluid and electrolyte therapy, shock, arterial blood gas analysis, respiratory failure and mechanical ventilation, and thromboembolism. The following sections cover surgeries in different organ systems and patient groups - cardiothoracic and vascular, neurosciences, paediatrics, obstetrics and gynaecology, gastrointestinal, genitourinary, orthopaedics, head and neck, and transplantation. The final section explains selected miscellaneous topics including nutrition, haemodynamic monitoring, echocardiography, renal replacement therapy, and antibiotics. Compiling 700 pages, the comprehensive text is further enhanced by clinical photographs, diagrams and tables. Key points Comprehensive guide to perioperative critical care in neonates, children and adults Covers complex surgeries in all organ systems Includes discussion on imaging, airway management, and ventilation Highly illustrated with clinical photographs, diagrams and tables

"Perioperative Addiction" addresses an issue that every anesthesiologist will encounter many times during the course of his or her career: the patient who arrives for operative care under the influence of legal or illegal drugs. The editors and contributors provide expert guidance on how to identify and manage the addicted patient, approaching the subject from the vantage points of the specific drug and of special patient populations.

Features:

Guidance for spotting and managing addicted patients

All common and important drugs of addiction, from opioids, cocaine, club drugs, and alcohol, to tobacco, marijuana, nitrous oxide, inhalants, and propofol

Special populations, including pregnant women, pain patients, adolescents, older patients, and healthcare professionals

Fascinating overview of the long history of addiction

Genetic basis of addiction, and the range of pharmacological treatments for addiction