This book offers an essential guide to managing the most-debated hot topics of practical interest in anesthesia and intensive care. Part I reviews the state of the art in issues concerning both intensive care medicine and anesthesia, such as perioperative medicine, acute liver failure, anesthesia monitoring and ERAS in hepatic surgery. Part II focuses on microbiome in critically ill patients, on COVID-19 aspects and related issues, on sepsis in pediatric patients and ventilatory management in obese patients. Written by leading experts and including updated references, it provides a comprehensive, easy-to-follow update on anesthesia and intensive care. The book clearly explains complex topics, offering practicing clinicians valuable insights into the latest recommendations and evidence in the field while, at the same time, making it a vital resource for students new to the fields of anesthesia and intensive care.
Author(s): Davide Chiumello
Publisher: Springer
Year: 2022
Language: English
Pages: 194
City: Cham
Contents
Part I: Anesthesia
1: Perioperative Management of Patients Affected by Ischemic Cardiomyopathy
1.1 Classification
1.2 Preoperative Evaluation
1.2.1 Anamnesis
1.2.2 Instrumental Tests
1.2.3 Biomarkers
1.2.4 Pharmacological Therapy
1.2.4.1 Beta-Blockers
1.2.4.2 Acetylsalicylic Acid
1.2.4.3 Platelet Glycoprotein Inhibitors (Clopidogrel, Tigaclogrel, Prasugrel)
1.2.4.4 Statins
1.2.4.5 Nitrates
1.2.5 Premedication
1.3 Intraoperative Management
1.3.1 Specific Issues
1.3.2 Anesthesia
1.3.2.1 Monitoring
1.3.3 Postoperative Period
1.3.4 Treatment of Acute Myocardial Ischemia
1.4 Conclusions
References
2: Acute Liver Failure: Definition, Epidemiology and Management – Update 2022
2.1 Introduction
2.2 ALF Aetiology and the Impact of Geographical Distribution
2.3 Clinical Manifestations of ALF
2.4 Indications for ICU Admission and Referral to a Transplant Centre
2.5 Intensive Care Treatment Aimed at Supporting Organ Function
2.6 Multi-Organ Failure Syndrome and the Multimodal Intensive Medical Treatment
2.7 Central Nervous System: Hepatic Encephalopathy, Intracranial Pressure and their Management
2.8 Cardiovascular Profile
2.9 Management of Respiratory Failure: Ventilation and Associated Procedures
2.10 Renal Failure
2.11 Infections
2.12 Haemostatic Profile
2.13 Novel Therapies: The Artificial Liver Support
2.13.1 Mars [114–120]
2.13.2 SPAD (Single-Pass Albumin Dialysis)
2.13.3 Prometheus (FPSA) [116, 123, 124]
2.13.4 High-Volume Plasma Exchange (PE)/Plasmapheresis (HVP)
2.14 Conclusions
References
3: Perioperative Medicine: Technical and Organizational Issues
3.1 Introduction
3.2 Preoperative
3.2.1 Risk Assessment
3.2.2 Prehabilitation
3.2.3 Management of Comorbidities
3.3 Intraoperative
3.4 Postoperative
3.5 Organizational Issues
3.6 Future Developments
3.7 Conclusion
References
4: Perioperative Hypertension and Anesthesia
4.1 Introduction
4.2 Classification and Guidelines
4.3 Physiology of Blood Pressure Regulation
4.4 Recommendations for Treatment
4.4.1 Common Antihypertensive Drugs and their Anesthetic Implications
4.4.2 Commonly Used Drugs
4.4.3 Significant Predictors of Non-adherence to Antihypertensive Therapy
4.4.4 Diuretics
4.4.4.1 Anesthetic Implications
4.4.5 ACEI
4.4.5.1 Anesthetic Implications
4.4.6 ARB
4.4.6.1 Anesthetic Implications
4.4.7 Direct Renin Inhibitors
4.4.7.1 Anesthetic Implications
4.4.8 Calcium Channel Blockers
4.4.8.1 Anesthetic Implications
4.4.9 Antagonists of α-Adrenergic Receptors (α-Blockers)
4.4.9.1 Anesthetic Implications
4.4.10 Blocking Agents of β-Adrenergic Receptors (β-Blocking Agents)
4.4.10.1 Anesthetic Implications
4.4.11 α-2 Agonists: Adrenergics (α-2 Agonists)
4.4.11.1 Anesthetic Implications
4.4.12 Other Vasodilators
4.4.12.1 Anesthetic Implications
4.5 Hypertension and Non-steroid Anti-Inflammatory Drugs (NSAIDs)
4.5.1 Anesthetic Implications
4.6 Conclusion
References
5: Depth of Anesthesia Monitoring
5.1 Introduction
5.2 The Electroencephalogram Anesthesia Patterns
5.2.1 Density Spectral Array (DSA), Fig. 5.3
5.3 Artifacts and Factors Worth of Particular Attention
5.4 Conclusions
References
6: ERAS (Enhanced Recovery After Surgery) in Liver Surgery
6.1 Introduction
6.2 Preoperative Evaluation
6.3 Preoperative Consultation/Counseling
6.4 Perioperative Nutrition
6.5 Preoperative Fasting and Carbohydrates Load
6.6 Bowel Preparation
6.7 Surgery
6.8 Nasogastric Tube
6.9 Prophylactic Abdominal Drainage
6.10 Anesthesia
6.11 Premedication
6.12 Antibiotics Prophylaxis and Steroids
6.13 Monitoring and Maintenance of Anesthesia
6.14 Hemodynamic Management
6.15 Intraoperative Ventilation
6.16 Analgesia
6.17 Postoperative Period
6.18 Postoperative Feeding and Early Nutrition
6.19 Postoperative Nausea and Vomiting (PONV)
6.20 Conclusions
References
Part II: Critical Care Medicine
7: The Microbiome in Critically Ill Patients
7.1 The Forgotten Organ and the Critical Care Medicine
7.2 Critical Disease and the Ecosystem of the Human Microbiota
7.3 Microbiota and Microbiome
7.4 Mechanisms of Dysbiosis in Sepsis
7.5 Dysbiosis Is a Potential Risk Factor for Sepsis
7.6 Can the Intestinal Microbiota Predict the Clinical Outcome of Sepsis?
7.7 Can Sepsis Originate from the Intestine?
7.8 The Altered Ecology of the Damaged Alveolus
7.8.1 From a Bacterial Point of View, Healthy Alveoli Are Inhospitable
7.9 Are Exacerbations of Chronic Respiratory Diseases Acute Infections?
7.10 Clinical Lessons to Undertake Further Studies
7.11 Modulation of the Microbiota as a Potential Therapeutic Immunonutrition
7.12 Selective Decontamination of the Digestive Tract
7.13 Future Perspectives
References
8: Coagulation Abnormalities in Patients with COVID-19
8.1 Introduction
8.2 SARS-CoV-2 Clinical Feature
8.3 Coagulation Abnormalities in Patients with COVID-19
8.4 Venous Thromboembolism in Critically Ill Patients
8.5 Venous Thromboembolism in Hospitalized Patients with COVID-19 Pneumonia
8.6 Arterial Thrombosis
8.7 Conclusion
References
9: Vascular Failure and Sepsis in Pediatrics
9.1 Introduction
9.2 Sepsis in Pediatrics: Definition and Diagnosis
9.3 Sepsis and Septic Shock in Children: Physiopathology
9.4 Identification and Treatment of Pediatric Sepsis in a Non-intensive Setting: Pediatric Sepsis 6 Algorithm
9.4.1 Ventilatory Support
9.4.2 Establishing Vascular Access (IV, IO) and Sampling for Blood Culture, Blood Gas Analysis and Lactate, and Glycemia
9.4.3 Volemic Filling
9.4.4 Inotropic and Vasopressor Agents and Hemodynamic Monitoring
9.5 Identification of the Source of Infection and Empirical Antibiotic Therapy
9.5.1 Sepsis/Septic Shock, Source Not Identified, Age up to 28 Days
9.5.2 Sepsis/Septic Shock, Source Not Identified, Age 28 Days or More
9.5.3 Pneumonia (Table 9.5)
9.5.4 Meningitis
9.6 Corticosteroids
9.7 Glycemia
9.8 Nutrition
9.9 Transfusions
9.10 Substitution therapies, immunoglobulin
9.11 Conclusions
References
10: Ventilatory Management of the Patient with Severe Obesity
10.1 Introduction
10.2 Respiratory Pathophysiology
10.3 Management of the Obese Patient with Acute Respiratory Failure
10.4 Airway Management
10.5 Mechanical Ventilation in Non-ARDS Patients
10.6 Recruitment Maneuver
10.7 PEEP
10.8 Tidal Volume
10.9 Mechanical Ventilation in ARDS Patients
10.10 Weaning and Extubation
10.11 The Obesity Paradox
10.12 Conclusions
References
