The High-risk Surgical Patient

Foreword
Preface
Contents
Contributors
Part I: Identification and Characterisation of High-Risk Surgical Patients
1: Defining the High-Risk Surgical Patient
References
2: The Frail Patient in the Operating Room: Practical Steps to Reduce the Operative Risk
2.1 Introduction
2.2 Frailty and Surgery: The Game Changer
2.3 Frail Assessment Tools: In Need for Feasibility to Expand the Recognition
2.4 Frailty, Ageing, and the High-Risk Surgical Patient
2.5 Frailty and Surgery in Elderly Patients: The New Comprehensive Paradigm
2.6 How to Improve the Outcomes of the Older Frail Surgical Patients
2.7 Physical Performance
2.8 Nutrition
2.9 Mental Health and Cognitive Dysfunction
2.10 Solid Organ Transplant Surgery and Frailty: Times Are (a)Changing
2.11 Conclusions
References
3: The High Risk Surgical Patients: The Pathophysiologic Perspective
3.1 Anemia
3.2 Pathophysiology of Oxygen Debt
3.3 Conclusions
References
4: Monitoring and Interpretation of Vital Signs in the High-Risk Surgical Patients
4.1 Heart Rate
4.1.1 Heart Rate and Circulating Blood Volume
4.1.2 Heart Rate and Increased O2 Demand
4.2 Blood Pressure
4.3 Respiratory Rate
4.4 Body Temperature
4.4.1 Effector Organs Response to Increased Body Temperature
4.4.2 Effector Organ Responses to Decreased Body Temperature
4.4.3 Effects of Body Temperature Changes
4.5 Pulse Oximetry
References
5: Evaluation and Critical Care Management of the Burn Patient
5.1 Introduction
5.2 Burn Category
5.3 Burn Extention Measurement
5.4 Pathophysiology of Wound Healing [2–5]
5.5 Shock: Ebb and Flow Phase
5.6 Sepsis
5.7 Inhalation Injury
5.8 First-Line Treatment
5.9 On Admittance
5.9.1 Primary Survey
5.9.2 Secondary Survey
5.10 Resuscitation from Burn Shock
5.10.1 Standard Monitoring Criteria
5.11 Nutrition [5, 8, 9, 12]
5.12 Wound Covering [4, 5, 8–10, 12]
5.13 Surgical Management
5.14 Criteria for Transfer a Patient to a Burn Centre [8, 9]
5.15 Clinical Scenario
5.15.1 Put the Actions in Order
5.15.2 Choose the Most Correct Answer
5.15.2.1 Choose the Correct Answer
5.15.3 Choose the Correct Solution
References
6: Acid–Base Abnormalities in Surgical Patients Admitted to Intensive Care Unit
6.1 Introduction
6.2 Metabolic Acid–Base Disorders in Surgical Patients
6.2.1 Metabolic Acidosis
6.2.1.1 Clinical Manifestations
Lactic Acidosis
Lactate Metabolism
Mechanisms of Anaerobic Lactate Production
Mechanisms of Aerobic Lactate Production
Treatment of Lactic Acidosis
Unmeasured Anion Acidosis
Ketoacidosis
Post-surgical Euglycemic Diabetic Ketoacidosis
Hyperchloremic Metabolic Acidosis
Situations More Frequently Associated with Hyperchloremic Acidosis in the Postoperative Period
Deleterious Effects of Hyperchloremic Acidosis
6.2.2 Metabolic Alkalosis
6.2.2.1 Pathophysiology
Generation of Metabolic Alkalosis
Maintenance of Metabolic Alkalosis
6.2.2.2 Causes of Metabolic Alkalosis
Response of Metabolic Alkalosis to Chloride Administration
6.2.2.3 Clinical Manifestations
6.2.2.4 Treatment
6.2.3 Complex Metabolic Disorders
6.3 Respiratory Acid–Base Disorders
6.3.1 Physiopathology
6.3.2 Clinical Manifestations
6.3.3 Treatment
References
7: Pre-operative Cardiovascular Risk Assessment in Non-cardiac General Surgery
7.1 Introduction
7.2 The Changing Landscape of Perioperative Evaluation
7.3 Pathophysiological Basis of Risk Stratification
7.4 Clinical Evaluation
7.4.1 Heart Failure (HF)
7.4.2 Coronary Artery Disease
7.4.3 Valvular Heart Disease
7.4.4 Arrhythmias
7.4.5 Pulmonary Hypertension
7.5 Determination of Functional Capacity
7.6 Intervention-Related Factors
7.6.1 Type of Surgery
7.6.2 Type of Anaesthesia
7.7 Complementary Tests for Cardiovascular Risk Assessment
7.7.1 Echocardiography
7.7.2 Non-invasive Imaging Test: Stress Test and Coronary Computed Tomography (CCT)
7.7.3 Invasive Coronary Angiography
7.7.4 Biomarkers
7.8 Management of Perioperative Antithrombotic Therapy
7.8.1 Antiplatelet Therapy
7.8.2 Anticoagulant Therapy
7.9 Practical Flow Chart
References
8: Post-operative Liver Failure and Pre-operative Evaluation of the Risk of Surgery in Patients with Liver Disease
8.1 Introduction
8.2 Definition of POLF
8.3 Pre-operative Risk Factors
8.3.1 Patient-Related Risk Factors
8.3.2 Surgery-Related Risk Factors
8.4 Pre-operative Evaluations
8.4.1 Volumetric Evaluation
8.4.2 Biochemical Assessment of Liver Function
8.4.3 Liver Functional Assessment
8.5 Conclusions
References
9: Radiology for Surgeons: Improving the Diagnostic Accuracy in the High-Risk Surgical Patient
References
10: Oncologic Emergencies in Patients Undergoing Major Surgery
10.1 Introduction
10.2 Febrile Neutropenia (FN)
10.3 Venous Thromboembolism (VTE)
10.4 Superior Vena Cava Syndrome (SVCS)
10.5 Tumor Lysis Syndrome (TLS)
10.6 Hypercalcemia of Malignancy
10.7 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
10.8 Neuro-Oncologic Emergencies
10.8.1 Neoplastic Epidural Spinal Cord Compression (ESCC)
10.8.2 Chemotherapy-Induced Myasthenic Crisis (MC)
References
11: The High-Risk Pediatric Surgical Patient
11.1 Introduction
11.2 Anesthesia-Related Morbidity and Mortality
11.2.1 Perioperative Morbidity
11.2.2 Perioperative Mortality
11.2.3 Post-operative Adverse Events and Post-arrest Mortality
11.3 Defining the Risk
11.4 The High-Risk Patient
11.4.1 The Premature, the Neonate, and the Infant
11.4.2 The Patient with Congenital Heart Disease and Complex Syndromes
11.4.2.1 The High-Risk Lesions
Single Ventricle Physiology
Patients with Williams–Beuren Syndrome (WS) and Non-WS Elastin Arteriopathy
Patients with Cardiomyopathy (Hypertrophic, Restrictive, and Dilated)
Patients with Ventricular Assist Devices
Association with Complex Genetic Syndromes
11.4.3 The Patient with Pulmonary Hypertension
11.4.4 The Patient with Respiratory or Airway Disease
11.5 Conclusions
References
12: Difficult Intubation in the High-Risk Surgical Patient
12.1 Introduction
12.2 Airway Management
12.3 Airway Assessment
12.4 Techniques and Devices for Airway Management
12.4.1 Mask Ventilation
12.4.2 Tracheal Intubation
12.4.3 Alternative Airway Techniques and Devices
12.4.3.1 Video Laryngoscopy
12.4.3.2 Fiber-Optic Bronchoscopy
12.4.3.3 Supraglottic Airway Devices
12.4.3.4 Surgical Airway
Surgical Technique
Cricothyrotomy Vs. Tracheostomy
12.5 Approach to the Difficult Airway
12.5.1 Anticipated Difficult Airway
12.5.2 Unanticipated Difficult Intubation with Easy Mask Ventilation
12.5.3 Unanticipated Difficult Intubation with Difficult Mask Ventilation
12.5.4 Muscle Relaxation
12.5.5 Extubation of the Difficult Airway Patient
12.6 Difficult Airway and the High-Risk Patient
12.6.1 Critically Ill Patients
12.6.2 The Trauma Patient
12.6.3 Morbid Obese Patients
12.7 Future Considerations
References
13: Recognition and Early Management of Sepsis in Frail Patients
13.1 Sepsis Biomarkers
13.2 Principles of Therapy of Surgical Infections in Sepsis
References
14: Preoperative Evaluation for Complex Pulmonary Surgery: How Can We Balance the Risk?
14.1 Patient Preoperative Assessment
14.2 Cardiological Status Evaluation
14.3 Respiratory Functional Status Evaluation
14.4 Surgical Approach and Analgesic Therapy
14.5 Physical Therapy and Rehabilitation
References
15: Assessment of Pre-operative Risk in Complex Cardiac Surgery
15.1 Introduction
15.2 Model Development, Performance Evaluation, and Validation of Risk Scores
15.3 Assessing Risk Stratification in Cardiac Surgery
15.4 Analysis of Risk Scores in Cardiac Surgery
15.5 Conclusion
References
Part II: Strategies to Improve the Outcome in High-Risk Surgical Patients
16: Patient Safety in Surgery: Strategies to Achieve the Best Outcome in the High-Risk Surgical Patient
16.1 Complexity and the Divided Brain
16.2 Patient Safety and High-Risk Surgery
References
17: Strategies to Reduce the Risk of Post-operative Pulmonary Complications
17.1 Introduction
17.2 Predicting PPCs
17.2.1 Risk Prediction Models
17.3 Pre-operative Strategies
17.3.1 Optimisation of Co-morbidities
17.3.2 Prehabilitation
17.3.3 Smoking Cessation
17.4 Intra-operative Strategies
17.4.1 General or Regional Anaesthesia
17.4.2 Protective Ventilation
17.4.3 Oxygen Titration
17.4.4 Airway Management and Use of Neuromuscular Blocking Drugs
17.4.5 Emergence from Anaesthesia
17.4.5.1 Drug Choice and Reversal Strategy for Neuromuscular Blocking Drugs
17.5 Post-operative Strategies
17.5.1 Post-operative Respiratory Support
17.5.1.1 Continuous Positive Airway Pressure
17.5.1.2 Nasal High Flow Therapy (NHFT)
17.5.2 Analgesia Optimisation
17.5.3 Other Post-operative Measures
17.5.3.1 Physiotherapy, Mobilisation and Oral Hygiene Bundles
17.5.3.2 Nasogastric Tubes
References
18: Prevention and Management of Perioperative Neurological Complications in High-Risk Surgical Patients
18.1 Central Nervous System Vascular Disease
18.2 Carotid Stenosis
18.3 Spinal Cord Ischaemia (SCI)
18.4 Cognitive Impairment: Dementia, Delirium, POCD
18.4.1 Dementia
18.4.2 Delirium
18.4.3 Postoperative Cognitive Decline (POCD)
18.5 Other Neurodegenerative Diseases (Parkinson’s Disease)
18.6 Epilepsy
18.7 Multiple Sclerosis
18.8 Myasthenia Gravis and Other Neuromuscular Diseases
18.9 Headache
18.10 Visual Loss
18.11 Conclusions
References
19: Acute Aortic Syndrome (AAS): A High-Risk Missed Diagnosis in the Emergency Department
19.1 Introduction
19.2 AAS Epidemiology
19.3 AAS Clinical Presentation
19.4 AAS Etiopathogenesis
19.4.1 Changes of the Aortic Wall with Aging
19.5 AAS: Peculiar Features
19.5.1 Different Manifestations of AAS
19.5.1.1 Aortic Dissection
19.5.1.2 AD Epidemiology and Natural History
19.5.1.3 Etiology
19.5.1.4 AD Clinical Presentation
19.5.1.5 AD Classification
19.5.2 Intramural Hematoma (IMH)
19.5.2.1 IMH
19.5.2.2 IMH Etiopathogenesis
19.5.2.3 IMH Clinical Presentation and Natural History
19.5.3 Penetrating Aortic Ulcer (PAU)
19.5.3.1 Definition
19.5.3.2 Natural History
19.5.3.3 PAU Clinical Presentation
19.6 AAS Diagnosis
19.6.1 AAS Radiological Findings
19.6.1.1 CT
19.6.1.2 Transthoracic Echocardiography (TTE)
19.6.1.3 Transesophageal Echocardiography (TEE)
19.6.1.4 Magnetic Resonance Imaging (MRI)
19.6.1.5 Specific Imaging Findings for Every Particular Kind of AAS
19.7 Treatment
19.7.1 Medical Management of AAS
19.7.2 AD
19.7.2.1 Type A Aortic Dissection
19.7.2.2 Type B Aortic Dissections
19.7.3 IMH
19.7.4 PAU
19.8 Follow-Up After AAS and Prognosis
References
20: Trans-Catheter Interventional Treatment of Structural Heart Diseases
20.1 Introduction
20.2 Transcatheter Aortic Valve Implantation
20.3 From Prohibitive Surgical Risk Patient to Low Risk
20.4 Patients’ Selection for TAVI
20.5 Different TAVI System
20.5.1 Edwards Lifesciences-SAPIEN
20.5.2 Medtronic CoreValve
20.5.3 Abbott St. Jude Portico
20.5.4 Boston Acurate Neo
20.6 Alternative Access for TAVI Implantation
20.6.1 Subclavian/Axillary
20.7 Direct-Aortic
20.7.1 Trans-Carotid
20.7.2 Trans-Apical
20.7.3 Trans-Caval
20.8 Trans-Catheter Mitral Procedures
20.8.1 Transcatheter Edge-to-Edge Mitral Valve Repair
20.8.2 MitraClip™ System
20.8.3 PASCAL™ Transcatheter Valve Repair System
20.8.4 Transcatheter Mitral Valve Chordal Repair
20.8.5 NeoChord™
20.8.6 HARPOON™ Mitral Valve Repair System
20.8.7 Indirect Mitral Annuloplasty
20.9 Carillon™ Mitral Contour System
20.9.1 Direct Mitral Annuloplasty
20.9.2 Transcatheter Mitral Valve Implantation
20.9.3 Tiara
20.9.4 Evoque
20.9.5 Tendyne
20.9.6 Intrepid
20.10 Transcatheter Tricuspid Valve Interventions
20.10.1 TriClip
20.10.2 Pascal TV Repair System
20.10.3 Cardioband Annuloplasty System
References
21: New Technologies in Urologic Surgery: Robotic and Minimally Invasive Procedures
21.1 Introduction
21.2 Minimally Invasive Surgery in Urology
21.3 Minimally Invasive Surgery for the Management of Renal Cancer in High-Risk Surgical Patients
21.4 Minimally Invasive Surgery for the Management of Prostate Cancer in High-Risk Surgical Patients
21.5 Minimally Invasive Surgery for the Management of Bladder Cancer in High-Risk Surgical Patients
21.6 Minimally Invasive Surgery for the Management of Benign Disease in High-Risk Surgical Patients
21.7 Conclusion
References
22: New Trends in Vascular Surgery: Less Open and More Endovascular Procedures
22.1 Introduction
22.2 Thoracic Aorta and Aortic Arch Pathologies
22.2.1 Abdominal and Thoracoabdominal Aorta Aneurysms
22.2.2 Peripheral Artery Disease (PAD) and Acute Limb Ischemia
22.2.3 Visceral Arteries
22.2.4 Carotid Stenosis
22.3 Conclusions
References
23: New Trends in Laparoscopic Procedures in the Emergency Abdominal Surgery
23.1 Laparoscopy for Abdominal Emergencies
23.2 Acute Appendicitis
23.3 Acute Cholecystitis
23.4 Perforated Peptidic Ulcer
23.5 Acute Diverticulitis
23.6 Small Bowel Obstruction
23.7 Ventral Hernias
23.8 Incarcerated/Strangulated Hernias
23.9 Abdominal Trauma
23.10 Contraindication
References
24: New Trends in the Treatment of Severe Acute Pancreatitis
24.1 Introduction
24.2 Presentation, Diagnosis, and Etiology
24.3 Assessment of Severity
24.4 Management Goals in Severe Acute Pancreatitis
24.5 General Principles in the ICU Care
24.6 Antibiotics
24.7 Enteral Feeding
24.8 Surgical and Endoscopic Interventions
24.8.1 Biliary Pancreatitis
24.8.2 Infected Pancreatic Necrosis
24.8.3 Other Pancreatic Complications
24.8.4 Abdominal Compartment Syndrome
24.8.5 Colon Perforation
24.8.6 Gangrenous Cholecystitis
24.9 Outcome
References
25: Point-of-Care Ultrasound in the Preoperative Evaluation of the High-Risk Surgical Patient Requiring Urgent Non-cardiac Surgery
25.1 Introduction
25.2 The Clinical Evaluation by PoCUS
25.3 Gastric Content
25.4 Identification/Management of the Difficult Airway
25.5 Assessment for Causes of Respiratory Distress
25.6 Cardiovascular Assessment
25.7 Abdominal Evaluation
25.8 Conclusions
References
26: Perioperative Monitoring in High-Risk Surgical Patients: A Step-by-Step Approach
26.1 Why Perioperative Monitoring Matters
26.2 First Step: Identify a High-Risk Patient
26.3 Second Step: Decide What to Monitor
26.4 Third Step: Choose a Monitoring Device and Create a Protocol for Use
26.5 Fourth Step: Continue Monitoring a Postoperative Patient
26.6 Conclusions
References
27: High-Risk Pancreatic Anastomosis: Prediction, Mitigation, and Management of Postoperative Pancreatic Fistula
27.1 Introduction
27.2 Prediction and Prevention of Pancreatic Fistula—Preoperative Setting
27.3 Mitigation Strategies in High-Risk Anastomoses—Intraoperative Setting
27.4 Management of Pancreatic Fistula—Postoperative Setting
27.5 Conclusions
References
Part III: New Trends in Acute Care of High-Risk Surgical Patients
28: Anesthesia in High-Risk Surgical Patients with Uncommon Disease
28.1 Introduction
28.2 Neurologic [2]
28.3 Ears, Nose, and Throat (ENT) [16]
28.4 Cardiovascular [26]
28.5 Respiratory [49]
28.6 Hepatic [57]
28.7 Renal [81]
28.7.1 Glomerular Diseases
28.7.2 Tubular Diseases
28.8 Muscular [103]
28.8.1 Skin [113]
28.9 Hematologic [147]
28.10 Endocrine [150]
28.11 Mitochondrial [174]
28.12 Conclusions
References
29: Perioperative Management and Surgical Challenges in Patients with Spinal Cord Dysfunction
29.1 Introduction
29.2 Anesthesiologic Challenges in People with Spinal Cord Injury/Disorder
29.3 Autonomic Dysreflexia
29.4 Neurogenic Bowel Dysfunction
29.5 Neurogenic Bladder
29.6 Infective Complications
29.7 Antithrombotic Prophylaxis
29.8 Pressure Ulcers
29.9 Problems Related to the Musculoskeletal System
29.10 Pregnancy
29.11 Clinical Case
29.12 Conclusions
References
30: Non-invasive Ventilation in the High-Risk Surgical Patients
30.1 Introduction
30.1.1 Acute Respiratory Complications
30.1.2 The Formation of Atelectasis Is Favored by the Following Pathophysiological Elements
30.1.2.1 Direct Compression on the Lung Parenchyma by the Diaphragm
30.1.2.2 Direct Injuries
30.1.2.3 Postoperative Pain
30.1.2.4 Respiratory Muscles and Surgery
30.1.2.5 Bariatric Surgery
30.1.2.6 Frailty
30.1.2.7 Aetiology
30.2 Risk Factors for Extubation Failure
30.3 Non-invasive Ventilation
30.4 The fan: Constitutive Elements and Operating Principles
30.4.1 Patient-Self-Inflicted Lung Injury (P-SILI)
Further Reading
31: Extracorporeal Life Support (ECLS) for Critically Ill Patients in the Emergency Department
31.1 Introduction
31.1.1 The Role of ECLS in the Emergency Department
31.2 Basics of ECLS
31.2.1 General Features
31.2.2 Veno-Arterial ECMO (VA ECMO)
31.2.3 Veno-Venous ECMO (VV ECMO)
31.3 Cardiocirculatory Failure
31.3.1 Cardiogenic Shock: Definition and Pathophysiology
31.3.2 Cardiogenic Shock: Etiologies and ECLS Indications
31.3.3 Right Heart Failure and Pulmonary Embolism
31.3.4 Refractory Cardiac Arrest
31.4 Respiratory Failure
31.5 Conclusions and Future Directions
References
32: Perioperative Management of Severe Bleeding and Coagulopathy in High-Risk Surgical Patients
32.1 Introduction
32.2 Perioperative Bleeding
32.3 Pathomechanisms of Perioperative Bleeding in Major Surgery
32.4 Perioperative Coagulation Monitoring
32.4.1 Viscoelastic Hemostatic Assays (VHA)
32.5 Procoagulant Interventions According to the ESAIC Guidelines [1]
32.6 Allogeneic Blood Transfusions According to the ESAIC Guidelines [1]
32.7 Facilitating PBM Guidelines Implementation
References
33: Endovascular Management of Post-Operative Bleeding
33.1 Introduction
33.2 Diagnostic
33.3 The Role of Interventional Radiology (IR)
33.4 After Liver Surgery
33.5 After Pancreatic Surgery
33.6 After Nephrectomy
33.7 After Liver Transplantation
33.8 After Digestive Tract Surgery
References
34: Evaluation and Management of Malnutrition in the High-Risk Surgical Patient
34.1 Introduction
34.2 Nutritional Assessment
34.2.1 Medical History
34.2.2 Clinical Examination
34.2.3 Biochemical Analyses
34.2.4 Nutritional Risk Screening and Assessment Tests
34.3 Problems During the Perioperative Period
34.4 Energy Requirements
34.5 Nutritional Therapy
34.5.1 Oral Nutrition
34.5.2 Nutritional Therapy
34.5.2.1 Enteral Versus Parenteral Nutrition
34.6 The Role of Nutrients in Recovery
34.7 Monitoring
References
35: The Role of Selective Drug Therapy in Reducing Mortality in the High-risk Surgical Patients (Tranexamic Acid, Selective Bowel Tract Decontamination, Levosimendan, Beta-blockers, Insulin, Aprotinin, and Statins)
35.1 Introduction
35.2 Drugs Increasing Survival
35.2.1 Tranexamic Acid
35.2.2 Levosimendan
35.2.3 Selective Decontamination of the Digestive Tract
35.3 Drugs Increasing Mortality
35.3.1 Beta-blockers
35.3.2 Insulin Glycemic Control
35.3.3 Statins
35.3.4 Aprotinin
35.4 Other Drugs
35.5 Conclusions
References
36: Strategies for Advanced Mechanical Circulatory Support in Refractory Cardiogenic Shock
36.1 Definition of Cardiogenic Shock
36.2 Advanced Mechanical Circulatory Support: Strategies in Refractory Cardiogenic Shock
36.2.1 Advanced Mechanical Circulatory Support as a Bridge to Recovery
36.2.2 Advanced Mechanical Circulatory Support as a Bridge to Heart Transplantation
36.2.3 Advanced Mechanical Circulatory Support as a Bridge to Decision or Bridge to Bridge
36.2.4 Advanced Mechanical Circulatory Support as Permanent Therapy
36.3 Choice of the Device for Circulatory Support
36.3.1 Profound Refractory Cardiogenic Shock or Cardiac Arrest (Risk of Impending Death)
36.3.2 Progressive Refractory Cardiogenic Shock
36.4 Advanced Mechanical Circulatory Support in Refractory Cardiogenic Shock: Clinical Scenarios
36.4.1 De Novo Acute Scenarios
36.4.1.1 Fulminant Myocarditis
36.4.1.2 Acute Myocardial Infarction
36.4.1.3 Mechanical Complications of Myocardial Infarction
36.4.1.4 Massive Pulmonary Embolism Complicated by Refractory Cardiogenic Shock
36.4.2 Decompensation of Chronic Cardiomyopathies
36.4.2.1 Advanced Mechanical Circulatory Support in Refractory Cardiogenic Shock Caused by Chronic Cardiomyopathies
References
37: Evaluation and Management of Patients with Left Ventricular Assist Device (LVAD) Requiring Noncardiac SurgicalProcedures
37.1 Introduction
37.2 Left Ventricular Assistance Device Models
37.3 Principles of Continuous Flow Left Ventricular Assistance Device Physiology
37.3.1 Pump Parameters
37.3.2 Monitoring Pump Parameters
37.4 Acquired Coagulopathy and Anticoagulation
37.5 Left Ventricular Assistance Device-Associated Complications
37.5.1 Infections
37.5.2 Bleedings
37.5.3 Thrombosis
37.6 Incidence of Noncardiac Surgical Procedures in Patients with Continuous Flow Left Ventricular Assistance Device
37.6.1 Emergency Surgery, Laparoscopic Surgery
37.6.2 Laparoscopy in Left Ventricular Assistance Device Patient
37.7 Perioperative Evaluation
37.7.1 Past Medical History and Organ Function
37.7.2 Pharmacotherapy
37.7.3 Imaging
37.7.4 Laboratory and Electrocardiography
37.7.5 Left Ventricular Assistance Device and Implantable Cardioverter-Defibrillator Information
37.8 Anesthetic Considerations
37.8.1 Induction of General Anesthesia
37.8.1.1 Antibiotics
37.8.1.2 Patients Positioning
37.8.2 Intraoperative Monitoring
37.8.3 During Anesthesia
37.8.4 Postoperative Period Management
37.9 Cardiopulmonary Resuscitation
References
38: Rescue Surgery and Failure to Rescue
38.1 Introduction
38.2 What Is a Complication?
38.3 Rescue Surgery
38.4 Failure to Rescue
References
39: Endoscopic Submucosal Dissection for Early Malignant Epithelial Neoplasms of the Digestive Tract in Frail and Elderly Patients
39.1 Introduction
39.2 Histologic Criteria and Evaluation for Endoscopic Submucosal Dissection
39.3 Therapeutic Strategies and Technical Consideration
39.4 How to Estimate the Depth of Tumor Infiltration
39.5 Conclusions
References
40: Advanced Therapeutic Endoscopy for Acute Pancreatic and Biliary Diseases in Frail Patients
40.1 Acute Cholangitis
40.2 Acute Cholecystitis
40.3 Acute Pancreatitis
40.4 Pancreatic Pseudocysts and WOPN
40.5 Postoperative and Traumatic Bile Leaks
40.6 Postoperative Pancreatic Leaks
40.7 Periampullary Duodenal Perforations
References
41: Appropriate Perioperative Therapy in Patients with Chronic Heart Failure Undergoing Surgery
41.1 Intraoperative Management
41.2 Perioperative Management of Patients with Chronic Heart Failure
41.3 Direct Consequence of Anaesthesia on Systemic Hemodynamics in Patients with Chronic Heart Failure
41.4 Conclusion
References
42: Robot-Assisted Pancreatic Surgery: Safety and Feasibility
42.1 Introduction
42.2 Robotic Pancreaticoduodenectomy (RPD)
42.3 Robotic Distal Pancreatectomy (RDP) with or Without Splenectomy
42.4 Robotic Enucleation (RE)
42.5 Robotic Atypical Resections (RAR)
42.6 Perioperative Management
42.7 Discussion
42.8 Conclusions
References
43: Safety of Minimally Invasive Laparoscopic Approach in Major Liver Surgery
43.1 Introduction
43.2 Potential Advantages of Minimally Invasive Liver Surgery
43.3 Current Evidence and Recommendations for LLR
43.4 Key Points for Safe Perioperative Management of Patients Undergoing Minimally Invasive Liver Surgery
43.5 Safe Adoption of Laparoscopic Liver Resections
43.6 Failures of the Minimally Invasive Laparoscopic Approach
43.7 The Robotic Approach
43.8 Integration with the New Technologies
References
Part IV: Improving Patients’ Safety and Prevention of Major Complications
44: Major Complications in Hepatobiliary and Pancreatic Surgery
44.1 Hepatobiliary Surgery
44.1.1 Hemostatic and Thrombotic Complications During Major Liver Resection
44.1.1.1 Post-hepatectomy Hemorrhage (PHH)
44.1.1.2 Vascular Thrombosis
44.1.2 Bile Leakage
44.1.3 Liver Failure
44.1.3.1 Evaluation of Portal Hypertension (PH)
44.1.3.2 Indication for Artificial Liver
44.1.3.3 Indication for Liver Transplantation (LT)
44.2 Pancreatic Surgery
44.2.1 Pancreatic Fistula (PF)
44.2.2 Delayed Gastric Emptying (DGE) After PD
44.2.3 Post Pancreatectomy Hemorrhage (PPH)
44.2.4 Ischemic Complications
44.2.5 Portal Vein Thrombosis (PVT)
44.2.6 Biliary Complications
44.2.7 Postoperative Acute Pancreatitis (POAP)
References
45: Major Complications After Esophageal, Gastric, and Bariatric Surgery
45.1 Esophageal Surgery
45.1.1 Anastomotic Leakage
45.1.2 Conduit Necrosis/Failure
45.1.3 Recurrent Laryngeal Nerve Injury
45.1.4 Chyle Leak
45.2 Gastric Surgery
45.2.1 Anastomotic Leak
45.2.2 Postoperative Bleeding
45.2.3 Postoperative Bowel Obstruction
45.2.4 Duodenal Leak
45.2.5 Postoperative Pancreatic Complications
45.3 Bariatric Surgery
45.3.1 Fistula
45.3.2 Bleeding
45.3.3 Herniation
45.3.4 Anastomotic Stenosis
45.3.5 Gastric Erosion
45.3.6 Intestinal Small Bowel Obstructions
References
46: Major Complications of Vascular Surgery
46.1 Graft Thrombosis
46.1.1 Introduction
46.1.2 General Principles
46.1.3 Clinical Presentation
46.1.4 Therapy
46.2 Anastomotic Aneurysms
46.2.1 Incidence and Anatomic Location
46.2.2 Pathogenesis
46.2.2.1 Local Factors
Arterial Wall Degeneration
Suture Line Disruption
Infection and/or Inflammation
Technical Errors
46.2.2.2 Systemic Factors
Prevention
46.2.3 Pathogenesis Clinical Diagnosis
46.2.4 History and Physical Examination
46.2.5 Imaging
46.2.6 Surgical Treatment
46.2.6.1 Indications for Treatment
46.2.6.2 Femoral Anastomosis
46.2.6.3 Aortic and Iliac Anastomosis
46.2.6.4 Carotid Anastomosis
46.2.7 Outcomes
46.3 Aortoenteric Fistulae
46.3.1 Treatment
46.4 Endovascular Complications
46.4.1 Access Site Complications
46.4.1.1 Groin, Retroperitoneal Hematoma, or Bleeding on Medial Brachial Fascial Compartment
46.4.1.2 Arteriovenous Fistula
46.4.1.3 Pseudoaneurysm (PSA)
Thrombosis
Nerve Injury
46.4.2 Procedure-Specific Complications
46.4.2.1 Dissection
46.4.2.2 Embolization
46.4.2.3 Perforation
46.5 Graft Infection
46.5.1 Introduction
46.5.2 Epidemiology
46.5.3 Classification
46.5.4 Diagnosis
46.5.5 Treatments and Outcomes: General Principles
References
47: Major Complications of Urologic Surgery
47.1 Endoscopic Procedures
47.2 Laparoscopic, Open Surgical Procedures
References
48: Major Complications of Thoracic Surgery
48.1 Introduction
48.2 The Aftermath of Surgery
48.2.1 Standard
48.2.2 Recent Developments in Postoperative Management
48.2.3 Enhanced Recovery After Surgery (ERAS)
48.3 Complications
48.3.1 General Considerations
48.3.2 Hemorrhagic complications
48.3.3 Respiratory
48.3.3.1 Bronchial Congestion
48.3.3.2 Pneumonia
48.3.3.3 Acute Respiratory Distress Syndrome (ARDS)
48.3.3.4 Empyema After Pneumonectomy
48.3.4 Surgery
48.3.4.1 Anastomosis
48.3.4.2 Surgical Planning
48.3.4.3 Intersegmental plane
48.3.5 Anesthetic Management
48.3.6 Cardiac Complications
48.3.6.1 Atrial Fibrillation (AF)
48.3.6.2 Acute Coronary Syndrome (ACS)
48.3.7 Chylothorax
48.3.8 Post-pneumonectomy Syndrome
48.3.9 Nerve Lesions
48.3.9.1 Recurrent Nerve Injury
48.3.9.2 Phrenic Nerve Lesion
48.3.9.3 Treatment
48.4 Prevention of Complications
48.5 Conclusions
References
49: Major Complications of Cardiac Surgery
49.1 Introduction
49.2 Stroke
49.3 Renal Failure
49.4 Prolonged Ventilation
49.5 Reoperation
49.5.1 Surgical Issues
49.5.2 Dual Antiplatelet Therapy Before Cardiac Surgery
49.6 Deep Sternal Wound Infection/Mediastinitis
49.6.1 Preoperative Prevention
49.6.2 Intraoperative Surgical Prevention
49.6.3 Postoperative Surgical Prevention
49.6.4 Management of Sternal Infections
References
50: Major Complications of Abdominal Organ Transplantation Surgery
50.1 Liver Transplantation (LT)
50.1.1 Vascular Complications
50.1.1.1 Hepatic Artery
50.1.1.2 Portal Vein
50.1.1.3 Inferior Vena Cava (IVC) and Hepatic Veins
50.1.2 Biliary Complications (BCs)
50.1.3 Early Graft Dysfunction (EGD) and Primary Non-function (PNF)
50.1.4 Acute Allograft Rejection (AR)
50.2 Kidney Transplantation (KT)
50.2.1 Bleeding
50.2.2 Vascular Complications
50.2.3 Lymphocele
50.2.4 Urological Complications (UC)
50.2.4.1 Ureteral Complications
50.2.5 Rejection
50.2.6 Graft Function
50.3 Pancreas Transplantation (PT)
50.3.1 Surgical Complications
50.3.1.1 Vascular Thrombosis
50.3.1.2 Leak
50.3.1.3 Bleeding
50.3.2 Non-surgical Complications
50.3.2.1 Graft Pancreatitis
50.3.2.2 Delayed Graft Function (DGF) and Primary Non-function (PNF)
50.3.2.3 Rejection (PR)
50.4 Small Bowel Transplantation
50.4.1 Infections
50.4.2 Rejection
50.4.3 Graft Versus Host Disease (GVHD)
References
51: Corticosteroid Insufficiency in High-Risk Surgical Patients
51.1 Introduction
51.2 Definition of Corticosteroids Insufficiency (Table 51.1)
51.2.1 Adrenal Insufficiency
51.2.2 Critical Illness-Related Corticosteroids Insufficiency
51.3 Mechanisms for Corticosteroids Insufficiency in the High-Risk Surgical Patient
51.3.1 Predisposing Factors
51.3.2 Drugs-Related Corticosteroids Insufficiency
51.3.3 Ischemic or Hemorrhagic Damage
51.3.4 Inflammation
51.4 Diagnosis of Corticosteroids Insufficiency in the High-risk Surgical Patient
51.4.1 Clinical Symptoms
51.4.2 Laboratory Testing
51.4.2.1 Standard Laboratory Testing
51.4.2.2 Endocrine Testing
51.4.2.3 Inflammatory Biomarkers
51.5 Treatment
51.5.1 Prevention of Perioperative Corticosteroids Insufficiency
51.5.2 General Management
51.5.3 Hormone Replacement Therapy for Adrenal Insufficiency
51.5.4 Corticotherapy for Critical Illness-Related Corticosteroids Insufficiency
51.5.4.1 Trauma
51.5.4.2 Cardiac Surgery
51.5.4.3 Non-cardiac Surgery
51.6 Conclusion
References
52: The Rationale Use of Antimicrobials in Septic Surgical Patients
52.1 Introduction
52.2 Choosing the Appropriate Antibiotic
52.2.1 Penetration and Pharmacokinetics
52.2.2 Time-Dependent Killers and Concentration-Dependent Killers
52.2.3 Bacteriostatic Vs Bactericidal
52.2.4 De-Escalation
52.2.5 Dose and Duration
52.3 Antibiotic Stewardship
52.4 Culture
52.5 Surgical Site Infections
52.5.1 Prophylaxis
52.5.2 MRSA
52.5.3 SSI Treatment
52.6 Biofilm
52.6.1 Invasive Fungal Infections
References
53: Major Complications of Heart Transplant Surgery
53.1 Introduction
53.2 Primary Graft Failure (PGF)
53.2.1 Risk Factors for PGF
53.2.2 Biomarkers
53.3 Atrial Thrombosis at the Suture Site
53.3.1 Treatment
53.4 Valvular Incompetence for Atrial Wall Distortion
53.4.1 Treatment
53.4.2 Valvular Surgery in Donor’s Hearts Before HT
53.5 Cardiac Tamponade
53.5.1 Diagnosis
53.5.2 Treatment
53.6 Pseudo-Cor-Triatriatum
53.7 Distortion of the Pulmonary Trunk
53.8 Sinoatrial Block and Arrhythmias
53.9 Complications Related to Aortic Anastomosis
53.10 Mediastinitis
53.11 Donor/Recipient Mismatch in Size
53.12 Conclusion
References
54: Major Complications of Lung Transplant Surgery
54.1 Introduction
54.2 Primary Graft Dysfunction
54.2.1 Pathophysiology
54.2.2 Therapy
54.3 Bleeding
54.4 Donor–Recipient Size Mismatch
54.5 Ischemia-Reperfusion Injury
54.5.1 Strategies to Prevent IRI
54.6 Bronchial Anastomotic Complications
54.6.1 Risk Factors for Airway Complications
54.6.2 Bronchial Vascularisation
54.7 Vascular Complications
54.7.1 Pulmonary Arterial Obstructions
54.7.1.1 Treatment
54.7.2 Pulmonary Venous Obstruction
54.7.2.1 Diagnosis
54.7.2.2 Treatment
54.8 Conclusions
References
55: 3D Printing Technology in Medicine: A Personalised Approach Towards a Safer Surgical Practice
55.1 Role of 3D Printing in Medicine
55.1.1 Surgical Planning
55.1.2 Medical Education and Specialist Training
55.2 Production Workflow
55.2.1 Understanding the Need
55.2.2 Image Acquisition and Processing
55.2.3 3D Printing the Model
55.2.4 Postprocessing and Validation
55.3 3D-Printed Organ Models for Surgical Applications
55.3.1 State of the Art
55.3.2 Design and Fabrication Approaches
55.3.2.1 All-Printed Organ Models
55.3.2.2 Hybrid-Assembling Organ Models
55.4 PRINTMED-3D: The Project
55.4.1 Integrated Platform for Three-Dimensional Medical Technologies: An Innovative Idea
55.4.2 A Revolutionary Approach
55.4.3 General Manufacturing Method
55.4.4 Quantitative and Functional Characterisation
55.5 Models for Specialist Training: Neurosurgery
55.5.1 Mould Design and Manufacturing Approach
55.5.2 Meningioma Resection Simulator
55.6 Models for Surgical Planning: Liver Surgery
55.6.1 Mould Design and Manufacturing Approach
55.6.2 Liver Transplantation Phantom
55.7 Conclusion
References
56: Multiorgan Procurement for Transplantation as a Way to Improve Surgical Education
56.1 Multiorgan Procurement as a Learning Opportunity for Surgical Practice
56.2 Multiorgan Procurement: A Challenge in Creating the Trained Surgeon in the Twenty-First century
56.3 Brief History of Multiorgan Donation and Procurement
56.4 Advantages of Training in Organ Procurement as a Basis for General Surgical Practice
56.5 Basic Maneuvers and Logistics During Multiorgan Procurement
56.6 The Split Liver, Living Donor Liver, and Pancreas Procurement: An Advanced Training in Hepatobiliary and Pancreatic Surgery
56.7 Trauma Surgery and Multiorgan Procurement
56.8 Conclusions
References
57: From “See One, Do One, Teach One” to Hands-On Simulation and Objective Assessment in Surgical Training
57.1 Introduction
57.2 Methods for Surgical Training
57.2.1 Box Trainer
57.2.2 Virtual Simulators
57.2.3 Virtual Scenarios for Team Training
57.2.4 Augmented Reality
57.2.5 Animal Lab
57.2.6 Cadaver Lab
57.2.7 Preceptoring and Proctoring
57.2.8 Telementoring
57.2.9 Telerobotic Assistance
57.2.10 Online Platforms
57.2.11 Activities Improving Surgical Performance
57.2.12 Non-technical Skills for Surgeons
57.3 Special Topics Regarding Surgical Training
57.3.1 The Role of Minimally Invasive Surgery in Surgical Training
57.3.2 Training Outside the Clinical Environment
57.3.3 Objective Assessment in Surgical Training
57.4 Progressive Surgical Training Model
57.5 Conclusions
References
58: New Trends in Surgical Education and Mentoring by Immersive Virtual Reality: An Innovative Tool for Patient’s Safety
58.1 The Shifting Landscape of Surgery Education
58.2 Fundamentals of Immersive Virtual Reality
58.3 Application of IVR in Surgical Education and Planning
58.3.1 IVR in Surgical Education
58.3.2 IVR in Preoperative Planning
58.4 Drawbacks of IVR
58.5 Our Experience Using IVR and Future Directions
References
59: Artificial Intelligence in the Management of Difficult Decisions in Surgery and Operating Room Optimization
59.1 Introduction
59.1.1 Supervised Learning
59.1.2 Unsupervised Learning
59.1.3 Reinforcement Learning
59.2 Machine Learning in Medicine
59.2.1 Artificial Neural Networks
59.2.2 Fuzzy Expert Systems
59.2.3 Evolutionary Computation
59.2.4 Hybrid Intelligent Systems
59.3 Intensive Care Units and Operating Room Logistics
59.4 Perioperative Optimization
59.4.1 Preoperative Period
59.4.2 Operating Room Period
59.4.3 Postoperative Period
59.5 Application of AI in the COVID-19 Epidemic
59.6 Limitations and Ethical Implications of Artificial Intelligence
59.7 Future Directions
References
Part V: Identifying the High-Risk Trauma Patient
60: Trauma Surgeons Training Programs
60.1 From Trauma Surgeon to the Acute Care Surgeon: An Evolving Concept Towards a Paradigm Shift
60.2 Practical Courses
Self-assessment Test (Three Questions, Four Answers)
References
61: Telemedicine for Prehospital Trauma Care: A Promising Approach
61.1 Telemedicine for Prehospital Trauma Care
61.2 Key Challenges for Telemedicine in Acute Trauma Care
61.3 Telemedicine in Acute Trauma Care
61.3.1 Telemedical Assistance
61.3.2 Telemedical Prenotification and Digital Medical Direction
61.4 Future Technology Innovations in Prehospital Trauma Care
61.4.1 Mobile Robotic Arm for Prehospital Ultrasound
61.4.2 Aerial Systems and Mobile Applications for Resuscitation
61.5 Conclusion
References
62: New Trends in Critical Care Assessment and Management of the Trauma Patient
62.1 Introduction
62.2 Resuscitation Techniques
62.2.1 Crystalloid Resuscitation
62.2.2 Permissive Hypotension
62.2.3 Damage Control Resuscitation
62.3 Product Utilization
62.3.1 Component Therapy vs. Whole Blood
62.3.2 Direct Peritoneal Resuscitation
62.4 Guiding Resuscitation
62.4.1 Point-of-Care Ultrasound: FREE/FATE
62.4.2 Damage Control Surgery
62.5 Conclusion
References
63: Potentially Preventable Trauma Deaths: A Challenge for Trauma Care Systems
63.1 Introduction
63.1.1 Definition of Preventable Trauma Deaths (PTDs)
63.2 The Burden of the Problem
63.3 How to Reduce Preventable Trauma Deaths to Zero
Self-assessment Test
References
64: Updates in the Management of Complex Pancreatic Trauma
64.1 Introduction
64.2 Presentation and Diagnosis
64.3 Assessment of Severity
64.4 Management of Pancreatic Injuries
64.5 Missed Pancreatic Injuries
64.6 Outcome and Postoperative Complications
64.7 Recent Guidelines
References
65: Updates in the Management of Complex Liver Trauma
65.1 Introduction
65.2 Liver Trauma Classification
65.3 Management Strategies
65.4 Non-operative Management of Liver Injury
65.5 Requirements of NOM in Severe Injuries
65.6 Complications of NOM
65.7 Extension of NOM
65.8 Follow-Up
References
66: Updates in the Management of Complex Renal Trauma
66.1 Introduction
66.2 Aetiology
66.3 Anatomy
66.4 Assessment
66.5 Team Brief/Handover
66.6 Primary Survey
66.7 History
66.8 Haematuria
66.9 Laboratory Tests
66.10 Radiological Investigations
66.11 Grading
66.12 Management
66.13 Conservative Management
66.14 Angiography and Embolisation
66.15 Iatrogenic Renal Vascular Injury
66.16 Indications for Surgery
66.17 Intraoperative Intravenous Pyelography (IVP)
66.18 Surgical Technique
66.19 Complications
66.20 Urinary Extravasation
66.21 Delayed Bleeding
66.22 Decreased Function
66.23 Hypertension
References
67: Updates in the Management of Complex Chest Trauma
67.1 Introduction
67.2 Pulmonary Parenchyma and Airway-Related Injuries
67.2.1 Pulmonary Injuries
67.2.1.1 Pulmonary Contusions
67.2.1.2 Pulmonary Lacerations
67.2.2 Airway-Related Injuries
67.3 Chest Wall Injuries
67.3.1 Classification
67.3.2 Diagnostics
67.3.3 Indication and Contraindication for Osteosynthesis of the Ribs
67.3.4 Surgical Approaches
References
68: Updates in the Management of Complex Cardiac Injuries
68.1 Introduction
68.2 A Brief History
68.3 Incidence
68.4 Initial Management and Assessment
68.5 Sternotomy, Thoracotomy and Pericardial Interventions
68.6 Adjuncts and Tricks
68.7 Mechanical Circulatory Support
68.8 Operative Repair of Specific Injuries
68.8.1 Laceration/Rupture
68.8.2 Coronary Artery
68.8.3 Valve Injury
68.8.4 Septal Defects
68.8.5 Retained Cardiac Missiles
68.8.6 Impalement Injuries
68.8.7 Surgery for Injuries not Directly Involving the Heart
68.8.8 Pericardium
68.8.9 Follow Up
68.9 Conclusions
References
69: The Ongoing Dilemma of Thoracoabdominal Injuries: Which Cavity and When?
69.1 Introduction
69.2 Definition, Perspective, Our Experience
69.3 The Dilemma: Which Cavity and When. The Rational for Surgical Approaches
69.4 Conclusions
References
70: Subclavian Vessel Injuries: An Anatomic and Surgical Challenge to the Surgeon
70.1 Introduction
70.2 Historical Perspective and Incidence
70.3 Anatomy
70.4 Incidence
70.5 Clinical Presentation
70.6 Diagnosis
70.7 Surgical Management
70.8 Morbidity
70.9 Outcomes and Mortality
70.10 Conclusions
References
71: Management of Complex Laryngotracheal Injuries: A Challenging Surgical Emergency
71.1 Introduction
71.2 Aetiology
71.3 Pathophysiology
71.3.1 Blunt Neck Trauma
71.3.2 Penetrating Neck Trauma
71.4 History and Physical Examination Findings
71.5 Evaluation
71.5.1 Flexible Laryngoscopy
71.5.2 Imaging Studies
71.5.3 Esophagoscopy
71.6 Anaesthesia in Laryngotracheal Trauma
71.7 Protocol for Different Grades of Injury
71.7.1 Grade I and II
71.7.2 Grade III
71.7.3 Grade IV
71.7.4 Grade V
71.8 Thoracic Trachea and Bronchial Injury
71.9 Esophageal Injury
71.10 Laryngotracheal Injury with Vascular Injury
71.11 Long-Term Complications of Laryngotracheal Trauma
References
72: Complex Duodenal Injuries
72.1 Surgical Anatomy
72.2 Epidemiology
72.3 Clinical Presentation
72.4 Imaging Studies
72.5 Laboratory Studies
72.6 Nonoperative Management
72.7 Operative Management
72.7.1 Duodenal Wall Hematomas
72.7.2 Exposure of Duodenal Injuries
72.7.3 Management of Minor or Moderately Severe Duodenal Injuries
72.8 Management of Severe Duodenal Injuries
72.9 Outcomes
References
73: Abdominal and Peripheral Vascular Injuries: Critical Decisions in Trauma
73.1 Abdominal
73.1.1 Introduction
73.1.2 Epidemiology
73.1.3 Pathophysiology
73.1.3.1 Blunt Trauma
73.1.3.2 Penetrating Trauma
73.1.4 Clinical Presentation and Diagnosis
73.1.5 Treatment
73.1.5.1 Prehospital Resuscitation
73.1.5.2 Emergency Department Resuscitation
73.1.5.3 Options for Management of Injuries to Abdominal Vessels: Non-Operative Management
73.1.5.4 Options for Management of Injuries to Abdominal Vessels: Endovascular Management
73.1.5.5 Options for Management of Injuries to Abdominal Vessels: Operative Management
73.1.6 Summary
73.2 Peripheral
73.2.1 Introduction
73.2.2 Epidemiology
73.2.3 Pathophysiology
73.2.4 Clinical Presentation and Diagnosis
73.2.4.1 Hemorrhagic Signs
73.2.4.2 Ischemic Signs
73.2.4.3 Hidden and in Development Clinical Pictures
73.2.4.4 Doppler Ultrasound Scan
73.2.4.5 CT Angiogram
73.2.4.6 Arteriography
73.2.5 Treatment
73.2.5.1 Minor Arterial Trauma
73.2.5.2 Major Arterial Trauma
73.2.5.3 Methods of Arterial Repair
73.2.5.4 Role of Fasciotomy
73.2.6 Summary
References
74: Updates in the Management of Complex Craniofacial Injuries
74.1 Definition and Epidemiology
74.1.1 Scoring Systems
74.2 Establishing the Priorities: Life-Sight Saving Injuries
74.2.1 Airways and Breathing
74.2.2 Circulation
74.2.3 Eyes
74.2.4 Treatment of Life-Sight Saving Injuries
74.2.5 Imaging and Diagnostic Tools
74.3 Associated Injuries
74.3.1 Traumatic Brain Injury
74.3.2 Cervical Spine Injury
74.3.3 Others
74.4 Updates in Surgical Treatment
74.4.1 Timing of Definitive Treatment
74.4.2 Intraoperative Airways Management
74.4.3 General Principle, Surgical Approaches, and Sequencing
74.5 Innovations and Technology
74.5.1 CAS in Acute Care Setting
74.5.2 Secondary Reconstruction
74.6 Multidisciplinary Management of Facial and Skull Base Injuries
74.6.1 Diagnosis and Preoperative Management
74.6.2 Treatment Indications
74.6.3 Surgical Technique
74.6.4 Postoperative Management
74.7 Special Part: Gunshot Injuries
74.7.1 Definition and Epidemiology
74.7.2 General Management and Priorities
74.7.3 Timing and Surgical Treatment
References
75: Non-Operative Management of Blunt Traumatic Injuries
75.1 What Is NOM?
75.2 Why Perform NOM?
75.3 General Principles
75.3.1 NOM for Spleen Injuries
75.3.2 NOM for Liver Injuries
75.3.3 NOM for Pancreas Injury
75.3.4 NOM for Kidney Injury
75.4 Particular Concerns About NOM
75.4.1 Long-Term Outcomes
75.4.2 Timing of Venous Thromboembolism (VTE) Prevention
References
76: Recent Advances in Minimally Invasive Surgery for Spinal Trauma
76.1 Introduction
76.2 Indications for Minimally Invasive Surgery
76.3 Percutaneous Pedicle Screw Instrumentation
76.3.1 Surgical Technique
76.3.2 Outcomes
76.3.3 Limitations
76.3.4 Percutaneous Pedicle Screw Instrumentation with Fusion
76.4 Percutaneous Vertebral Augmentation
76.4.1 Surgical Technique
76.4.2 Outcomes
76.5 Lateral Approaches to the Spine
76.5.1 Outcomes for Treatment of Trauma
76.6 Navigation and Robotic Guidance
References
77: Current Perspectives of Interventional Radiology in Trauma
77.1 Introduction
77.2 Treatment Modalities
77.3 Specific Organ System Management
77.3.1 Aorta
77.3.2 Liver
77.3.3 Spleen
77.3.4 Kidney
77.3.5 Pelvis
77.3.6 Extremities
77.4 Other Organs
References
78: Strategies to Control Hemorrhage in the Trauma Patient
78.1 Introduction
78.2 Point of Injury Strategies
78.3 Intravascular Control
78.4 Operative Control
78.5 Future
78.6 Conclusion
References
79: Selective Use of Anesthetics in Patients with Major Trauma
79.1 Introduction
79.2 Primary Survey and Monitoring
79.2.1 Assessing the Airway
79.2.2 Induction and Intubation
79.2.3 Special Considerations for Airway Management
79.3 Hemodynamic Considerations
79.3.1 Fluids in Resuscitation
79.3.2 Coagulopathy in Trauma
79.4 Perioperative Care
79.4.1 Intraoperative Considerations
79.4.2 Postoperative Considerations
79.5 Special Populations
79.5.1 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
79.5.2 Thoracic Trauma
79.5.3 Pregnancy
79.5.4 Traumatic Brain Injury and Spinal Cord Injury
79.5.5 Burns
References
80: Lifesaving and Emergency Surgical Procedures in Trauma Patients
80.1 Emergency Surgical Airway Management in Trauma Patients
80.1.1 Surgical Cricothyroidotomy
80.1.2 Cricothyroidotomy: Traditional Technique
80.1.3 Percutaneous Bougie-Assisted Cricothyroidotomy
80.1.4 Percutaneous Cricothyroidotomy Technique (PCT)
80.1.5 Needle Cricothyrotomy (NC) and Percutaneous Transtracheal Jet Ventilation (PTTJV)
80.2 Management of Massive Intrathoracic Hemorrhage: Surgical Procedures and Damage Control Techniques
80.2.1 Tube Thoracostomy
80.2.2 Finger Thoracostomy
80.2.3 Anterolateral Thoracotomy
80.2.4 Posterolateral Thoracotomy
80.2.5 Emergency Department Thoracotomy (EDT)
80.2.6 Clamping the Pulmonary Hilum for Evacuation of Bronchovascular Air Embolism
80.2.7 Pulmonary Tractotomy
80.2.8 Median Sternotomy, Cardiopulmonary Bypass (CPB), and ECMO for Traumatic
80.2.8.1 Cardiothoracic Emergencies
80.2.8.2 Cardiopulmonary Bypass for Blunt Cardiac Trauma
80.2.8.3 CPB for Injury of the Thoracic Aorta
80.2.8.4 ECMO for Massive Lung Injuries and for Organ Procurement
80.3 Overview of Surgical Procedure in Patients with Complex Abdominal Organ Injuries
80.3.1 Basic Strategy for Complex Liver Injuries
80.3.2 Damage Control Surgery (DCS) for Liver Injuries
80.3.3 Surgical Strategy for Associated Vascular Injuries of the Liver
80.3.4 Total Hepatic Vascular Exclusion and Supracoeliac Aortic Clamping
80.3.5 Emergency Liver Transplantation After Total Hepatectomy and Veno-Venous Bypass
80.3.6 Hepatic Necrosis After Emergency Procedures
80.3.7 Pancreaticoduodenal Injuries
80.4 Complex Abdominal Vascular Injuries
80.4.1 Mattox and Cattell–Braasch Maneuvers
80.4.2 Control of the Supracoeliac Abdominal Aorta
80.4.3 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Regional Perfusion Optimization
80.4.4 Pre-Peritoneal Pelvic Packing (PPP) for Inferior Retroperitoneal Bleeding Secondary to Complex Pelvic Injuries
References
81: Extracorporeal Membrane Oxygenation (ECMO) in Trauma Patients
81.1 Introduction
81.1.1 Time Trends and Indications for ECLS in Trauma Patients
81.1.2 Challenges of Using ECLS in Trauma: Anticoagulation and Surgery
81.2 Chest Trauma and Acute Respiratory Distress Syndrome
81.3 Cardiac Trauma and Traumatic Cardiac Arrest
81.4 Hemorrhagic Conditions
81.5 Traumatic Brain Injury (TBI)
81.6 Hypothermia and Drowning
81.7 Burn Injuries
81.8 ECLS in Military Settings
81.9 ECLS for Trauma in Children
81.10 Predictors for Survival
81.11 Conclusions and Future Directions
References
82: The Role of Trauma Surgeon in Mass Casualties
82.1 Introduction
82.2 Disaster
82.3 Disaster Planning
82.4 Trauma Surgeon as Team Leader
82.5 The Triage
82.6 Trauma Care in the Disaster Area
82.7 Evacuation and Transportation of Critically Ill Patients
82.8 Definitive Surgical Treatment on the Field and in the Hospital
82.9 Incident Command Center
82.10 Escalating the Surgical Response
82.11 Creation of Medical Response Teams
82.12 The Surgeon’s Role in the Aftermath
82.13 Training
82.14 Conclusions
References