Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery as an effective multimodality treatment option for selected patients with peritoneal surface malignancies. This tutorial discusses the anaesthetic considerations and physiological impacts of the procedure.
This case report describes a number of risk factors that are associated with potential deformation or fracture of spinal needles during subarachnoid anaesthesia, followed by some practical tips on how to avoid this complication and how to deal with it if it occurs.
This tutorial aims to provide the reader with a framework for approaching the complex physiologic changes and challenges of liver transplant anesthesiology. After reading this article the reader should be able to understand the common perioperative issues surrounding the patient with liver failure and recognize that outcomes are dependent on a multidisciplinary approach to management.
This tutorial covers ultrasound-guided paravertebral nerve block. It discusses the basic anatomy, indications and complications associated with this peripheral regional anaesthesia. The article goes into detail the preparation required to carry out this block and discusses 3 common ultrasound-guided approaches that can be utilized.
This article highlights factors that make patients at high risk of perioperative myocardial ischaemia. It also discusses evidence for anaesthetic technique for this high-risk group and the management of intra-operative myocardial ischaemia.
This tutorial is based on learning from incidents reported to the National Health Service England and Wales National Reporting and Learning System, and covers infusion safety, preoperative assessment and bone cement implantation syndrome.
This tutorial describes the conduct of Deep Hypothermic Circulatory Arrest and its relevance to the anaesthetist, using the latest available evidence. The concept of therapeutic hypothermia, options for intraoperative monitoring and the different neuroprotective strategies are discussed.
The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients.
The aim of these guidelines is to provide a comprehensive range of evidence-based recommendations for interventions to be applied during the pre-, intra- and postoperative periods for the prevention of SSI, while also considering aspects related to resource availability and values and preferences.
Angela Enright, MB, FRCPC, Kate Grady, BSc, MB, BS, FRCA, FFPMRCA, FRCOG, Faye Evans, MD Journal of Obstetrics and Gynaecology Canada (Oct 2015)