Vascularized composite allotransplantation for the forearm is a complex surgical procedure, requiring multidisciplinary collaboration. It is important to provide optimal blood flow to the grafts, effective immunosuppression, and early rehabilitation for graft survival and good functional outcomes. As ischemia-reperfusion injury and substantial but unquantifiable blood loss are inevitable in thi...

conclusions despite the fact that anesthesia in chronic liver disease is a scary and pretty challenging condition for every anesthesiologist, this hazard could be diminished by meticulous attention on optimizing the patient’s condition preoperatively and choosing appropriate anesthetic regimen and drugs in this setting. although there are paucity of statistics and investigations in this specifi...

Introduction: Mitochondrial Disorders (1/4,000 patients) are rare and caused by dysfunctional mitochondria. Anesthetic consideration in patients with involves careful preoperative perioperative observations. Objective: To provide a brief insight into how general anesthetics interfere mitochondrial energy formation pathways help form precautions for anesthesiologists when managing Disorder. Revi...

1. Understand the different criteria that are used to diagnose a child with obstructive sleep apnea (OSA). 2. Understand the pathophysiologic changes that occur in children with OSA. 3. Understand the anesthetic implications of OSA. 4. Develop an anesthetic plan, including premedication, induction, maintenance, extubation, pain management, and post-operative monitoring. 5. Predict which patient...

Over the past 50 years the incidence of anesthesia-related cardiac arrest has declined, despite increased patient co-morbidities, the most significant determinant of anesthetic risk. Multiple factors have contributed to this improvement including safer anesthetic agents, better monitoring devices and the development of a specialized pediatric environment. Provider skill has benefitted from impr...

Intraoperative neurophysiological monitoring (IONM) during corrective spinal surgery is widely used. Because of the possible interference with the recording of evoked potentials by inhalational anesthetics, total intravenous anesthetic (TIVA) regimens have been advocated. TIVA regimens may be difficult to use in pediatric populations due to metabolic factors. We report on the results of multimo...

Waste anesthetic gases (WAGs) can be defined as all halogenated organic compounds (including methoxyflurane, halothane, isoflurane, sevoflurane, desflurane, and enflurane) and nitrous oxide that escape from the anesthetic circuit, or are exhaled by the patient. Management of WAGs intuitively seems prudent, but because excessive exposure is often difficult to detect without special monitoring de...

The American Society of Anesthesiologists (ASA) produces the Standards for Basic Anesthetic Monitoring for appropriate patient monitoring during basic anesthesia (1). The standards document is periodically revised and updated, and includes recommendations for the use of moderate and deep sedation. As a number of nonanesthesiology specialists, including gastroenterologists, orthopedic surgeons, ...

Takayasu's arteritis (TA) is a chronic inflammatory disease involving the aorta. Because TA sometimes involves cerebral arteries, anesthetic debates focus on cerebral monitoring. There is limited evidence as to which cerebral monitoring method is most adequate. Furthermore, there is insufficient evidence to determine which anesthetic technique is better for TA parturients. We experienced the ca...