Enhanced Recovery for Breast Reconstruction Surgery.

PURPOSE OF REVIEW: Enhanced recovery pathways are a well-described perioperative healthcare program involving evidence-based interventions. Enhanced recovery is designed to standardize techniques such as drug selection and nerve blocks in order to speed recovery and reduce overall hospital costs. RECENT FINDINGS: A PubMed literature search was performed for articles that included the terms enhanced recovery and breast reconstruction surgery. The present investigation summarizes enhanced recovery literature related to breast surgery with a focus on breast reconstruction. Enhanced recovery considerations discussed in this review include patient education, preadmission optimization, perforator flap planning, anesthetic techniques, optimized fasting, venous thrombosis prophylaxis, early mobilization, and antimicrobial prophylaxis.

Postinduction Paced Pulseless Electrical Activity in a Patient With a History of Oropharyngeal Instrumentation-Induced Reflex Circulatory Collapse.

BACKGROUND: Reflex hypotension and bradycardia have been reported to occur following administration of several drugs associated with administration of anesthesia and also following a variety of procedural stimuli. CASE REPORT: A 54-year-old postmenopausal female with a history of asystole associated with sedated upper gastrointestinal endoscopy and post-anesthetic-induction tracheal intubation received advanced cardiac resuscitation after insertion of a temporary transvenous pacemaker failed to prevent pulseless electrical activity. The patient's condition stabilized, and she underwent successful cataract extraction, intraocular lens implantation, and pars plana vitrectomy. CONCLUSION: Cardiac pacemaker insertion prior to performance of a procedure historically associated with reflex circulatory collapse can be expected to protect a patient from bradycardia but not necessarily hypotension.

Novel Influenza A (H1N1) Viral Infection in Late Pregnancy: Report of a Case.

Health care workers, including anesthesia providers, are often exposed to different infectious disease processes. In the operating room, anesthesia providers, nurses, and surgical staff use universal precautions as a standard of practice. The novel influenza A (H1N1) epidemic has heightened concerns because diagnosis is often delayed and transmission can affect those in a close radius to the infected host. The objectives of this report are to describe the intensive care management and outcomes of severe H1N1 viral infection in a patient in the last trimester of pregnancy and to review the epidemiology, management, and outcomes of similar US cases.