Regional Anesthesia for Vascular Surgery and Pain Management.

Patients undergoing vascular surgery tend to have significant systemic comorbidities. Vascular surgery itself is also associated with greater cardiac morbidity and overall mortality than other types of noncardiac surgery. Regional anesthesia is amenable as the primary anesthetic technique for vascular surgery or as an adjunct to general anesthesia. When used as the primary anesthetic, regional anesthesia techniques avoid complications associated with general anesthesia in this challenging patient population. In this article, the authors describe regional anesthetic techniques for carotid endarterectomy, arteriovenous fistula creation, lower extremity bypass surgery, and amputation.

The role of perioperative chewing gum on gastric fluid volume and gastric pH: a meta-analysis.

STUDY OBJECTIVE: To determine if preoperative gum chewing affects gastric pH and gastric fluid volume. DESIGN: Systematic review and meta-analysis. METHODS: Data sources included Cochrane, PubMed, and EMBASE databases from inception to June 2012 and reference lists of known relevant articles without language restriction. Randomized controlled trials in which a treatment group that chewed gum was compared to a control group that fasted were included. Relevant data, including main outcomes of gastric fluid volume and gastric pH, were extracted. RESULTS: Four studies involving 287 patients were included. The presence of chewing gum was associated with small but statically significant increases in gastric fluid volume (mean difference = 0.21 mL/kg; 95% confidence interval, 0.02-0.39; P = .03) but not in gastric pH (mean difference = 0.11 mL/kg; 95% confidence interval, -0.14 to 0.36; P = .38). Gastric fluid volume and gastric pH remained unchanged in subgroup analysis by either sugar or sugarless gum type. CONCLUSIONS: Chewing gum in the perioperative period causes small but statically significant increases in gastric fluid volume and no change in gastric pH. The increase in gastric fluid most likely is of no clinical significance in terms of aspiration risk for the patient. Elective surgery should not necessarily be canceled or delayed in healthy patients who accidentally chew gum preoperatively.

Special anesthetic consideration for the patient with a fragility fracture.

In this article, an overview is presented of perioperative management of the patient with a fragility fracture, including preoperative risk stratification and optimization, anesthesia risks, anesthesia options, and postoperative pain management. Issues of preoperative evaluation that are of concern for the anesthesiologist because of their direct effect on intraoperative care are discussed. A team interdisciplinary approach and good communication between specialties involved in care of elderly surgical patients is important for optimal patient outcomes and to avoid perioperative complications. Cooperation between anesthesiology and medicine is indispensable in reaching a reasonable consensus regarding preoperative evaluation and should occur on a case-by-case basis.