Update on anesthesia considerations for electroconvulsive therapy

Depression is diagnosed in 14 million Americans every year, and pharmacotherapy is the standard treatment. However, in approximately 50% of patients, pharmacology intervention does not resolve depression. Electroconvulsive therapy [ECT] has been a mainstay as a treatment option for treatment-resistant major depression since its inception in the 1930s. It has also been shown to be effective in treatment-resistant mania and catatonic schizophrenia. The complication rate of ECT has improved from 50% in the 1960's to almost anecdotal adverse events, similar to the morbidity and mortality seen in minor surgery and childbirth. Although anesthetic agents are administered briefly, many patients experience significant fluctuations in physiologic parameters. The clinical anesthesiologist must be aware of these changes as well as have an understanding of perioperative pharmacological interventions. ECT is a proven therapy for select psychiatric patients, and appropriate anesthesia is a critical part of successful ECT. Careful review of the patient's medical history may reveal pertinent anesthetic considerations

Autosomal dominant polycystic kidney disease-clinical challenges

While not very common, the clinical anesthesiologist can expect to see between two and three patients per year with autosomal dominant polycystic kidney disease, ADPKD. Careful education and proper planning are essential to assure appropriate care for these patients. In addition, co-morbid conditions associated with the disease, make it especially challenging for the anesthesiologist who must be prepared for all contingencies. Also, decreased renal function and the systemic effects combine to create unique problems in properly anesthetizing these patients. Finally, proper preoperative assessment is essential to protect patients with ADPKD, and special care should be taken to select drugs that rely on non-renal metabolism for excretion. This review summarizes anesthetic considerations regarding epidemiologic, diagnostic, genetic, and perioperative clinical issues related to this disease

Postoperative nausea and vomiting. a review

Post operative nausea and vomiting [PONV] remains an unpleasant and persistent problem for patients undergoing surgery. In fact PONV are among the most important factors contributing to delay in discharge of patients and an increase in unanticipated admissions after ambulatory surgery. Anesthesia providers are most often blamed for PONV, sometimes rightfully so, many times wrongly so. PONV is a multifactorial issue involving many physiological and biological mechanisms. As the trend towards ambulatory surgery increases, PONV continues to pose serious challenges for anesthesia providers because the potential cost savings of performing surgeries on an ambulatory basis may be negated by unanticipated hospital admission. Although PONV may be unavoidable in some patients for reasons we do not fully understand, there are risk factors that can be identified. As anesthesiologists it is essential for us to understand the mechanisms involved in nausea and vomiting and the available perioperative treatment options. We must do whatever we can to prevent and treat PONV and improve patient outcome for both medical and economic reasons