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

Modern strategies for the anesthetic management of the patient with diabetes

Diabetes Mellitus [DM] is an endocrine disease with high incidence. Long-term complications involve the eyes, kidneys, nerves, and blood vessels, resulting in hypertension, cardiac ischemia, atherosclerosis, and renal failure, among other syndromes. Given this prevalence, anesthesiologists, especially those who work with older patients, may expect to encounter some aspect of diabetes almost every day. Appropriate preoperative evaluation and rational intraoperative and postoperative management of this complex disease in elective and emergency circumstances are essential. Recent studies have emphasized the need to maintain tight perioperative glycemic control and new guidelines have been presented

Arteriovenous malformation, complications, and perioperative anesthetic management

Arteriovenous malformations [AVMs] are the most common intracranial vascular malformation, with an estimated occurrence of 1:5000-1:2000 persons. The repair requires careful embolization, often followed by stereotactic radiosurgery and can also include open craniotomy. Preoperatively, patients may be healthy or dramatically unstable, as 30-50% of these cases present with acute cerebral hemorrhage. One of the most important considerations for the anesthesiologist should be attempting to achieve hemodynamic stability in the face of potential increased intracranial pressure and subsequent vulnerability of the tissues to ischemic insult. Knowledge of the risks and hazards of the procedure and collaboration with specialists, including neuroradiologists, critical care physicians, and potentially neurosurgeons, ultimately form the basis for appropriate management. AVM's can lead to potentially fatal ischemic or hemorrhagic complications that may occur in up to 8% of cases. The protection of the airway, adequate monitoring, and maintaining cardiovascular and neurological stability, are critical. Further, in the setting of a radiological suite, peripheral location considerations involving equipment, monitors, and appropriate drugs and sustaining the patient's immobility during the radiological procedures, while managing potential perioperative complications are all essential

Anesthetic considerations for the neonate with tracheoesophageal fistula

Trachenesophageal fistula [TEF] and associated esophageal atresia [LA] in the neonate, presents during the First week of life. This congenital defect can be complicated by aspiration, respiratory distress, and other congenital anomalies. The knowledge and ability of the anesthesiologist to anticipate the challenges in managing neonates presenting for repair, plays an important role in their treatment and survival. Also, it is not uncommon or anesthesiologist to care for a patient later in life following repair of TEF. A familiarity with the immediate complications and long term outcome and sequelae after TEE repair is important to ensure the best patient outcome