Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement.

The perioperative management of patients using glucagon-like peptide 1 receptor agonists remains a topic of debate. While several multisociety statements have been published recently, the recommendations vary significantly in terms of medication management and preoperative fasting protocols for these patients. This document represents a multidisciplinary consensus statement led by the Society for Perioperative Assessment and Quality Improvement (SPAQI).

Preoperative management of medications for psychiatric disorders.

Perioperative medication management is a complex topic. Physicians working in the perioperative space are frequently called upon to make decisions regarding continuing or stopping certain medications. For patients with psychiatric disorders, the overwhelming recommendation is to continue therapy with heightened awareness of anesthesiologists regarding potential side effects or medication interactions.

Preoperative Management of Cardiovascular Medications: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement.

Cardiovascular conditions such as hypertension, arrhythmias, and heart failure are common in patients undergoing anesthesia for surgical or other procedures. Numerous guidelines from various specialty societies offer variable recommendations for the perioperative management of these medications. The Society for Perioperative Assessment and Quality Improvement identified a need to provide multidisciplinary evidence-based recommendations for preoperative medication management.

Preoperative Management of Medications for Rheumatologic and HIV Diseases: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement.

Perioperative medical management is challenging because of the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources use recommendations derived from individual studies and do not include a multidisciplinary focus on formal consensus.

Postdural Puncture Headache-Risks and Current Treatment.

Purpose Of Review: This manuscript aims to review the risks and the current treatments for postdural puncture headache (PDPH).

Recent Findings: PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals.

Preoperative Management of Medications for Psychiatric Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement.

There is a lack of guidelines for preoperative management of psychiatric medications leading to variation in care and the potential for perioperative complications and surgical procedure cancellations on the day of surgery. The Society for Perioperative Assessment and Quality Improvement identified preoperative psychiatric medication management as an area in which consensus could improve patient care. The aim of this consensus statement is to provide recommendations to clinicians regarding preoperative psychiatric medication management.

Preoperative Management of Medications for Neurologic Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement.

Neurologic diseases are prevalent in patients undergoing invasive procedures; yet, no societal guidelines exist as to best practice in management of perioperative medications prescribed to treat these disorders. The Society for Perioperative Assessment and Quality Improvement tasked experts in internal medicine, anesthesiology, perioperative medicine, and neurology to provide evidence-based recommendations for preoperative management of these medications. The aim of this review is not only to provide consensus recommendations for preoperative management of patients on medications for neurologic disorders, but also to serve as an educational guide to perioperative clinicians.

Endocrine emergencies in anesthesia.

Purpose Of Review: An increasing number of patients with endocrine disorders will present to the operating rooms. In this review, we outline the common endocrine disorders that the anesthesiologist may face in the perioperative time span, review the controversies in optimal management, as well as summarize the recent literature for the management of these complex patients.

Recent Findings: Perioperative management of pheochromocytoma and paraganglioma has been facilitated by improved medical management and the adoption of minimally invasive surgical techniques.

The Electrophysiology Laboratory: Anesthetic Considerations and Staffing Models.

The electrophysiology laboratory facilitates complex procedures on patients, many of whom have advanced disease processes and extensive comorbidities. Historically, nurses administered sedation as required, but in recent years a shift to anesthesiologist-led sedation has been promoted for patient safety and advanced therapeutic considerations. Uncertainty remains, however, regarding whether the electrophysiology laboratory is best staffed with general or cardiothoracic anesthesiologists.

Nonoperating room anesthesia in different parts of the world.

Purpose Of Review: Advances in early diagnosis and treatment of diseases using minimally invasive procedures has led to an increase in the number of cases in locations outside the operating room. This surge created the need for anesthesia services to expand to these areas to provide well tolerated and favorable procedural conditions. The present review describes nonoperating room anesthesia patterns in different parts of the world.

Periprocedural management of patients on oral anticoagulation: focus on regional anesthesia.

The management of anticoagulant medications in patients undergoing regional anesthesia procedures remains an evolving topic. As with all procedures, the goal is to maintain balance between bleeding and thrombotic risks when interrupting oral anticoagulants. In contrast with operating room procedures, in which the blood loss volume is probably the most important concern, for regional anesthesia procedures, it is the location of the bleeding event that takes precedence.

Updates in periprocedural management of direct oral anticoagulants.

Purpose Of Review: As the prevalence of patients on antithrombotics is increasing, anesthesiologists must have a firm understanding of these medications and considerations for their periprocedural management. This review details up-to-date periprocedural management of direct oral anticoagulants (DOACs).

Recent Findings: DOACs have favorable pharmacokinetics including quick onset of action and short half-lives.

Perioperative Considerations for a Patient with a Left Ventricular Assist Device Undergoing Thyroidectomy.

As the population ages, ventricular assist devices (VADs) are becoming more prevalent, even in the outpatient perioperative setting. Patients with VADs present unique challenges for the anesthesiologist, who needs to have a thorough understanding of device physiology and design an appropriate anesthetic plan. This case report demonstrates an alternative monitored anesthesia care (MAC) anesthetic technique for a patient with a left VAD undergoing total thyroidectomy.

Contemporary personalized β-blocker management in the perioperative setting.

Beta-adrenergic blockers (β-blockers) are clearly indicated for the long-term treatment of patients with systolic heart failure and post-acute myocardial infarction. Early small-scale studies reported their potential benefits for perioperative use; subsequent randomized controlled trials, however, failed to reproduce earlier findings. Furthermore, their role in reducing major postoperative cardiac events following noncardiac and cardiac surgery remains controversial.

Periprocedural Anticoagulation Management For Nonoperating Room Anesthesia Procedures: A Clinical Guide.

Non-operating room anesthesia presents unique challenges for anesthesiologists. Limited preprocedural optimization and unfamiliarity with the location and procedure itself add to the difficulties in delivering safe care for these patients. Management of chronic oral anticoagulation can prove especially problematic since risks of bleeding for non-operating room procedures vary widely and differ from traditional surgeries.

Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study.

Background: Preoperative and postoperative anemia have been identified individually as potential risk factors for postoperative complications after coronary artery bypass grafting (CABG) surgery. Their interrelationship with acute kidney injury (AKI) and long-term mortality, however, has not been clearly defined and was the purpose of this study.

Methods: We retrospectively evaluated 6,130 adult patients undergoing CABG surgery performed at a single large academic medical center.