Anesthetic implications of necrotizing fasciitis

Dr. Belous

AANA journal. 71, no. 1, (2003): 37

This is a review article. It focuses on the issue of anesthesia for cases of necrotizing fasciitis. There are several key considerations to keep in mind. Untreated cases often present as septic shock requiring vasoactive drug administration. Mortality can be as high as 20 to 50 %. These patients definitely require some form of invasive monitoring of hemodynamics and vigorous volume resuscitation. Infected dead tissue tends to bleed and blood products should be readily available. Clotting factor deficiencies may also need replacement. As a rule, multiple surgeries will be required and should be prepared for. In some severe tracheostomy may be indicated along with ICU care. These patients will require pain management, physical therapy and often psych consultations. Intraoperatively, anesthesia provider should be prepared to deal with large fluid shifts, hemodynamic instability, and frequent positioning changes, as well as the use vasoactive drugs.

RN's Role in Managing OB Complications

Vyacheslav Belous, DO

Journal of Perinatal and Neonatal Nursing

Vol. 23, No. 1, pp. 23–30

Complications in Obstetric Anesthesia

Nursing’s Role to Anticipate, Recognize, and Respond

Bernadette Balestrieri-Martinez, MSN, RNC, CCNS

This article discusses the important role of nursing staff in being able to recognize complications of obstetric anesthesia.  It stresses the importance of enhanced education in early recognition and treatment of obstetric anesthesia and proposes a curriculum for this purpose. Major complications are listed and detailed, which include local toxicity, high block, post-dural puncture headache, unilateral blocks or patchy blocks, bladder dysfunction, maternal pyrexia, neurologic complications, pulmonary aspiration, difficult/failed intubation, hypotension, hypovolemia, malignant hyperthermia, and cardiovascular instability.

MH and Graves Disease, Dr. Belous

Vik Belous, DO

Article:

Malignant Hyperthermia in a patient with Graves’ disease during subtotal thyroidectomy

Kozo Nishiyama, et al. Endocrine Journal. 2001, 48 (2), 227-232.

Summary:

In this article authors describe a case report of a patient with Graves’ disease who developed malignant hyperthermia while undergoing a subtotal thyroidectomy under general anesthesia. There are a few important take home points from this reading. Patients in hypermetabolic state either secondary to thyroid storm or malignant hyperthermia have overlapping signs, which makes the distinction difficult especially in a patient under general anesthesia. Nevertheless, anesthesia provider must remain vigilant about making correct diagnosis. Muscle rigidity is not always a sure way to differentiate MH and thyroid toxicity. Laboratory studies will help with making final diagnosis, yet dantrolene therapy should be instituted as soon as possible. One should keep in mind that there some reports suggesting a relationship between MH and hyperthyroidism.