Epidural Abscess

Postoperative Management of Postnatal Complications

The postpartum period is the time after delivery when physiological changes by the pregnancy return to the previous state. Primary postpartum haemorrhage takes place during the first 24 hours, and secondary postpartum haemorrhage occurs between 24 hours and 6 weeks after delivery. Many disorders can occur in the immediate postpartum period, there is a considerable source of morbidity and mortality in women of reproductive age, which can be mild to severe and life-threatening. Protocols aimed at the multidisciplinary management of postpartum haemorrhage, and together with the use of coadjuvant hemostatic agents, the activation of massive transfusion protocols in a responsible manner, and surgical management have improved the prognosis of these patients.

Anesthetic Management of Pregnant Patients with Infectious Disease

Fever is often the result of an infection. The most common sites for infection during pregnancy are fetal membranes, urinary and respiratory tracts, and the postpartum uterine cavity. The most frequent etiologies of intrapartum fever are chorioamnionitis and neuraxial anesthesia. Maternal and fetal exposure to hyperthermia and inflammation is associated with adverse consequences for the mother and the neonate. In pregnant women with fever, anesthesiologists are not only involved in providing analgesia, but also in the correct anesthetic management for the surgical treatment of the infectious region. Thus, as pyrexia may change both obstetric and anesthetic management, preventing maternal fever is imperative. Emerging and challenging infectious diseases, as COVID-19, remind us of the susceptible nature of pregnant and early postpartum women to severe respiratory infections, reinforcing the importance of vaccines and therapeutic measures during pregnancy.

Treatment of Lumbar Tuberculosis with Spinal Endoscopy

The authors present a case of a 25-year old female patient who presented to their facility with a chief complaint of low back pain and discomfort for the previous two months. The symptoms gradually worsened. The patient denied any fever, night sweats, and other aches. Symptoms worsened when standing up. They were also aggravated by changing the body position. In particular, bending forward was restricted. There was no radiating pain in the lower extremities. An MRI of the lumbar spine revealed a lesion raising suspicions of tuberculosis of the spine, which was later confirmed with biopsy and cultures. The patient was placed on oral multi antituberculosis antibiotic treatment but responded poorly to this treatment without much clinical improvement. Therefore, endoscopic access was chosen to debride and irrigate the paraspinal tuberculous abscess, which successfully treated the infection. The authors report the case details to illustrate that a combination of antibiotic treatment and endoscopic debridement may resolve the lumbar spine's complicated infection adequately. Minimally invasive endoscopic irrigation and lavage of paraspinal tuberculous abscesses can be considered an alternative to open surgery.

Postoperative Management of Sequelae, Complications, and Readmissions Following Outpatient Transforaminal Lumbar Endoscopy

Best management practices of complications resulting from outpatient transforaminal endoscopic decompression surgery for lumbar foraminal and lateral recess stenosis are not established. Recent advances in surgical techniques allow for endoscopically assisted bony decompression for neurogenic claudication symptoms due to spinal stenosis. These broadened indications also produced a higher incidence of postoperative complications ranging from dural tears, recurrent disc herniations, nerve root injuries, foot drop, facet and pedicle fractures, or infections. Postoperative sequelae such as dysesthetic leg pain, and infiltration of the surgical access and spinal canal with irrigation fluid causing spinal headaches and painful wound swelling, as well as failure to cure, are additional common postoperative problems that can lead to hospital readmissions and contribute to lower patient satisfaction with the procedure. In this chapter, the authors focus on analyzing the incidence of such problems and, more importantly, how to manage them. While the incidence of these problems is recogniz-ably low, knowing the art of managing them in the postoperative recovery period can make the difference between a flourishing endoscopic outpatient spinal surgery program and one that will continue to struggle with replacing traditional open spinal surgeries.

Physiology of the Newborn

The survival of the neonates is dependent on the physiological characteristics that enable them to adapt themselves initially to the placenta and then to the extra uterine environment. Of all the pediatric patients, neonates exhibit the most distinguishing physiological features that ensure their rapid development. This chapter focuses on the physiological characteristics exhibited by the neonates in the intrauterine as well as the extra uterine environment.

Thoracic Anesthesia

Given a higher prevalence of smoking, pulmonary and cardiovascular disease, and in many cases carcinoma, thoracic surgical patients experience a higher risk for perioperative morbidity and mortality than that of broader surgical populations. Careful preoperative assessment of functional status and a focus on optimizing preexisting conditions prove critical to successful surgical outcomes. As open thoracotomies decline in number, minimally invasive surgeries – including video assisted thoracoscopy (VAT) and robotic surgical approaches pose new challenges for intraoperative anesthetic management. Although double lumen endotracheal tubes remain the most common approach to lung isolation, an array of newer endobronchial blockers provide opportunities to facilitate surgery in patients with difficult airways as well as those requiring lobar isolation to tolerate surgical resection. Surgery of the esophagus and trachea continue to pose enormous challenges to both our intraoperative management and postoperative care. In thoracic surgery, perhaps more so than any other field, there is no doubt that anesthetic interventions in the preoperative, intraoperative, and postoperative settings directly impact patient survival and recovery. Evolving surgical techniques – particularly the move toward less invasive surgery – will challenge our current dogma pertaining to anesthetic management of the thoracic surgical patient – necessitating outcomes based research to further reduce adverse perioperative outcomes and enhance surgical recovery.

Iatrogenic Pathology in Anesthesiology and Intensive Care

The iatrogenic pathology occurring in anesthesiology and intensive care is a consequence of errors made due to ignorance (the incapacity to identify suddenly appearing pathological situations), negligence (deficiencies in applying correct medical conduct) or clinical misjudgment. In the field of anesthesiology, this type of pathology comprises complications in pre-anesthetic, anesthetic and post-anesthetic periods, the consequences of pharmacological effects of the administered anesthetic drugs, technical complications related to airway security, anesthetic machine functioning and monitoring equipment, the anesthetic technique utilized and the differing reactivity of patients to the chosen anesthetic procedure. In intensive care, regarding critical care patients with multiple organ dysfunctions, the main source of iatrogenesis is represented by invasive maneuvers (mechanical ventilation techniques, monitoring, vascular approaches). To all these are added complications related to administered drugs, artificial nutrition, volemic therapy and the high risk of infection.

Iatrogenic Lesions in Neurology

Iatrogenic neurological disorders can be induced by several factors, such as pharmacological agents prescribed for treatment or prevention (drug-induced neurological disorders [DIND]), complications of diagnostic and treatment procedures, like cerebral angiography or lumbar puncture, organ transplantation (related to the surgical procedure of transplantation, post-transplant immunosuppression, opportunistic infection or the inherent disorders that lead to transplantation), radiation therapy, etc. Iatrogenic neurological effects may be devastating due to the higher potential irreversibility of central nervous system, peripheral nervous system, neuromuscular junction (NMJ) and/or muscular system involvement. DIND represent the majority of iatrogenic neurological disorders. Drugs may directly induce neurological damage (through primary neurotoxicity, such as damage to the bloodbrain barrier [BBB], disturbances of brain energy metabolism, ion channels/neurotransmitters disturbances, mitochondrial dysfunction, metabolitemediated toxins, drug-induced selective cell death) or do so indirectly (cardiovascular, hematological or renal effects). Identification of DIND is important because early recognition and drug withdrawal can prevent irreversible damage. The numerous intrinsic risk factors for DIND should be well known by medical practitioners.

Costotransversectomy Approach

Minimally Invasive Transpedicular Approach

Otitis Media Updates and Current Approaches

Otitis media (OM) is the most common diagnosis for medical visits in preschool-age children and is the most frequent indication for outpatient antibiotic use in the United States. For any provider who works with pediatric patients, diagnosis and appropriate management of OM is an essential skill, as an estimated 80% of children will suffer from at least one episode in their lifetime. Timely and accurate diagnosis and appropriate management of AOM may have significant consequences for ambulatory health care utilization and expenditures. This chapter addresses the epidemiology, risk factors, pathogenesis, microbiology, diagnosis, treatment and complications of otitis media.

Clincal Anatomy for the Pediatrician

The anatomy of the head and neck is rich in depth and detail. This chapter explores the fundamentals of otolaryngologic anatomy and discusses common pathologies associated with each section. The chapter is separated in sections discussing the ears, nasal cavity, oral cavity and oropharynx, the neck and the larynx.