Chapters authored
Anesthesia for Plastic Surgery Procedures By Víctor M. Whizar-Lugo and Ana C. Cárdenas-Maytorena
Plastic surgery is currently more popular and available with increasing frequency throughout the world. Its advances are related to progress in anesthesiology. Nowadays, it is possible to operate patients with pathologies that previously did not allow this type of surgery. The developments in perioperative monitoring, pharmacology, prevention of complications, and the wide communication between patients and physicians, as well as the development of surgical units that facilitate a prompt programming and reduce the total costs, have resulted in a logarithmic growth of plastic and reconstructive surgery procedures. Local, regional, or general anesthesia, anesthetic monitoring, or conscious sedation is used routinely, allowing to manage patients as ambulatory or short stay. Deep vein thrombosis and pulmonary embolism remain the most frequent complications, followed by postoperative pain, nausea, and vomiting.
Part of the book: Anesthesia Topics for Plastic and Reconstructive Surgery
Perioperative Complications in Plastic Surgery By Víctor M. Whizar-Lugo, Jaime Campos-León and Alejandro
Moreno-Guillen
Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. The proper selection and correct preoperative assessment of patients are the key to stay away from unwanted events. Preanesthesia evaluation is mandatory in each patient and must include clinical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, type of surgery, experience of the anesthesiologist, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of moving away from the guidelines already established for an excellent practice or the result of sentinel events rather than human errors. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most frequent complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, dehiscence of wounds, brain damage, and dead. Anesthesiologists, surgeons, nurses, and all personnel involved in the care of these patients must work as a team of highly qualified and updated professionals.
Part of the book: Anesthesia Topics for Plastic and Reconstructive Surgery
Local Anesthetics By Víctor M. Whizar-Lugo, Karen L. Íñiguez-López, Ana C. Cárdenas-Maytorena and Cristian D. Ramírez-Puerta
The fascinating history of local anesthetics (LAs) began in South America with the herbal and traditional use of cocaine leaves by the indigenous peoples of Peru and Bolivia, the sacred plant of the Incas Erythroxylum coca. The use for anesthetic purposes dates back to 1884. Since then, the evolution of LAs has been closely related to research motivated by its efficacy and safety versus toxicity. According to their chemical structure, these drugs are classified into two main groups: esters and amino amides; however, there are three LAs with different characteristics: articaine, sameridine, and centbucridine. The pharmacological and toxic mode of action is primarily in the voltage-dependent sodium channels located in the cell membrane, which clinically produces analgesia, anesthesia, seizures, arrhythmias, and cardiac arrest. The quality of anesthesia and analgesia depends on the type of LA, dose, and application technique, while the deleterious effects are secondary to its plasma concentration. Nonanesthetic properties of LAs such as their antimicrobial, antineoplastic, antiarrhythmics, antitussive, and antiasthmatics effects have been described and are briefly reviewed.
Part of the book: Topics in Local Anesthetics
Regional Anesthesia in Times of COVID-19 By Víctor M. Whizar-Lugo, Karen L. Iñiguez-López and Guillermo Castorena-Arellano
The globalized coronavirus pandemic 2019 has kept us on our toes. Although confusion is widespread and there is a trend toward normalization of almost all human activities, outbreaks remain frequent. The majority of patients with COVID-19 have a trivial to moderate clinical course; a small group develops severe pneumonia and other life-threatening complications. Vaccination against this virus has contributed to better control of the pandemic, but there are no antiviral drugs that have demonstrated efficacy; therefore, the management of surgical patients confirmed or suspected of this disease is a challenge for health care workers, including the anesthesiologists, as well as the non-COVID-19 patients who at a given moment could become carriers or sick. General anesthesia produces aerosols and risks medical and technical personnel being infected, especially those who manage the airway. On the other hand, regional anesthesia has advantages over general anesthesia because the airway is not handled; however, its limited duration is the most important concern. It is reasonable that regional anesthesia occupies a preponderant place in the safe management of all patients, as long as the type of surgery allows it, the anesthesiologist has sufficient skills and patients accept the proposed technique. At this time of globalized crisis due to COVID-19, the intrapandemic anesthetic management of patients undergoing surgery continues to be a changing task, a challenge that has been solved as new data based on solid scientific evidence arise, besides the development of drugs, safer vaccines, equipment, and health prophylactic methods. There is a clear tendency to use regional anesthesia whenever this is possible.
Part of the book: Topics in Regional Anesthesia
Postoperative Analgesia in Plastic Surgery Procedures By Daniela Arévalo-Villa, Andrea Figueroa Morales, Roberto de Jesús Jiménez-Contreras and Víctor M. Whizar-Lugo
Advances in the knowledge of the secondary effects of acute postoperative pain have motivated anesthesiologists and surgeons to pay special attention to its prevention and correct management. Surgical procedures in plastic surgery are very varied and produce postoperative pain in direct relation to the site, type, and extent of surgery, with facial interventions being the least painful (with the exception of rhinoplasty) and the most painful being breast surgery, abdominoplasty, and extensive liposuctions due to the possibility of trauma to peripheral nerves and greater secondary inflammation. The combination of surgeries produces more intense post-surgical pain. There is insufficient data on the frequency and severity of pain after plastic surgery, be it reconstructive or cosmetic. Although opioids have been considered to be the cornerstone in the treatment of postsurgical pain, their use in plastic surgery patients must be carefully evaluated for various reasons that interfere with the results of this type of surgery. Similar to other surgical specialties, multimodal analgesia is now the most appropriate way to prevent and treat pain in these patients. This chapter is a comprehensive review of the management of acute postoperative pain in certain plastic surgery procedures, with emphasis on the multimodal approach.
Part of the book: Topics in Postoperative Pain
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