Huge numbers of patients referred to pain service have kidney function impairment to some extent. Pain physicians face puzzling cases and may find themselves struggling and divided between the decisions of providing adequate pain reliever, at the same time avoiding further damage to kidneys, and excessive accumulation of medications and their metabolites, also negative interactions with patient’s other medications. In this chapter, we will reason about the prevalence of pain in patients with renal impairment, pharmacodynamics and pharmacokinetics of pain medications in this group, optimization of pain control, preferred choice of drugs according to the level of kidney damage, and feasibility of alternative pain management techniques.
Part of the book: Pain Management in Special Circumstances
2020 has seen the whole world battling a pandemic. Coronavirus Disease 2019 (COVID-19) is primarily transmitted through respiratory droplets when in close contact with an infected person, by direct contact, or by contact with contaminated objects and surfaces. Aerosol generating procedures (AGPs) like intubation have a high chance of generating large concentrations of infectious aerosols. AGPs potentially put healthcare workers at an increased risk of contracting the infection, and therefore special precautions are necessary during intubation. The procedure has to be performed by an expert operator who uses appropriate personal protective equipment (PPE). Modifications of known techniques have helped to reduce the chances of contracting the infection from patients. The use of checklists has become standard safe practice. This chapter looks at the current knowledge we have regarding this illness and how we should modify our practice to make managing the airway both safer for the patient and the healthcare workers involved. It addresses the preparation, staff protection, technical aspects and aftercare of patients who need airway intervention. It recommends simulation training to familiarize staff with modifications to routine airway management.
Part of the book: Special Considerations in Human Airway Management
Recognizing airway trauma and safety management is challenging for any anaesthesiologist. Many types of airway injuries require identifying airway anatomy correctly; early assessment and proper management are crucial for saving many lives. Proper management involves the classification of those patients into three categories. Each one has a unique and different control. Knowing your capabilities and skills are very important for safe airway management. It does not matter where you are but skills, knowledge of airway management algorithms and tools you have. After reading this book chapter, the participant will be able to define airway trauma, proper airway risk assessment and safety management.
Part of the book: Special Considerations in Human Airway Management