You’re Wrong,

I’m Right

Corey S. Scher · Anna Clebone

Sanford M. Miller · J. David Roccaforte

Levon M. Capan Editors

Dueling Authors Reexamine Classic

Teachings in Anesthesia

123

You’re Wrong, I’m Right

Corey S. Scher

•

Anna Clebone

Sanford M. Miller

•

J. David Roccaforte

Levon M. Capan

Editors

You’re Wrong, I’m Right

Dueling Authors Reexamine Classic

Teachings in Anesthesia

123

Editors

Corey S. Scher, MD

Clinical Professor of Anesthesiology,

Department of Anesthesiology

Perioperative Care and Pain Medicine,

New York University School of Medicine

New York, NY

USA

Anna Clebone, MD

Assistant Professor, Department

of Anesthesia and Critical Care

The University of Chicago

Chicago, IL

USA

Sanford M. Miller, MD

Clinical Professor of Anesthesiology

(Emeritus), Former Assistant Director of

Anesthesiology, Bellevue Hospital Center

Retired from Department of

Anesthesiology, Bellevue Hospital Center

New York University School of Medicine

New York, NY

USA

J. David Roccaforte, MD

Clinical Associate Professor of

Anesthesiology and Surgery,

Department of Anesthesiology

Bellevue Hospital Center, Perioperative Care

and Pain Medicine, New York University

School of Medicine, Surgical Intensive

Care Unit

New York, NY

USA

Levon M. Capan, MD

Department of Anesthesiology

Perioperative Care and Pain Medicine,

Vice Chair Faculty Promotion Associate

Director Anesthesia Service Bellevue

Hospital Center

New York, NY

USA

ISBN 978-3-319-43167-3 ISBN 978-3-319-43169-7 (eBook)

DOI 10.1007/978-3-319-43169-7

Library of Congress Control Number: 2016947744

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is

concerned, speciﬁcally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction

on microﬁlms or in any other physical way, and transmission or information storage and retrieval, electronic

adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.

The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not

imply, even in the absence of a speciﬁc statement, that such names are exempt from the relevant protective laws and

regulations and therefore free for general use.

The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed

to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,

express or implied, with respect to the material contained herein or for any errors or omissions that may have been

made.

Printed on acid-free paper

This Springer imprint is published by Springer Nature

The registered company is Springer International Publishing AG Switzerland

To all of my hearts, Lisa, Ryan, Danielle, Oliver, and Dakota

—Corey S. Scher

To my wonderful husband, Keith Ruskin

—Anna Clebone

To my wife, Marcia, who has stood with me for 61 years

—Sanford M. Miller

Preface

Our journals are designed for critical readers to determine whether the best freshly published

papers will become essential for practice or not. As anesthesiologists work more hours, with

fewer resources and sicker patients than ever before, it is truly a challenge to maintain

currency. For many, reading on the subject of anesthesia does not take priority while juggling

a personal and professional life. Investing in print copies or gaining Internet access to journals

in our ﬁeld is low on the to-do list.

Anesthesiologists love to talk to fellow anesthesiologists about cases. Even the most dour

clinicians will come to life when another anesthesiologist says, “You will never believe what

happened to me in the operating room last week.” It is readily transparent than many clinicians

are holding onto clinical paradigms that were learned in residency that are, at a minimum, now

controversial and sometimes no longer true.

There has been a veritable explosion over the last 20 years of high-quality research in

anesthesiology, pain medicine, and critical care. The merit of each journal is quantitatively

determined by its “Impact Factor”—the frequency that its articles are cited in other papers or

reports. The impact of anesthesiology and its related ﬁelds has soared by over 65 % in the past

5 years. Fully overwhelming evidence now inﬂuences the clinical care of patients in our ﬁeld

and is the reason for this gain. Despite new statistical measures, project design, and editorial

approval, many clinicians are holding onto practice parameters that are outdated or irrelevant.

The process of practice change involves 3 steps. With the introduction of a new practice

parameter, the provider goes through: (1) denial, (2) understanding that there is controversy,

and (3) after more time than should be needed, acceptance.

The editors of this book made a bold attempt at creating a book that is targeted at every

clinician in the ﬁeld, whether they stay current or not. We present 126 cases, broken down by

subspecialty, where the author has a “split personality.” After a case is presented, the author

forcefully represents 2 adversarial positions: a pro stance and a con stance. In each case, the

authors speak freely, having checked their academic title at the door. During a freewheeling

discussion, the case authors alternate between talking off the cuff and presenting current

evidence. The book is meant as an easy read that can be opened up at any page. Each case is

only a few pages long and can capture the attention of the reader for as long as needed. This is

not meant to be a reference book. Simply stated, the cases are meant to be entertaining and a

“fun read.”

In almost every clinical arena, concepts that we thought were written in stone are on the

road to becoming myths. Examples include the utility of cricoid pressure, the use of normal

saline, left uterine displacement, and the neurotoxicity of inhaled anesthetics in young chil-

dren. These are just the tip of the iceberg of controversial topics recently debated in our

high-impact journals. Large database analyses on an increasingly large number of topics

demand a change in practice.

Another objective of this book is to help the reader take a small step toward currency. The

informal presentation of topics is what we believe is the most accessible way to convey new

information to a large number of readers. This is how information is most frequently shared in

the “real world” both inside and outside of medicine. We believe that this book accomplishes

vii

this goal of information sharing, and that most of the cases in the book address the most

relevant controversies in anesthesiology today.

The pro– con approach offers advantages over other methods of teaching. These cases can

be presented to residents in a manner similar to the Socratic method. In our experience,

residents do prefer to be taught using a case-based method. Long intervals exist in the

operating room during which minimal activity occurs, althoug h vigilance must still be

maintained. Case-based discussions are a perfect way to spend this time. This book is

essentially a library for a teacher who is looking for high-quality case-based topics.

The enthusiasm of the authors of each case was the most satisfying aspect of this book. The

quality of each case demonstrates that sentiment. Each case author is to be commended for the

wisdom and skillful writing contributed to these cases. While we are grateful for everyone

involved in getting this work to print, we will be most grateful if the readers simply enjoy this

book and use it as a road to currency and an important mode of teaching anesthesia.

New York, USA Corey S. Scher

Chicago, USA Anna Clebone

viii Preface

Contents

Part I General

1 Should Recent Clinical Trials Change Perioperative Management

in Patients with Cardiac Risk Factors? ........................... 3

Corey S. Scher

2 Should Real-Time Ultrasound Guidance Be Routinely

Used for Central Venous Catheter Placement? ...................... 7

James Leonard

3 A Patient with Chronic Kidney Disease Is Coming to the Operating

Room for an Emergent Procedure, Which Intravenous Fluid Do You

Plan to Give Her?........................................... 11

Jacob Tiegs and Arthur Atchabahian

4 Just Say NO to Nitrous! ...................................... 15

Corey S. Scher

5 Closed-Loop Anesthesia: Wave of the Future or No Future? ........... 19

Cedar J. Fowler and Howard Ching

6 Should Acute Respiratory Distress Syndrome (ARDS) Preventative

Ventilation Be Standard in the Adult Operating Room? ............... 21

Samir Kendale

7 I Gave Rocuronium 3 Hours Ago, Do I Need to Reverse?.............. 23

Daniel Kohut and Kevin Turezyn

8 How Do You Recognize and Treat Perioperative Anaphylaxis?.......... 25

Amit Prabhakar, Melville Q. Wyche III, Paul Delahoussaye,

and Alan David Kaye

9 Is Monitored Anesthesia Care (MAC) Safe for All Cases? ............. 29

Kenneth M. Sutin and Jonathan Teets

10 Does Electrophysiology Really Have to Reprogram My Patient’s

Pacemaker Prior to Electroconvulsive Therapy? .................... 33

Ethan O. Bryson

11 When Can Transesophageal and Trans-Thoracic Echocardiography

Be Useful in a Non-Cardiac Case?............................... 35

Lisa Q. Rong

12 Should Antiﬁbrinolytics Be Used in Patients Undergoing

Total Joint Replacements? .................................... 39

Suzuko Suzuki

13 Will Operating Rooms Run More Efﬁciently When Anesthesiologists

Get Involved in Their Management? ............................. 43

Steven D. Boggs, Mitchell H. Tsai, and Mohan Tanniru

14 Are Outcomes Better for Trauma Patients Who Are Treated

Early with Clotting Factors? ................................... 49

Steven D. Boggs and Ian H. Black

15 Should Cerebral Oximetry Be Employed in Morbidly Obese Patients

Undergoing Bariatric Surgery? ................................. 53

David Porbunderwala

16 Is Normal Saline Solution the Best Crystalloid for Intravascular

Volume Resuscitation? ....................................... 55

Saad Rasheed

Part II Cardiac

17 Should Local Anesthesia with Conscious Sedation Be Considered

the Standard of Care Over General Anesthesia for Transcatheter

Aortic Valve Replacement via the Transfemoral Approach? ............ 59

Glen D. Quigley and Jennie Y. Ngai

18 Should Antiplatelet Therapy Be Stopped Preoperatively in a Patient

with Coronary Artery Stents? .................................. 63

Caitlin J. Guo and Katherine Chuy

19 Is Extubating My Cardiac Surgery Patient Postoperatively in the

Operating Room a Good Idea? ................................. 67

Joseph Kimmel and Peter J. Neuburger

20 Is a Pulmonary Artery Catheter Needed If You Have Transesophageal

Echocardiography in a Routine Coronary Artery Bypass Grafting? ...... 71

Christopher Y. Tanaka and John Hui

21 When Should You Transfuse a Patient Who Is Bleeding After

Cardiopulmonary Bypass? .................................... 75

Cindy J. Wang

22 Neuraxial Versus General Anesthesia in a Patient with Asymptomatic

Severe Aortic Stenosis........................................ 79

Patrick B. Smollen and Arthur Atchabahian

23 Should High-Risk Cardiac Patients Receive Perioperative Statins? ....... 81

Himani V. Bhatt

24 Cardiopulmonary Bypass Cases: To Hemodilute or Not? .............. 83

Nicole R. Guinn

25 Are Seizures Really a Problem After the Use of Antiﬁbrinolytics?........ 85

Dmitry Rozin and Madelyn Kahana

26 Is Regional Anesthesia for Cardiac Surgery a Good Idea? ............. 87

M. Megan Chacon

27 Are Surgical and Anesthesia Medical Missions in

Low- and Middle-Income Countries Helping or Hurting? The Evolving

Fields of Global Anesthesia and Global Surgery..................... 89

Jamey Jermaine Snell

Part III Thoracic

28 Can Oxygenation in Single-Lung Thoracic Surgery Be Affected

by Inhibition of Hypoxic Pulmonary Vasoconstriction?................ 95

Rebekah Nam

x Contents

29 Is a Bronchial Blocker Just as Good as a Double-Lumen

Tube for Achieving Adequate Lung Isolation? ...................... 97

Alexandra Lewis and David Amar

30 Your Thoracic Epidural is Not Working: How Do You Provide

Analgesia Post-thoracotomy?................................... 101

Angela Renee Ingram and Anuj Malhotra

Part IV Pediatric

31 Pediatric Upper Respiratory Infection: You Cancelled the Cas e

and Told the Parents to Reschedule, Right? ........................ 105

Brian Blasiole

32 Does a Low Mean Blood Pressure in the Neonate Under Anesthesia

Lead to Cognitive Deﬁcits? .................................... 109

Anna Clebone and Corey S. Scher

33 Does Rapid Sequence Induction Have a Role in Pediatric Anesthesia? .... 111

Michale Sofer

34 Anesthetic Neurotoxicity: Is Anesthesia Toxic to the Developing

Brain? Should I Cancel My Baby’s Surgery?....................... 115

Misuzu Kameyama and Corey S. Scher

35 Should an Anxious Parent Be Allowed to Be Present for the Induction

of Anesthesia in Her Child? ................................... 117

Paul A. Tripi and Mark M. Goldﬁnger

36 What Is the Role of Premedication in the Pediatric Patient? ............ 121

Elliot S. Schwartz and Anna Clebone

37 Presence of Family Members in the Operating Room: Is This

Really Helpful?............................................. 125

Michelle N. Gonta and Misuzu Kameyama

38 Is It Appropriate for Complicated Pediatric Surgical Patients

to Receive Care Outside of Specialized Pediatric Centers? ............. 127

Mark M. Goldﬁnger and Paul Tripi

39 Are the Transfusion Goals for a Premature Infant the Same

As for a 7-Year-Old? ........................................ 131

Olga N. Albert

40 How Should You Get the Autistic Child into the Operating

Room When the Mother Objects to Intramuscular Ketamine? .......... 133

Glenn E. Mann and Jerry Y. Chao

41 Is “Deep” Extubation Preferable in Patients at Risk

for Bronchospasm? .......................................... 135

Manoj Dalmia

42 What Is the Best Approach to a Pediatric Patient

with an Unexplained Intraoperative Cardiac Arrest? ................. 139

Sherryl Adamic and Anna Clebone

43 Malignant Hyperthermia: “It Certainly Is” Versus

“It Certainly Is Not!” ........................................ 143

Corey S. Scher

Contents xi