Latest Updates

Nonpulmonary Thoracic Procedures

Jaida C Fitzgerald, MD
    • Compared to open surgery, minimally invasive surgical approaches for esophagectomy have been associated with less blood loss as well as shorter length of stay at intensive care unit and the hospital.
    • Implementation of thoracic epidural analgesia for post esophagectomy pain control has been shown to result in earlier mobilization, decreased incidence of pulmonary complications, and decreased incidence of anastomotic leaks.
    • There is a decreased incidence of respiratory complications with the intraoperative use of lung protective strategies during esophagectomy.

Carotid Endarterectomy

Louisa Palmer, MD, Amanda Widing, MD,1 PGY-3 Resident
    • Increased focus on patient selection with respect to 3- to 5-year predicted survival
    • Improvement in medical management including preoperative optimization and updated decision support for preoperative cardiac testing
    • Improvement in outcomes after carotid artery stenting makes it a reasonable alternative to carotid endarterectomy
    • Increased prevalence of ultrasound-guided techniques for deep and superficial cervical plexus block
    • Investigation of use of transcranial Doppler for detection of carotid thrombosis and early hyperperfusion syndrome

Allergic Response

    • Antihistamines to block the binding of histamine at target sites, aspirin and NSAIDs to block the synthesis of prostaglandin D2, and leukotriene antagonists blocking it’s downstream effects
    • Allergen immunotherapy to induce long-lasting clinical tolerance in sensitized patients in an antigen-specific approach
    • Monoclonal antibodies against IL-5 (mepolizumab, reslizumab), and IL-5 receptor (benralizumab) for treatment of hypereosinphilia and proposed for allergy diseases

Wide Complex Tachycardia

Sally Graglia, MD, Gary Green, MD
    • An unstable patient with wide-complex tachycardia may be approached with the usual advanced cardiac life support algorithms: high-quality chest compressions and defibrillation in pulseless patients and synchronized cardioversion in patients with a pulse.
    • Recent data suggest limited utility of Advanced Cardiac Life Support interventions (medications, advanced airway) compared with basic life support, reminding providers to focus on effective cardiopulmonary resuscitation and defibrillation (avoiding implantable cardioverter-defibrillator or pacemaker devices).

Sclerotherapy

Khalil H. Chamseddin, MD, Melissa L Kirkwood, MD
    • Polidocanol is now FDA approved in a foam formulation
    • Correction of axial great spahenous vein reflux first is essential for optimal success of venous sclerotherapy treatments
    • Venous duplex ultrasonography has revolutionized the treatment of varicose and spider veins.
    • Sclerotherapy is reproducible and noninvasive and can objectively identify areas of reflux in the great and small saphenous systems, as well as detect pathologic conditions in the deep venous system and incompetent perforating vessels. Sclerosants may be classified into three main categories: hypertonic solutions, chemical irritants, and detergents.
    • The detergent class of sclerosants form aggregates on endothelial cell surfaces and cause endofibrosis by disrupting the integrity of the cells. Polidocanol (POL) is the most commonly used sclerotherapy agent worldwide. Sodium tetradecyl sulfate (STS) is also a commonly used agent in the United States; both POL and STS are approved by the FDA.

Allergic Response

    • Antihistamines to block the binding of histamine at target sites, aspirin and NSAIDs to block the synthesis of prostaglandin D2, and leukotriene antagonists blocking it’s downstream effects
    • Allergen immunotherapy to induce long-lasting clinical tolerance in sensitized patients in an antigen-specific approach
    • Monoclonal antibodies against IL-5 (mepolizumab, reslizumab), and IL-5 receptor (benralizumab) for treatment of hypereosinphilia and proposed for allergy diseases

Specific Antibiotic Agents

Michael S. Calderwood, MD, MPH, Alyssa R. Letourneau, MD, MPH
    • Latest ECC guidelines for management of infective endocarditis
    • Latest IDSA guidelines on diagnosis and management of prosthetic joint infection
    • Latest scientific statement from AHA on infective endocarditis in adults
    • Latest IDSA for Healthcare Epidemiology of America guidelines on antibiotic stewardship programs

Specific Antibiotic Agents

Michael S. Calderwood, MD, MPH, Alyssa R. Letourneau, MD, MPH
    • Latest ECC guidelines for management of infective endocarditis
    • Latest IDSA guidelines on diagnosis and management of prosthetic joint infection
    • Latest scientific statement from AHA on infective endocarditis in adults
    • Latest IDSA for Healthcare Epidemiology of America guidelines on antibiotic stewardship programs
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