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Anaesthesiologists frequently encounter patients with diseases of the endocrine system, in particular diabetes mellitus. The major risk factors for people with diabetes undergoing surgery are the associated end-organ diseases: cardiovascular autonomic neuropathy, joint collagen tissue, and immune deficiency. Due to the fact that endocrine diseases can be associated with significant peri-operative morbidity and mortality, it is critical that anaesthesiologists understand these disorders and when indicated request the appropriate investigations.

BackgroundSteep Trendelenburg during surgery has been associated with many position-related injuries. The American Society of Anesthesiology practice advisory recommends documentation, frequent position checks, avoiding shoulder braces, and limiting abduction of upper extremities to avoid brachial plexopathy. We conducted a web-based survey to assess anesthesiologists’ practices, institutional policies, and complications encountered when using steep Trendelenburg.MethodsTwo thousand fifty randomly selected active members of the American Society of Anesthesiology were invited via email to participate in a 9-item web-based survey. Results are reported as absolute numbers and proportions with 95% confidence interval (CI).ResultsSurvey response rate was 290 of 2050 (14.1%). 44.6% (95% CI, 38.9–50.3) of the respondents documented anesthesia start and finish, 73.9% (95% CI, 68.8–79) frequently checked positioning during surgery, 30.8% (95% CI, 25.4–36.2) reported using shoulder braces, 66.9% (95% CI, 61.5–72.3) tucked patients’ arms to the side, 54.0% (95% CI, 48.2–59.8) limited fluid administration, and more than two-thirds did not limit the duration or inclination angle. Notably, 63/290 (21.7%) reported a complication and only 6/289 (2.1%) had an institutional policy. The most common complication was airway and face edema, second was brachial plexus injury, and third was corneal abrasions. Most institutional policies, when present, focused on limiting duration of steep Trendelenburg and communication with surgical team. Only 1/6 policies required avoiding use of shoulder braces.ConclusionBased on survey results, practices related to steep Trendelenburg varied among USA anesthesiologists. Differences included protective measures, documentation, positioning techniques, fluid management, and institutional guidelines. The singular commonality found among all respondents was lack of institutional policies. Survey results highlighted the need for institutional policies and more education.

A growing number of surgical patients present to the operating room with implantable cardioverter defibrillators (ICD). Peri-operative care of these patients dictates that ICD function be suspended for many surgical procedures to avoid inappropriate, and possibly harmful, ICD therapy triggered by electromagnetic interference (EMI). An alternative to reprogramming the ICD is the use of a magnet to temporarily suspend its function. However, this approach is not without complications. We report a case where magnet use failed to inhibit ICD sensing of EMI, and a shock was delivered to the patient. Measures to decrease EMI, controversies regarding magnet use, and expert recommendations are discussed.

Extubation in the OR can be safely performed in a select group of cardiac surgery patients without any increase in postoperative morbidity or mortality. The proposed mathematical model performed reasonably well in predicting a successful extubation in the OR.