Clinical Pearls for Subspecialty Care

Painful Disease States

  • Pathophysiology: Acute Pain, Cancer-Related Pain, Chronic Pain States, Acute and Chronic Neck and Low Back Pain, Neuropathic Pain States (Complex Regional Pain Syndrome Types I and II, Postherpetic Neuralgia, Phantom Limb, Post-Stroke, Peripheral Neuropathies [e.g., Diabetic Neuropathy], Somatic Pain Conditions: Myofascial Pain, Facet Arthropathy, etc.)
  • Treatment: Acute Postoperative and Posttraumatic Pain, Postoperative Epidural Analgesia Neuraxial Opioids, Peripheral Nerve Blockade and Catheters, Patient-Controlled Analgesia, Other Modalities, Multimodal Analgesia (Nonsteroidal Analgesics, Electrical
    Stimulation, Acupuncture, Ketamine, etc.)
  • Cancer-Related Pain: Systemic Medications, Tolerance and Addiction, Continuous Spinal and Epidural Analgesia, Neurolytic and Non-Neurolytic Blocks, World Health Organization Analgesic Ladder
  • Chronic Pain (Non-Cancer-Related): Systemic Medications: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Opioid Analgesics, Anticonvulsants, Antidepressants, Spinal and Epidural Analgesia, Peripheral Nerve Blocks, Sympathetic Nerve Blocks, Other Techniques (TENS, Spinal Cord Stimulation, Neuroablation – Surgical and Chemical Neurolysis)

Pediatric Anesthesia

  • Apparatus: Breathing Circuits (Advantages/Disadvantages, Dead Space, Etc.), Humidity, Thermal Control, Endotracheal Tube Selection (Cuffed vs. Uncuffed) and Sizing, Warming Devices (Types, Efficacy, Complications), Premedication (Drugs, Dosage, Routes, Vehicles, Including Topical Anesthetics), Parental Presence
  • Agents and Techniques: Induction Techniques, Anesthetics (Actions Different From Adults, Drug Toxicities Preferentially Occurring in Children [e.g., Propofol], Opioid Dosing and Sensitivity, Neuromuscular Blockers (Sensitivity, Congenital Diseases, Complications of
    Succinylcholine, Age-Related and Drug-Related Pharmacodynamics and Pharmacokinetics), Regional Anesthesia, Fluid Therapy and Blood Replacement, Physiologic Anemia, Glucose Requirements, Problems in Intubation and Extubation (Full Stomach, Diaphragmatic Hernia, Tracheoesophageal Fistula, Pierre-Robin, Treacher-Collins, Crouzon’s, Goldenhar’s, Hurler’s, Awake/Fiberoptic Intubation, Dentition, Laryngospasm, Stridor)
  • Neonatal Physiology: Respiratory (Development, Anatomy, Surfactant, Pulmonary Oxygen Toxicity, Pulmonary Function, Lung Volumes vs. Adult Airway Differences, Infant vs. Adult
  • Cardiovascular: Transition, Fetal to Adult, Persistent Fetal Circulation, Retinopathy of Prematurity (Anesthetic Implications), Metabolism, Fluid Distribution and Renal Function, Thermal Regulation (Neutral Temperature, Nonshivering Thermogenesis), Fetal Hemoglobin, Prematurity, Apnea of Prematurity, Bronchopulmonary Dysplasia
  • Congenital Heart and Major Vascular Disease: Cyanotic Defects, Acyanotic Defects, Primary Pulmonary Hypertension, Major Vascular Malformations (Coarctation, Persistent Patent Ductus Arteriosus, Vascular Rings), Altered Uptake/Distribution of IV and Inhalation Anesthetics,
    Anesthetic Considerations Cardiac Surgery (Corrective and Palliative, Noncardiac Surgery, Chronic Congenital Heart Disease, Corrected, Uncorrected, and Palliated in Childhood Beyond the Newborn and Infant Periods and Adulthood)
  • Emergencies in the Newborn (Diaphragmatic Hernia, Tracheoesophageal Fistula and Esophageal Atresia, Neonatal Lobar Emphysema, Pyloric Stenosis, Necrotizing Enterocolitis, Omphalocele/Gastroschisis, Respiratory Distress Syndrome: Etiology, Management, Ventilation Techniques, Myelomeningocele (Pediatric Medical Problems with Anesthetic Implications)
  • Respiratory: Upper Respiratory Infections (Colds, Epiglottitis, Laryngotracheobronchitis),
    Bronchopulmonary Dysplasia, Cystic Fibrosis
  • Musculoskeletal: Muscular Dystrophies, Myotonias, etc.
  • Developmental Delay, Cerebral Palsy, Autism
  • Childhood Obesity
  • Endocrine Diseases: Childhood Diabetes, Congenital Adrenal Hyperplasia, etc.
  • Skeletal Abnormalities with Or without Systemic Implications : Klippel-Feil, Achondroplasia,
    Marfan’s, Morquio’s, Osteogenesis Imperfect
  • Trisomy 21 and Other Chromosomal Abnormalities
  • Juvenile Rheumatoid Arthritis
  • Anemias: Congenital and Acquired: Iron Deficiency, Physiologic Anemia, Sickle Cell,
    Thalassemia, etc.
  • Malignant Hyperthermia in Children: Susceptibility, Associated Diseases, Anesthetic
    Management of MH Susceptibility, Intraoperative Diagnosis, Treatment
  • Otolaryngology: Cleft Lip and Palate, Tonsillectomy and Adenoidectomy, Common Ear
    Procedures, Peritonsillar Abscess, Flexible and Rigid Bronchoscopy, Diagnostic and
    Therapeutic Laryngoscopy Techniques (Jet Ventilation, Laser Implications), Airway
    Foreign Bodies
  • Neurosurgery: Craniotomies for Tumor Or Vascular Malformations, Hydrocephalus,
    Ventriculoperitoneal Shunts, Craniofacial Procedures, Tethered Spinal Cord, Halo
    Placement Implications,
  • Thoracic Surgery: Anterior Mediastinal Mass, Lung Isolation Techniques, Pectus Excavatum and Carinatum
  • General and Urologic Surgery: Laparotomy vs Laparoscopy, Bowel Surgery, Urologic Surgery (Wilms Tumor, Ureteral Reimplantation, Bladder and Urethral Malformations, Neuroblastoma)
  • Orthopedic Surgery: Fractures and Dislocations, Congenital Hip Dysplasia, Foot and Hand Malformations, Scoliosis Implications and Repair
  • Ophthalmologic: Strabismus, Cataract, Glaucoma Procedures, etc.
  • Outpatient Pediatric Anesthesia (Indications and Contraindications, Anesthetic Considerations (Premedication, Induction, Maintenance, Monitoring, Recovery Period, Discharge Criteria, Post-Discharge
  • Monitoring/Follow-Up: Postoperative Analgesia, Systemic Medications and Routes of Administration, Multimodal Therapy, Regional Techniques (Caudal, Epidural, Nerve Blocks)
  • Postoperative Nausea and Vomiting: Risk Factors, Prophylaxis, Treatment
  • Pediatric Sedation: Guidelines, Pharmacology, Credentialing, Indications, Monitoring,
  • Pediatric Anesthesia Outside the Operating Rooms: Diagnostic and Interventional Radiologic
    Procedures, Gastroenterology Laboratory, MRIs, Radiation Therapy

Obstetric Anesthesia

  • Maternal Physiology: Effects of Pregnancy on Uptake and Distribution, Respiratory (Anatomy, Lung Volumes and Capacities, Oxygen Consumption, Ventilation, Blood Gases, Acid Base), Cardiovascular (Aorto-Caval Compression, Regulation of Uterine Blood Flow), Renal, Liver (Albumin/Globulin Ratio, Protein Binding of Drugs), Gastrointestinal (Gastric Acid, Motility, Anatomic Position, Gastroesophageal Sphincter Function), Hematology (Blood Volume, Plasma Proteins, Coagulation)
  • Placenta: Placental Exchange (O2, CO2, Placental Blood Flow, Barrier Function)
  • Maternal-Fetal Considerations: Pharmacology (Anesthetic Drugs and Adjuvants, Oxytocic Drugs (Indications, Adverse Effects), Tocolytic Drugs (Indications, Adverse Effects), Antiseizure Drugs; Interactions (Magnesium Sulfate), Mechanisms of Placental Transfer, Placental Transfer of Specific Drugs, Fetal Disposition of Drugs, Drug Effects on Newborn
  • Amniotic Fluid (Amniocentesis, Oligohydramnios, Polyhydramnios)
  • Antepartum Fetal Assessment and Therapy (Ultrasonography, FHR Monitoring, Nonstress
    Test, Stress Test, Biophysical Profile)
  • Anesthetic Techniques and Risks (Elective vs. Emergency, General vs. Regional): Systemic Medications (Opioids, Sedatives, Inhalational Agents), Regional Techniques, Epidural, Caudal, Spinal, Combined Spinal/Epidural, Paracervical Block, Lumbar Sympathetic Block, Pudendal Block)
  • Complications (Aspiration, Nerve Palsies)
  • Physiology of Labor (Metabolism, Respiration, Cardiovascular, Thermoregulation)
  • Influence of Anesthetic Technique on Labor
  • Cesarean Delivery: Indications, Urgent/Emergent, Anesthetic Techniques and Complications,
    Difficult Airway, Aspiration Prophylaxis
  • Problems During Pregnancy and Delivery: Anesthesia for Cerclage or Non-Obstetric Surgery, Ectopic Pregnancy, Spontaneous Abortion, Gestational Trophoblastic Disease (Hydatid Mole), Autoimmune Disorders (Lupus, Antiphospholipid Syndrome), Endocrine (Thyroid, Diabetes, Pheochromocytoma), Heart Disease (Valvular Disorders, Pulmonary Hypertension, Congenital Heart
    Disease, Arrhythmias, Cardiomyopathy), Hematologic (Sickle Cell Anemia, Idiopathic Thrombocytopenic Purpura, Von Willebrand Disease, Disseminated Intravascular Coagulation (DIC), Anticoagulant Therapy, Rh and ABO Incompatibility), Hypertension (Chronic, Pregnancy-Induced), Neurologic (Seizures, Myasthenia, Spinal Cord Injury, Multiple Sclerosis,
    Subarachnoid Hemorrhage), Respiratory (Asthma, Respiratory Failure), Renal, Human Immunodeficiency Virus Infection
  • Problems of Term and Delivery: Intrapartum Fetal Assessment (Fetal Heart Rate Monitoring, Fetal Scalp Blood Gases, Fetal Pulse Oximetry), Preeclampsia and Eclampsia, Supine Hypotensive Syndrome, Aspiration of Gastric Contents, Embolic Disorders (Amniotic Fluid Embolism, Pulmonary Thromboembolism), Antepartum Hemorrhage (Placenta Previa, Abruptio Placenta, Uterine Rupture), Postpartum Hemorrhage (Uterine Atony, Placenta Accreta, Cord Prolapse, Retained Placenta, Dystocia, Malposition, and Malpresentation (Breech, Transverse Lie), Maternal Cardiopulmonary Resuscitation, Fever and Infection, Preterm Labor, Vaginal Birth After Cesarean Section (VBAC), Multiple Gestation
  • Resuscitation of Newborn: Apgar Scoring, Umbilical Cord Blood Gas Measurements, Techniques and Pharmacology of Resuscitation, Intrauterine Surgery (Maternal and Fetal Considerations, Intrauterine Fetal Resuscitation)

Otorhinolaryngology (ENT) Anesthesia

  • Airway Endoscopy
  • Microlaryngeal Surgery
  • Laser Surgery: Hazards, Complications (Airway Fires, Etc.)

Anesthesia For Plastic Surgery

  • Liposuction

Anesthesia For Laparoscopic Surgery

  • Anesthetic Management, Complications: Cholecystectomy, Gynecologic Surgery, Gastric Stapling, Hiatus Hernia Repair

Ophthalmologic Anesthesia

  • Retrobulbar and Peribulbar Blocks
  • Open Eye Injuries

Orthopedic Anesthesia

  • Tourniquet Management
  • Complications
  • Regional vs. General Anesthesia


  • Burn Management
  • Mass Casualty
  • Biological Warfare

Anesthesia for Ambulatory Surgery

  • Patient Selection and Preoperative Management
  • Anesthetic Management
  • Discharge Criteria and Postoperative Follow-Up (Including Continuous Nerve Blocks)
  • Office-Based Anesthesia: Equipment, Safety, Organization, Patient Management

Geriatric Anesthesia/Aging

  • Pharmacological Implications, MAC Changes
  • Physiological Implications: CNS, Circulatory, Respiratory, Renal, Hepatic

Critical Care

  • Shock States: Etiology, Classification, Pathophysiology, Septic Shock and Life-Threatening Infection, Systemic Inflammatory Response Syndrome
  • Multiple Organ Dysfunction Syndrome
  • Poisoning and Drug Overdose
  • Near-Drowning
  • Infection Control: General and Universal Precautions, Needle Stick Injury, Catheter Sepsis, Nosocomial Infections
  • Antibiotics: Antibacterial, Antifungal, Antiviral, Antiparasitic; Antimicrobial Resistance
Course Information
Dr. Michael Ho
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