What's New | Decker

Krystina Geiger, PharmD, BCPS, BCCCP, Michael J Schontz, PharmD, BCPS, BCCCP

Cardiovascular and neurologic adverse effects can amount from local anesthetic systemic toxicity (LAST). The most current recommendations include lipid emulsion therapy as a standard of care for when the patient becomes hemodynamically unstable due to LAST.
Liposomal bupivacaine is a delayed release formulation of standard bupivacaine and the most recent local anesthetic with a novel delivery system. This may present a gateway for advancement of new formulations and new approaches to regional techniques.
Enhanced recovery after surgery protocols are becoming more common in the surgical world. Local anesthetics will be playing a role in the reduction of opiate consumption and opiate-related side effects. Additionally, mitigation of opiate prescriptions may assist with the reduction of illicit opiate drug use.

Boxiang Jiang, MD, Jeffrey Marks, MD, FACS, Hahn Soe-Lin, MD

Endoluminal lumen apposing metal stents have been utilized to create palliative fistula formation.
Endoluminal primary and secondary bariatric procedures are being developed and utilized.
Endoluminal full thickness resection and mucosal resection techniques are being developed to allow for organ sparing therapy.
The submucosal space originally investigated and utilized in POEM has become the new space for further endoluminal therapies.
Closure of fistulas are being developed with the use of suturing and over the scope clip technologies.

Emmanuel M. Gabriel, MD, PhD, Steven N Hochwald, MD, FACS

Matthew R Cooperberg, MD, MPH

The evidence is increasingly clear that early detection of higher risk prostate cancers based on prostate-specific antigen (PSA) testing reduces prostate cancer mortality but at the cost of overdiagnosis and potential overtreatment of low-risk disease.
The best way to implement PSA testing likely involves early baseline assessment and infrequent repeat testing for the majority of men with low baseline PSA.
Shared decision-making around PSA testing can be relatively straightforward and should focus on the fact that the purpose of screening is early identification of potentially lethal disease. The man should understand, ideally before a PSA test and certainly before a biopsy, that low-risk disease, if identified, does not require immediate treatment in most cases.

KyoungBin Im, MD, MS

NREM parasomnias have a common underlying pathophysiology with varying clinical manifestations.
NREM parasomnias are often secondary to sleep deprivation and other primary sleep disorders.
Sleep-related eating disorders are strongly associated with zolpidem, especially when given to patient with restless legs syndrome.
REM sleep behavior disorder (RBD) diagnosis is based on the history (dream enactment) and the evidence of REM without atonia from polysomnogram.
RBD is considered precursor of neurodegenerative diseases such as Parkinson diseases, Lewy body disease, and synucleinopathy.

Ashok R Shaha, MD, FACS, Rebecca Tuttle, MD

John D. Brunzell, MD, FACP, R Alan Failor, MD

2018 Diabetes Canada Clinical Practice Guidelines Expert Committee: Dyslipidemia.
2017 Dyslipidemia: Current Therapies and Guidelines for Treatment.
2017 American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease.

Michael R Foley, MD, Trevor E Quiner, MD, MSc, Resident Physician

Amniotic fluid debris found in maternal lungs are not criteria to diagnose amniotic fluid embolism.
Cardiovascular support during amniotic fluid embolism includes basic life support and advanced cardiac life support.
Coagulopathy related to amniotic fluid embolism should be treated aggressively with massive transfusion protocols.
Cases of amniotic fluid embolism and biologic samples should be reported to national registries.

Pharmacology