Patients presenting for vascular surgery frequently have multiple comorbidities associated with increased surgical risk. Additionally, certain types of vascular surgery can induce stress on the patient and create increased risk for complications. These factors often necessitate closer monitoring to facilitate early intervention. The anesthesiologist may elect to perform certain invasive procedures to aid in perioperative care. Procedures reviewed include placement of peripheral intravenous catheters, arterial catheters, central venous catheters, pulmonary artery catheters, and lumbar cerebrospinal fluid drains. For each procedure, this chapter discusses clinical applications, contraindications, site selection, required equipment and setup, placement techniques, potential usage of ultrasound guidance, and possible complications.

Trauma is the leading nonobstetric cause of death in pregnant patients, and parturient women have unique physiologies, pathologies, and considerations. The aim of this chapter is to discuss these differences and address ways to treat these patients immediately following trauma and in the critical care setting. The chapter addresses blunt, penetrating, and burn trauma in the pregnant patient. Additionally, it will highlight several common critical pathologies seen in pregnancy such as eclampsia; hemolysis, elevated liver enzymes, and low platelets syndrome; and acute respiratory distress syndrome, as well as some pre-existing conditions made more complicated by the pregnant state.

Lung isolation can be used during thoracic surgery to selectively ventilate a single lung for a discrete purpose. There are several indications for lung isolation, with the strength of each indication varying from absolutely indicated to preferable. Indications for lung isolation are reviewed in this chapter. Three main techniques for achieving lung isolation are also reviewed in detail. These include intentional mainstem with a single-lumen endotracheal tube, use of a double-lumen endobronchial tube and use of a bronchial blocker. The benefits and drawbacks of each technique are discussed. Finally, specific steps to troubleshoot hypoxia during one-lung ventilation are reviewed.

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