Thiele, Cameron M.

Hypertrophic olivary degeneration (HOD) is a rare condition characterized by degeneration and hypertrophy of the inferior olivary nucleus (ION) in the brainstem. This case report presents a 39-year-old woman with HOD undergoing left total shoulder arthroplasty. Despite long-standing concerns about regional anesthesia in patients with central nervous system disorders, an interscalene catheter was placed using ultrasound and nerve stimulation guidance. The patient experienced effective analgesia without new neurologic deficits. This report highlights the safe use of regional anesthesia in patients with HOD and underscores the need for individualized anesthetic management and further research to establish clear guidelines.

Psychotropic drugs are used in the treatment of psychiatric and non-psychiatric conditions. Many patients who are on psychotropic medications may present for procedures requiring anesthesia. Psychotropic medications can have dangerous interactions with drugs commonly used in anesthesia, some of which can be life-threatening. In this review, we describe the current anesthetic considerations for patients on psychotropic drug therapies, including antidepressants, antipsychotics, mood stabilizers, anxiolytics, and stimulants. The pharmacology, side effects, and potential drug interactions of the commonly prescribed psychotropic drug therapies with anesthetic agents are described. Further, we highlight the current recommendations regarding the cessation and continuation of these medications during the perioperative period.

Public trust in physicians has declined over the last 50 years. Future physicians will need to mend the patient–physician trust relationship. In conjunction with the American Medical Association’s Accelerating Change in Medical Education initiative, the Mayo Clinic Alix School of Medicine implemented the Science of Health Care Delivery (SHCD) curriculum—a 4-year curriculum that emphasizes interdisciplinary training across population-centered care; person-centered care; team-based care; high-value care; leadership; and health policy, economics, and technology—in 2015. In this medical student perspective, the authors highlight how the SHCD curriculum has the potential to address issues that have eroded patient–physician trust. The curriculum reaches this aim through didactic and/or experiential teachings in health equity, cultural humility and competence, shared decision making, patient advocacy, and safety and quality of care. It is the authors’ hope that novel medical education programs such as the SHCD curriculum will allow the nation’s future physicians to own their role in rebuilding and fostering public trust in physicians and the health care system.