Ugeskrift for laeger
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Management of perioperative treatment with anticoagulants and antiplatelet drugs is a complex medical problem. Careful preoperative evaluation of the risk of bleeding and thromboembolism with and without of antithrombotic therapy is the key prerequisite to secure safe outcome of elective, invasive procedures performed on patients treated with antithrombotic agents. In emergency cases, knowledge of the pharmacokinetics and pharmacodynamics of antithrombotic drugs and of the effect of antidotes and blood-derived, recombinant, and other haemostatic products is important.
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Cardiac patients lack compensatory capacity during bleeding, pain, and infection with an increased risk of perioperative cardiac complications. The mortality following serious postoperative cardiac events is 1400 patients per year in Denmark. ⋯ Information about the patient's heart disease should be available and treatment optimated before surgery and anaesthesia. Evidence-based preoperative risk assessment and perioperative patient care for patients with heart disease and hypertension are summarised.
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Major surgical procedures are still beset with morbidity and hospitalisation. This short survey discusses different pathogenic factors that may contribute to morbidity, with an emphasis on surgical stress responses, pain relief and all-over perioperative care in accordance with the principles of fast-track surgery. It is emphasized that further advances require a multi-disciplinary approach with a focus on process organization and where sufficient quantity is available to secure anaesthesiological, surgical and nursing care expertise.