The Mount Sinai journal of medicine, New York
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Serious neurological complications after spinal anesthesia are rare, but do occur. The most common are postdural puncture headache and hypotension. Hypotension after spinal anesthesia is a physiological consequence of sympathetic blockade. The diagnoses and management of these sequelae are discussed.
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Selected orthopedic surgical procedures, such as total joint arthroplasty and spinal instrumentation, have some of the highest perioperative transfusion rates of all surgical procedures. Blood transfusions carry the risk of complications, including the transmission of disease, immunomodulation, and hemolytic and non-hemolytic reactions. Strategies that reduce or remove the risk of allogeneic transfusion include preoperative autologous donation, acute normovolemic hemodilution, perioperative cell salvage techniques, deliberate hypotension, and pharmacologic interventions. This paper will review the current status of these therapies in the orthopedic surgical patient.
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Comparative Study
Comparison of arterial systolic pressure variation with other clinical parameters to predict the response to fluid challenges during cardiac surgery.
Prophylactic optimization of stroke volume during surgery has been thought by some to reduce complications following surgery. Mechanical ventilation has been shown to induce variations in systolic systemic arterial blood pressure. Measuring such variations in systolic pressure (SPV) might serve as an attractive method for guiding fluid therapy intraoperatively. ⋯ Although significant intergroup differences in the extent of systolic pressure variations were observed, no appropriate threshold values could be determined that would accurately predict the response to a fluid bolus. There is a relationship between SPV and SPVdown values and intravascular volume status. SPV and echocardiographic-derived values did not predict the response to a fluid bolus as well as values obtained from the pulmonary artery catheter.
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The practice of neuroanesthesia at the Mount Sinai Medical Center focused initially on clinical practice, followed by specialization. This article presents a brief history of the division and a description of the areas of interest, presentations, and publications that have originated there.
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Historical Article
The Mount Sinai Hospital's role in the development of anesthesia safety standards.
The Department of Anesthesiology of The Mount Sinai Hospital was closely involved in introducing anesthesia safety standards for anesthesia breathing systems, the introduction of the first disposable plastic anesthesia breathing system, the layout of the controls on gas machines, nontoxic airways, safe ethylene oxide sterilization and safe obstetrical anesthesia.