The Mount Sinai journal of medicine, New York
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Airway management is a critical component of modern anesthetic care. Advances in airway management, as well as the recent history of airway management teaching at The Mount Sinai Hospital, are reviewed.
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There has been growing interest in defining and measuring outcomes for cardiac surgical patients. Outcomes measures have been used in many hospitals as tools for measuring the quality of care, although it is difficult to infer from them how care might be improved. Traditionally, the major outcome endpoints used in cardiac surgery have been the 30-day mortality and morbidity rates. ⋯ By using outcome prediction tools and making conclusions based on preoperative risk factor information, surgeons and anesthesiologists are able to make better decisions about treatment strategies. Additionally, operating room and intensive care unit personnel can use these data to schedule cases and allocate resources more efficiently. These data are also very important for hospital administrators and insurance providers.
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Review
The open lung concept of alveolar recruitment can improve outcome in respiratory failure and ARDS.
Respiratory failure is a common finding in the ICU and in the management of complex cases in the operating room. Over the last ten years, it has become clear that modes of mechanical ventilation and lung recruitment may play a role both in cytokine modulation and patient outcome. Early lung recruitment and alveolar stabilization may play a very important role in the management of patients with respiratory failure and adult respiratory distress syndrome (ARDS). ⋯ This technique not only improves oxygenation, but also affects surfactant function and cytokine modulation. The open lung concept is physiologically based on the Law of Laplace. Adhering to the principles of the open lung concept, pressure-controlled ventilation may improve patient outcome by reducing the extent of irreversible structural damage to the lungs caused by mechanical ventilation.
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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.