Clinics in chest medicine
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The basic objectives of any anesthetic are to provide the patient with safe analgesia and amnesia and to provide the surgeon with adequate conditions to perform the surgical procedure. This article discusses the different routes through which these objectives may be met.
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This article describes the pathophysiology of the respiratory system after upper abdominal surgery, emphasizing the role of respiratory muscle dysfunction. The history of current techniques to measure respiratory muscle function are reviewed. The authors describe the postoperative pattern of breathing, speculate on the physiologic mechanisms responsible and discuss the data supporting the role of reflexes arising from the abdomen and the shift of neural output to different respiratory muscles. Finally, the authors review the impact of "closed" surgical interventions such as laparoscopic cholecystectomy.
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Clinics in chest medicine · Jun 1993
ReviewPerioperative respiratory care of the patient undergoing upper abdominal surgery.
The respiratory system is invariably affected during and after abdominal surgery. In high-risk patients, this may result in the development of postoperative pulmonary complications (PPC). Several pulmonary and nonpulmonary risk factors have been identified as good predictors for PPC. This article summarizes the treatments that may help prevent the development of PPC in patients undergoing upper abdominal surgery.
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Clinics in chest medicine · Jun 1993
ReviewCardiac risk evaluation and management in noncardiac surgery.
A careful history, physical examination, resting electrocardiogram, and chest radiograph are essential for preoperative cardiac assessment of adult patients. The nine individual Goldman indicators of increased perioperative cardiac risk and evidence of an unstable coronary ischemic syndrome should be specifically sought in each patient and treated when possible. After initial assessment, patients who still have a medium level of perioperative risk can usually be accurately assigned to a high- or low-risk category through the use of exercise testing and the selective use of dipyridamole thallium imaging.