Critical care clinics
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Procedural anesthesia at the bedside offers patients relief from anxiety, discomfort, and pain and may expedite the procedure by increasing patient cooperation. Prospective planning requires knowledge of the condition of the patient and an assessment of the anesthetic requirements of the proposed procedure. The spectrum of anesthetic options includes sedation and analgesia, monitored anesthesia care, to total intravenous anesthesia (see Fig. 1). ⋯ Although an anesthesiologist is not required to administer medications and monitor the patient for sedation and analgesia or monitored anesthesia care, TIVA requires the services of an anesthesiologist. Costs are influenced by the personnel requirements and length of the procedure, which sets the drug requirements and drug costs. In the end, personal experience combined with knowledge should guide the provider to offer efficacious and cost-effective procedural anesthesia in the ICU.
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Critical care clinics · Jan 2000
ReviewMinimally invasive surgery. Bedside tracheostomy and gastrostomy.
Minimally invasive surgical techniques have gathered tremendous momentum. Most patient benefit is realized in the ambulatory setting. Smaller incisions result in less pain and earlier return to activities. ⋯ Devastating complications can become life-threatening. Attention to detail is required to avoid or respond promptly to complications. In this way, patients receive maximal benefit at minimal risk.
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Critical care clinics · Jan 2000
ReviewBedside open abdominal surgery. Utility and wound management.
Abdominal pathology in the critically ill or injured patient frequently leads to the use of open abdominal techniques or the actual performance of abdominal surgery in the ICU. All individuals responsible for the care of patients in the ICU should be familiar with the concepts and techniques of open abdomen wound management. ⋯ Development of a successful Surgery Outside the Operating Room program depends on mature cooperation between the surgeons and other professional ICU staff. Logistic details of such a program should be discussed and a scheduling protocol should be prepared before an emergent need for bedside surgery.
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Slow continuous renal replacement therapy is more hemodynamically stabilizing and is replacing conventional hemodialysis as the therapy of choice for acute renal failure in the intensive care unit. This article presents practical information, including basic terminology, basic physiology, technical aspects, and indications for and application of this technique.
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Critical care clinics · Jan 2000
ReviewBedside diagnostic ultrasound and therapeutic ultrasound-guided procedures in the intensive care setting.
The availability, portability, safety, and other features of ultrasound have ushered this relatively new imaging modality into the everyday clinical practice of multiple disciplines. Features unique to ultrasound lend this imaging modality the opportunity for extensive use in the ICU. ⋯ This article is a review and could not possibly cover all bedside uses of ultrasound or provide in-depth information of specific uses described in this article. Hopefully, this article will spark an interest and prove as a starting point on a rewarding learning adventure.