Cleveland Clinic journal of medicine
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Medical consultants need to recommend the safest and the most effective ways to manage chronic medications in the perioperative period. Outcomes data from clinical trials are limited in regard to perioperative medication management, so specific clinical trials are not available to guide decision-making in most circumstances. More studies in this field are needed. Communication and collaboration with anesthesiologists and surgeons as well as with primary care physicians are key to achieving optimal outcomes.
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Postoperative fever should be evaluated with a focused approach rather than in "shotgun" fashion. Most fevers that develop within the first 48 hours after surgery are benign and self-limiting. ⋯ Fever that develops after the first 2 days following surgery is more likely to have an infectious cause, but noninfectious causes that require further evaluation and treatment must also be considered. When evaluating postoperative fever, a helpful mnemonic is the "four Ws": wind (pulmonary causes: pneumonia, aspiration, and pulmonary embolism, but not atelectasis), water (urinary tract infection), wound (surgical site infection), "what did we do?" (iatrogenic causes: drug fever, blood product reaction, infections related to intravenous lines).