Journal of anesthesia
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Journal of anesthesia · Jan 2009
ReviewComplexity of blood volume control system and its implications in perioperative fluid management.
The use of fluid therapy attempts to optimize blood circulation by manipulating the circulating blood volume (BV). BV may be a key intermediate parameter between fluid therapy and the blood circulation, and it has been assumed that BV can be controlled by fluid therapy. In order to construct a fluid therapy protocol, firstly, we have to confirm whether BV can actually be controlled by fluid therapy. ⋯ Because inflammation and some hormones control vascular permeability and the renal adjustment of solutes and fluids, such factors may readjust the BV even after interventional fluid therapy. Perioperative BV may be predominantly controlled by an internal regulatory system, regardless of whether "restrictive" or "liberal" fluid management strategies are employed. Recognizing this physiological control of BV may help us to develop individualized fluid management strategies.
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Journal of anesthesia · Jan 2008
ReviewThe anesthesia information management system for electronic documentation: what are we waiting for?
The anesthesia information management system (AIMS) will be part of the future of healthcare. An electronic medical records system or AIMS will provide clear and concise information and have the potential to integrate information across the entire hospital system, improve quality of care, reduce errors, decrease risks, and improve revenue capture. The practice of anesthesia requires a medical record system that can capture data in real time. In this article, we describe challenges that must be overcome to establish an efficient electronic medical record system for anesthesiology.
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General anesthesia accompanied by surgical stress is considered to suppress immunity, presumably by directly affecting the immune system or activating the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Along with stress such as surgery, blood transfusion, hypothermia, hyperglycemia, and postoperative pain, anesthetics per se are associated with suppressed immunity during perioperative periods because every anesthetic has direct suppressive effects on cellular and neurohumoral immunity through influencing the functions of immunocompetent cells and inflammatory mediator gene expression and secretion. ⋯ Alternatively, the anti-inflammatory effects of anesthetics may be beneficial in distinct situations involving ischemia and reperfusion injury or the systemic inflammatory response syndrome (SIRS). Clinical anesthesiologists should select anesthetics and choose anesthetic methods with careful consideration of the clinical situation and the immune status of critically ill patients, in regard to long-term mortality, morbidity, and the optimal prognosis.