International anesthesiology clinics
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Carcinoid syndrome, although rare, can create serious problems to the anesthetist, both by the nature and variability of clinical manifestations and by the complications that can occur peroperatively. Recent research has led to a better understanding of the pathophysiology of the disease process. However, modern medicine is far from unraveling the precise nature and physiological effects of all the peptide mediators produced by these tumors. ⋯ Survival rates in patients following excision of gastric and appendical carcinoid tumors approach those of the general population as a whole and the chance of metastasis is extremely low. Only two series have been published in the anesthetic literature on anesthesia for patients with carcinoid syndrome, although there are many single-case reports. Despite the rarity of this syndrome, further formal studies into the anesthetic management of this condition should be encouraged.
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Indications for mechanical ventilation have evolved substantially since widespread use of ventilatory support began in the early 1960s. While the metabolic and blood-gas alterations that mandate institution of ventilatory support have remained unaltered, new noninvasive modes of ventilation have widened the therapeutic options available to patients in acute respiratory failure. An understanding of the effect of mechanical ventilation on other organ systems has clarified the role of mechanical ventilation in the treatment of conditions other than respiratory failure such as stroke or head injury. ⋯ Understanding the epidemiology of respiratory failure in different disease categories is important to physicians, patients, and families in making informed decisions about their care. Mechanical ventilation represents a vital, fundamental form of life support. As the diseases, tools, and treatments change in anesthesia and critical care, careful definition of the role of mechanical ventilation in specific diseases, the route by which it is delivered, and the ability of such a form of life support to affect outcome will continue to be necessary.