Minerva anestesiologica
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Pulmonary capillary pressure (Pcap) is the predominant force that drives fluid out of the pulmonary capillaries into the interstitium. Increasing hydrostatic capillary pressure is directly proportional to the lung's transvascular filtration rate, and in the extreme leads to pulmonary edema. In the pulmonary circulation, blood flow arises from the transpulmonary pressure gradient, defined as the difference between pulmonary artery (diastolic) pressure and left atrial pressure. ⋯ In the presence of a normal PAOP and an increased pressure gradient between Pcap and PAOP, the tendency for fluid leakage in the capillaries and subsequent edema development may substantially be underestimated. Tho-roughly validated methods have been developed to assess Pcap in humans. At the bedside, measurement of Pcap can easily be determined by analyzing a pressure transient after an acute pulmonary artery occlusion with the balloon of a Swan-Ganz catheter.
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Minerva anestesiologica · Jan 2006
ReviewStandards of care for ambulatory surgery. Are we up to speed.
Ambulatory surgeries are becoming increasingly more common in daily anesthesia practice, placing greater demands on anesthesia providers to offer timely and thorough preoperative evaluation and preparation, optimal patient and surgical selection, and efficient, safe, and timely postanesthesia care, all of which necessitate an active participation of an anesthesiologist in all aspects of the organization and coordination of perioperative management. Numerous studies over the last couple of decades have introduced various organizational models for pre-anesthesia screening, with a goal of improving patient satisfaction, controlling the cost, and decreasing surgical delays. Having recognized the importance of anesthesia selection regarding patient comfort and the duration of post-anesthesia recovery in the ambulatory setting, many anesthesiologists have focused their attention on studying various anesthesia modalities and techniques with new emphasis on preemptive interventions (e.g. preoperative antiemetics, continuous peripheral nerve blocks). Finally, a concept of bypassing traditional recovery period in the post-anesthesia recovery rooms (''fast tracking'') that had been scrutinized over the last decade has been accepted as cost effective and safe, providing adequate patient selection.