Anesthesiology clinics of North America
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Understanding the risk factors for the development of PPCs allows targeted interventions aimed at reducing the frequency and severity of PPCs. The broad categories of what increases the likelihood of developing a PPC are understood but specific understanding of how individual risk factors act to cause PPCs is lacking,and there is little information regarding the interaction or synergy between risk factors. ⋯ The ongoing controversy regarding the value of regional analgesia or anesthetic techniques, especially epidural analgesia and anesthesia, in reducing or preventing PPCs requires well-done randomized clinical trials. Further research is also needed in the area of postoperative care such as interventions in patients with OSA or the use of inventive spirometric techniques.
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The effects of aging on the body are numerous, but the most important point with regard to surgery is to differentiate the effects of aging from those of the pathology associated with a disease process that may also be present in the elderly patient. Studies tend to validate the premise that there are no labs mandated solely because of a patient's age. ⋯ In assessing a patient's overall physiologic state an organ systems based approach focusing on the cardiac, respiratory, renal, hepatic, endocrine, nutritional, and neurologic systems may be warranted and beneficial. In the elderly population one of the key predictors of perioperative complications seems to be the geriatric patient's preoperative condition and preoperative level of functioning.
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Anesthesiol Clin North America · Mar 2004
ReviewAge-associated issues in preoperative evaluation, testing, and planning: pediatrics.
The author has reviewed recent developments in preoperative assessment and testing, emphasizing issues that are of greatest concern in pediatric patients. Attention to these areas during the process of preoperative preparation and appropriate communication of conditions that may contribute to increased peri-operative risk will provide greater predictability for families, surgeons, and operating room staff. This predictability is an important component to improved patient or family satisfaction and operating room efficiency.
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Anesthesiol Clin North America · Mar 2004
ReviewPerioperative anesthesia clinical considerations of alternative medicines.
The presence of nutraceutical agents in the United States health care system dictates the need for a general understanding of these agents by all physicians and health care providers. Increasing trend toward reimbursement of herbal medicines by the insurance companies and managed care organizations have further encouraged their use. Because herbs are listed under the "supplement" category by the Food and Drug Administration, the Dietary Supplement and Health Education Act establishes no protocol for standardization of the products labeled as "supplements" thereby increasing the risk for adverse effects associated with the use of these products. ⋯ Although this idea holds some promise in the elective-care settings, anesthetic care in emergency settings should be based on a thorough drug-intake history from the patient or a relative, if possible. Unfortunately, the anesthesia literature has not addressed this new group of health supplements, despite many of these drugs having the potential to cause serious health problems and drug-herb interactions. There is a need to conduct additional scientific clinical trials to study the anesthetic responses to commonly used nutraceutical agents.
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Since 1992, the American Society of Anesthesiologists has produced 12 evidence-based practice guidelines, 2 practice advisories, and 3 guideline updates. These documents have assisted anesthesiologists and practitioners in many other specialties. Their brevity, practicality, and ease of use, coupled with a thorough and systematic evaluation of the evidence have been instrumental in bringing together the science and practice of medicine. ⋯ The goal is to systematically collect and evaluate evidence from multiple sources and apply it ina comprehensive manner to the guideline recommendations. The ASA guideline and advisory development process is continuing to evolve in response to changes in medical technology, research, and practice. By providing synthesized evidence from multiple sources and robust clinical recommendations the ASA offers the practice of anesthesiology, an invaluable bridge between science and clinical practice.