Anesthesiology clinics of North America
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Anesthesiol Clin North America · Sep 2003
ReviewNew treatments for perioperative cardiac arrhythmias.
Cardiac arrhythmias remain a major source of morbidity, mortality, and prolonged postoperative hospital stay in surgical patients. Recent studies in patients experiencing out-of-hospital cardiac arrest have expanded our knowledge in the management of cardiac arrhythmias. Future advances require additional studies focused on the unique proarrhythmic substrates in surgical patients, to provide a clear rationale for antiarrhythmic drug therapy in the perioperative period.
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Anesthesiol Clin North America · Sep 2003
ReviewAnesthetic management of the adult patient with congenital heart disease.
As the number of CHD repairs in adults continues to increase, these operations will be performed in a wider variety of institutions and systems. Unfortunately, not all of these centers will have an optimal environment for correcting CHD in adults. ⋯ Optimal care of these patients is provided by cardiologists who are trained and experienced in pediatric and adult cardiology, by surgeons who are trained and experienced in treating CHD, and by anesthesiologists who are experienced in caring for adults with CHD. Whatever the setting, cardiac anesthesiologists involved in these cases must be thoroughly aware of the anesthetic implications for the unique pathophysiology of each patient, and they must not rely on their "usual" expectations of either true pediatric CHD or acquired adult heart disease.
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Anesthesiol Clin North America · Sep 2003
ReviewMonitoring anticoagulation and hemostasis in cardiac surgery.
The need to monitor anticoagulation and hemostasis during and after cardiac surgery has led to recognition of the importance of evaluation and use of hemostasis monitors in this setting. Consequently, rapid and accurate identification of abnormal hemostasis has been the major impetus for the development of point-of-care tests and their use in transfusion algorithms for cardiac surgical and other critically ill patients.
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This article reviews past and present neuroprotective efforts and outlines a framework for the future development of techniques for neuroprotection during cardiac surgery.
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Anesthesiol Clin North America · Jun 2003
Historical ArticleThe development of ambulatory anesthesia and future challenges.
It is difficult to predict the future but foolish to ignore the past. The history of ambulatory anesthesia is one of many trends and societal or economic forces that have provided the impetus for the growth of the specialty. By understanding the events of the past one can have a greater understanding of the present and some insight into the possible trends of the future. ⋯ Although new technology may increase the direct costs of providing care in the operating room, the overall costs to society should be reduced by a decrease in lost productivity and individual suffering on the part of the patients. Regardless of future changes, the anesthesiologist must remain dedicated to the safety and comfort of the patient first and foremost. If that happens, then the future of ambulatory anesthesiology and surgery will continue to be bright.