Anesthesiology clinics of North America
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Anesthesiol Clin North America · Jun 2001
ReviewGeneral pediatric emergencies. Malignant hyperthermia syndrome.
Anesthesiologists always undertake the challenge of keeping themselves informed about advances in medical knowledge aggressively; however, they have not been particularly active in the areas of patient education and advocacy. Malignant hyperthermia syndrome is a unique condition that anesthesiologists as clinicians understand well--in most cases, better than other specialists. They are positioned best to inform patients initially about the significance of malignant hyperthermia syndrome susceptibility and to provide an ongoing resource for counseling. The physician-patient relationship, according to the American Society of Anesthesiologists' Guidelines for the Ethical Practice of Anesthesiology, "involves special obligations for the physician that include placing the patient's interest foremost, faithfully caring for the patient, and being truthful." The care, counseling, and support that anesthesiologists bring to the patient susceptible to malignant hyperthermia syndrome truly fulfills this relationship.
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Anesthesiol Clin North America · Mar 2001
ReviewAnesthesia for laparoscopy with emphasis on outpatient laparoscopy.
Laparoscopy has developed extremely rapidly and is currently applicable to virtually every surgical subspecialty. Most of the experience is with gynecologic laparoscopy, which has been performed for many years. Some of these procedures are simple and brief, with minimal gas insufflation. ⋯ At present, this technology allows only diagnostic and minor operative procedures, the stage at which conventional laparoscopy was in the early 1980s. Further developments in optical fibers could reduce the requirements for general anesthesia for other operations and substantially reduce postoperative morbidity. Until then, laparoscopy continues to present many challenges.
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A variety of laparoscopic procedures can be performed on patients under regional anesthesia. Diagnostic laparoscopy in elective and emergency patients, pain mapping, laparoscopy for infertility, and tubal sterilization are some examples. The key benefits of regional anesthesia include less emesis, less postoperative pain, shorter postoperative stay, improved patient satisfaction, and overall safety. ⋯ Successful implementation of regional anesthesia is an important determinant of how anesthesiologists, surgeons, and surgical facilities cope with new challenges. In the future, it could be possible to provide "walk-in/walk-out" regional anesthesia with a real possibility of fast tracking patients through the recovery process after ambulatory surgery. For maximal patient safety, however, facilities offering regional anesthesia must have appropriately trained anesthesia personnel and the equipment necessary for monitoring and providing full resuscitation in the event of complications or a need to convert to general anesthesia.
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The pediatric applications of minimally invasive surgical procedures such as thoracoscopy continue to increase. Specific alterations in anesthetic management may be required during the perioperative care of these patients. This article reviews the anesthetic care of infants and children during thoracoscopy with emphasis on cardiopulmonary disturbances of the patient, techniques to isolate the operative and nonoperative lungs and provide one-lung ventilation to improve surgical visualization, cardiopulmonary alterations induced by the creation of the artificial pneumothorax or the absorption of CO2 by the plural surface, intraoperative management of one-lung ventilation, and the potential for and treatment of inadvertent CO2 embolism.
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Organ viability associated with renal transplantation is a product of the managing of the donor patient, the allograft, and the recipient patient. Short- and long-term outcome is influenced by perioperative fluid and drug treatment, and the function and viability of the transplanted kidney seem to be optimized if graft perfusion is maximized through mild hypervolemia. At the same time, careful balancing of intraoperative fluids is necessary against cardiovascular problems frequently encountered in patients with uremia. Close intraoperative monitoring, optimization of intravascular fluid volume status to maximize kidney perfusion, and prompt correction of electrolyte disturbances (especially potassium) are key to short- and long-term success of renal transplants.