Anesthesiology clinics of North America
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Anesthesiol Clin North America · Dec 2000
ReviewPhysiologic acid-base and electrolyte changes in acute and chronic renal failure patients.
Patients with acute and chronic renal failure are vulnerable to a wide variety of acid-base and electrolyte disturbances. The variety is related not only to predictable disturbances that arise as a consequence of impaired urinary excretion, but also to associated factors, such as intercurrent disease processes, chronic medications, and renal replacement therapy. This article emphasizes the pathogenesis, diagnosis, and treatment of common problems, including metabolic acidosis, hyponatremia, hypernatremia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
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Anesthesiol Clin North America · Dec 2000
ReviewOliguria in the ICU. Systematic approach to diagnosis and treatment.
Perioperative oliguria is common but rarely implies acute renal failure. We should interpret oliguria as a sign of intravascular hypovolemia and treat it as prerenal until proven otherwise. On the other hand, the absence of oliguria does not exclude acute renal failure. The most reliable clinical indicator of progressive renal dysfunction is a serial decline in creatinine clearance estimation, a measure of glomerular filtration rate.
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This article describes the efforts of a group of anesthesiologists at Rex Hospital in Raleigh, North Carolina, to provide a wide range of anesthesiology and perioperative services. The group's philosophy that anesthesiologists are best positioned to provide such a range of services is exemplified by the work that this group performs in a 400-bed community hospital. The group's primary mission is to provide operating room anesthesia and comprehensive perioperative medicine services. This model of anesthesiologists' involvement is one example of the ways anesthesiologists can and should be involved in perioperative medicine and other acute care services in hospitals today to secure a brighter and more stable future for themselves and for their specialty.
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Anesthesiol Clin North America · Sep 2000
ReviewPerioperative management issues in pediatric patients.
Recent developments in perioperative practice, emphasizing issues that are of greatest concern in pediatric patients, are reviewed in this article. Many areas bear further evaluation in the evolving field of perioperative medicine: Effective techniques of psychologic preparation for children and their parents in an era in which the family rarely encounters the hospital environment before the day of surgery Application of newer intraoperative anesthetics, such as new narcotics and muscle relaxants, to shorten PACU and pediatric ICU stay while maintaining safety and comfort Critical evaluation of current methods of pain management to optimize comfort, while minimizing cost of such management in an increasingly cost-conscious health care environment The recent advent of a process for credentialing pediatric anesthesia fellowship programs, which requires a research component, bodes well for the prospect of finding answers to some of these questions.
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Anesthesiology faces many challenges in the years ahead. To meet these challenges, the author hypothesizes that perioperative medicine, which includes the spectrum of care from preoperative assessment to postoperative care, offers the best chance for the specialty to survive and prosper. ⋯ Implementation may be difficult and the author explores how a transition from traditional procedure-focused anesthesiology to a broader based specialty may be accomplished. The special needs of perioperative medicine and how they differ from anesthesiology are also presented.