Anesthesiology clinics
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Anesthesiology clinics · Jun 2013
ReviewAnesthetic considerations for electrophysiologic procedures.
The array of diagnostic and therapeutic procedures performed in the cardiology electrophysiology laboratory has expanded rapidly. Increasingly more facilities and cardiologists are performing these procedures, and the number of patients for whom these procedures are indicated is expanding. ⋯ Therefore, anesthesia providers must be prepared to handle a broad range of case complexity. This article addresses the implications of providing anesthesia safely and effectively in the electrophysiology laboratory.
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After more than a decade of attention, the risks inherent in cardiac surgery have been well documented, but examples of effective interventions to reduce this risk remain scarce. The need is great, because the patient population is vulnerable and the potential consequences of poor outcomes are ever present and significant. This article reviews a decade of discussion surrounding quality and safety issues in cardiac surgery, and concludes with examples of strategies that have shown great promise for improving cardiac surgery quality and safety.
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Anesthesiology clinics · Jun 2013
Anesthetic considerations for adults undergoing fontan conversion surgery.
There are currently in North America more adults with congenital heart disease than children. This article discusses the anesthetic considerations in adults with single-ventricle physiology and prior repairs who present for Fontan conversion surgery as a demonstration of the challenges of caring for adults undergoing interventions for the repair of congenital heart defects. The care of these patients requires an understanding of the impact of passive pulmonary blood flow and single systemic ventricular physiology. The perioperative morbidity in this patient population remains high.
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Anesthesiology clinics · Mar 2013
ReviewNew and future resuscitation fluids for trauma patients using hemoglobin and hypertonic saline.
Hemoglobin-based oxygen carriers (HBOC) and hypertonic saline solutions (HSS) are used for resuscitation of trauma patients with hemorrhagic shock. In this review, the clinical application, dosing, administration, and side effects of these solutions are discussed. Although HBOC and HSS are not ideal resuscitation fluids, until rapidly thawed universal donor frozen blood and blood component therapy becomes widely available in North America, these fluids should to be considered immediately after injury and throughout the spectrum of care for patients with hemorrhagic shock, until blood and blood components become available.
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Significant advancements in nonsurgical and surgical approaches to control bleeding in severely injured patients have also improved the treatment of critical trauma-related coagulopathy. Nonsurgical procedures such as angiographic embolization are progressively considered to terminate arterial bleeding from pelvic fractures. ⋯ The administration of coagulation factors and factor concentrates may be useful for correcting systemic coagulopathy and reducing the need for fresh frozen plasma, platelet, and red blood cell transfusions, which are associated with various adverse outcomes. In this review, nonsurgical management of critical trauma bleeding is discussed.