Acta chirurgica Iugoslavica
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Cardiomyopathies are myocardial diseases in which there is structural and functional disorder of the heart muscle, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease. Cardiomyopathies are grouped into specific morphological and functional phenotypes: dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and unclassified cardiomyopathies. Patients with dilated and hypertrophic cardiomypathy are prone to the development of congestive heart failure in the perioperative period. ⋯ Drug therapy should be optimized and continued preoperatively. Surgery should be delayed (unless urgent) in patients with decompensated or untreated cardiomyopathy. Preoperative evaluation requires integrated multidisciplinary approach of anesthesiologists, cardiologist and surgeons.
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In patients with respiratory pathology changes in respiratory physiology may lead to clinical problems during the conduct of anesthesia and the perioperative period. An understanding of the disease processes that can affect the lungs and pleura allows the anesthesiologist to account for the potential complications of these conditions and manage the anesthetic accordingly. ⋯ A thorough medical history, physical examination and some functional tests are the keys in decision-making in preparation for anesthesia and surgery. The burden of respiratory disease is reviewed, and some important areas of current interest are highlighted.
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This article explains the most frequent psychiatric disorders such as co-morbidity in the acute surgical treatment, along with its position and importance for the surgical procedure. Besides basic features of these disorders, epidemiology and clinical expression, this article holds the latest therapeutic approach, side effects, toxicity and drug interactions, during the surgical procedure. Frequent postoperative problems, delirium, and postoperative cognitive disorders are noted in these patients. To avoid these complications, it is recommended to use a mini-mental score examination to re-evaluate the decision and indication for high risk surgery patient.
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Hemodynamic instability is the major concern in surgical patients with pericardial diseases, since general anesthesia and positive pressure ventilation may precipitate cardiac tamponade. In advanced constriction diastolic impairment and myocardial fibrosis/atrophy may cause low cardiac output during and after surgery. Elective surgery should be postponed in unstable patients with pericardial comorbidities. ⋯ Etiology of pericardial diseases is an important issue is the preoperative management. Patients with neoplastic pericardial involvement have generally poor prognosis and any elective surgical procedure should be avoided. For patients with acute viral or bacterial infection or exacerbated metabolic, uremic, or autoimmune diseases causing significant pericardial effusion, surgery should be postponed until the causative disorder is stabilized and signs of pericarditis have resolved.
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In patients with valvular heart disease planned for any type of surgery preoperative evaluation and preparation are especially important for a successfull outcome of the surgery. Preoperative preparation and intraoperative treatment of patients with valvular heart disease are different de-Spending on the type of valvular disease: aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation or mitral valve prolapse. ⋯ In the paper we will separately discuss bacterial endocarditis profilaxys which can occur after the surgery of patients with valvular disease. Since the patients with valvular disease, and especially the ones with implanted prosthetic valve or heart arrhythmia, are usually on oral anticoagulation therapy, it will be given recommendations for treatment of patients on oral anticoagulation therapy as part of preoperative preparations.