The Surgical clinics of North America
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Surg. Clin. North Am. · Dec 2005
Review Comparative StudyPerioperative issues: myocardial ischemia and protection--beta-blockade.
Approximately one third of patients undergoing noncardiac surgery have coronary artery disease, and cardiovascular complications are an important cause of perioperative morbidity and mortality. Several algorithms are available to assess the risk for peri-operative cardiac events. ⋯ These investigations show that perioperative beta-blockers significantly reduce morbidity and mortality in noncardiac surgery and appear to offer the greatest benefit to high-risk patients. Because of the lower complication rate in intermediate- and low-risk patients and the absence of large randomized controlled trials, the role of beta-blockers in this population is less well-defined.
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Perioperative anemia is common and is associated with increased need for blood transfusion in the perioperative period. Perioperative anemia has also been linked to increased morbidity and mortality in surgical patients. ⋯ Additional advances in surgical technology that reduce blood loss intraoperatively are associated with a reduction in postoperative anemia and should be used whenever possible. All strategies to prevent anemia in the perioperative period should be considered in an effort to minimize exposure of surgical patients to blood transfusion.
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Advances in technology and pharmacology continue to change techniques for anesthesia. So-called "fast-track" anesthesia has led to the development of new anesthetic agents and changes in anesthetic practice, including the increased use of regional anesthesia, techniques involving continuous plexus catheters to improve postoperative analgesia, and total intravenous anesthesia. ⋯ Advances have also produced additional intraoperative monitoring through the use of depth-of-anesthesia monitors and transesophageal echocardiography. Future areas of development are likely to include target-controlled infusion pumps as well as techniques and medi-cations that improve fast-track anesthesia safely.
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This article examines the epidemiology and risk factors for the development of surgical site infections (SSIs), the importance of appropriate administration of prophylactic antibiotics, nonpharmacologic strategies, and the role of new "active" devices in reducing SSIs. A review of the pertinent English-language literature shows that many factors contribute to the risk of a patient developing an SSI. ⋯ The use of new "active" antibacterial devices may reduce risk further. Surgeons can minimize the risk to the patient of the development of SSI through strict adherence to established surgical guidelines for perioperative care.
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Surg. Clin. North Am. · Dec 2005
ReviewPerioperative management of special populations: the geriatric patient.
Americans over age 65 represent the fastest growing segment of the United States population. As a result, the demographic landscape of America is changing. ⋯ With aging, baseline functions of almost every organ system undergo progressive decline resulting in a decreased physiologic reserve and ability to compensate for stress. Pain control, postoperative cognitive dysfunction, end-of-life issues, and realistic expectations after surgery are paramount issues throughout the perioperative period.