The Surgical clinics of North America
-
Surg. Clin. North Am. · Dec 2005
Review Comparative StudyStandardization of perioperative management: clinical pathways.
Many initiatives have been introduced in the past decades to standardize and improve clinical perioperative care and thereby improve patient care. Clinical pathways (also known as integrated care pathways, critical pathways, critical paths, care paths) are structured multidisciplinary care plans that detail essential steps in the care of patients with a specific clinical problem. They are designed to support the implementation and translation of national guidelines into local protocols and their subsequent application to clinical practice. In surgery, clinical pathways are standardized protocols for the management of patients who have common conditions undergoing common surgical procedures.
-
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.
-
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.
-
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.
-
This article addresses the management of postoperative bleeding. The problem is called postoperative bleeding rather than postoperative hemorrhage to emphasize the fact that perfect postoperative hemostasis rather than acceptable postoperative blood loss is the ideal. Postoperative bleeding is a risk of all surgical procedures. The best way to reduce the risk of hemorrhage is to identify and correct potential causes of coagulopathy both pre- and post-operatively.