The Surgical clinics of North America
-
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.
-
Surg. Clin. North Am. · Dec 2005
Review Comparative StudyPerioperative cardiac issues: postoperative arrhythmias.
This article reviews current concepts about the diagnosis and acute management of postoperative arrhythmias. A systematic approach to diagnosis of arrhythmias and evaluation of predisposing factors is presented, followed by consideration of common bradyarrhythmias and tachyarrhythmias in the postoperative setting. ⋯ The initiating factor for an arrhythmia following surgery is usually a transient insult such as hypoxemia, cardiac ischemia, catecholamine excess, or electrolyte abnormality. Management includes correction of these imbalances and, if clinically indicated, medical therapy directed at the arrhythmia itself.
-
Surg. Clin. North Am. · Dec 2005
Review Comparative StudyOperating room management: operative suite considerations, infection control.
An operating room's condition is rarely directly implicated in dis-ease transmission. Even so, to prevent such rare transmissions,hospitals must be thoughtful in designing operating rooms as important adjuncts to infection control. ⋯ Hospitals can avert potential infectious problems through preventive maintenance and the use of infection control risk assessments (ICRAs) for preemptive consideration of infectious risks before renovations, repairs and new construction. Guidelines should be consulted and incorporated into each operating room's policies and procedures.
-
Surg. Clin. North Am. · Dec 2005
Review Comparative StudyPerioperative management of special populations: immunocompromised host (cancer, HIV, transplantation).
Optimal perioperative care of the immunocompromised patient requires an understanding of the consequences of disease-specific pharmacologic therapies. The toxicity profile of these therapies can strongly influence the decision algorithms for delivering care in the perioperative period. ⋯ The article addresses such topics as cardiotoxicity, pulmonary toxicity, hepatotoxicity, genitourinary toxicity, neurotoxicity, myelosuppression, cutaneous toxicity, mitochondrial toxicity, lipodystrophy, hypersensitivity, and liver dysfunction. The article also describes the use of corticosteroids, calcineurin inhibitors, sirolimus, and antimetabolites.
-
Surg. Clin. North Am. · Dec 2005
Review Comparative StudyPreoperative evaluation: pulmonary, cardiac, renal dysfunction and comorbidities.
This article reviews evidence supporting the exercise of risk assessment and demonstrates how it assists in determining which patients should undergo a planned invasive procedure. The article focuses on the preoperative functional assessment of three major organ systems--cardiac, pulmonary, and renal--and reviews guide-lines for determining which patients need additional testing of organ system function. The article also discusses how to improve the condition of selected patients so that the surgeon can achieve the best possible result and outcome.