The Surgical clinics of North America
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Despite many medical advances, the incidence of postoperative nausea and vomiting (PONV) and postdischarge nausea and vomit-ing (PDNV) remains high. Sequelae such as dehydration, wound dehiscence, bleeding and others, contributed to increased healthcare costs and patient dissatisfaction. This article reviews the literature regarding the anatomy of emesis, the predictors of PONV and various treatments.
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Surg. Clin. North Am. · Dec 2005
Review Comparative StudyPerioperative pain control: a strategy for management.
A thorough understanding of the anatomy and neurophysiology of the pain response is necessary for the effective treatment of perioperative pain. This article describes the mechanisms that produce pain,including those related to inflammation. Other topics include the pharmacologies of nonopioid and opioid analgesics. ⋯ The pharmacology of local anesthesia is discussed. The six major adverse reactions to local anesthetics are cardiac arrhythmias, hypertension, direct tissue toxicity, central nervous system toxicity, methemoglobinemia and allergic reactions. Methods for measuring pain are described.
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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.
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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.