The Surgical clinics of North America
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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.
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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.
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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.