The Surgical clinics of North America
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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.
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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.
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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.
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Surg. Clin. North Am. · Dec 2005
Review Comparative StudyPerioperative management of special populations: obesity.
Surgeons and hospitals must be aware of the special considerations for treating obese patients. Obesity involves increased incidence of several comorbidities, such as coronary heart disease and hyper-tension, which increase perioperative risk. ⋯ For these and other reasons, medical professionals must make thorough evaluations to properly identify and address medical comorbidities and other issues associated with obese patients. Medical professionals must, for example, use invasive arterial monitoring for severely obese patients and ensure that operating room tables can accommodate obese patients.
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For the first time in human history, the numbers of overweight and underweight individuals are about the same, at 2.1 billion each. Along with the current worldwide obesity epidemic is the explosion of obesity- and overweight-related health problems, including diabetes and the metabolic syndrome, musculoskeletal disorders,cardiovascular disease, pulmonary disorders, and certain forms of cancer. Obesity and overweight account for a significant percentage of overall health care costs and contribute significantly to morbidity and mortality in the United States and around the world.