The Mount Sinai journal of medicine, New York
-
Over the past several decades, there have been evolutionary changes in both surgery and anesthesia. Newer anesthetics have excellent safety profiles and are associated with fewer hemodynamic side effects and rapid elimination from the body. Innovative surgical techniques are less invasive and cause less perioperative patient pain. ⋯ Because of the remote nature of the private surgeon's office, the proper selection of both patient and procedure to be performed is of utmost importance. It is likewise imperative that the practitioner assures that the patient does not experience excessive postoperative pain and/or nausea and vomiting. It is of the utmost importance that the practicing anesthesiologist assure that every location in which procedures and surgeries are performed is a safe anesthetizing location.
-
Anemia is common in critically ill patients. Although the goal of transfusion of red blood cells is to increase oxygen-carrying capacity, there are contradictory results about whether red blood cell transfusion to treat moderate anemia (e.g., hemoglobin 7-10 g/dL) improves tissue oxygenation or changes outcomes. Whereas increasing levels of anemia eventually lead to a level of critical oxygen delivery, increased cardiac output and oxygen extraction are homeostatic mechanisms the body uses to prevent a state of dysoxia in the setting of diminished oxygen delivery due to anemia. ⋯ These studies have generally shown increases in near-infrared spectroscopy derived measurements of tissue oxygenation following transfusion. Studies evaluating the effect of transfusion on the microcirculation have shown that transfusion increases the functional capillary density. This article will review fundamental aspects of oxygen delivery and extraction, and the effects of red blood cell transfusion on tissue oxygenation as well as the microcirculation.
-
In a complicated and specialized population, such as patients undergoing cardiac and major vascular procedures, patients, clinicians, and hospitals may be best served and resources conserved with a specialized preanesthesia clinic. A specialized preanesthesia clinic for cardiac and major vascular procedures has a focused staff usually consisting of practitioners with cardiac and major vascular surgical care experience designed to address the patient evaluation, the information gathering, the necessary consultations, the required testing, and specific needs for the day of cardiac and major vascular surgery. ⋯ Resident trainee education can also be enhanced by a specialized preanesthesia clinic for cardiac and major vascular rotations. The ultimate goal of a specialized preanesthesia clinic is to ensure a safe and efficient perioperative cardiac and major vascular surgical experience in complicated patients undergoing complex procedures.