Cleveland Clinic journal of medicine
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Anesthesiologists are the primary users of preoperative medical consultations (consults), but the information in consults is often of limited usefulness to anesthesiologists and the rest of the surgical and perioperative team. The purpose of a consult is not to "clear" a patient for surgery but rather to optimize a patient's underlying disease states before they are compounded by the insult of surgery. Too often consults provide advice on subjects that are in the realm of expertise of the anesthesiologist--such as the type of anesthesia to administer or what intraoperative monitoring to use--and thus risk being ignored. Consults should instead provide specific data about the patient that are pertinent to the surgery, as well as guidance on preoperative and postoperative disease management.
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Case Reports
Case studies in perioperative management: challenges, controversies, and common ground.
This collection of case studies is designed to illustrate challenging and controversial aspects of perioperative medicine. The authors guide readers through four case narratives punctuated by practical multiple-choice questions followed by the authors' commentary on the evidence supporting various answer choices and related considerations. The objective is to examine issues and key evidence that should inform the decision-making process in important aspects of perioperative management.
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Perioperative fluid management remains controversial. Nevertheless, its optimization is essential to reducing the risk of postoperative complications, which have been shown to profoundly affect patients' short- and long-term outcomes. ⋯ The optimal fluid is controversial, although colloids appear to have some physiologic advantages over crystalloids. Minimally invasive technologies have emerged for intraoperative monitoring of blood flow, which may enable more precise fluid titration.