Cleveland Clinic journal of medicine
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Postoperative fever should be evaluated with a focused approach rather than in "shotgun" fashion. Most fevers that develop within the first 48 hours after surgery are benign and self-limiting. ⋯ Fever that develops after the first 2 days following surgery is more likely to have an infectious cause, but noninfectious causes that require further evaluation and treatment must also be considered. When evaluating postoperative fever, a helpful mnemonic is the "four Ws": wind (pulmonary causes: pneumonia, aspiration, and pulmonary embolism, but not atelectasis), water (urinary tract infection), wound (surgical site infection), "what did we do?" (iatrogenic causes: drug fever, blood product reaction, infections related to intravenous lines).
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Medical consultants need to recommend the safest and the most effective ways to manage chronic medications in the perioperative period. Outcomes data from clinical trials are limited in regard to perioperative medication management, so specific clinical trials are not available to guide decision-making in most circumstances. More studies in this field are needed. Communication and collaboration with anesthesiologists and surgeons as well as with primary care physicians are key to achieving optimal outcomes.
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Inhaled and intravenous anesthetic agents have diverse effects on the nervous, cardiovascular, and respiratory systems. Spinal and epidural anesthetics also produce significant physiologic changes. ⋯ Evidence is just beginning to emerge, however, on the relation between specific anesthetics and anesthetic techniques and long-term clinical outcomes. A proposed relationship between anesthetics, inflammation, and long-term outcomes has attracted increasing research interest but has yet to be well defined.
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The quality of postoperative pain management can be improved. Although many safe and effective therapies exist, their utilization varies considerably between and within institutions. Major challenges include the appropriate prescribing of analgesic therapies and the timely response to suboptimal pain control. Patients' satisfaction with their analgesic care may depend less on how well their pain is controlled and more on the attentiveness of their caregivers.