Journal of clinical anesthesia
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To evaluate the utilization of the surgical step-down unit (SSDU) by a sample of patients who were preoperatively booked for admission to the unit, and to identify those patient characteristics and perioperative variables that are associated with an intervention in the unit. ⋯ Less than half of patients identified were actually admitted to the SSDU postoperatively; of those, less than half required an intervention. The Surgical Apgar Score, a score based on intraoperative factors, predicted the need for an intervention during SSDU admission. Consideration should be given to the development of a predictive score that emphasizes intraoperative factors and early postoperative factors to optimize allocation of this scarce resource.
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The perioperative management of a patient receiving a bilateral hand transplant is presented. The anesthetic management required careful fluid administration, homeothermic temperature maintenance, and postoperative analgesia. The role of different anesthesia subspecialties is highlighted.
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Case Reports
Perioperative management of a neurosurgical patient with a meningioma and recent coronary artery stent.
Patients who undergo placement of a drug-eluting coronary artery stent are prescribed dual antiplatelet therapy for one year. Early cessation of this therapy is a risk factor for a major adverse cardiac event, especially in high-risk patients. The perioperative physician team must evaluate the risk of surgical bleeding relative to the thrombotic risk during the perioperative period in patients taking dual antiplatelet therapy who must undergo intracranial neurosurgery. ⋯ An intravenous infusion of the antiplatelet drug, eptifibatide, replaced clopidogrel and was continued until 8 hours prior to surgical incision. During resection of the meningioma, no unusual surgical bleeding was noted. The patient was discharged on postoperative day 3 with satisfactory recovery.