Journal of clinical anesthesia
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Glycemic control has received intense scrutiny in the last decade as an important aspect of patient care. Earlier studies suggested that tight glycemic control (target level of 80 - 110 mg/dL) improved outcomes in intensive care unit (ICU) patients. Subsequent trials did not confirm the same benefit. ⋯ Tight glycemic control was associated with a high incidence of hypoglycemia, which may offset some of its potential benefits. Tight glycemic control in the perioperative and intensive care settings should not be totally abandoned either as a clinical practice or as a subject of future research. Beneficial effects of tight glycemic control may be demonstrated when the appropriate glycemic targets are matched to the appropriate population.
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Understanding the management of the parturient with single ventricle physiology starts with knowledge of the lesion, the patient's current stage of surgical palliation, her current functional status, and the impact of pregnancy and labor on her cardiac physiology. A multidisciplinary team approach, described in this article, is crucial to a positive outcome.
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Angioedema is a potentially life-threatening condition that may present at any point in the perioperative care of patients. It requires prompt recognition and diagnosis; the primary concern during acute attacks is airway management. The pathophysiology, various causes of angioedema, and treatment strategies according to underlying etiology are presented.
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Bilateral total knee replacement is becoming one of the more commonly performed orthopedic procedures for patients with advanced arthritis of both knees. The surgeon may decide to operate on both knees simultaneously, sequentially, or in a staged manner. The safety of this procedure is still debated due to wide variation in the studies and their endpoints. Although there are advantages with bilateral procedures such as reduced cost and improved rehabilitation, there is definite evidence of increased cardiopulmonary, thromboembolic, neurological, bleeding, and transfusion complications with bilateral knee replacement versus unilateral knee replacement, particularly in elderly patients with comorbidities.
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Neural blockade of the scalp may be used as an adjunct to general anesthesia or serve as the principal anesthetic for both intracranial and extracranial procedures. Effective scalp blockade typically requires anesthetizing multiple peripheral nerves; blockade of one or more of these is often used to diagnose and treat conditions such as chronic headache. ⋯ The vascularity of the scalp, proximity of arteries supplying the cerebral circulation, use of large volumes of local anesthetic, and presence of intracranial devices or bony defects require attention. The impact of perioperative scalp blockade on acute and chronic pain may offer insight into the benefits of perioperative neural blockade generally.