Journal of clinical anesthesia
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Much has been written about Canada's health care system as all countries wrestle with rising health costs. Few, however, have attempted to describe the influence of a system of health care on a nonprimary care specialty such as anesthesia. The purpose of this review is to describe the Canadian system, contrast it with that of the United States, and outline the impact that Canadian Medicare has had on anesthetic practice. ⋯ Each provincial medical association is responsible for negotiating the fee schedules with the provinces on behalf of its members. Since these associations must respond to the majority of their members, it has been the perception of specialty groups such as anesthesia that the emphasis of allocations in recent years has been on primary care fields. Anesthetists have therefore found themselves increasingly involved with the collective negotiation process as an unwanted necessity of practice.(ABSTRACT TRUNCATED AT 400 WORDS)
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Review Case Reports
Anesthetic management of obstructive sleep apnea patients.
Presented in an illustrative case report and a review of the anesthetic management of obstructive sleep apnea patients. Preoperative evaluation should include a thorough airway evaluation and a comprehensive cardiovascular and pulmonary evaluation. With polysomnography, identification of the severity of sleep apnea can be idenified. ⋯ Opioids and sedatives should be avoided, as should other drugs that have central and sedating effects. Postoperative pain is effectively controlled with acetaminophen and topical anesthetic sprays. Postoperative monitoring for apnea, desaturation, and dysrhythmias is a necessity in sleep apnea patients.
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Approximately 40% of physician office time and 33% of hospital time are devoted to patients 65 years of age or older. Over half of the older population requires some surgical intervention. Because of decreased physiologic reserve and increased number of underlying medical disorders, the older patient is at increased risk for intraoperative and postsurgical complications. ⋯ Risk factors should be assessed initially by a focused history and physical examination and by simple tests. Additional diagnostic testing should be reserved for the patient who is not clearly at low or high risk. For optimal preoperative evaluation of the elderly patient, the physician should identify systemic disease, determine if the patient is receiving appropriate therapy, delineate the operative risks, and make recommendations that can potentially reduce the operative risks and postoperative complications.
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Review Case Reports
Postextubation laryngeal spasm in an unanesthetized patient with Parkinson's disease.
We present a patient with Parkinson's disease who experienced laryngeal spasm after tracheal extubation without having been anesthetized. This patient's trachea was intubated because of respiratory arrest. We postulate that her postextubation laryngospasm was related to Parkinson's disease.
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To review the basic pathophysiology of altered coagulation associated with cardiopulmonary bypass and autologous blood transfusion in cardiac surgery. ⋯ Coagulation disorders in cardiac surgery are caused by many factors, such as heparin, platelet dysfunction, and fibrinolysis. Rational use of blood component therapy and medications such as heparin, protamine, and desmopressin are mandatory. Autologous blood transfusion is very useful in decreasing or obviating the use of homologous blood transfusion.