Journal of clinical anesthesia
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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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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.
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Review Case Reports
The cardiac, obstetric, and anesthetic management of pregnancy complicated by acute myocardial infarction.
Myocardial infarction (MI) occurring during pregnancy is a rare but potentially lethal event for both mother and fetus, particularly when it occurs in the third trimester or peripartum period. The authors report two cases of MI occurring in the third trimester of pregnancy and review the literature. ⋯ The preferred method of delivery in the pregnant MI patient is addressed, with emphasis on the need for individualization of care and coordination between the cardiac, obstetric, and anesthetic teams. Finally, the authors review the risks of subsequent pregnancy in this patient population.
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Pulmonary edema developing after the relief of upper airway obstruction has been reported in association with a diversity of etiologic factors, including hanging, strangulation, tumors, foreign bodies, goiter, and laryngospasm. Since 1977, 18 cases of adults with postobstructive pulmonary edema associated with anesthesia have been reported. ⋯ Risk factors for the development of upper airway obstruction have been identified in the majority of these cases. A heightened awareness among anesthesiologists of this poorly recognized and hence often perplexing syndrome may help reduce the occurrence and facilitate the treatment of this potential complication of perioperative airway management.
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Review Randomized Controlled Trial Comparative Study Clinical Trial
Simulation technique for difficult intubation: teaching tool or new hazard?
This investigation evaluated the risks of a simulation drill designed to improve the skill of anesthesia personnel in dealing with an unexpected difficult intubation. In a controlled prospective study, 40 patients with normal airways scheduled to undergo noncardiothoracic surgery were randomized into two groups of 20 patients. In the control group, intubation was performed by standard techniques. ⋯ There were five uncomplicated esophageal intubations in the simulation group compared with none in the control group (p = 0.001). No other adverse events were recorded. The potential hazards of esophageal intubation should be considered before this simulation drill is performed.