Journal of anesthesia
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Journal of anesthesia · Jan 2008
ReviewManagement of the difficult and failed airway in obstetric anesthesia.
Difficulty with airway management in obstetric patients occurs infrequently and failure to secure an airway is rare. A failed airway may result in severe physical and emotional morbidity and possibly death to the mother and baby. Additionally, the family, along with the medical and nursing staff, may face emotional and financial trauma. ⋯ Finally, the need for specific equipment in the obstetric difficult and failed airway is discussed. Worldwide maternal mortality reflects the health of a nation. However, one could also claim that, particularly in Western countries, maternal mortality may reflect the health of the specialty of anesthesia.
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Journal of anesthesia · Jan 2008
ReviewThe anesthesia information management system for electronic documentation: what are we waiting for?
The anesthesia information management system (AIMS) will be part of the future of healthcare. An electronic medical records system or AIMS will provide clear and concise information and have the potential to integrate information across the entire hospital system, improve quality of care, reduce errors, decrease risks, and improve revenue capture. The practice of anesthesia requires a medical record system that can capture data in real time. In this article, we describe challenges that must be overcome to establish an efficient electronic medical record system for anesthesiology.
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General anesthesia accompanied by surgical stress is considered to suppress immunity, presumably by directly affecting the immune system or activating the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Along with stress such as surgery, blood transfusion, hypothermia, hyperglycemia, and postoperative pain, anesthetics per se are associated with suppressed immunity during perioperative periods because every anesthetic has direct suppressive effects on cellular and neurohumoral immunity through influencing the functions of immunocompetent cells and inflammatory mediator gene expression and secretion. ⋯ Alternatively, the anti-inflammatory effects of anesthetics may be beneficial in distinct situations involving ischemia and reperfusion injury or the systemic inflammatory response syndrome (SIRS). Clinical anesthesiologists should select anesthetics and choose anesthetic methods with careful consideration of the clinical situation and the immune status of critically ill patients, in regard to long-term mortality, morbidity, and the optimal prognosis.
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Journal of anesthesia · Jan 2008
ReviewGuideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.
Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. ⋯ Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.