American journal of therapeutics
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Sarcoidosis is a multisystemic granulomatous disease, which uncommonly affects nervous system. However, when present, it may affect both central and peripheral nervous systems and potentially mimics other chronic diseases of the nervous system. ⋯ Early diagnosis and aggressive treatment of neurosarcoidosis are necessary to produce satisfactory clinical outcomes. This review discusses clinical manifestations, current diagnostic studies, and currently available modalities for management of neurosarcoidosis.
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Hospitals are subject to more economic pressures than ever before. On the one hand, cost containment or cost reduction is paramount, particularly in relation to costly branded pharmaceuticals. On the other hand, quality measures and value-based reimbursement penalizes poor patient care. ⋯ Lastly, we summarize many studies demonstrating the robust effect of IV acetaminophen on patient satisfaction. A holistic view of total hospital performance should be adopted when reviewing drugs rather than a silo mentality within the pharmacy. While IV acetaminophen adds to drug costs, the body of evidence indicates this drug has the potential to improve outcomes and hospital efficiency.
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Acute pulmonary embolism (PE) is a relatively rare but potentially fatal complication during the perioperative period. Its diagnosis is particularly challenging in the anesthetized patient, yet early diagnosis and treatment are essential in preventing morbidity and mortality. Preventative measures including anticoagulant treatment are well-established modalities in the management of venous thromboses and PE in the nonsurgical patient. ⋯ Conventional treatment is often not an option in the perioperative period, as surgical bleeding may be equally life threatening as a PE. Therefore, techniques that target the embolism directly and avoid systemic anticoagulation seem to promise safer and more efficient treatment of the patient with PE in the perioperative period. Fast detection, correct diagnosis, and appropriate treatment are all essential in improving the outcome of this severe complication.
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Sepsis and septic shock remain a major cause of morbidity and mortality. The complexity of the disease pathophysiology has resulted in a rich area of research on etiology and therapeutics. Anesthesiologists will often encounter the syndrome in their routine practice. This review summarizes some of the basic concepts of therapeutics and some novel therapeutics that are pertinent to anesthesia.
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Pulmonary hypertension is a condition that can result in serious complications in patients undergoing any type of anesthesia during the perioperative period. By definition, pulmonary artery hypertension is caused by a persistent rise in mean pulmonary artery pressure ≥25 mm Hg with Pulmonary capillary wedge pressure ≤ 15 mm Hg or exercise mean pulmonary artery pressure ≥35 mm Hg and pulmonary vascular resistance ≥ 3 wood unit's. The severity of the complications depends on the severity of the underlying condition, other comorbidities, and type of procedure, anesthetic technique, and anesthetic drugs. In this article, we briefly review the pulmonary vascular physiology, pathophysiology of the disease, clinical assessment and diagnosis, treatment options, and the anesthetic management of these patients.