International anesthesiology clinics
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Thermoregulatory responses in infants and children are now fairly well understood. The phenomenon of heat loss in children during surgery is widely acknowledged. Hypothermia is most likely to occur during long surgical procedures in an air-conditioned operating room, particularly when respiration is controlled. ⋯ Perioperative hypothermia results from decreased metabolic heat production, increased environmental heat loss, redistribution of heat within the body, and anesthesia-induced inhibition of thermoregulation. Radiation and convection from the skin surface combine with evaporation from tissues inside surgical incisions to decrease mean body temperature. Perioperative hypothermia can be limited by prewarming the skin surface before induction of anesthesia, warming the operating room, humidifying the airway, and warming intravenous fluids.
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Kidney transplantation in adults, infants, and children is a safe and effective treatment of ESRD. In 1990, for all patients with irreversible ESRD, transplantation is the preferred treatment over dialysis. ⋯ Thus increased use of grafts from living donors appears warranted. Continued refinements and advances in immunosuppression should result in even better long-term graft and patient survival.
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Intelligent, safe use of muscle relaxants dictates that the clinician monitor neuromuscular function in all patients to determine each patient's sensitivity to relaxants. Restoration of muscle strength is a function of pharmacological antagonism of residual NMB, spontaneous recovery as the concentration of relaxant declines at the neuromuscular junction, or both. ⋯ As new relaxants with very short half-lives become available, it is likely that steady states of relaxation will increasingly be maintained with continuous infusions. In this setting, the rapid rate of spontaneous recovery of both clinical neuromuscular function and an adequate margin of safety may vastly reduce the need for pharmacological antagonism.