Anesthesiology clinics
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Patients with endocrinopathies frequently present to the operating room. Although many of these disorders are managed on a chronic basis, patients may have acute changes in the perioperative period that, if left unrecognized, can have a negative effect on perioperative morbidity and mortality. ⋯ This article focuses on the 4 most commonly encountered endocrinopathies: diabetes mellitus, hyperthyroidism, hypothyroidism, and adrenal insufficiency. Specific challenges pertaining to patients with pheochromocytoma are also discussed.
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The acutely septic patient is a multifaceted challenge for the anesthetist. Unlike most elective surgery patients, acutely septic patients have severe systemic disease before the physiologic insults of anesthesia and surgery. ⋯ However, the acuity and time course of intraoperative events, including hemorrhage and drug-induced shock states, compel the anesthetist to respond aggressively with therapies that may or may not be strongly substantiated with long-term data in the intensive care unit setting. The anesthesiologist must place considerations concerning short-term survival from the acute insult of surgery ahead of longer-term considerations.
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Anesthesiology clinics · Mar 2010
ReviewAnesthetic concerns in trauma victims requiring operative intervention: the patient too sick to anesthetize.
Trauma is the third leading cause of death in the U. S. ⋯ Rapid intraoperative treatment of life-threatening conditions following injury includes the use of 'controlled-under resuscitation' of fluid administration until surgical hemorrhage control, early factor replacement in addition to transfusion of packed red blood cells, and use of adjuvant therapies such as recombinant factor VIIa. These treatment strategies, other recent developments in acute trauma resuscitation, and a review of associated co-existing medical conditions that may impact mortality, are presented.
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Anemia is commonly encountered in the preoperative patient. Determination of the cause of the anemia can affect perioperative surgical and medical management and outcome. ⋯ The authors review the evaluation of anemia and evidence regarding perioperative blood transfusions. Recommendations on the treatment of anemia, including perioperative blood transfusions, are outlined.
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Anesthesiology clinics · Sep 2009
Review Case ReportsInformed consent and the ethical management of the older patient.
Informed consent in elderly patients presents many ethical and legal challenges. Most aging patients are competent to provide consent for medical care. The purpose of informed consent is to promote autonomy, to protect a patient from undesired treatment, and to help the patient to make appropriate medical care decisions that correlate with his or her personal values. ⋯ Advance directives are legally and ethically binding tools by which patients can express their decisions regarding medical care before they lose capacity to do so. Discussion of do-not-resuscitate orders is part of informed consent, and patients' wishes regarding resuscitation in the operating room should be respected. Surrogate consent for participation in research is not necessarily allowed by IRB approval and research protocols.