Anesthesiology clinics
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Anesthesiology clinics · Jun 2006
ReviewPast accomplishments and future directions: risk prevention in anesthesia and surgery.
Anesthesiology has served as a model for patient safety in health care and was the first medical profession to treat patient safety as an independent problem. Anesthesiology has implemented widely accepted guidelines on basic monitoring, conducted long-term analyses of closed malpractice claims, developed patient simulators as meaningful training tools, and addressed problems of human error. ⋯ The program has reduced postoperative complications in the Veterans Administration, at both national and local levels. It is becoming more evident that processes and events during surgery can be important determinants of long-term outcomes after anesthesia and surgery.
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Anesthesiology clinics · Jun 2006
ReviewPharmacologic modulation of operative risk in patients who have cardiac disease.
Cardiac complications continue to compose a major proportion of serious postoperative morbidity and mortality, and it is appropriate, therefore, that this area has received a lot of attention in the search for pharmacologic modulation of surgical outcomes. Despite numerous studies, conclusive data does not exist, making it difficult to recommend a course of action. beta-blockade has not only made it into national protocols, but is even considered as a quality assessment measure. However, the data are not quite as conclusive as it may sometimes appear. ⋯ For clonidine and statins, the data are even more tenuous, and largely based on retrospective reviews (with the exception of postprocedure use of statins, which is well supported). Here again, the results of large-scale prospective trials must become available before recommendations can be made. Finally, promising data indicate that it might be possible to modulate by pharmacologic means the neurocognitive decline that is frequently associated with cardiac surgery, and which is often considered by patients to be the most troublesome complication of the intervention.
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Anesthesiology clinics · Jun 2006
ReviewInteractions of volatile anesthetics with neurodegenerative-disease-associated proteins.
The prevalence of the neurodegenerative disorders is increasing as life expectancy lengthens, and there exists concern that environmental influences may contribute to this increase. These disorders are varied in their clinical presentation, but appear to have a common biophysical initiation. ⋯ Although data in support of an interaction in animal models are still lacking, data from clinical studies indicate an association, which provides further cause for concern. Many opportunities exist for rapid progress at all levels on defining whether anesthetics do indeed contribute to the pathogenesis of these progressive, debilitating disorders.
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Anesthesiology clinics · Jun 2006
ReviewLong-term outcome after anesthesia and surgery: remarks on the biology of a newly emerging principle in perioperative care.
There is a strong possibility that the risk from anesthesia and surgery carries over from the immediate perioperative period to more remote time points. This extended risk seems to influence the progression, severity, and complication rate of certain chronic illnesses, such as vascular heart disease and some of the malignancies, although other disease processes might be affected as well. With the recognition that the perioperative process could be responsible for later adverse events comes the need to reassess existing patient safety models, because some of the risk could be preventable. ⋯ Additionally, we need to examine how genetic diversity or acquired defects alter the immune response to tissue injury and infection so that we can improve risk stratification and preemptive therapies. In the meantime, we must strive to improve short- and long-term outcomes by expanding our efforts to reduce disease activity preoperatively, to control the surgical stress response and infection rate, and to use tissue-preserving surgical techniques. Long-term patient safety after anesthesia and surgery is not a specialty-by-specialty endeavor; it requires a highly collaborative, institutional, and national effort to foster innovative research and health care process improvements.
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Ethical concerns are common in palliative care settings. Rather than provide an exhaustive list of possible ethical problems one may come upon, this article describes areas of concern that are frequently encountered by perioperative health care providers, especially anesthesiologists, in the palliative care arena.