Articles: postoperative.
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Anesthesia and analgesia · May 2014
ReviewStrategies for net cost reductions with the expanded role and expertise of anesthesiologists in the perioperative surgical home.
The Perioperative Surgical Home is a model adopted by the American Society of Anesthesiologists to increase quality and patient safety and to decrease costs. This Special Article is about the latter topic. Using narrative review, we show that there are two principal opportunities for net cost reduction. ⋯ These two are the same as the principal ways that a positive return on investment can be achieved from use of an anesthesia information management system. Three other opportunities are much less likely to achieve as large (if any) net cost reduction among all patients but may at some hospitals. These are to reduce cancellations, operating room times, and/or hospital postoperative lengths of stay.
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B-Type natriuretic peptides and troponin measurements have potential in predicting risk in patients undergoing non-cardiac surgery. Using the American Heart Association framework for the evaluation of novel biomarkers, we review the current evidence supporting the peri-operative use of these two biomarkers. ⋯ However, only pre- and postoperative natriuretic peptide measurement and postoperative troponin measurement have shown clinical utility. It is now important for trials to be conducted to determine whether integrating pre- and postoperative natriuretic peptide and postoperative troponin measurement into clinical practice is able to improve clinical outcomes in patients undergoing non-cardiac surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2014
Review[Anaesthesiological management of patients with dementia].
The aging society challenges anaesthesiologists with a growing number of patients with dementia. These and their relatives worry about an aggravation of an already existing dementia or even the postoperative evocation of one. Common volatile anaesthetics and propofol are suspected to increase dementia - associated protein tau and amyloid-betalevels in the brain. ⋯ In dementia, perioperative malfunction of cognition, memory, attention, information processing, communication and social interaction abilities is of profound influence on the perioperative management. This review mentions actual knowledge about dementia forms and symptoms in brief. Recommendations for the anaesthesia care are given in more detail.
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A large proportion of patients undergoing surgery have coexisting chronic kidney disease, placing them at greater risk of postoperative morbidity and mortality. The purpose of this review is to review the recent developments in how renal function is estimated, how this relates to surgical outcomes, and how this has been applied clinically. ⋯ Improved accuracy in defining kidney disease will aid clinicians in identifying higher risk patients, and aid earlier diagnosis of acute kidney injury. Further research is required, specifically on the implications of kidney disease in noncardiac surgical patients, and how defining renal function before and after surgery can aid in preventive strategies.