Articles: postoperative-complications.
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Postoperative pulmonary complications are not uncommon, and the factors that contribute to lung dysfunction are well documented. Postoperative pain, spasm, and paralysis are all known to reduce lung function, although relief of pain does not completely restore function. Rather, diaphragmatic dysfunction has been found to persist even with adequate pain relief. ⋯ Muscle paralysis can also create or contribute to atelectasis. Microthromboembolism impedes perfusion distribution, adding to the other causes of a ventilation-perfusion mismatch. Different anesthetic techniques and intraoperative management may help prevent or reduce the incidence of postoperative lung complications.
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Acta Chir Scand Suppl · Jan 1989
ReviewThe influence of anesthesia and postoperative analgesic management of lung function.
General anesthesia itself may influence postoperative lung function. It leads to a depression of the functional residual capacity, which, in combination with surgical trauma and postoperative pain, can provoke insufficient breathing, retention of bronchial secretions, and atelectasis. ⋯ After upper abdominal or thoracic surgery, postoperative epidural analgesia causes a significant increase of lung function as compared with systemic analgesia. The combination of regional anesthesia and general anesthesia intraoperatively appears to reduce lung function much less than general anesthesia alone.
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This brief review presents an update of studies on postoperative fatigue and convalescence and the way in which they are affected by anesthetic technique. Development of postoperative fatigue is related to the degree of surgical trauma, but not to general anesthesia, and it cannot be predicted from age, sex, duration of surgery, or preoperative assessment of various nutritional parameters. Postoperative fatigue correlates with deterioration in nutritional status and impaired adaptability of heart rate to orthostatic stress and bicycle exercise. ⋯ Pain relief with regional anesthetics does not improve postoperative fatigue after abdominal surgery; however, no studies are available that evaluate the effects of regional analgesia with concomitant inhibition of the stress response. Controlled studies suggest that the use of regional anesthesia with local anesthetics reduces duration of hospitalization and time to ambulation. Further studies are needed to define the relative roles of immobilization, impaired nutritional intake, and surgical stress response in the pathogenesis of postoperative fatigue.
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Anesthesia can have various effects on the outcome of surgery, especially gastrointestinal procedures. Many anesthetic agents, for example, produce a fall in lower esophageal sphincter pressure, which can allow reflux of gastric contents into the lower esophagus. ⋯ Anesthetic technique can affect the success of intestinal anastomosis; for example, intravenous induction agents and some inhalational anesthetics decrease regional blood flow, whereas regional anesthetics may act to increase colonic blood flow. Other aspects of anesthetic management are also discussed as they relate to surgical outcome; examples are the use of invasive monitoring in elderly patients, the importance of oxygen delivery to the anastomosis, and the effect of transfusion on survival after surgery for carcinoma.
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Beitr Infusionsther · Jan 1989
Review[The status of blood coagulation preparations within the scope of modern hemotherapy in surgical patients].
The risks and adverse reactions of fresh frozen plasma (FFP) and coagulation components have changed considerably in the last few years because of the spread of HIV on the one hand, and advances in the preparation and sterilization of coagulation components on the other. Therefore, the indication for FFP and the various coagulation components deserves constant consideration; this is the intention of this paper. FFP is still the therapeutic choice for the treatment of acquired (complex) plasmatic coagulation disorders, even though the (still) small risk of virus transmission in Middle Europe has to be taken into account. ⋯ Finally, the necessity for an adequate diagnostic procedure is emphasized. Close cooperation between the physicians in the clinics and in the department of transfusion medicine/hemostaseology reduces unnecessary and inadequate application of coagulation components. This also means an improvement of the patient's therapy.