Perioperative care

From Citizendium
Revision as of 10:40, 8 July 2009 by imported>Robert Badgett
Jump to navigation Jump to search
This article is a stub and thus not approved.
Main Article
Discussion
Related Articles  [?]
Bibliography  [?]
External Links  [?]
Citable Version  [?]
 
This editable Main Article is under development and subject to a disclaimer.
See also preoperative care

Perioperative care is defined as "interventions to provide care prior to, during, and immediately after surgery."[1]

[edit intro]

Classification

Intraoperative Care

Postoperative Care

Components of postoperative care may include incentive spirometry.

Complications

Myocardial infarction

Myocardial infarction is usually NSTEMI.[2][3]

Older studies showed higher mortality, perhaps due to only detecting large infarctions.[4]

Specific interventions

Medical consultation

The benefits of medical consultation are not clear in an observational study.[5]

Blood transfusions

Among patients receiving coronary artery bypass grafting, there may be no meaningful difference between transfusing to maintain a hemoglobin levels > 8 g/dL versus a hemoglobin levels > 9 g/dL.[6] However, hemoglobin levels < 8 g/dL may increase complications.[7]

Glucose control

Regarding intraoperative control of glucose, a randomized controlled trial concluded "the increased incidence of death and stroke in the intensive treatment group raises concern about routine implementation of this intervention."[8]

References

  1. National Library of Medicine. Perioperative care. Retrieved on 2007-11-21.
  2. Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM (December 1990). "Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group". N. Engl. J. Med. 323 (26): 1781–8. PMID 2247116[e]
  3. Badner NH, Knill RL, Brown JE, Novick TV, Gelb AW (March 1998). "Myocardial infarction after noncardiac surgery". Anesthesiology 88 (3): 572–8. PMID 9523798[e]
  4. Plumlee JE, Boettner RB (July 1972). "Myocardial infarction during and following anesthesia and operation". South. Med. J. 65 (7): 886–9. PMID 5038186[e]
  5. Auerbach AD, Rasic MA, Sehgal N, Ide B, Stone B, Maselli J (2007). "Opportunity missed: medical consultation, resource use, and quality of care of patients undergoing major surgery". Arch. Intern. Med. 167 (21): 2338–44. DOI:10.1001/archinte.167.21.2338. PMID 18039993. Research Blogging.
  6. Bracey AW, Radovancevic R, Riggs SA, et al (1999). "Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome". Transfusion 39 (10): 1070–7. PMID 10532600[e]
  7. Carson JL, Noveck H, Berlin JA, Gould SA (2002). "Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion". Transfusion 42 (7): 812–8. PMID 12375651[e]
  8. Gandhi GY, Nuttall GA, Abel MD, et al (2007). "Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial". Ann. Intern. Med. 146 (4): 233–43. PMID 17310047[e]

See also