laparoscopic surgery in the high risk patient

... stratifying risk (table 1.3) Its limitations are few but include: • • The index underestimated risk in Class I and II patients undergoing aortic surgery • 10 The index overestimated the incidence ... FOR THE HIGH RISK PATIENT Clinical predictors Minor Intermediate Major Functional capacity Excellent Moderate Poor Low Intermediate High Surgical risk Non-invasive risk stratification Invasive risk ... adaptable to individual clinical situations rather than rigidly applying an index score alone when estimating peri-operative risk 17 ANAESTHESIA FOR THE HIGH RISK PATIENT • This philosophy maintains that...

Ngày tải lên: 13/08/2014, 03:21

... anaesthetists for the 1998/99 report.3 41 ANAESTHESIA FOR THE HIGH RISK PATIENT • The NCEPOD clinical coordinators, together with the advisory groups for anaesthesia and surgery, review the completed ... ANAESTHESIA FOR THE HIGH RISK PATIENT PATIENT-RELATED FACTORS The relative increases in risk associated with the presence of patient- related factors is given in table 2.1 Smoking Smoking has long ... Unfortunately few patients will have read the chapter in this text on the meaning of risk! 25 ANAESTHESIA FOR THE HIGH RISK PATIENT Further reading Adams AM, Smith AF Risk perception and communication:...

Ngày tải lên: 13/08/2014, 03:21

... result RISK FACTORS IN PAIN MANAGEMENT Site of injury Pain that interferes with deep breathing and coughing confers the greatest risk to the patient and therefore the anatomical site of the surgery ... abdominal problems and then by pain in the peripheries When planning postoperative pain relief the site of surgery must be considered in conjunction with the patient s other risk factors 53 ANAESTHESIA ... recommended the systematic assessment and recording of 54 ANALGESIA FOR THE HIGH RISK PATIENT pain during the postoperative period.4 There is no objective measure of pain, the report of the patient is the...

Ngày tải lên: 13/08/2014, 03:21

... either total IV anaesthesia or inhalational anaesthesia, for the critically ill patient in the operating theatre Few have much experience of Ketamine in the UK Therefore, despite its strong theoretical ... demonstrate falls in cardiac parameters.9 Choice of anaesthetic agent in the septic patient There are no controlled studies in septic patients from the ICU undergoing surgery in the operating room What ... tubes and bags increases with the severity of the patient s condition Every piece of equipment inserted into the patient is there for a reason 79 ANAESTHESIA FOR THE HIGH RISK PATIENT (or time...

Ngày tải lên: 13/08/2014, 03:21

... 119 ANAESTHESIA FOR THE HIGH RISK PATIENT • Following this, the same group studied 220 high- risk patients this time undergoing major-elective and semi-elective surgery In these patients, they confirmed ... considered for limb, perineum and lower abdominal surgery and for laparotomy when combined with GA 111 ANAESTHESIA FOR THE HIGH RISK PATIENT When choosing GA in the elderly, the following should be considered: ... occurs during tidal ventilation The increase in CV can, on the whole, be explained by the loss in elastic tissue with age • Aside from an increase in CV with age there is an increase in residual...

Ngày tải lên: 13/08/2014, 03:21

... that appropriate monitoring be instituted before the induction of any form of anaesthesia in these high- risk patients In addition to routine standard monitoring, anaesthetists should have a very ... undergoing low risk surgery but must be supplemented by additional monitoring for patients undergoing intermediate or high risk surgery: • • • invasive cardiovascular monitoring, temperature, urine ... cardiac risk (Ͻ 1% mortality): • • • • endoscopic procedures, superficial procedures, cataract surgery, breast surgery 129 ANAESTHESIA FOR THE HIGH RISK PATIENT In general, in the presence of clinical...

Ngày tải lên: 13/08/2014, 03:21

... providing anaesthesia for the high risk gastrointestinal patient will be gleaned purely from experience gained in managing other patients In other words, anaesthesia for gastrointestinal surgery ... perioperative hypothermia are discussed in the chapter on the critically ill patient in the operating theatre • Monitoring should be appropriate to the status of the patient There should be a ... Different definitions focus on different points in this continuum: Normal Progressive renal insufficiency Anuric/no intrinsic function 179 ANAESTHESIA FOR THE HIGH RISK PATIENT Useful clinical definitions...

Ngày tải lên: 13/08/2014, 03:21

... Aprotinin: There were reports of renal problems from high doses of the protease inhibitor, aprotinin, in cardiac surgery patients However, the most recent study found no effect of aprotinin on ... hypertension FURTHER CARDIAC TESTING PRIOR TO NON-CARDIAC SURGERY The decision to recommend further non-invasive testing or invasive testing for the individual patient being considered for surgery ultimately ... improve GFR.10 Thus increasing blood pressure with noradrenaline (norepinephrine) may improve creatinine clearance 189 ANAESTHESIA FOR THE HIGH RISK PATIENT For example, there are numerous studies...

Ngày tải lên: 13/08/2014, 03:21

... important mechanism in maintaining CO in the impaired ventricle Further, increases in CO are mediated through aortic chemoreceptors inducing sympathetically mediated increases in contractility (and ... use of stored blood in all patients 217 ANAESTHESIA FOR THE HIGH RISK PATIENT Transmission of infection by blood transfusion There remains an exceedingly small but real risk of infection from transfusion ... competent patients therefore have the right to refuse life-sustaining treatment In addition, patients not have the right to demand life-sustaining treatment when the clinician considers it inappropriate.17...

Ngày tải lên: 13/08/2014, 03:21

... following emergency and non-emergency surgery in the UK was in 25 and in 200, respectively.11 246 THE MEANING OF RISK Table 17.2 – Examples of the risks of surgery in the UK Statistic Incidence ... 0.48 Risk in 10 in 11 in 25 in 200 Transposing these figures to the risk ladder in figure 17.1 shows that the risks of undergoing a surgical procedure are not insignificant (table 17.2) Patient s ... that there is no single level of risk that is universally acceptable.4 For example, some individuals will choose what they 244 THE MEANING OF RISK Everyday risks Clinical risks in 1 in 10 Very high...

Ngày tải lên: 13/08/2014, 03:21

Ngày tải lên: 13/08/2014, 20:22

... metaanalysis because they are the most specific clinically relevant outcomes of invasive fungal infections There were no missing data for these two main outcomes in the included studies The other outcomes ... in the literature search Two independent reviewers examined the titles and the abstracts of all identified trials to confirm they fulfilled the inclusion criteria They examined and recorded the ... Adequate Either Intravenous, oral, or Double-blind 119 trauma or after intraof patients with enteral fluconazole 800 mg abdominal or intra-thoracic surgery adult patients with at loading following by...

Ngày tải lên: 12/08/2014, 23:20

... (dobutamine ≥5 mcg/kg/min, epinephrine >0.05 mcg/kg/min, milrinone >0.25 mcg/kg/min, norepinephrine >0.02 mcg/kg/min) in the presence of low MAP (

Ngày tải lên: 13/08/2014, 20:22

... cancer was the first episode while in the remaining patients high risk episode was recurrent (range, 2-11 resections; average 2.8 resections) In all patients, WL cystoscopy was negative Urinary cytology ... resections of high risk patients and if the improvement in the rate of detection of flat lesions in the follow-up may improve the use of additional treatment and the prognosis of these patients Conclusions ... conceived the study and participated in its design and coordination All authors read and approved the final manuscript Competing interests The authors declare that they have no competing interests...

Ngày tải lên: 18/06/2014, 16:20

... involved in screening for HIV should be aware of the limitations between assays and know which test their institution uses Clinicians need to have a high index of suspicion in patients with risk ... have been reported in the United States with 52 of those patients having originated in Western Africa [2] Given the low prevalence of HIV-2 in industrialized countries, the clinical course and ... the determination of HIV-2 viral load in the United States (Table 1) This creates a dilemma in the treatment of HIV-2 infected patients as viral loads are an integral part of patient monitoring...

Ngày tải lên: 10/08/2014, 05:21

... survivors as therapeutic goals in high- risk surgical patients Chest 1998, 94:1176-1186 Boyd O, Grounds RM, Bennett ED: A randomised controlled trial of the effect of deliberate preoperative increase ... mortality and morbidity in high- risk surgical patients JAMA 1993, 270:2699-2707 Bishop MU, Shoemaker WC, Appel PL, et al: Prospective randomised trial of survivor values of cardiac index Oxygen delivery ... article as: Bennett: The high- risk surgical patient revisited Critical Care 1998 2:1 Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough...

Ngày tải lên: 12/08/2014, 18:20

... beta-blocking agents indicated in some patients? The author(s) declare that they have no competing interests These data suggesting that GDT should be implemented in high risk surgical patients ... 6% to 7% in the patients with RCRI scores of and more A high- risk surgical procedure was performed in a minority of the patients, and the effects of beta-blockade were neutral in these patients ... analysis included the vast majority of the patients (80% of the cohort) Second, RCRI assess specifically the cardiac risk of the patient, not the mortality related to the surgical procedure Accordingly,...

Ngày tải lên: 12/08/2014, 23:20

Ngày tải lên: 12/08/2014, 23:21

... outcome for these patients [13,14]; however, in the absence of data describing the size of the high- risk population, it is difficult to convince clinicians and managers either of the need to introduce ... were much greater in the high- risk population than in the standard population Patients in the high- risk population were older, more likely to undergo emergency surgery and remained in hospital for ... those patients who require continued ICU care The highest mortality rates were identified in the group of patients admitted to the ICU following initial care on a standard ward following surgery The...

Ngày tải lên: 12/08/2014, 23:23

... hrs following the post-dialysis dose There is a case report in which lithium levels were maintained in the therapeutic range by intraperitoneal administration of lithium during continuous peritoneal ... shunting, thereby decreasing first pass metabolism; decrease in quantities and affinity of plasma proteins, thereby increasing free-drug levels; increase in volume of distribution in patients ... gabapentin in patients with HCV [55] These findings suggest that valproate can be used for some patients with HCV without adversely affecting ALT levels Obtaining pretreatment baseline ALT levels in...

Ngày tải lên: 25/10/2012, 10:51