ISSN:8756-0437    

DOI:10.1002/ssu.2980060302

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe patient with cancer poses a challenge to the anesthesiologist for a variety of reasons including the effects of cancer (altered hemostasis, depressed immune response, and compromised airways), the effects of chemotherapy (malfunction of the myocardium, lungs, kidneys, and bone marrow; depression of pseudocholinesterase; and production of the syndrome of inappropriate secretion of antidiuretic hormone), as well as effects of radical cancer surgery (massive blood loss and the need for prolonged anesthesia). Anesthetic techniques to address these problems had their beginnings in the Department of Anesthesiology at Memorial Sloan‐Kettering Cancer Center. This paper traces the development of modern oncologic anesthesia and discusses how these advances significantly reduced operative mortalit

ISSN:8756-0437    

DOI:10.1002/ssu.2980060303

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe administration of nitrous oxide rapidly inactivates the vitamin B12‐dependent enzyme methionine synthase. This inactivation disrupts the normal interrelationships between vitamin B12and folic acid, and results in altered levels of folic acid derivatives and certain amino acids and their metabolites. Attempts have been made to use the antifolate properties of nitrous oxide to treat patients with leukemia. Although transient improvements may be observed in patients with leukemia who are given nitrous oxide, prolonged administration of nitrous oxide is highly toxic and causes marked hematological and neurological abnormalities. Animal andin vitrostudies suggest that the action of nitrous oxide may be tumor selective, and that nitrous oxide may interact with and enhance the therapeutic effect of other antitumor agents. However, there is a delicate balance between the possible beneficial and harmful effects of nitrous oxide, and the conditions for which nitrous oxide may prove useful as a chemotherapeutic adjuvant remain to be definedConcern has also been raised that nitrous oxide may have carcinogenic potential, especially in operating room and dental personnel who are chronically exposed to trace concentrations of this gas. However, there is no convincing evidence to date that nitrous oxide causes cancer in either animals or human

ISSN:8756-0437    

DOI:10.1002/ssu.2980060304

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractCancer is second only to trauma as the leading cause of death in children 1–15 years of age. Pediatric cancer patients have unique physiologic, pharmacologic, and psychologic considerations that present a unique challenge to the anesthesiologist. A thorough understanding of pediatric tumors, along with chemotherapeutics and their complications, is necessary to plan anesthetic management properly. Special attention is directed to the psychologic needs and preparation of both the patient and parents. Close cooperation and coordination among the pediatric oncologist, surgeon, and anesthesiologist are necessary for safe and expeditious operative car

ISSN:8756-0437    

DOI:10.1002/ssu.2980060305

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractChildren presenting with advanced leukaemia and non‐Hodgkin's lymphoma may develop life‐threatening complications in the early stages of management. Major metabolic disturbances with encephalopathy, septicaemic shock, pneumonitis, massive haemorrhage, or the physical effects of tumour masses may on occasion warrant intensive therapy. Close liaison between paediatric oncologists, oncological surgeons, and anesthesiologists is essential in establishing admission criteria for such cases and in defining therapeutic end points in the event of multisystem failure. This paper discusses the principles of intensive care management of patients with haematological malignancies by considering two cases who developed the tumour lysis syndrome with respiratory and renal failure. A case associated with metabolic encephalopathy is also descri

ISSN:8756-0437    

DOI:10.1002/ssu.2980060306

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractAfter the first 5 years of life, cancer is one of the three most common causes of death. Most investigations of cancer pain have shown that 50–70% of patients suffer needlessly. Pain may be due to the tumor or a co‐existant benign pain syndromeMethods of pain management include: 1)neurolytic blockade:stellate ganglion block, celiac plexus block, lumbar sympathetic block, epidural phenol, subarachnoid neurolysis; and 2)non‐pharmacologic methods:radiofrequency thermocoagulation lumbar sympathectomy, transcutaneous nerve stimulation (TENS), dorsal column stimulation (DCS)In summary, we utilize every possible combination of therapeutic modalities for cancer pain management. With so many safe procedures available, we encourage the primary physician to refer patients early in their disease process. Neurolytic procedures should be performed prior to initiation of high dose narcotic therapy, radiation, chemotherapy, and surgery when pos

ISSN:8756-0437    

DOI:10.1002/ssu.2980060307

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractInadequate pain relief remains a problem for many patients with cancer. Narcotic administration by the epidural or subarachnoid route is a relatively recent innovation and is indicated when pain is poorly controlled with high doses of systemic narcotics, or when patients experience limiting narcotic side effects. When given by the epidural or intrathecal route, narcotics have a longer duration of action and a lower dose is effective. These techniques involve personnel trained in catheter insertion and maintenance. Epidural and intrathecal administration of narcotics is an alternative when oral narcotics are ineffectiveIn this report the term “intraspinal” refers to epidural and/or subarachnoid placement of catheters and dr

ISSN:8756-0437    

DOI:10.1002/ssu.2980060308

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractAmbulatory surgical procedures are a large and increasing fraction of all surgery in the United States. A specialized health care team must be assembled to care for these patients and meet their special needs. Ambulatory surgery patients should be selected according to medical and psychosocial criteria. Patient preparation includes a history and physical examination, limited laboratory tests, empty stomach, and appropriate monitoring. Premedication should be supportive, and verbal as well as medicinal; drugs include ataractics and analgesics. All forms of general or regional anesthesia may be used. Recovery goals must be well defined, aiming for “home readiness.” Ambulatory anesthesia care is concluded with postdischarge follow‐up, for quality assurance and risk manag

ISSN:8756-0437    

DOI:10.1002/ssu.2980060309

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe use of lasers has simplified, shortened, and made less traumatic many surgical procedures. It has also increased the range of conditions amenable to treatment in all of the surgical specialties. There are, however, potentially serious hazards associated with the surgical use of lasers. The most serious hazards are explosions and fire, particularly during surgery on the airway, where flammable material, i.e., the endotracheal tube, high oxygen concentrations, and the laser, which is a high energy ignition source, are in close proximity. This report deals with techniques of anesthesia delivery that minimize the risks to the patient and operating room environment consequent on laser use in the airway. Laser use elsewhere in or on the body is associated with no greater danger than the use of electro‐cautery and requires no special anesthetic adaptatio

ISSN:8756-0437    

DOI:10.1002/ssu.2980060310

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThis brief review of the anesthesiologist's role in the team effort necessary for the safe treatment of airway tumors by laser beam is provided to acquaint the referring physician or medical oncologist with some of the anesthesiologist's operating room concerns and how they are met. The necessity of bringing the patient to a level of maximum physiologic reserve prior to treatment becomes obvious with information gained by scanning this review. The referring physician or medical oncologist aids the patient and the anesthesiologist and surgeon by performing a thorough preoperative cardiopulmonary evaluation and therapeutic intervention, as indicated by patient need. The review includes a description of the actions of the carbon dioxide (CO2) and neodynium‐yttrium aluminum garnet (YAG) lasers, “laser safety” for patients and personnel, monitoring, guarding the airway, ignition dangers, and comments on the use of jet and high frequency jet ventilation (

ISSN:8756-0437    

DOI:10.1002/ssu.2980060311

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY