ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05612.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Although the experience of a surgical and anaesthesiological procedure is unique to every patient, many preoperative events and routines will to a certain extent be shared by a majority of patients. This review will be limited to this area of routine preoperative care and evaluation, as applied to and by the anaesthesia team before elective surgery. The word “routine” is used more in the sense of what is most commonly done; the notion of a mechanically performed act is totally inappropriate and dangerous in this cont

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05613.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstention from food and drink prior to anaesthesia remains a cornerstone in safe practice. Despite the lack of scientific support, previous guidelines, similar for fluids and solids, have for more than three decades more often than not recommended “nil by mouth” (“nothing‐per‐os”; “NPO” in the US) after midnight or a fixed duration of time. Based on an increased number of studies of relevance to the duration of preoperative fasting, reviews on this subject concerning both adults (1) and children (2) and a large number of editorials (3–7), have recently been published. Since there may be a discrepancy between conclusions based on scientific studies and the current routine practice ‐ this presentation is intended to survey the current recommendations in different countries and how they relate to publications on the subject. Opinions are mainly derived from officers of associations linked to The World Federation for Anaesthesiologists (WFSA) and from

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05614.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Along with the decision for surgery in children comes a concern for the development of minor psychological disturbances close to the event and possibly also later in life. There is always also anxiety for the procedure and its influence on normal physiological functions. It is true that these matters are valid also in the adult. There are, however, two factors that differ. One is the special relationship to family or legal guardian and the other is the skill needed to communicate with infants, pre‐school children and other childre

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05615.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The psychological component of preoperative preparation should be completed with a selective use of drugs. The days of poly‐pharmacy are over. Heavily sedated patients coming to the operation room with minimal oral secretions are not the purpose of modern premedication. Anxiolysis and slight sedation (painless patients) and analgesia (patients suffering from pain) are the main goals. Anticholinergics should be used only when needed, as is the case with premedication generally. The use of antiemetics and that of agents given for prophylaxis against allergic reactions or aspiration pneumonitis depend on specific needs of the patient. More accurate and generally accepted but simple methods are needed in studying the effects of different premedicants. The present results produced with a huge number of different more or less validated assessments can seldom be compared with each othe

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05616.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The obstetric patient presents unique challenges to the anaesthesiologist. The physiologic changes in the mother during pregnancy and the anaesthetic implications of these changes, associated with the pathophysiologic conditions frequently superimposed on the pregnancy distinguish the parturient from the other patients about to undergo anaesthesia and surgery. Furthermore, the obstetric patient may be in acute pain from labour and frequently needs urgent surgical intervention because of sudden changes in the condition of the mother or the fetus.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05617.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05618.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Hyper‐ or hypofunctioning endocrine organs present a number of perianaesthetic challenges. This review covers some of the issues of perianaesthetic management of patients with primary or coexisting pathology of the following endocrine organs: The pancreas with diabetes mellitus as the most common endocrine cause of primary and secondary organ dysfunctions affecting anaesthetic care. Adrenal cortical pathology with excess or deficiency of adrenocortical hormones. Pheochromocytoma of the adrenal medulla with infrequent but challenging perianaesthetic problems. Thyroid gland diseases with hyper‐ or hypothyroidism. Parathyroid gland pathology with hypercalcaemia or hypocalcaemia. Disorders of the anterior and posterior pituitary gland. The carcinoid syndrome and more uncommon endocrinopathies such as adenomas from the gastroenteropancreatic endocrine tissues and the ovarian hyperstimulation syndrome are also reviewed brie

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05619.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The incidence of a difficult laryngoscopy or intubation varies from 1.5% to 13%, and failed intubation has been identified as one of the anaesthesia‐related causes of death or permanent brain damage. Problems in the airway management can be predicted based on previous anaesthesia records, the medical history of the patient and a physical examination. Several radiological measurements have been reported to be associated with a difficult intubation. The sensitivities of the commonly used bedside tests i.e. the Mallampati classification and the thyromental distance have been reported to be from 42% to 81%, and from 62% to 91%, respectively. The figures for the specificity have varied from 66% to 84% and from 25% to 82%, respectively. The other subjective assessments and objective measurements employed for the prediction of a difficult intubation reach comparable sensitivities and specificities. Evidently, the positive predictive value is improved, if combinations of tests are use

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05620.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The surgery and trauma‐induced modulation of the coagulation system includes a considerable risk of perioperative thromboembolic complications unless effective thromboprophylactic treatment is given. In the present survey the patient at risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) is characterized and the documented efficacy of different currently used thromboprophylactic regimens is summarized. Systemic thromboprophylactic treatment may include a risk of an increased bleeding tendency which may lead to haemorrhagic complications. In patients with a coagulation abnormality or in patients receiving anticoagulants for perioperative thromboprophylaxis there is a fear among anaesthesiologists that the use of regional anaesthesia (spinal or epidural) may be associated with spinal haemorrhagic complications, i.e. with spinal haematoma formation leading to compression of the spinal cord and severe neurologic sequelae. Present aspects on the risk of spinal haematoma formation at the combined use of pharmacological thromboprophylactic regimens and spinal or epidural anaesthesia/analgesia are therefore summarized. Pregnancy is associated with changes in the haemostatic system, which in the preeclamptic or eclamptic patient may be rather pronounced and constitute a clinical problem since regional anaesthetic techniques are often preferred for obstetric anaesthesia/analgesia. The specific problems to be considered prior to the choice of regional anaesthesia/analgesia for a parturient with a suspected coagulation disorder are therefore commented on in more detail. Finally, recommendations are given for safe spinal and epidural analgesic and anaesthetic routines in patients with potential haemostatic disturbances due to thromboprophylactic treatment with anticoagulants or bleeding disorder

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05621.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY