Perioperative care: Difference between revisions
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:See also [[preoperative care]] | :See also [[preoperative care]] | ||
'''Perioperative care''' is defined as "interventions to provide care prior to, during, and immediately after surgery."<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?term=perioperative+care |title=Perioperative care |accessdate=2007-11-21 |author=National Library of Medicine |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> | '''Perioperative care''' is defined as "interventions to provide care prior to, during, and immediately after surgery."<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?term=perioperative+care |title=Perioperative care |accessdate=2007-11-21 |author=National Library of Medicine |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> | ||
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Components of postoperative care may include [[incentive spirometry]]. | Components of postoperative care may include [[incentive spirometry]]. | ||
== | ==Complications== | ||
The | ===Myocardial infarction=== | ||
[[Myocardial infarction]] is usually NSTEMI.<ref name="pmid2247116">{{cite journal |author=Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM |title=Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group |journal=N. Engl. J. Med. |volume=323 |issue=26 |pages=1781–8 |year=1990 |month=December |pmid=2247116 |doi= |url= |issn=}}</ref><ref name="pmid9523798">{{cite journal |author=Badner NH, Knill RL, Brown JE, Novick TV, Gelb AW |title=Myocardial infarction after noncardiac surgery |journal=Anesthesiology |volume=88 |issue=3 |pages=572–8 |year=1998 |month=March |pmid=9523798 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-3022&volume=88&issue=3&spage=572 |issn=}}</ref> | |||
Older studies showed higher mortality, perhaps due to only detecting large infarctions.<ref name="pmid5038186">{{cite journal |author=Plumlee JE, Boettner RB |title=Myocardial infarction during and following anesthesia and operation |journal=South. Med. J. |volume=65 |issue=7 |pages=886–9 |year=1972 |month=July |pmid=5038186 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0038-4348&volume=65&issue=7&spage=886 |issn=}}</ref> | |||
==Specific interventions== | ==Specific interventions== | ||
===Medical consultation=== | |||
The benefits of medical consultation are not clear in an observational study.<ref name="pmid18039993">{{cite journal |author=Auerbach AD, Rasic MA, Sehgal N, Ide B, Stone B, Maselli J |title=Opportunity missed: medical consultation, resource use, and quality of care of patients undergoing major surgery |journal=Arch. Intern. Med. |volume=167 |issue=21 |pages=2338–44 |year=2007 |pmid=18039993 |doi=10.1001/archinte.167.21.2338}}</ref> | |||
===Blood transfusions=== | ===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.<ref name="pmid10532600">{{cite journal |author=Bracey AW, Radovancevic R, Riggs SA, ''et al'' |title=Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome |journal=Transfusion |volume=39 |issue=10 |pages=1070–7 |year=1999 |pmid=10532600 |doi= |issn=}}</ref> However, hemoglobin levels < 8 g/dL may increase complications.<ref name="pmid12375651">{{cite journal |author=Carson JL, Noveck H, Berlin JA, Gould SA |title=Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion |journal=Transfusion |volume=42 |issue=7 |pages=812–8 |year=2002 |pmid=12375651 |doi= |issn=}}</ref> | 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.<ref name="pmid10532600">{{cite journal |author=Bracey AW, Radovancevic R, Riggs SA, ''et al'' |title=Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome |journal=Transfusion |volume=39 |issue=10 |pages=1070–7 |year=1999 |pmid=10532600 |doi= |issn=}}</ref> However, hemoglobin levels < 8 g/dL may increase complications.<ref name="pmid12375651">{{cite journal |author=Carson JL, Noveck H, Berlin JA, Gould SA |title=Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion |journal=Transfusion |volume=42 |issue=7 |pages=812–8 |year=2002 |pmid=12375651 |doi= |issn=}}</ref> | ||
Revision as of 09:40, 8 July 2009
- See also preoperative care
Perioperative care is defined as "interventions to provide care prior to, during, and immediately after surgery."[1]
[]
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
- ↑ National Library of Medicine. Perioperative care. Retrieved on 2007-11-21.
- ↑ 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]
- ↑ 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]
- ↑ Plumlee JE, Boettner RB (July 1972). "Myocardial infarction during and following anesthesia and operation". South. Med. J. 65 (7): 886–9. PMID 5038186. [e]
- ↑ 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.
- ↑ 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]
- ↑ 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]
- ↑ 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]