Perioperative care: Difference between revisions
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The benefits of 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> | The benefits of 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== | ==Specific interventions== | ||
===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> | ||
===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."<ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, ''et al'' |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=Ann. Intern. Med. |volume=146 |issue=4 |pages=233–43 |year=2007 |pmid=17310047 |doi= |issn=|url=http://www.annals.org/cgi/content/full/146/4/233}}</ref> | |||
==References== | ==References== | ||
Revision as of 11:36, 23 January 2008
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.
Benefits of perioperative medical consultation
The benefits of consultation are not clear in an observational study.[2]
Specific interventions
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.[3] However, hemoglobin levels < 8 g/dL may increase complications.[4]
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."[5]
References
- ↑ National Library of Medicine. Perioperative care. Retrieved on 2007-11-21.
- ↑ 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]