Influence of perioperative care on outcome:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
2006
|
| Series: | Anesthesiology clinics
24,2 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XIV S., S. 235 - 425 Ill., graph. Darst. |
| ISBN: | 1416035729 |
Staff View
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| adam_text | CONTENTS
Foreword xi
Lee A. Fleisher
Preface xiii
Steffen E. Meiler
Past Accomplishments and Future Directions: Risk Prevention
in Anesthesia and Surgery 235
Robert K. Stoelting and Shukri F. Khuri
Anesthesiology has served as a model for patient safety in health care
and was the first medical profession to treat patient safety as an inde¬
pendent problem. Anesthesiology has implemented widely accepted
guidelines on basic monitoring, conducted long term analyses of
closed malpractice claims, developed patient simulators as meaning¬
ful training tools, and addressed problems of human error. The
National Surgical Quality Improvement Program is the first national,
validated, and peer controlled program that uses risk adjusted
outcomes for the comparative assessment and improvement of the
quality of surgical care. The program has reduced postoperative com¬
plications in the Veterans Administration, at both national and local
levels. It is becoming more evident that processes and events during
surgery can be important determinants of long term outcomes after
anesthesia and surgery.
Long term Outcome After Anesthesia and Surgery: Remarks on
the Biology of a Newly Emerging Principle in Perioperative Care 255
Steffen E. Meiler
There is a strong possibility that the risk from anesthesia and sur¬
gery carries over from the immediate perioperative period to more
remote rime points. This extended risk seems to influence the pro¬
gression, severity, and complication rate of certain chronic illnesses.
With the recognition that the perioperative process could be
responsible for later adverse events comes the need to reassess
VOLUME 24 • NUMBER 2 • JUNE 2006 v
existing patient safety models, because some of the risk could be
preventable. In the meantime, we must strive to improve short and
long term outcomes by expanding our efforts to reduce disease
activity preoperatively, to control the surgical stress response and
infection rate, and to use tissue preserving surgical techniques.
Non pharmacologic Prevention of Surgical Wound Infection 279
Daniel I. Sessler
Wound infections are relatively common postoperative complica¬
tions that are generally detected 5 to 9 days after surgery. Adequacy
of host immune defenses is the primary factor that determines
whether wound contamination progresses into a clinical infection.
Many determinants of infection risk are under the direct control of
anesthesiologists; factors that are at least as important as prophy¬
lactic antibiotics. This article reviews non pharmacologic methods
of reducing infection risk, including studies that demonstrate the
benefits of keeping patients normothermic and supplying supple¬
mental oxygen during surgery.
Bioecologic Control of Inflammation and Infection in
Critical Illness 299
Stig Bengmark
Surgical and medical emergencies and treatments are still affected
by an unacceptably high rate of morbidity and mortality. Sepsis is
the most common medical and surgical complication and the tenth
most common cause of death. Antibiotics and antagonists and
inhibitors of proinflammatory cytokines have not met expectations.
Selective bowel decontamination is no longer a treatment option.
After more than 30 randomized clinical trials and 30 years of dedi¬
cated efforts to combat sepsis by the use of various combinations of
antibiotics, we seem ready to conclude that the vigorous use of
antibiotics does not significantly reduce mortality in critically ill
patients. Side effects and price constitute important obstacles, espe¬
cially when it comes to use of cytokine antagonists and inhibitors.
Linking Stress to Inflammation 325
Angelika Bierhaus, Per M. Humpert, and Peter P. Nawroth
Acute and chronic psychosocial stress leads to the activation of
leukocytes and inflammatory reflexes, resulting in metabolic
changes. These cellular responses contribute to the finding, that
psychosocial stress is an independent predictor of mortality. This
article links the current knowledge on inflammatory reactions
induced by psychosocial stress to metabolic and vascular disease.
vi CONTENTS
Novel Chemical Mediators in the Resolution of Inflammation:
Resolvins and Protectins 341
Charles N. Serhan
This article describes two novel families of compounds, resolvins
and protectins, that carry potent biological actions and biosynthetic
pathways from eicosapentaenoic acid and docosahexaenoic acid,
the major omega 3 polyunsaturated fatty acids (PUFA) present in
fish oils. The biosynthesis of resolvins and protectins and their roles
in inflammatory exudates uncovered to date indicate that the reso¬
lution of acute inflammation is, in fact, an active process governed
by biochemical pathways under genetic and nutritional control
because omega 3 PUFA are widely appreciated as essential fatty
acids. These new results link them to previously uncharted path¬
ways and roles as precursors in the resolution of acute inflammation
and tissue injury. Moreover, the resolvins and protectins are potent
agonists of endogenous anti inflammation and are pro resolving
chemical mediators.
Pharmacologic Modulation of Operative Risk in Patients Who
Have Cardiac Disease 365
Ashley M. Shilling and Marcel E. Durieux
This article discusses the use of pharmacologic interventions for
preventing cardiovascular morbidity and mortality. Multiple stud¬
ies have attempted to demonstrate improved perioperative out¬
comes secondary to pharmacologic interventions. The literature on
p blockers, clonidine, and statins, and their role in reducing car¬
diovascular morbidity and mortality, is reviewed. The data are
optimistic but inconclusive. Although the use of P blockers in
patients who have documented coronary artery disease undergo¬
ing major vascular procedures appears supported, it seems prema¬
ture to recommend fj blockade for all patients with cardiac risk. For
clonidine and statins, the data are even more tenuous. The article
also discusses the use of aprotinin and lidocaine to reduce cogni¬
tive dysfunction in patients after cardiac surgery. Large scale
prospective trials will need to be undertaken before recommenda¬
tions can be made in any of these areas.
Interactions of Volatile Anesthetics with Neurodegenerative
Disease Associated Proteins 381
Anna Carnini, Maryellen Fazen Eckenhoff, and
Roderic G. Eckenhoff
The prevalence of neurodegenerative disorders is increasing as life
expectancy lengthens. There exists concern that environmental
influences may have a role in causing these disorders, which are
varied in their clinical presentation, but appear to have a common
biophysical initiation. That initiation is the misfolding and aggre¬
gation of specific proteins. Anesthetics enhance aggregation of
CONTENTS vii
|
| adam_txt |
CONTENTS
Foreword xi
Lee A. Fleisher
Preface xiii
Steffen E. Meiler
Past Accomplishments and Future Directions: Risk Prevention
in Anesthesia and Surgery 235
Robert K. Stoelting and Shukri F. Khuri
Anesthesiology has served as a model for patient safety in health care
and was the first medical profession to treat patient safety as an inde¬
pendent problem. Anesthesiology has implemented widely accepted
guidelines on basic monitoring, conducted long term analyses of
closed malpractice claims, developed patient simulators as meaning¬
ful training tools, and addressed problems of human error. The
National Surgical Quality Improvement Program is the first national,
validated, and peer controlled program that uses risk adjusted
outcomes for the comparative assessment and improvement of the
quality of surgical care. The program has reduced postoperative com¬
plications in the Veterans Administration, at both national and local
levels. It is becoming more evident that processes and events during
surgery can be important determinants of long term outcomes after
anesthesia and surgery.
Long term Outcome After Anesthesia and Surgery: Remarks on
the Biology of a Newly Emerging Principle in Perioperative Care 255
Steffen E. Meiler
There is a strong possibility that the risk from anesthesia and sur¬
gery carries over from the immediate perioperative period to more
remote rime points. This extended risk seems to influence the pro¬
gression, severity, and complication rate of certain chronic illnesses.
With the recognition that the perioperative process could be
responsible for later adverse events comes the need to reassess
VOLUME 24 • NUMBER 2 • JUNE 2006 v
existing patient safety models, because some of the risk could be
preventable. In the meantime, we must strive to improve short and
long term outcomes by expanding our efforts to reduce disease
activity preoperatively, to control the surgical stress response and
infection rate, and to use tissue preserving surgical techniques.
Non pharmacologic Prevention of Surgical Wound Infection 279
Daniel I. Sessler
Wound infections are relatively common postoperative complica¬
tions that are generally detected 5 to 9 days after surgery. Adequacy
of host immune defenses is the primary factor that determines
whether wound contamination progresses into a clinical infection.
Many determinants of infection risk are under the direct control of
anesthesiologists; factors that are at least as important as prophy¬
lactic antibiotics. This article reviews non pharmacologic methods
of reducing infection risk, including studies that demonstrate the
benefits of keeping patients normothermic and supplying supple¬
mental oxygen during surgery.
Bioecologic Control of Inflammation and Infection in
Critical Illness 299
Stig Bengmark
Surgical and medical emergencies and treatments are still affected
by an unacceptably high rate of morbidity and mortality. Sepsis is
the most common medical and surgical complication and the tenth
most common cause of death. Antibiotics and antagonists and
inhibitors of proinflammatory cytokines have not met expectations.
Selective bowel decontamination is no longer a treatment option.
After more than 30 randomized clinical trials and 30 years of dedi¬
cated efforts to combat sepsis by the use of various combinations of
antibiotics, we seem ready to conclude that the vigorous use of
antibiotics does not significantly reduce mortality in critically ill
patients. Side effects and price constitute important obstacles, espe¬
cially when it comes to use of cytokine antagonists and inhibitors.
Linking Stress to Inflammation 325
Angelika Bierhaus, Per M. Humpert, and Peter P. Nawroth
Acute and chronic psychosocial stress leads to the activation of
leukocytes and inflammatory reflexes, resulting in metabolic
changes. These cellular responses contribute to the finding, that
psychosocial stress is an independent predictor of mortality. This
article links the current knowledge on inflammatory reactions
induced by psychosocial stress to metabolic and vascular disease.
vi CONTENTS
Novel Chemical Mediators in the Resolution of Inflammation:
Resolvins and Protectins 341
Charles N. Serhan
This article describes two novel families of compounds, resolvins
and protectins, that carry potent biological actions and biosynthetic
pathways from eicosapentaenoic acid and docosahexaenoic acid,
the major omega 3 polyunsaturated fatty acids (PUFA) present in
fish oils. The biosynthesis of resolvins and protectins and their roles
in inflammatory exudates uncovered to date indicate that the reso¬
lution of acute inflammation is, in fact, an active process governed
by biochemical pathways under genetic and nutritional control
because omega 3 PUFA are widely appreciated as essential fatty
acids. These new results link them to previously uncharted path¬
ways and roles as precursors in the resolution of acute inflammation
and tissue injury. Moreover, the resolvins and protectins are potent
agonists of endogenous anti inflammation and are pro resolving
chemical mediators.
Pharmacologic Modulation of Operative Risk in Patients Who
Have Cardiac Disease 365
Ashley M. Shilling and Marcel E. Durieux
This article discusses the use of pharmacologic interventions for
preventing cardiovascular morbidity and mortality. Multiple stud¬
ies have attempted to demonstrate improved perioperative out¬
comes secondary to pharmacologic interventions. The literature on
p blockers, clonidine, and statins, and their role in reducing car¬
diovascular morbidity and mortality, is reviewed. The data are
optimistic but inconclusive. Although the use of P blockers in
patients who have documented coronary artery disease undergo¬
ing major vascular procedures appears supported, it seems prema¬
ture to recommend fj blockade for all patients with cardiac risk. For
clonidine and statins, the data are even more tenuous. The article
also discusses the use of aprotinin and lidocaine to reduce cogni¬
tive dysfunction in patients after cardiac surgery. Large scale
prospective trials will need to be undertaken before recommenda¬
tions can be made in any of these areas.
Interactions of Volatile Anesthetics with Neurodegenerative
Disease Associated Proteins 381
Anna Carnini, Maryellen Fazen Eckenhoff, and
Roderic G. Eckenhoff
The prevalence of neurodegenerative disorders is increasing as life
expectancy lengthens. There exists concern that environmental
influences may have a role in causing these disorders, which are
varied in their clinical presentation, but appear to have a common
biophysical initiation. That initiation is the misfolding and aggre¬
gation of specific proteins. Anesthetics enhance aggregation of
CONTENTS vii |
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| spelling | Influence of perioperative care on outcome guest ed. Steffen E. Meiler Philadelphia [u.a.] Saunders 2006 XIV S., S. 235 - 425 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Anesthesiology clinics 24,2 Anesthesia Anesthesiology Perioperative Care Perioperative Phase (DE-588)4173783-0 gnd rswk-swf Anästhesie (DE-588)4001833-7 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Perioperative Phase (DE-588)4173783-0 s Anästhesie (DE-588)4001833-7 s b DE-604 Meiler, Steffen E. Sonstige oth Anesthesiology clinics 24,2 (DE-604)BV021538977 24,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014867047&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Influence of perioperative care on outcome Anesthesiology clinics Anesthesia Anesthesiology Perioperative Care Perioperative Phase (DE-588)4173783-0 gnd Anästhesie (DE-588)4001833-7 gnd |
| subject_GND | (DE-588)4173783-0 (DE-588)4001833-7 (DE-588)4143413-4 |
| title | Influence of perioperative care on outcome |
| title_auth | Influence of perioperative care on outcome |
| title_exact_search | Influence of perioperative care on outcome |
| title_exact_search_txtP | Influence of perioperative care on outcome |
| title_full | Influence of perioperative care on outcome guest ed. Steffen E. Meiler |
| title_fullStr | Influence of perioperative care on outcome guest ed. Steffen E. Meiler |
| title_full_unstemmed | Influence of perioperative care on outcome guest ed. Steffen E. Meiler |
| title_short | Influence of perioperative care on outcome |
| title_sort | influence of perioperative care on outcome |
| topic | Anesthesia Anesthesiology Perioperative Care Perioperative Phase (DE-588)4173783-0 gnd Anästhesie (DE-588)4001833-7 gnd |
| topic_facet | Anesthesia Anesthesiology Perioperative Care Perioperative Phase Anästhesie Aufsatzsammlung |
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