Medically complex patients:
Gespeichert in:
| Weitere Verfasser: | , |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pennsylvania
Elsevier
[2016]
|
| Schriftenreihe: | Anesthesiology clinics
volume 34, number 4 (December 2016) |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | xvi Seiten, Seite 633-820 Illustrationen |
| ISBN: | 9780323477345 |
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| 245 | 1 | 0 | |a Medically complex patients |c editors Robert B. Schonberger, Stanley H. Rosenbaum |
| 264 | 1 | |a Philadelphia, Pennsylvania |b Elsevier |c [2016] | |
| 300 | |a xvi Seiten, Seite 633-820 |b Illustrationen | ||
| 336 | |b txt |2 rdacontent | ||
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| 490 | 1 | |a Anesthesiology clinics |v volume 34, number 4 (December 2016) | |
| 490 | 0 | |a Clinics review articles | |
| 700 | 1 | |a Schonberger, Robert B. |4 edt | |
| 700 | 1 | |a Rosenbaum, Stanley H. |4 edt | |
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Datensatz im Suchindex
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| adam_text | Titel: Medically complex patients
Autor: Schonberger, Robert B
Jahr: 2016
Medically Complex Patients
Contents
Foreword: The Patient with Multimorbidities: Does 1 + 1 Always Simply Equal 2? xiii
Lee A. Fleisher
Preface: Medically Complex Patients xv
Robert B. Schönberger and Stanley H. Rosenbaum
Anesthetic Management of the Adult Patient with Concomitant Cardiac and
Pulmonary Disease 633
Misty A. Radosevich and Daniel R. Brown
Several common diseases of the cardiac and pulmonary systems and the
interactions of the two in disease and anesthetic management are dis-
cussed. Management of these disease processes in isolation is reviewed
and how the management of one organ system impacts another is then
explored. For example, in a patient with acute lung injury and right heart
failure, lung-protective ventilation may directly conflict with strategies to
minimize right heart afterload. Such challenging clinical scenarios require
appreciation of each disease entity, their appropriate management, and
the balance between competing priorities.
Anesthesia for the Patient with Concomitant Flepatic and Renal Impairment 645
Tricia E. Brentjens and Ryan Chadha
Hepatic and renal disease are common comorbidities in patients present-
ing for intermediate- and high-risk surgery. With the evolution of perioper-
ative medicine, anesthesiologists are encountering more patients who
have significant hepatic and renal disease, both acute and chronic in na-
ture. It is important that anesthesiologists have an in-depth understanding
of the physiologic derangements seen with hepatic and renal disease to
evaluate and manage these patients appropriately. Perioperative manage-
ment requires an understanding of the physiologic perturbations associ-
ated with each disease process. This article elucidates the goals in the
management and treatment of this complex patient population.
Coexisting Cardiac and Hematologic Disorders 659
Jordan E. Goldhammer and Benjamin A. Kohl
Patients with concomitant cardiac and hematologic disorders presenting
for noncardiac surgery are challenging. Anemic patients with cardiac dis-
ease should be approached in a methodical fashion. Transfusion triggers
and target should be based on underlying symptomatology. The approach
to anticoagulation management in patients with artificial heart valves, car-
diac devices, or severe heart failure in the operative setting must encom-
pass a complete understanding of the rationale of a patient s therapy as
well as calculate the risk of changing this regimen. This article focuses
viii Contents
on common disorders and discusses strategies to optimize care in pa-
tients with coexisting cardiac and hematologic disease.
Surgical Critical Care for the Trauma Patient with Cardiac Disease 669
Michael M. Woll and Linda L. Maerz
The elderly population is rapidly increasing in number. Therefore, geriatric
trauma is becoming more prevalent. All practitioners caring for geriatric
trauma patients should be familiar with the structural and functional
changes naturally occurring in the aging heart, as well as common preex-
isting cardiac diseases in the geriatric population. Identification of the
shock state related to cardiac dysfunction and targeted assessment of
perfusion and resuscitation are important when managing elderly patients.
Finally, management of cardiac dysfunction in the trauma patient includes
an appreciation of the inherent effects of trauma on cardiac function.
Surgical Critical Care for the Patient with Sepsis and Multiple Organ Dysfunction 681
Gary J. Kami and Kimberly A. Davis
Sepsis and multiple organ dysfunction syndrome (MODS) is common in
the surgical intensive care unit. Sepsis involves infection and the patient s
immune response. Timely recognition of sepsis and swift application of
evidence-based interventions is critical to the success of therapy. This
article reviews the nature of the septic process, existing definitions of
sepsis, and current evidence-based treatment strategies for sepsis and
MODS. An improved understanding of the process of sepsis and its rela-
tion to MODS has resulted in clinical definitions and scoring systems that
allow for the quantification of disease severity and guidelines for treatment.
Anesthesia for Patients with Concomitant Cardiac and Renal Dysfunction 697
Radwan Safa and Nicholas Sadovnikoff
Renal disease and cardiovascular disease are commonly encountered in
the same patient. The dynamic interactions between renal disease and
cardiovascular disease have an impact on perioperative management.
Renal failure is an independent risk factor for cardiovascular disease and
the link between the two disease states remains to be fully elucidated.
Anesthesia for Patients with Anemia 711
Aryeh Shander, Gregg P. Lobel, and Mazyar Javidroozi
Anemia is a common and often ignored condition in surgical patients. Ane-
mia is usually multifactorial and iron deficiency and inflammation are
commonly involved. An exacerbating factor in surgical patients is iatro-
genic blood loss. Anemia has been repeatedly shown to be an indepen-
dent predictor of worse outcomes. Patient blood management (PBM)
provides a multimodality framework for prevention and management of
anemia and related risk factors. The key strategies in PBM include support
of hematopoiesis and improving hemoglobin level, optimizing coagulation
and hemostasis, use of interdisciplinary blood conservation modalities,
and patient-centered decision making throughout the course of care.
Contents
Anesthesia Patients with Concomitant Cardiac and Hepatic Dysfunction 731
Julianne Ahdout and Michael Nurok
Anesthesia and surgery in patients with hepatic and cardiac dysfunction
poses a challenge for anesthesiologists. It is imperative to optimize these
patients perioperatively. Cirrhosis is associated with a wide range of car-
diovascular abnormalities. Cirrhotic cardiomyopathy is characterized by
blunted contractile responsiveness or systolic incompetence, and/or dia-
stolic dysfunction. In liver disease, anesthetic drug distribution, meta-
bolism, and elimination may be altered. Among patients with liver
disease, propofol is a reasonable anesthetic choice and cisatracurium is
the preferred neuromuscular blocker. Regional anesthesia should be
used whenever appropriate if not contraindicated by coagulopathy,
because it reduces the need for systemic analgesia.
Anesthesia for Patients with Traumatic Brain Injuries 747
Bishwajit Bhattacharya and Adrian A. Maung
Traumatic brain injury (TBI) represents a wide spectrum of disease and dis-
ease severity. Because the primary brain injury occurs before the patient
enters the health care system, medical interventions seek principally to
prevent secondary injury. Anesthesia teams that provide care for patients
with TBI both in and out of the operating room should be aware of the spe-
cific therapies and needs of this unique and complex patient population.
Anesthesia for Patients with Concomitant Sepsis and Cardiac Dysfunction 761
Abed Abubaih and Charles Weissman
Anesthesiologists faced with a patient with sepsis and concurrent cardiac
dysfunction must be cognizant of the patient s cardiac status and cause of
the cardiac problem to appropriately adapt physiologic and metabolic
monitoring and anesthetic management. Anesthesia in such patients is
challenging because the interaction of sepsis and cardiac dysfunction
greatly complicates management. Intraoperative anesthesia management
requires careful induction and maintenance of anesthesia; optimizing intra-
vascular volume status; avoiding lung injury during mechanical ventilation;
and close monitoring of arterial blood gases, serum lactate concentra-
tions, and hematology renal and electrolyte parameters. Such patients
have increased mortality because of their inability to adequately compen-
sate for the cardiovascular changes caused by sepsis.
Anesthesia for Patients with Peripheral Vascular Disease and Cardiac Dysfunction 775
Sara E. Neves
Patients with vascular disease and cardiac dysfunction present particular
challenges to the anesthesiologist. They are hemodynamically brittle, at
high risk of morbidity and mortality during surgery, and often carry addi-
tional comorbidities that increase their complexity and risk. Those with pe-
ripheral vascular disease should be assumed to have coronary artery
disease and tend to have other systemic vascular problems. Poor cardiac
function further worsens perfusion in an already compromised peripheral
Contents
vascular system. Care of these patients requires judicious monitoring, an
anesthetic that optimizes hemodynamic function, and avoidance of partic-
ularly likely complications such as perioperative myocardial ischemia,
stroke, and bleeding.
Anesthesia for Patients with Concomitant Hepatic and Pulmonary Dysfunction 797
Geraldine C. Diaz, Michael F. O Connor, and John F. Renz
Hepatic function and pulmonary function are interrelated with failure of one
organ system affecting the other. With improved therapies, patients with
concomitant hepatic and pulmonary failure increasingly enjoy a good qual-
ity of life and life expectancy. Therefore, the prevalence of such patients is
increasing with more presenting for both emergent and elective surgical
procedures. Hypoxemia requires a thorough evaluation in patients with
end-stage liver disease. The most common etiologies respond to appro-
priate therapy. Portopulmonary hypertension and hepatopulmonary syn-
drome are associated with increased perioperative morbidity and
mortality. It is incumbent on the anesthesiologist to understand the phys-
iology of liver failure and its early effect on pulmonary function to ensure a
successful outcome.
Index
809
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| title_full | Medically complex patients editors Robert B. Schonberger, Stanley H. Rosenbaum |
| title_fullStr | Medically complex patients editors Robert B. Schonberger, Stanley H. Rosenbaum |
| title_full_unstemmed | Medically complex patients editors Robert B. Schonberger, Stanley H. Rosenbaum |
| title_short | Medically complex patients |
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