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Anesthesia Essay

argumentative Essay
2071 words
2071 words
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A. Type of Anesthesia Although the comorbidities and type of surgery dictate certain decisions in managing patient care, anesthesiologists maintain various modalities for the perioperative period. These consist of anything from local to regional anesthesia, including neuraxial techniques and peripheral nerve blocks, as well as monitored anesthesia care with sedation to general anesthesia. Overlapping of different anesthetic types and combinations of regional analgesics to supplement general anesthesia occur frequently. Debate on the superiority of regional anesthesia to general anesthesia continues to date. Current literature does not support any difference in mortality between regional and general anesthesia. The largest randomized study to date highlighting this issue, the General Anesthesia Local Anesthesia (GALA) study group, demonstrated no significant difference amongst patients receiving local versus general anesthesia for carotid endarterectomy surgery45. Following that randomized clinical trial, a retrospective review of the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) reported similar results46. In another report from the ACS-NSQIP focusing on endovascular aortic repair, a lack of difference in mortality amongst local anesthesia, spinal anesthesia or general anesthesia emerged47. Moreover, meta-analyses of regional anesthesia versus general anesthesia for total hip arthroplasty and total knee arthroplasty revealed no difference in mortality.48, 49 Although there may be no difference in mortality, regional and local anesthesia offer other advantages compared to. sole general anesthesia. Such advantages may decrease morbidity associated with surgery and the patient’s existing medical st... ... middle of paper ... ... glucose measurements. Continuation into the immediate postoperative period remains important as well. Once in a steady state, treatment ought to be converted to a subcutaneous BBI regimen. For conversion from intravenous to subcutaneous insulin, a transition protocol should be employed 124. Many diabetic patients undergo minor surgery in an ambulatory care setting. Basal insulin management must occur as outlined above. However, no evidence exists that perioperative blood glucose control improves outcomes after one-day surgery. Thus, it is not advisable to use a perioperative insulin drip, even if blood glucose values exceed the recommended goal. In the event of an excessively high blood glucose level, deliberation for postponement of elective surgery should be given. The definition of a cutoff point for cancellation should be in consensus with a hospital policy.

In this essay, the author

  • Explains that anesthesiologists maintain various modalities for the perioperative period, from local to regional anesthesia, including neuraxial techniques and peripheral nerve blocks, as well as monitored and sedated anesthetic care.
  • Explains that current literature does not support any difference in mortality between regional and general anesthesia. the largest randomized study, the american college of surgeons national quality improvement program, reported similar results.
  • Explains that regional and local anesthesia offer other advantages compared to sole general and may decrease morbidity associated with surgery and the patient’s existing medical status.
  • Explains the controversy surrounding cancer recurrence rates and regional anesthesia. retrospective reviews determined that supplementation of general anesthetics with epidural or paravertebral blocks decreased cancer
  • Explains that sqip considers normothermia a priority in the perioperative period.
  • Explains that hypothermia leads to an increased rate of ssi through multiple mechanisms. it weakens the immune system through impaired leukocyte migration, neutrophil phagocytosis, and by reducing reactive oxygen intermediates.
  • Explains that hypothermia results in coagulopathy, which leads to transfusion of blood products. platelets undergo morphologic changes that decrease the capacity to activate clot formation.
  • Explains that perioperative hypothermia increases the risk of cardiac morbidity through increased catecholamine release, systemic vasoconstriction, shivering, and increased blood pressure. this effect is expected to be exaggerated in elderly patients.
  • Explains that preventing hypothermia to less than 36°c decreases the risks of ssis, coagulopathy, prolonged recovery periods, and cardiac morbidity.
  • Explains that the critical role of fluid management is another challenge for perioperative team members. multiple factors, including type and duration of surgery and anesthesia, impact the decisions in guiding fluid therapy.
  • Argues that the debate on colloid versus crystalloid fluid therapy remains unresolved. the recent cochrane database reviews demonstrated no difference in the treatment of critically ill, trauma, burn and surgical patients.
  • Explains that while the debate regarding fluid type continues, increased controversy surrounds the amount of fluids to be given within the perioperative period.
  • Explains that some randomized controlled trials have been conducted to assess the benefit of perioperative supplemental oxygen therapy. the jury is still out about beneficial effects of hyperoxia.
  • Explains that diabetes mellitus increases morbidity and mortality through multiple complications, including myocardial ischemia, retinopathy, autonomic and peripheral neuropathy, and nephropathy.
  • Explains that long-term improvement of glycemic control reduces and delays the onset of diabetic complications.
  • Recommends setting a target goal of 140 mg/dl in non-icu patients and between 140-180 mg in icu. all diabetic patients who are admitted to the hospital should receive bbi therapy.
  • Recommends a transition protocol for diabetic patients undergoing major surgery, such as cardiac, vascular, or major abdominal surgery.
  • Opines that perioperative blood glucose control does not improve outcomes after one-day surgery. deliberation for postponement of elective surgery should be given.
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