Critical care medicine in transition the anesthesiologist's role
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1997
|
| Schriftenreihe: | Anesthesiology clinics of North America
15,4 |
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| Online-Zugang: | Inhaltsverzeichnis |
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| adam_text | CRITICAL. CARF MF.DICINE IN TRANSITION:
THH ANESTHESIOLOGIST S ROLE
CONTENTS
Foreword xi
Jonathan L. Benumof
Preface xiii
Philip D. Lumb
Anesthesiology: Traditional Linkages to Critical Care
Medicine , 725
Barry A. Shapiro
Early development of anesthesiology included positive pressure
ventilation in airway management that became exorably linked
with intensive care. Post World War II, socioeconomic factors
created a divergent evolution of anesthesiology in Europe as
compared to the United States. This created separate paths lead¬
ing to the same end, namely, modern day intensive care units
based upon the fundamentals of anesthesiology practice. Present
health care economics in the United States may very well lead to
a further convergence of critical care and anesthesiology.
Guest Editor s Commentary 731
Philip D. Lumb
The Preoperative Assessment Clinic: Its Value and
Function 735
Michael L. Ault, Stephanie J. Cooper, and William T. Peruzzi
The goals and mechanics of preoperative assessment, and a ratio¬
nale for its use, guide the setup of a preoperative clinic. With an
ANESTHESIOLOGY CLINICS OF NORTH AMERICA
VOLUME 15 • NUMBER 4 • DECEMBER 1997 V
organ systems approach (pulmonary, cardiac, renal, and endo¬
crine) and with suggestions for the clinics functional efficiency,
physical structure, and quality assessment, the authors recom¬
mendations allow the clinician to complete the preoperative as¬
sessment in a timely, cost effective manner. Detailed recommen¬
dations for staffing and patient flow are also discussed in this
article.
Guest Editor s Commentary 752
Philip D. Lumb
The Perioperative Approach to the High Risk Surgical
Patient 755
Michael W. Russell and Clifford S. Deutschman
The management of surgical patients has changed dramatically
in recent years. This article reviews the physiologic and metabolic
changes that characterize the response to surgery in older patients
with severe pre exisitng medical conditions are presenting for
more complex procedures. Finally, the authors examine what is
known about the implications of achieving (or failing to achieve)
that response with or without exogenous support. The article
concludes with a theoretical discussion of the concept of recovery
phsiology as a series of definable states representing relative
probabilities of normal or disordered system response.
Guest Editor s Commentary 776
Philip D. Lumb
Perioperative Pharmacology 779
Michael J. Murray
Pharmacokinetic and pharmacodynamic principles have been de¬
veloped to describe how a desired blood level and effect of a
medication is achieved. These principles usually must be modi¬
fied during the perioperative period because many medications
given to patients in the operating room and in the intensive care
unit are frequently not given to the point at which steady state
drug concentrations are achieved. Furthermore, because many
patients have altered renal and hepatic function, either because
of the effects of anesthetics, the surgical procedure, or of disease,
pharmacokinetic and pharmacodynamic principles are further al¬
tered. In managing patients in the operating room or in the
intensive care unit, it is probably easiest when dosing to effect,
and when appropriate, to guide dosing schedules by measuring
serum drug levels.
Guest Editor s Commentary 794
Philip D. Lumb
vi CONTENTS
Right Ventricular Function and Failure in the Perioperative
Period 797
Daniel P. Stolzfus
A plethora of pathophysiologic conditions, often occuring in the
perioperative period, contribute to right ventricular dysfunction.
A relative lack of provider knowledge, coupled with an absence
of routine monitors sensitive for this condition, result in missed
diagnoses. Myocardial ischemia and ventricular dilatation, sec¬
ondary to pulmonary hypertension, is likely the principle cause
of ventricular failure. Bedside diagnosis of right ventricular dys¬
function has being realized with the use of a modified pulmonary
artery catheter. Although few large studies exist, effective treat¬
ment centers on the restoration of right ventricular perfusion, and
reduction of chamber distension.
Fast Track: What Is It? 823
Peter J. Papadakos and Gary A. Ritzel
Over the past few years, a large number of centers have converted
to a strategy of early extubation in patients undergoing cardio
thoracic surgery. Physicians have an obligation to ask whether
such cost containment carries through additional risks. The use
of fast tracking has greatly increased the turnaround time and
efficacy of the intensive care unit service. This article reviews the
unlimited opportunities for anesthesiologists for quality assur¬
ance programs.
Guest Editor s Commentary 829
Philip D. Lumb
New Technologies for the Perioperative Physician 833
David T. Porembka and C. William Hanson III
The thrust for technology improvement is generated both by
physicians and manufacturers for the betterment of patient care.
This article addresses technologies such as interventional catheter
techniques for acute coronary artery syndromes, transesophageal
echocardiography (TEE), in the critically ill patient, inhaled nitric
oxide, and partial liquid ventilation.
Data Collection and Analysis in the ICU 879
Charles G. Durbin, Jr
This article describes the breadth and types of data sources that
are encountered in the critical care environment. Some are identi¬
cal to those observed in the operating room and some are unique
to the intensive care unit. Specific sources discussed in this article
include physiologic data and monitoring, laboratory data, out¬
comes information and prediction systems, critical care research,
and quality and cost information.
CONTENTS vii
Guest Editor s Commentary 898
Philip D. Lumb
Clinical Guideline Development in Critical Care Medicine 901
Jonathan Ketzler, Saeed Habibi, and Douglas B. Coursin
This article differentiates between practice parameters, guidelines,
and standards of care. It describes a variety of methods for
developing and instituting guidelines. This article also reviews
several examples of national guidelines and how they were devel¬
oped and implemented.
Guest Editor s Commentary 911
Philip D. Lumb
Managed Care and the Anesthesiologist s Role in Critical
Resource Management 915
Charles B. Watson
Anesthesiologists, like other physicians, face dramatic changes as
the basic funding methodology for health care converts from a
traditional third party indemnity insurance model to a geometri¬
cally growing corporate model. Anesthesiologists will either join
in and lead efforts to streamline surgical services and expedite
safe, cost effective surgical care, or face an increasingly limited
role in surgical care and, possible, replacement by alternative
surgical anesthesia care delivery groups. Key opportunities for
the anesthesia community to join in redefining cost competitive
surgical services include preoperative assessment and processing,
operating room resource and systems management, and postop¬
erative care.
Guest Editor s Commentary 936
Philip D. Lumb
Anesthesiology: 21st Century Opportunities 941
Philip D. Lumb
Anesthesiologists lead the most sophisticated health care team in
medicine. Partnerships among anesthesiologists, surgeons, instru¬
ment manufacturers, software developers, and others will de¬
velop as minimally invasive and ambulatory surgery centers be¬
come the standard of sophisticated care delivery. This article
reviews 21st century opportunities and options for anesthesiolo¬
gists.
Cumulative Index 1997 951
Subscription Information Inside back cover
Viii CONTENTS
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| publishDate | 1997 |
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| publisher | Saunders |
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| series | Anesthesiology clinics of North America |
| series2 | Anesthesiology clinics of North America |
| spellingShingle | Critical care medicine in transition the anesthesiologist's role Anesthesiology clinics of North America Anesthesiologists Critical care medicine Lebensbedrohende Krankheit (DE-588)4283991-9 gnd Qualitätssicherung (DE-588)4126457-5 gnd Managed Care (DE-588)4461436-6 gnd Medizinische Versorgung (DE-588)4038270-9 gnd Intensivtherapie (DE-588)4027258-8 gnd Intensivmedizin (DE-588)4027263-1 gnd |
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| title | Critical care medicine in transition the anesthesiologist's role |
| title_auth | Critical care medicine in transition the anesthesiologist's role |
| title_exact_search | Critical care medicine in transition the anesthesiologist's role |
| title_full | Critical care medicine in transition the anesthesiologist's role Philip D. Lumb guest ed. |
| title_fullStr | Critical care medicine in transition the anesthesiologist's role Philip D. Lumb guest ed. |
| title_full_unstemmed | Critical care medicine in transition the anesthesiologist's role Philip D. Lumb guest ed. |
| title_short | Critical care medicine in transition |
| title_sort | critical care medicine in transition the anesthesiologist s role |
| title_sub | the anesthesiologist's role |
| topic | Anesthesiologists Critical care medicine Lebensbedrohende Krankheit (DE-588)4283991-9 gnd Qualitätssicherung (DE-588)4126457-5 gnd Managed Care (DE-588)4461436-6 gnd Medizinische Versorgung (DE-588)4038270-9 gnd Intensivtherapie (DE-588)4027258-8 gnd Intensivmedizin (DE-588)4027263-1 gnd |
| topic_facet | Anesthesiologists Critical care medicine Lebensbedrohende Krankheit Qualitätssicherung Managed Care Medizinische Versorgung Intensivtherapie Intensivmedizin Aufsatzsammlung |
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