Evidence-Based Practice of Anesthesiology

Author: Lee A. Fleisher
Published: April 2004
Publisher: Elsevier Science
ISBN: 0721694098
Hardcover Book
Number of Pages: 496

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Using an evidence-based approach, this title explores 71 important topics in perioperative management -- discussing the clinical options, examining the relevant clinical research, and presenting expert, evidence-based practice recommendations. Inside, you'll find all of today's most effective approaches for everything from preoperative assessment ... through intraoperative anesthesia administration and monitoring ... to postoperative pain management. North American and European anesthesiologists address a number of specific questions about basing their practice on the medical literature that have not been covered adequately in traditional reviews and book chapters. For each question, they provide a background or introduction, outline the options for treatment, review the evidence, identify areas of uncertainty, outline available guidelines, and provide their own recommendations. The general areas they cover are preoperative preparation, perioperative management, regional anesthesia, monitoring, cardiovascular anesthesia, neurosurgical anesthesia, obstetric anesthesia, pediatric anesthesia, and pain. They write for novices and consultants in the field.

Table of Contents
1 Evidence-based practice guidelines - the American society of anesthesiologists' approach 3
2 Does routine testing affect outcome? 11
3 Should preoperative hemoglobin always be obtained? 15
4 Is routine preoperative pregnancy testing necessary? 18
5 Is a preoperative screening clinic cost-effective? 23
6 Who should have a preoperative 12-lead electrocardiogram? 27
7 When should pulmonary function tests be performed preoperatively? 31
8 Does the airway examination predict difficult intubation? 34
9 What is the optimal evaluation of the patient with obstructive sleep apnea? 47
10 Is ther e an optimal timing for smoking cessation? 57
11 Does prophylactic coronary revascularization reduce cardiac complications? 62
12 Should antihypertensive medications be continued through the perioperative period? 68
13 Should patients with asthma be given preoperative medications including steroids? 77
14 Is autologous predonation cost-effective? 82
15 Does a history of difficult intubation necessitate awake airway management? 91
16 Should regional or general anesthesia be used for cases in which the patient has an anticipated difficult airway? 96
17 Is there an ideal approach to the malignant hyperthermia-susceptible patient? 102
18 What is the optimal perioperative management for latex allergy? 111
19 What reduces the risk of aspiration? 118
20 Is there an optimal treatment for aspiration? 125
21 What is the best strategy to prevent PONV? 130
22 Does the choice of fluid matter in major surgery? 136
23 Does the choice of muscle relaxant affect outcome? 145
24 Maintenance of perioperative normothermia is beneficial 150
25 When should perioperative glucocorticoid replacement be administered? 157
26 Should beta-adrenergic blocking agents be given routinely in noncardiac surgery? 163
27 Are alpha-2 agonists effective in reducing perioperative cardiac complications in noncardiac surgery? 168
28 Does perioperative hyperglycemia increase the risk of postoperative complications? 172
29 What is the best means of preventing perioperative renal dysfunction? 181
30 What works in a patient with acute respiratory distress syndrome? 191
31 Is there an optimal perioperative hemoglobin? 197
32 Is acute normovolemic hemodilution cost-effective? 205
33 What drugs decrease postoperative bleeding? 210
34 Fondaparinux : what is its efficacy and safety in surgical patients? 218
35 Can we prevent recall during anesthesia? 223
36 What actions can be used to prevent peripheral nerve injury? 228
37 Is one general anesthetic technique associated with faster recovery? 236
38 Choice of general anesthetic for ambulatory surgery 241
39 What criteria should be used for discharge after outpatient surgery? 247
40 What is the optimal intraoperative and postoperative management of the obstructive sleep apnea patient 253
41 Do intensive care specialists improve patient outcome? 258
42 Is regional anesthesia superior to general anesthesia for hip surgery? 267
43 Should spinal anesthesia be performed in patients with multiple sclerosis? 270
44 Is regional anesthesia safe in the patient on antiplatelet agents? 277
45 Does intraoperative regional anesthesia decrease perioperative blood loss? 283
46 Should additives be used for peripheral nerve blocks? 287
47 The best approaches to prophylaxis against DVT formation when using a combination of neuraxial anesthesia and heparins 292
48 Vitamin K antagonists and spinal axis anesthesia 305
49 Herbal medications and spinal axis anesthesia 312
50 What is the optimal management of postdural puncture headache? 314
51 When is an epidural blood patch indicated? 318
52 Is regional anesthesia appropriate for outpatient surgery? 323
53 Do pulmonary artery catheters influence outcome in noncardiac surgery? 331
54 Does intraoperative neuromonitoring affect outcome? 336
55 What is the best method of diagnosing perioperative myocardial infarction? 344
56 Is OPCAB superior to CABG? 353
57 Fast-track cardiac anesthesia - is it safe? 359
58 Which should be done first, a CABG or a CEA, or should both be done together? 364
59 Is regional anesthesia superior to general anesthesia for infrainguinal revascularization? 369
60 Is there a difference in perioperative morbidity and mortality in patients undergoing carotid endarterectomy with local versus general anesthesia? 372
61 Timing of surgery after an ischemic stroke 379
62 Is there a best technique in the patient with increased intracranial pressure? 389
63 Does labor epidural analgesia affect labor outcome? 395
64 Anesthesia for cesarean delivery : regional or general? 401
65 Does anesthesia increase the risk to the parturient undergoing non-obstetric surgery? 407
66 Should succinylcholine be used in children? 415
67 How young is the youngest infant for outpatient surgery? 419
68 Should a child with a respiratory tract infection undergo elective surgery? 424
69 Is preemptive analgesia clinically effective 433
70 Is epidural analgesia superior to IV-PCA? 441
71 Optimal postoperative analgesia 449
Index 459

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