Patients surgical

Desflurane is less potent than the other fluorinated anesthetics having MAC values of 5.7 to 8.9% in animals (76,85), and 6% to 7.25% in surgical patients. The respiratory effects are similar to isoflurane. Heart rate is somewhat increased and blood pressure decreased with increasing concentrations. Cardiac output remains fairly stable. Desflurane does not sensitize the myocardium to epinephrine relative to isoflurane (86). EEG effects are similar to isoflurane and muscle relaxation is satisfactory (87). Desflurane is not metabolized to any significant extent (88,89) as levels of fluoride ion in the semm and urine are not increased even after prolonged exposure. Desflurane appears to offer advantages over sevoflurane and other inhaled anesthetics because of its limited solubiHty in blood and other tissues. It is the least metabolized of current agents. 

Sodium is contraindicated in patients with hypernatremia, fluid retention, and when the administration of sodium or chloride could be detrimental. Sodium is used cautiously in surgical patients and those with circulatory insufficiency, hypoproteinemia, urinaiy tract obstruction, congestive heart failure, edema, and renal impairment. Sodium is a Pregnancy Category C drug and is used cautiously during pregnancy. 

Bjorkman S, Wada DR, Berling BM, Benoni G. Prediction of the disposition of midazolam in surgical patients by a physiologically based pharmacokinetic model. J Pharm Sci 2001 Sep 90(9) 1226-41. 

Weed HG. Antimicrobial prophylaxis in the surgical patient. Med Clin North Am 2003 87 59-75. 

The Veteran Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N Eng J Med 1991 325 525-532. 

Rollins C, Thomson C, Crane T. Pharmacotherapeutic issues. In Rolandelli RH, Bankhead R, Boullata JI, Compher CW, eds. Enteral and Tube Feeding. 4th ed. Philadelphia Elsevier 2005 291-305. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. New Engl J Med 2001 345 1359-1367. Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. New Engl J Med 1991 325 525-532. 

Crabtree TD, Pelletier SJ, Gleason TG, Pruett TL, Sawyer RG Clinical characteristics and antibiotic utilization in surgical patients with Clostridium difficile-associated diarrhea. Am Surg 1999 65 507-511. 

Pseudomembranous colitis (PMC) results from toxins produced by Clostridium difficile. It occurs most often in epidemic fashion and affects high-risk groups such as the elderly, debilitated patients, cancer patients, surgical patients, any patient receiving antibiotics, patients with nasogastric tubes, or those who frequently use laxatives. 

The most common mixed acid-base disorder is respiratory and metabolic alkalosis, which occurs in critically ill surgical patients with respiratory alkalosis caused by mechanical ventilation, hypoxia, sepsis, hypotension,... 

Kim KY, McCartney JR, Kaye W, Boland RJ, Niaura R. (1996). The effect of cimetidine and ranitidine on cognitive function in postoperative cardiac surgical patients. Int J Psychiatry Med. 26(3) 295-307. Ko FN, Huang TF, Teng CM. (1991). Vasodilatory action mechanisms of apigenin isolated from Apium graveolens in rat thoracic aorta. Biochim Biophys Acta. 1115(1) 69-74. 

Salmon P, Evans R, Humphrey DE. (1986). Anxiety and endocrine changes in surgical patients. BrJ din Psychoi. 25(pt 2) 135-41. 

Hull RD, Hirsh J, Sackett DL, et al. Cost-effectiveness of primary and secondary prevention of fatal pulmonary embolism in high-risk surgical patients. CMAf 1982 127 990-5. 

To circumvent problems, encourage patient compliance, avoid excessive doses, avoid combining sympatholytics and -blockers, and maintain antihypertensive medication in surgical patients. When discontinuing medication, taper the dose slowly, one drug at a time use special caution in patients with coronary artery or cerebrovascular disease. 

Use in surgical patients Avoid aspirin, if possible, for 1 week prior to surgery because of the possibility of postoperative bleeding. 

Fig. 7. Percentage of surgical patients avoiding donor blood transfusion in the protocol-defined target population (blood loss >20 ml per kilogram body weight) from postoperative day 1 through day 21 (or hospital discharge). First bar is the Oxygenf-treated patients second bar, control group ( p<0.05 between groups). From Ref. [27], with permission.

Fig. 8. Assessment of gut oxygenation status during surgery. Changes in CO2 gap in surgical patients randomized to Oxygent (RFC) or placebo (controls) (ANH = acute normovolemic hemodilution PP = post-protamine administration CC = chest closure p<0.05 between groups). The dashed line represents the upper limit of normal for CO2 gap (8 torr). Postoperative recovery of gut function was determined by shorter time to first bowel movement (2 vs. 5 days p<0.007) and earlier consumption of solid food (1.8 vs. 4.1 days p = 0.056). From Ref. [29], with permission.

R.J. Frumento, L. Mongero, Y. Naka, E. Bennett-Guerrero, Preserved gastric tono-metric variables in cardiac surgical patients administered intravenous perflubron emulsion, Anesth. Analg. 94 (2002) 809-814. 

It is indicated in prevention and treatment of deep vein thrombosis and pulmonary embolism in surgical patients, prevention of extracorporeal thrombosis during haemodialysis. 

Fukusaki M et al Effects of controlled hypotension with sevoflurane anesthesia on hepatic function of surgical patients. Eur J Anaesthesiol 1999 16 111. [PMID 10101627]... 

Heparin-induced thrombocytopenia (HIT) is a systemic hypercoagulable state that occurs in 1-4% of individuals treated with UFH for a minimum of 7 days. Surgical patients are at greatest risk. The reported incidence of HIT is lower in pediatric populations outside the critical care setting and is relatively rare in pregnant women. The risk of HIT may be higher in individuals treated with UFH of bovine origin compared with porcine heparin and is lower in those treated exclusively with LMWH. 

King RF, Macfie J, Hill G (1981) Activities of hexokinase, phosphofructokinase, fructose bisphosphatase and 2-oxoglutarate dehydrogenase in muscle of normal subjects and very ill surgical patients. Clin Sci 60 451-456... 

Bouillon, T., Kietzmann, D., Port, R., Meineke, I., Hoeft, A. Population pharmacokinetics of piritramide in surgical patients, Anesthesiology 1999, 90, 7-15. 

Warfarin (Fig. 10-22c) is a synthetic compound that inhibits the formation of active prothrombin. It is particularly poisonous to rats, causing death by internal bleeding. Ironically, this potent rodenticide is also an invaluable anticoagulant drug for treating humans at risk for excessive blood clotting, such as surgical patients and those with coronary thrombosis. ... 

Small subcutaneous closes of heparin have been found to be effective in high-nsk post-surgical patients and in patients with acute myocardial infarction. The preventive treatment is commenced a few hours before an operative procedure and continued postoperatively for 4 to 5 days. As the result of a study in 1975. low-dose heparin prophylaxis in high-nsk patients who undergo abdomina-thoracic surgery has become a widely accepted practice, However, preventive anticoagulant therapy, to date, has been unsatisfactory and controversial in the instances of hip surgery or prostatectomy. 

Fullerton DA, Kirson LE, Jones SD, McIntyre RC (1996) Adenosine is a selective pulmonary vasodilator in cardiac surgical patients. Chest 109(1) 41—46 Gao Z, Li BS, Day YJ, Linden J (2001) A3 adenosine receptor activation triggers phosphorylation of protein kinase B and protects rat basophilic leukemia 2H3 mast cells from apoptosis. Mol Pharmacol 59(l) 76-82... 

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