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Intraoperative Ultrasound in Spinal Surgery
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Updates in perioperative medicine.

Suparna Dutta1, Steven L Cohn2, Kurt J Pfeifer3

  • 1Department of Medicine, Rush Medical College, Chicago, Illinois.

Journal of Hospital Medicine
|September 19, 2015
PubMed
Summary

This review highlights key perioperative medicine updates. Continue beta-blockers, avoid routine troponin screening, and manage obstructive sleep apnea preoperatively for better surgical outcomes.

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Area of Science:

  • Perioperative Medicine
  • Clinical Practice Guidelines
  • Surgical Patient Care

Background:

  • The surgical patient population is aging and increasingly complex, necessitating updated perioperative care knowledge.
  • Optimizing perioperative care requires understanding the latest evidence-based literature.
  • This review focuses on recent literature with high potential clinical impact.

Purpose of the Study:

  • To summarize and critique recent perioperative literature.
  • To identify literature that can impact clinical practice.
  • To provide guidance for optimizing care in complex surgical patients.

Main Methods:

  • Literature search conducted via MEDLINE.
  • Articles published between January 2014 and April 2015 were reviewed.
  • Ten articles were selected by author consensus based on scientific rigor and clinical relevance.

Main Results:

  • Long-term beta-blockade should be continued preoperatively.
  • Routine postoperative troponin screening is not recommended.
  • Initiating or continuing aspirin or clonidine perioperatively offers no benefit and may increase risks.
  • Preoperative diagnosis and treatment of obstructive sleep apnea can reduce cardiovascular complications.
  • New pulmonary risk indices accurately estimate postoperative pulmonary complications.
  • Postoperative atrial fibrillation is linked to increased long-term stroke risk.
  • CHADS2 scores outperform the Revised Cardiac Risk Index for predicting outcomes in nonvalvular atrial fibrillation.
  • Bridging anticoagulation significantly increases bleeding risk compared to not bridging.

Conclusions:

  • Recent literature offers crucial insights for perioperative clinicians.
  • Key areas include preoperative risk assessment and medication management.
  • The findings support evidence-based adjustments to postoperative medical care.