Rutherford's 035: Intraoperative Management скачать в хорошем качестве

Rutherford's 035: Intraoperative Management

#VascularSurgery #IntraoperativeManagement #PatientSafety #MedicalMonitoring #InfectionControl #BloodManagement #Anesthesia #OperatingRoom #SurgicalTechniques #RutherfordVascular Welcome to a deep dive into the critical world of *intraoperative management* during **vascular surgery**, drawn from Rutherford's Vascular Surgery 10th Edition. This phase is pivotal, setting the stage for recovery and long-term patient outcomes, especially in often older, complex patients with limited physiological reserve. *Tailoring anesthesia* is absolutely essential for safety. Options range from local blocks using agents like lidocaine and bupivacaine to moderate sedation where patients maintain airway protection, through to general anesthesia requiring airway support. Regional techniques like spinal or epidural offer benefits like prolonged pain relief but require careful management of associated risks like hypotension or spinal hematoma with blood thinners. Continuous *patient monitoring* is vital for real-time tracking and adjustment. Standard monitors include ECG, pulse oximetry, capnography, and often an arterial line for continuous blood pressure. While advanced monitors like PA catheters provide data, large studies haven't shown they improve routine outcomes. Key management focuses include *infection control**. Preventing Surgical Site Infections (SSIs) is paramount. **Timing of antibiotic prophylaxis* is critical, ideally within 60 minutes before incision, with specific guidance for endovascular procedures. Proper skin preparation is also essential. Maintaining *homeostasis* is crucial as surgical stresses can be harmful. *Preventing hypothermia* is vital due to risks of wound infection, coagulopathy, and cardiac events. Active warming strategies are key. *Glycemic control* is also important, as hyperglycemia increases SSI risk, with current practice leaning towards maintaining blood glucose below 200 mg/dL rather than ultra-tight control. Managing *anticoagulation and antiplatelets* (like heparin and dual antiplatelet therapy) is complex, balancing clotting and bleeding risks. Transfusion carries risks like TRALI and TACO, making **strategies to avoid allogeneic transfusion**, such as cell salvage, increasingly important. Ultimately, this complex environment demands constant *vigilance* and seamless teamwork from the entire surgical team.