Skip to main content
SpringerLink
Log in

The Perioperative Management of the Acute Care Surgical Patient

  • Chapter
Acute Care Surgery

  • 2286 Accesses

Abstract

In an apneic 70-year-man who is recovering in the intensive care unit after a protracted operative intervention 3 days ago, you notice that his ventilatory management is highlighted as follows:

  1. (A)

    Volume-cycle ventilation

  2. (B)

    FiO2 is 60%

  3. (C)

    PEEP is 15cm H2O

  4. (D)

    Pressure support

  5. (E)

    Endotracheal suctioning

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Woolf PD. Endocrinology of shock. Ann Emerg Med 1986; 15(12):1401–1405.

    Article  CAS  PubMed  Google Scholar 

  2. Cuthbertson DP. Second annual Jonathan E. Rhoads Lecture.The metabolic response to injury and its nutritional implications: retrospect and prospect. JPEN J Parenter Enteral Nutr 1979; 3(3):108–129.

    Article  CAS  PubMed  Google Scholar 

  3. Brozena SC, Jessup M. The new staging system for heart failure. What every primary care physician should know. Geriatrics 2003; 58(6):31–36.

    PubMed  Google Scholar 

  4. Azoulay E, Pochard F, Chevret S, Adrie C, Bollaert PE, Brun F, Dreyfuss D, Garrouste-Orgeas M, Goldgran-Toledano D, Jourdain M, Wolff M, Le Gall JR, Schlemmer B. Opinions about surrogate designation: a population survey in France. Crit Care Med 2003; 31(6):1711–1714.

    Article  PubMed  Google Scholar 

  5. Baradarian R, Ramdhaney S, Chapalamadugu R, Skoczylas L, Wang K, Rivilis S, Remus K, Mayer I, Iswara K, Tenner S. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol 2004; 99(4):619–622.

    Article  PubMed  Google Scholar 

  6. Rotondo MF, Zonies DH. The damage control sequence and underlying logic. Surg Clin North Am 1997; 77:761–777.

    Article  CAS  PubMed  Google Scholar 

  7. Schein M, Saadia R, Decker GG. The open management of the septic abdomen. Surg Gynecol Obstet 1986; 163(6):587–592.

    CAS  PubMed  Google Scholar 

  8. Lindblat B, Hakansson H. The rationale for “second look operation” in mesenteric vessel occlusion with uncertain intestinal viability at primary surgery. Acta Chir Scand 1987; 153:531–533.

    Google Scholar 

  9. Heys SD, Ogston KN. Peri-operative nutritional support: controversies and debates. Int J Surg Invest 2000; 2(2):107–115.

    CAS  Google Scholar 

  10. Freeman BD, Borecki IB, Coopersmith CM, Buchman TG. Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients. Crit Care Med 2005; 33(11):2513–2520.

    Article  PubMed  Google Scholar 

  11. Weil MH, Bisera J, Trevino RP, Rackow EC. Cardiac output and end-tidal carbon dioxide. Crit Care Med 1985; 13(11):907–909.

    Article  CAS  PubMed  Google Scholar 

  12. Moore FD. Bodily changes in surgical convalescence. I. The normal sequence observations and interpretations. Ann Surg 1953; 137(3):289–315.

    Article  CAS  PubMed  Google Scholar 

  13. Udelsman R, Holbrook NJ. Endocrine and molecular responses to surgical stress. Curr Probl Surg 1994; 31(8): 653–720.

    Article  CAS  PubMed  Google Scholar 

  14. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids-new mechanisms for old drugs. N Engl J Med 2005; 353(16):1711–1723.

    Article  CAS  PubMed  Google Scholar 

  15. Amar D, Fleisher M, Pantuck CB, Shamoon H, Zhang H, Roistacher N, Leung DH, Ginsburg I, Smiley RM. Persistent alterations of the autonomic nervous system after noncardiac surgery. Anesthesiology 1998; 89(1):30–42.

    Article  CAS  PubMed  Google Scholar 

  16. Gianotti L, Broglio F, Aimaretti G, Arvat E, Colombo S, Di Summa M, Gallioli G, Pittoni G, Sardo E, Stella M, Zanello M, Miola C, Ghigo E. Low IGF-I levels are often uncoupled with elevated GH levels in catabolic conditions. J Endocrinol Invest 1998; 21(2):115–121.

    CAS  PubMed  Google Scholar 

  17. Exton JH, Friedmann N, Wong EH, Brineaux JP, Corbin JD, Park CR. Interaction of glucocorticoids with glucagon and epinephrine in the control of gluconeogenesis and glycogenolysis in liver and of lipolysis in adipose tissue. J Biol Chem 1972; 247(11):3579–3588.

    CAS  PubMed  Google Scholar 

  18. Calzia E, Koch M, Stahl W, Radermacher P, Brinkmann A. Stress response during weaning after cardiac surgery. Br J Anaesth 2001; 87(3):490–493.

    Article  CAS  PubMed  Google Scholar 

  19. Weekers F, Van den Berghe G. Endocrine modifications and interventions during critical illness. Proc Nutr Soc 2004; 63(3):443–450.

    Article  PubMed  Google Scholar 

  20. Schricker T, Wykes L, Carli F. Epidural blockade improves substrate utilization after surgery. Am J Physiol Endocrinol Metab 2000; 279(3):E646–E653.

    CAS  PubMed  Google Scholar 

  21. Bessey PQ, Watters JM, Aoki TT, Wilmore DW. Combined hormonal infusion simulates the metabolic response to injury. Ann Surg 1984; 200(3):264–281.

    Article  CAS  PubMed  Google Scholar 

  22. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345(19):1359–1367.

    Article  PubMed  Google Scholar 

  23. Takala J, Ruokonen E, Webster NR, Nielsen MS, Zandstra DF, Vundelinckx G, Hinds CJ. Increased mortality associated with growth hormone treatment in critically ill adults. N Engl J Med 1999; 341(11):785–792.

    Article  CAS  PubMed  Google Scholar 

  24. Peeters RP, Wouters PJ, Kaptein E, van Toor H, Visser TJ, Van den Berghe G. Reduced activation and increased inactivation of thyroid hormone in tissues of critically ill patients. J Clin Endocrinol Metab 2003; 88(7):3202–3211.

    Article  CAS  PubMed  Google Scholar 

  25. Wang C, Chan V, Yeung RT. Effect of surgical stress on pituitary-testicular function. Clin Endocrinol (Oxf) 1978; 9(3):255–266.

    Article  CAS  Google Scholar 

  26. Van den Berghe G, de Zegher F. Anterior pituitary function during critical illness and dopamine treatment. Crit Care Med 1996; 24(9):1580–1590.

    Article  PubMed  Google Scholar 

  27. Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Related perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 2005; 173(6):627–634.

    CAS  PubMed  Google Scholar 

  28. Auerbach AD, Goldman L. Beta-blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA 2002; 287(11):1435–1444.

    Article  CAS  PubMed  Google Scholar 

  29. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, Fleisher LA, Froehlich JB, Gusberg RJ, Leppo JA, Ryan T, Schlant RC, Winters WL Jr, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC Jr. American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 2002; 105(10):1257–1267.

    PubMed  Google Scholar 

  30. Wiest D. Esmolol. A review of its therapeutic efficacy and pharmacokinetic characteristics. Clin Pharmacokinet 1995; 28(3):190–202.

    Article  CAS  PubMed  Google Scholar 

  31. Kertai MD, Klein J, Bax JJ, Poldermans D. Predicting perioperative cardiac risk. Prog Cardiovasc Dis 2005; 47(4):240–257.

    Article  PubMed  Google Scholar 

  32. Landesberg G. Monitoring for myocardial ischemia. Best Pract Res Clin Anaesthesiol 2005; 19(1):77–95.

    PubMed  Google Scholar 

  33. Chu WW, Dieter RS, Stone CK. Evolving clinical applications of cardiac markers: a review of the literature. WMJ 2002; 101(3):49–55.

    PubMed  Google Scholar 

  34. Lorente L, Henry C, Martin MM, Jimenez A, Mora ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care 2005; 9(6):R631–R635.

    Article  PubMed  Google Scholar 

  35. Canaud B, Desmeules S, Klouche K, Leray-Moragues H, Beraud JJ. Vascular access for dialysis in the intensive care unit. Best Pract Res Clin Anaesthesiol 2004; 18(1):159–174.

    Article  PubMed  Google Scholar 

  36. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, Laporta DP, Viner S, Passerini L, Devitt H, Kirby A, Jacka M. Canadian Critical Care Clinical Trials Group. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 2003; 348(1):5–14.

    Article  PubMed  Google Scholar 

  37. Murphy GS, Nitsun M, Vender JS. Is the pulmonary artery catheter useful? Best Pract Res Clin Anaesthesiol 2005; 19(1):97–110.

    PubMed  Google Scholar 

  38. Laupland KB, Bands CJ. Utility of esophageal Doppler as a minimally invasive hemodynamic monitor: a review. Can J Anaesth 2002; 49(4):393–401.

    Article  PubMed  Google Scholar 

  39. Theodoropoulos G, Lloyd LR, Cousins G, Pieper D. Intraoperative and early postoperative gastric intramucosal pH predicts morbidity and mortality after major abdominal surgery. Am Surg 2001; 67(4):303–308.

    CAS  PubMed  Google Scholar 

  40. Webb RK, Ralston AC, Runciman WB. Potential errors in pulse oximetry. II. Effects of changes in saturation and signal quality. Anaesthesia 1991; 46(3):207–212.

    Article  CAS  PubMed  Google Scholar 

  41. Ralston AC, Webb RK, Runciman WB. Potential errors in pulse oximetry. III: Effects of interferences, dyes, dyshaemoglobins and other pigments. Anaesthesia 1991; 46(4):291–295.

    Article  CAS  PubMed  Google Scholar 

  42. Li J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J Emerg Med 2001; 20(3):223–229.

    Article  CAS  PubMed  Google Scholar 

  43. Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342(20):1471–1477.

    Article  CAS  PubMed  Google Scholar 

  44. Glare PA, Walsh TD. Clinical pharmacokinetics of morphine. Ther Drug Monit 1991; 13(1):1–23.

    Article  CAS  PubMed  Google Scholar 

  45. Seifert CF, Kennedy S. Meperidine is alive and well in the new millennium: evaluation of meperidine usage patterns and frequency of adverse drug reactions. Pharmacotherapy 2004; 24(6):776–783.

    Article  CAS  PubMed  Google Scholar 

  46. Garnacho-Montero J, Amaya-Villar R, Garcia-Garmendia JL, Madrazo-Osuna J, Ortiz-Leyba C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med 2005; 33(2):349–354.

    Article  PubMed  Google Scholar 

  47. Hund E. Neurological complications of sepsis: critical illness polyneuropathy and myopathy. J Neurol 2001; 248(11):929–934.

    Article  CAS  PubMed  Google Scholar 

  48. Birck R, Krzossok S, Markowetz F, Schnulle P, van der Woude FJ, Braun C. Acetylcysteine for prevention of contrast nephropathy: meta-analysis Lancet 2003; 362(9384): 598–560.

    Article  CAS  PubMed  Google Scholar 

  49. Merten GJ, Burgess WP, Gray LV, Holleman JH, Roush TS, Kowalchuk GJ, Bersin RM, Van Moore A, Simonton CA 3rd, Rittase RA, Norton HJ, Kennedy TP. Prevention of contrastinduced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 2004; 291(19):2328–2334.

    Article  CAS  PubMed  Google Scholar 

  50. Heyland DK, Samis A. Does immunonutrition in patients with sepsis do more harm than good? Intensive Care Med 2003; 29(5):669–667.

    PubMed  Google Scholar 

  51. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340(6):409–417.

    Article  CAS  PubMed  Google Scholar 

  52. Schuerer DJ, Whinney RR, Freeman BD, Nash J, Prasad S, Krem MM, Mazuski JE, Buchman TG. Evaluation of the applicability, efficacy, and safety of a thromboembolic event prophylaxis guideline designed for quality improvement of the traumatically injured patient. J Trauma 2005; 58(4):731–739.

    Article  PubMed  Google Scholar 

  53. Taylor JH, Beilman GJ. Hyperglycemia in the intensive care unit: no longer just a marker of illness severity. Surg Infect (Larchmt) 2005; 6(2):233–245.

    Article  Google Scholar 

  54. Salem M, Tainsh RE Jr, Bromberg J, Loriaux DL, Chernow B. Perioperative glucocorticoid coverage: a reassessment 42 years after emergence of a problem. Ann Surg 1994; 219(4): 416–425.

    Article  CAS  PubMed  Google Scholar 

  55. Prigent H, Maxime V, Annane D. Clinical review: corticotherapy in sepsis. Crit Care 2004; 8(2):122–129.

    Article  PubMed  Google Scholar 

  56. Docter R, Krenning EP, de Jong M, Hennemann G. The sick euthyroid syndrome: changes in thyroid hormone serum parameters and hormone metabolism. Clin Endocrinol 1993; 39:499–518.

    Article  CAS  Google Scholar 

  57. Van den Berghe G, de Zegher F, Bouillon R. Clinical review 95: acute and prolonged critical illness as different neuroendocrine paradigms. J Clin Endocrinol Metab 1998; 83(6):1827–1834.

    Article  PubMed  Google Scholar 

  58. Van den Berghe G, de Zegher F, Baxter RC, Veldhuis JD, Wouters P, Schetz M, Verwaest C, Van der Vorst E, Lauwers P, Bouillon R, Bowers CY. Neuroendocrinology of prolonged critical illness: effects of exogenous thyrotropinreleasing hormone and its combination with growth hormone secretagogues. J Clin Endocrinol Metab 1998; 83(2):309–319.

    Article  PubMed  Google Scholar 

  59. Van den Berghe G, Baxter RC, Weekers F, Wouters P, Bowers CY, Iranmanesh A, Veldhuis JD, Bouillon R. The combined administration of GH-releasing peptide-2 (GHRP-2), TRH and GnRH to men with prolonged critical illness evokes superior endocrine and metabolic effects compared to treatment with GHRP-2 alone. Clin Endocrinol (Oxf) 2002; 56(5):655–669.

    Article  Google Scholar 

  60. Van den Berghe G, de Zegher F. Anterior pituitary function during critical illness and dopamine treatment. Crit Care Med 1996; 24(9):1580–1590.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA

    Craig M. Coopersmith MD

  2. Departments of Surgery, Anesthesiology, and Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Timothy G. Buchman PhD, MD

Authors
  1. Craig M. Coopersmith MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy G. Buchman PhD, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA

    L. D. Britt MD, MPH (Brickhouse Professor of Surgery and Chairman) (Brickhouse Professor of Surgery and Chairman)

  2. Department of Surgery, Oregon Health Sciences University, Portland, OR, USA

    Donald D. Trunkey MD (Professor) (Professor)

  3. Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA

    David V. Feliciano MD (Professor of Surgery, Chief of Surgery) (Professor of Surgery, Chief of Surgery)

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Coopersmith, C.M., Buchman, T.G. (2007). The Perioperative Management of the Acute Care Surgical Patient. In: Britt, L.D., Trunkey, D.D., Feliciano, D.V. (eds) Acute Care Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-69012-4_5

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-69012-4_5

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-34470-6

  • Online ISBN: 978-0-387-69012-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation