Department of Anesthesiology and Critical Care, Beaujon University Hospital, Paris 7 Paris Diderot University, Clichy, France.
Curr Opin Anaesthesiol. 2010 Apr;23(2):201-8. doi: 10.1097/ACO.0b013e328336aeef.
The present review examines the trends and controversies on how perioperative care can influence outcome after anesthesia and surgery.
Recent studies indicate that anesthesia and perioperative care may have a major impact on long-term postoperative mortality and major complications in surgical patients by decreasing the rate of individual decisions. The use of a surgical checklist in the operating room improves postoperative mortality by decreasing the rate of individual decisions and facilitating communication between anesthesiologists, surgeons and intensivists. Antiplatelet therapy should not be discontinued routinely before elective surgery in patients with coronary or vascular occlusive disease. Attenuation of the surgical stress response by beta-blockers decreases long-term major adverse cardiac events, but may increase the incidence of postoperative stroke. The long-term impact on outcome of tight glycemic control and intraoperative hemodynamic optimization requires further investigation.
The use of a surgical checklist may reduce postoperative mortality and complications in surgical patients. The optimal dosing and timing of perioperative beta-blockade should decrease the incidence of postoperative stroke. However, to date, the long-term risk:benefit balance of attenuation of the perioperative stress response remains controversial. Red cell transfusion is unavoidable in some cases, but is associated with worsened outcome in various surgical situations. Future research should focus on the risk:benefit balance of anesthesia and surgery. This will contribute to promoting the role of anesthesiologists as physicians of the perioperative period.
本综述探讨了围手术期护理如何影响麻醉和手术后结局的趋势和争议。
最近的研究表明，麻醉和围手术期护理可以通过降低个体决策率，对手术患者的长期术后死亡率和主要并发症产生重大影响。在手术室使用手术清单可以通过降低个体决策率并促进麻醉师、外科医生和重症监护医生之间的沟通，来降低术后死亡率。有冠状动脉或血管阻塞性疾病的患者在择期手术前不应常规停用抗血小板治疗。β受体阻滞剂减弱手术应激反应可降低长期主要不良心脏事件的发生率，但可能增加术后中风的发生率。术中血糖控制和血流动力学优化的长期对结局的影响需要进一步研究。
手术清单的使用可能会降低手术患者的术后死亡率和并发症。围手术期β受体阻滞剂的最佳剂量和时机应降低术后中风的发生率。然而，迄今为止，减轻围手术期应激反应的风险获益平衡仍存在争议。在某些情况下，红细胞输注是不可避免的，但在各种手术情况下与预后恶化相关。未来的研究应集中在麻醉和手术的风险获益平衡上。这将有助于促进麻醉师作为围手术期医生的角色。
