Critical care of the vascular surgery patient.
Providing effective critical care to vascular surgical patients is challenging to the intensivist. These patients often have multiple significant concurrent diseases that need to be adequately managed. A selective policy for identifying patients that need ICU is recommended. Early and smooth restoration to their preoperative physiological homeostasis is crucial. Optimal pain relief, return to normothermia, and adequate intravascular volume replacement are thus key interventions. Epidurals provide excellent analgesia. Vigilant monitoring and decisive therapy of the wide range of complications that may occur in the postoperative is of paramount importance. The level of monitoring should be an extension of that done intraoperatively. Hemorrhage and thrombosis are dreaded sequelae; cardiac morbidity and mortality is significant. Respiratory complications may necessitate prolonged postoperative mechanical ventilation. Careful clinical evaluation is necessary to detect the various neurological complications that may occur. Renal and gastrointestinal complications are potentially lethal. Graft sepsis may occur later. The development of new techniques, such as endovascular repairs of aneurysms, may minimize the need for ICU.
Gopalan
P Dean
PD
Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of Natal, 719 Umbilo Road, Durban 4013, South Africa. gopaland1@nu.ac.za
Burrows
Richard C
RC
D058186:Acute Kidney Injury / Q000209:etiology; D015360:Analgesia, Epidural; D015897:Comorbidity; D003422:Critical Care; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D011182:Postoperative Care; D012907:Smoking / Q000009:adverse effects; D014652:Vascular Diseases / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D020246:Venous Thrombosis / Q000209:etiology