The hypertensive surgical patient. Controversies in management

The authors use data gathered from recent clinical and laboratory studies to deal with the following six questions often facing the physician caring for hypertensive patients before, during, and after surgery. Which hypertensive patient is at increased surgical risk? When must elective surgery be delayed? Should antihypertensive medication be discontinued preoperatively? What is the ideal intraoperative blood pressure? What anesthetic techniques are best suited for hypertensive patients? Which patients are at most risk of a postoperative hypertensive crisis?     

The nutrition of the elderly surgical patient

The key concepts regarding nutrition of elderly patients prior to surgery are outlined. The main metabolic changes that occur during surgical stress, paying special attention to the characteristics of elderly patients, are described. Lastly, the caloric-energy intake required by postoperative geriatric patients is evaluated and the methods of food intake compared to the benefits obtained are analysed.     

长期饮酒与高血压脑出血手术预后相关性分析

目的:探讨高血压脑出血手术预后与长期饮酒相关性。方法:120例高血压脑出血病人根据饮酒情况分为治疗组40例与对照组80例,治疗组有长期饮酒史,对照组从不饮酒或偶少许饮酒,两组所有患者都采用手术治疗。结果:经过观察,治疗组的有效率显著低于对照组,病死率显著高于对照组义(P<0.05)。治疗组在术后3天、14天与28天脑水肿体积明显多于对照组(P<0.05)。治疗组术后再出血、肺炎与肾功能衰竭发生率明显高于对照组(P<0.05)。结论:长期饮酒能够降低高血压脑出血手术疗效,提高术后并发症,缓解脑水肿缩小变化。故应尽早采取措施,采取综合措施促使患者限酒戒酒,提高患者生活质量。     

Positioning the surgical patient

Optimal surgical positioning will aid surgical and anaesthetic access to the patient and reduce the risk of injury. Safe positioning represents a considerable challenge. To overcome this it is imperative that the anaesthetist, surgeon and theatre personnel work together as a well-coordinated team. Knowledge of the equipment and steps required to correctly position the patient are also key to achieving the required position safely.