Livros e Capítulos de Livros - LIM/08
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A coleção de Livros e Capítulos de Livros reúne capítulos e resumos de obras produzidas por autores do sistema FMUSP-HC que inclui a Faculdade de Medicina da Universidade de São Paulo (FMUSP), o Hospital das Clínicas da FMUSP e demais institutos associados.
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- Hyperosmolar Fluids(2022) TAVARES, C.; ALCâNTARA, A. L. L. Latorre de; MURATA, K. N.; SASAKI, S.Intravenous hyperosmolar fluids have been used for the clinical management of intracranial hypertension. The most suitable agent depends on the patient’s age, comorbidities, and clinical status. Since hypertonic saline causes an intravascular volume expansion, it can be advantageous for hypovolemic patients. Still, it should be used with caution in patients with cardiac heart failure, in whom it may precipitate acute pulmonary edema. In contrast, mannitol induces a strong diuretic response that can lead to a severe blood volume depletion that should be promptly treated to avoid complications. Other concerns related to its use are the rebound phenomenon and a potential risk of hematoma expansion in patients with intracranial hemorrhages. The main concern in patients receiving hypertonic saline is hypernatremia. It poses a theoretical risk of osmotic demyelination when serum sodium levels rise quickly, especially in hyponatremic patients. Both agents can cause renal injuries but through distinct mechanisms. Whereas high serum mannitol concentrations can lead to osmotic nephrosis, renal function impairment associated with hypertonic saline infusion seems to be mediated by hypernatremia and hyperchloremia. Further research is warranted to determine the optimal agent and their best means of administration (boluses vs. continuous infusions) for each neurocritical condition. More extensive clinical trials are needed to address long-term outcomes, adverse events, and quality of life with both agents. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
- Anesthesia for Vascular Surgery(2022) SIMõES, C. M.Anesthesia for vascular procedures in cancer patients can be challenging. In this chapter, we discuss some important aspects in preoperative evaluation and anesthesia planning, including risk stratification, medications, and also other patient potential risks. Onco-anesthesia has some specific aspects and should be considered an emerging subspecialty with critical competencies to be developed. Venous access, hemodynamic monitoring, blood and fluid management, analgesia, and also enhanced recovery bundles must be considered for all patients. Also, anesthesia technique may be an important factor to be studied. Postoperative care is also specific, and we must consider some situations more frequent in cancer patients-that will be discussed as analgesia and its adverse effects-that may be present and should be prevented. © Springer Nature Switzerland AG 2022.
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