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In anesthesiology and critical care medicine, specific arterial blood pressure targets should be attained, depending on the setting. For instance, a growing body of evidence indicates that perioperative blood pressure should not markedly deviate from its usual level. This underscores the importance of blood pressure measurement, ideally non-invasively, and has therefore spurred intense research efforts . Recent advances in non-invasive blood pressure monitoring are noteworthy. They involve not only innovative technologies such as the automatic finger cuff but also the widely used automatic upper arm cuff. The present chapter aims at providing a state of the art of non-invasive blood pressure monitoring in adult patients in acute care settings with emphasis on recent advances. This chapter addresses several key issues such as “are non-invasive measurements of blood pressure true and accurate?”, “can non-invasive monitoring detect changes in blood pressure? ” and “what if the patient is obese and / or has cardiac arrhythmia?”
In perioperative medicine, optimal fluid management during and after the surgery is often debated. However, it is clear that poor fluid management and periods of hypotension are closely linked to worse outcomes. Both excessively liberal and restrictive fluid regimens lead to harm. Goal-directed pathways, where fluid or vasopressor administration targets a predefined hemodynamic parameter, are occasionally used. However, these require advanced hemodynamic monitoring, have limited evidence to support them and are often too complex, resulting in unsuccessful implementation.
Artificial intelligence (AI) focuses on machines capable of replicating human decision making. Within AI, predictive analytics use existing data to predict future events. These predictions can be integrated into open- or closed-loop systems, guiding fluid or vasopressor administration and reducing the clinician’s cognitive burden. This chapter provides an introduction to predictive analytics in perioperative fluid management, an overview of published literature, andsuggestions as to how the technology might develop in the future.
With increasing awareness that many commonly used medicines can adversely impact patient outcomes of dental procedures, it has become more important for dentists to ensure medications are appropriately managed perioperatively. Managing medicines taken by patients before and after their dental procedures is a common and sometimes confusing clinical problem. Traditionally, the responsibility for perioperative medication management has been deferred to the patient’s prescribing doctor. However, doctors are often unfamiliar with the physiological impacts of dental procedures and few have access to oral and dental prescribing guidelines. The prescriber can still be consulted, but dentists are encouraged to take a more active role in the clinical decision-making regarding medication management, especially since the dentist is responsible for the procedure itself. Medication management is also becoming more important due to the ever-growing list of medicines that can adversely impact on dental procedures. Medication-related risks include increased chance of perioperative bleeding, infection, impaired wound healing, diabetic ketoacidosis, and medication-related osteonecrosis of the jaw.
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