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This book aims to provide the modern anaesthesiologist and interested clinician with the tools to understand how anaesthesia and surgery influence human physiology, how information about the anaesthetic state and the different homeostatic systems of the human body is collected and processed, and how this information can be integrated to optimize and individualize care to the patient by helping us to swiftly respond to changes: personalized anaesthesia.
Liver surgery can be remarkably safe: a zero mortality rate has been achieved with liver resections when patients are properly selected and with meticulous perioperative care . In order to maintain liver function in individual patients undergoing anaesthesia and surgery, the single most important factor is maintaining its perfusion. In order to avoid hypoxic liver injury, preserving sinusoidal blood flow is best done by maintaining an adequate perfusion pressure and avoiding a high central venous pressure. Reducing intraoperative blood loss and maintaining systemic haemodynamics likely play major roles in avoiding hypoxic liver injury. It is still unknown which vasoactive drugs are preferred when haemodynamic instability occurs; Noradrenaline seems to be well tolerated as long as hypovolaemia is avoided. Ischaemic preconditioning and pharmacological preconditioning and postconditioning are promising, but their clinical relevance remains to be determined. Finally there are no good markers of hepatocyte damage that could be used intraoperatively to optimize anaesthetic management.
Personalized Anaesthesia presents a modern vision of anaesthesia. Integrating technology and knowledge from leading experts in the field, this book will change the way anaesthesia is both taught and practiced. Modern practice requires the anaesthetist to provide patient-specific management. This is the first resource to be organised by the desired physiological effect, rather than by drug groupings, explaining how physiological changes can be produced and controlled according to the characteristics of each patient and the particular surgical context. The book integrates physiology, pharmacology and technology, and applies these concepts in a systematic manner to each homeostatic system. This will optimise drug titration, effect quantification and decision making in anaesthesia practice to match the needs of the individual patient. Complex mathematical and scientific concepts are explained using accessible text, colour illustrations throughout and graphs. This is an essential text for any consultant or trainee working in anaesthesia.
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