RESUMEN
The American Rare Donor Program (ARDP), headquartered in Philadelphia, Pennsylvania, maintains a comprehensive database of donors with "rare blood types." The ARDP secures blood and blood products for difficult-to-transfuse patients. Remarkably, a significant number of physicians, both in the United States and abroad, remain unaware of the unique and critical services that the ARDP provides to critical care specialists and their patients.
Asunto(s)
Bancos de Sangre , Antígenos de Grupos Sanguíneos , Incompatibilidad de Grupos Sanguíneos/prevención & control , Transfusión Sanguínea , Bases de Datos Factuales , Bancos de Sangre/organización & administración , Donantes de Sangre/provisión & distribución , Humanos , Deficiencia de IgA , Sistema de Registros , Estados UnidosRESUMEN
There is precedent in medicine for recognizing and accepting intact decisional capacity and the subsequent ability to provide valid consent in one treatment domain, while simultaneously recognizing that the patient lacks decisional capacity in other domains. As such, obtaining consent for anesthesia for a surgical procedure is a separate entity from obtaining consent for the surgery itself. Anesthesia for surgery and the surgical procedure itself are separate treatment domains and as such require separate consents. Anesthesiologists should understand the independence of these functionally linked consent processes and be vigilant with respect to the informed consent process. The cases reported in this article show that capacity for surgical consent may be inadequate for consent to anesthesia because anesthesia involves more abstract concepts requiring a higher cognitive state than surgery, thus requiring a higher state of cognitive capacity for understanding.
Asunto(s)
Anestesia , Comprensión , Consentimiento Informado , Procedimientos Quirúrgicos Operativos , Anciano , Anestesiología , Formularios de Consentimiento , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Anestésicos Locales/efectos adversos , Benzocaína/efectos adversos , Metahemoglobinemia/inducido químicamente , Anestésicos Locales/farmacocinética , Benzocaína/farmacocinética , Hospitales de Veteranos/normas , Humanos , Metahemoglobinemia/epidemiología , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/epidemiología , Estados Unidos , United States Department of Veterans AffairsAsunto(s)
Interacciones Farmacológicas , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacocinética , Atención Perioperativa/métodos , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/farmacocinética , Interacciones Farmacológicas/fisiología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Atención Perioperativa/efectos adversosAsunto(s)
Analgésicos Opioides/efectos adversos , Buprenorfina/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Trastornos Relacionados con Sustancias/complicaciones , Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Cocaína/complicaciones , Trastornos Relacionados con Cocaína/psicología , Semivida , Humanos , Masculino , Persona de Mediana Edad , Morfina/uso terapéutico , Dolor Postoperatorio/complicacionesAsunto(s)
Color/normas , Plasma , Anestesiología/normas , Bancos de Sangre/normas , Humanos , Plasma/metabolismoAsunto(s)
Anticonvulsivantes/efectos adversos , Aspirina/efectos adversos , Aspirina/farmacocinética , Ácido Valproico/efectos adversos , Ácido Valproico/farmacocinética , Anciano , Anticonvulsivantes/sangre , Anticonvulsivantes/farmacocinética , Aspirina/sangre , Proteínas Sanguíneas/efectos de los fármacos , Proteínas Sanguíneas/metabolismo , Mareo/sangre , Mareo/inducido químicamente , Interacciones Farmacológicas , Monitoreo de Drogas , Humanos , Masculino , Ácido Valproico/sangreRESUMEN
Many physicians overlook, or are unaware of, most drug-drug interactions. In our patient, the local anesthetic used for an axillary block may have been the precipitating drug in a cascade of drug-drug interactions that resulted in a cardiac arrest. The combination of multiple preoperative drug-drug interactions prevented the return of a stable native cardiac rhythm for almost 24 h. The mechanisms of interactions of these frequently used drugs are described, and the reader is guided to sources that identify and simplify the understanding of potentially dangerous drug-drug interactions.