Ugeskrift for laeger
-
Ugeskrift for laeger · Jan 1995
[Pain and convalescence after ambulatory inguinal herniotomy during local anesthesia].
Postoperative pain and convalescence following ambulatory inguinal herniotomy in local infiltration anesthesia was evaluated in this descriptive study. Sixty consecutive patients (median age 63 yr) were included. Per- and postoperative pain treatment were pre- and postoperative oral tenoxicam and methadone plus infiltration of the surgical field with up to 60 ml of 0.25% bupivacaine. ⋯ Fifty-two patients were satisfied with the anesthesia and eight patients not satisfied due to fear of intraoperative pain. This study shows that inguinal herniotomy can be performed routinely as an outpatient procedure under local infiltration anesthesia. However, late postoperative pain was significant and should be improved with multi-modal analgesia.
-
Lymphangioleiomyomatosis (LAM) is a rare disease, which only affects women of childbearing age. A case of LAM in a 36-year-old woman is presented. ⋯ Treatment of the disease aims at an inhibition of the presumed growth-promoting effect of oestrogen on the smooth muscle cells. However, progression is often seen in spite of treatment.
-
One patient developed pneumothorax during laparoscopic cholecystectomy. The pneumothorax was immediately drained with an intercostal canula. A diaphragmatic lesion caused by the electrocoagulator was identified and closed, surgery was completed, and the patient was not seriously affected by the complication. ⋯ Pneumothorax is a rare, but potentially fatal complication. Immediate treatment is essential and easy. This report should make anaesthetists and surgeons aware of the possibility of gas insufflated during laparoscopy producing a pneumothorax, particularly with the increased use of the technique for major upper abdominal procedures.
-
A total of 379 patients admitted to the Intensive Care Unit (ICU) for mechanical ventilation were prospectively investigated for lesions of the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to five days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in respectively 76 (20%) and 110 (29%) patients. ⋯ Former ulcerations of the nose were associated with a tendency toward nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming studies.
-
Realizing that achievement in postoperative pain treatment was not satisfactory, central health authorities in USA, United Kingdom and Australia have published guidelines for managing acute pain. Establishing acute pain services is thought to be one of the means of improving pain relief in the individual patient. ⋯ At this moment, introduction of acute pain services is at a preliminary stage in Denmark, and consequently an overview of results obtained from abroad is given including pain treatment techniques, management and safety measures, as well as visions concerning the impact of optimal pain relief upon convalescence. We conclude that the introduction of acute pain services is bound to optimize postoperative patient care and might well prove to be a significant factor in reducing postoperative morbidity.