International journal of surgery
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We sought to assess the effects of aortic cross-clamp time (XCL) on outcome following cardiac surgery in low- and high-risk patients. ⋯ Prolonged cross-clamp time significantly correlates with major post-operative morbidity and mortality in both low- and high-risk patients. This effect increases with increasing XCL time. Prior knowledge on this effect can help in preventing some of these complications.
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Surgeons are faced with the dilemma that many clinical questions in their daily practice to do not have universally agreed answers, but patients increasingly demand the 'best practice' from their doctors. In addition time pressures mean that clinicians are unable to keep up with the full spectrum of published research. We have adopted an approach first pioneered in emergency medicine, namely the Best Evidence Topic or Best BET. ⋯ Once the relevant papers are found, these papers are critically appraised, the relevant data to answer the question is extracted, tabulated and summarised. A clinical bottom line is reached after this process. The resulting BETs, written by practising surgeons can then provide robust evidence-based answers to important clinical questions asked during our daily practice.
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To report the outcome of patients treated for colonic neoplasms using a laparoscopic assisted technique since its introduction at the University Hospital of the West Indies, Jamaica. ⋯ Appropriately selected patients with colonic neoplasms can be safely subjected to a laparoscopic assisted resection and expect to enjoy the advantages of this technique even in a developing country setting. The outcome of thirty consecutive laparoscopic assisted colectomies is reported demonstrating that this technique can be safely applied to selected patients with colonic carcinomas in developing countries.
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Peri-operative monitoring technology has made great strides in the last 20 years with the introduction of minimally invasive devices to measure inter alia stroke volume, cardiac output, depth of anaesthesia and cerebral and tissue oxygen monitoring. Despite these technological advances, peri-operative management of the high risk major surgery patient has remained virtually unchanged. The vast majority of patients undergo a pre-operative assessment which is neither designed to quantify functional capacity nor predict outcome. ⋯ It is perhaps not surprising that outcome still remains poor in high-risk patients.(1) In this review, we will briefly describe the role of peri-operative optimization, some of the available monitors and indicate how their combined use might be beneficial in managing the high-risk surgical patient. We believe that although there is now evidence to suggest that the use of individual new monitors (such as assessment of fluid status, depth of anaesthesia, tissue oxygenation and blood flow) can influence outcome, it will only be their combination that will radically improve the peri-operative management and outcome of high-risk surgical patients. It is a matter of some urgency that large scale, prospective and collaborative studies be designed, funded and executed to prove or disprove this hypothesis.