Cirugía española
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Correct monitoring of medicosurgical critically-ill patients aids the early diagnosis and appropriate treatment of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The abdominal cavity and the retroperitoneum act sealed compartments and any change in the volume of their contents can increase intraabdominal pressure (IAP). ⋯ To diagnose IAH and ACS, measurement of IAP, abdominal perfusion pressure and intramucous gastric pH must be performed and the results correlated with signs of clinical deterioration in the patient. Medical therapeutic measures in ACS are limited and abdominal decompression is the established symptomatic treatment of this entity.
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The use of thoracic drains after cardiac surgery is distressing to patients and can cause a local inflammatory response. The objective of this study was to demonstrate the efficacy and safety of the flexible Blake drain for mediastinal and pleural drainage following cardiac surgery. ⋯ The use of flexible Blake drains reduced drainage after cardiac surgery without increasing the risk of bleeding or tamponade and can therefore be systematically used in cardiac surgery. Because of their flexibility, these drains produce less irritation, with accelerated recovery and lower analgesic use.
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To quantify readmission rates due to both major and minor complications per year of study in an ambulatory surgery program and to assess the effect of including patients with greater severity on the results. ⋯ Safety is an attitude and when the surgeon and the anesthesiologist apply appropriate patient selection criteria and perform a careful preanesthesia evaluation, there is no reason to expect more complications in ambulatory patients than in inpatients.