Military medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Simplified use of mixed propofol and alfentanil for anesthesia in remote locations.
Total intravenous anesthesia (TIVA) is a useful technique in precarious situations in which anesthesia ventilators and medical gas can be difficult to obtain. The aim of the study is to compare TIVA technique using a simplified infusion scheme for propofol and alfentanil mixed together (45 ml of propofol 1% and 2,500 micrograms of alfentanil in a 50-ml syringe) with an inhalational anesthetic technique (isoflurane/N2O, sufentanil). Thirty-two American Society of Anesthesiologists physical status I patients undergoing orthopedic surgery were studied. ⋯ Only patients receiving TIVA had responses to surgery. In the TIVA group, time to extubation was shorter (16 +/- 5 vs. 25 +/- 7 minutes) and postoperative requirement for morphine was lower (6.2% vs. 25%) than in the inhalation group (p < 0.05). TIVA using a mixture of propofol and alfentanil is a reliable technique of anesthesia in patients without multiple injuries.
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Experience with advanced surgery for the treatment of civilian gunshot injuries supports the changes in approach and indications for the treatment of war gunshot injuries. Eight patients with gluteal gunshot wounds are presented with typical war injuries. ⋯ Complications developed in cases of colonic and rectal injuries for which advanced surgery was performed in the treatment of the war wound. Poor conditions for advanced surgery during war can change the final result, making the outcome of the war wound worse.