Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Nov 1991
Randomized Controlled Trial Clinical TrialAntibiotic prophylaxis in penetrating injuries of the chest.
Most prospective studies recommend antibiotic prophylaxis whilst a thoracostomy tube is in place or even longer. We conducted a randomised study of 188 patients with penetrating chest injuries requiring a chest drain. Of these patients, 95 received a single dose of ampicillin before insertion of the chest tube, the remaining 93 patients received additional antibiotic prophylaxis for as long as the drain was in place. ⋯ It is concluded that single-dose prophylaxis in penetrating chest trauma is as effective as prolonged prophylaxis. The importance of chest physiotherapy immediately after the drain insertion and of early removal of the drain is stressed. The role of various possible risk factors in the development of sepsis is discussed.
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Ann R Coll Surg Engl · Nov 1991
Use of operating theatres: the effects of case-mix and training in general surgery.
Details of theatre occupancy times for a surgical unit in a district general hospital and associated cottage hospital were recorded over a 4-month period. The average time of the procedures individually and reclassified within the BUPA schedule showed that both the severity of the procedure and the grade of surgeon influenced future theatre needs. ⋯ The hidden cost of training surgeons in general surgical operative procedures can be estimated as a result. It is concluded that current measures of resource use which rely only on the bed use and ignore operating theatre needs and training requirements for non-consultant grades will be misleading, particularly in relation to the large element of minor or intermediate surgery which constitutes the bulk of most district health authorities' workload.
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Ann R Coll Surg Engl · Nov 1991
Application of the laryngeal mask airway to thyroid surgery and the preservation of the recurrent laryngeal nerve.
We report our experience of using the laryngeal mask airway (LMA) in 13 consecutive patients undergoing thyroid surgery and discuss the advantages and limitations of the technique. We also describe a method, based on the use of the LMA, for identifying and preserving the recurrent laryngeal nerve during thyroid surgery.