Annals of the Royal College of Surgeons of England
-
A prospective audit of 1111 general surgical procedures undertaken on 1040 elderly patients (over 64 years) revealed a mortality of 3.5% in potentially viable patients. Aged patients (over 74 years) had twice the mortality of old patients (65-74 years). Emergency surgery carried a sevenfold risk factor which is greater than is usually described. ⋯ We conclude that mortality rates in the elderly could be improved by encouraging elective surgery and avoiding diagnostic laparatomy in patients with incurable surgical disease. We also suggest that no inexperienced surgeon should operate unsupervised on any elderly patient who is in ASA category 4 or 5, or who undergoes major or intermediate surgery. Further, all elderly patients in ASA category 4 or 5, or those with previous medical problems who have major emergency procedures should be managed postoperatively in a high dependency care unit.
-
Ann R Coll Surg Engl · Jan 1989
Randomized Controlled Trial Comparative Study Clinical TrialSubcutaneous ketamine analgesia: postoperative analgesia using subcutaneous infusions of ketamine and morphine.
A series consisting of 32 women undergoing total abdominal hysterectomy received a standard narcotic-free anaesthetic. For the first 24 h postoperatively, eight were given the standard regimen of intramuscular morphine sulphate whilst the other three groups received continuous subcutaneous infusions of either morphine sulphate, ketamine hydrochloride or the two drugs combined. The amount of time they were pain free, the incidence of sleep and nausea, together with cardiovascular and respiratory changes were recorded. ⋯ No patient reported psychomimetic side effects, but ketamine on its own produced feelings of malaise in three patients on the second postoperative day. Subcutaneous infusions provide better postoperative analgesia than intermittent intramuscular morphine. Ketamine on its own cannot be advocated, but combined with morphine it allows a single infusion rate to be used for all patients, decreasing the need for nursing and medical involvement.
-
Ann R Coll Surg Engl · Jul 1988
What becomes of junior surgical trainees? A review of Cardiff registrars 1973-1983.
A survey was conducted of doctors who trained as Rotating Surgical Registrars on the Cardiff Rotational Training Scheme between 1973 and 1983. 51 of 63 former registrars responded. All passed FRCS. 45 remained in surgery on leaving the rotation. 19 are now consultants, 12 senior registrars and 14 are still registrars in 8 different surgical specialties. ⋯ Of the 12 non-responders it is known that at least 6 are surgeons (2 consultants, 2 senior registrars, 2 registrars). It is concluded that the Rotational Training Scheme successfully promoted surgical careers for the majority of trainees.
-
Ann R Coll Surg Engl · May 1988
Comparative StudySubclavian vein catheterisation for parenteral nutrition.
Two hundred and twenty-six central venous catheters were placed in 195 consecutive patients requiring central venous catheterisation for total parenteral nutrition (TPN). Of these 226 catheters, 198 were placed percutaneously into the subclavian vein by the infraclavicular route. In 99 consecutive subclavian catheter insertions, a 12G needle with introducing sheath was used to puncture the vein (Group 1). ⋯ Pneumothorax occurred on three occasions (3.0%) in Group 1 but did not occur in Group 2. However, there were two episodes of pleural extravasation in Group 2 (2.0%) which may have been due to guide wire perforation of a central vein; this complication did not occur in Group 1. Although the Seldinger technique of insertion should reduce the incidence of pneumothorax, care should be taken in passage of the guide wire.
-
Postoperative morbidity in fifty day care patients undergoing spinal anaesthesia was evaluated by means of a postoperative questionnaire. Despite the use of a 26G spinal needle in all patients, there was an overall incidence of spinal headache of 18%, which rose to 39% when considering patients under 40 years of age. ⋯ Patients receiving spinal anaesthesia were compared with a smaller group of patients receiving general anaesthesia for similar procedures, and this group showed no evidence of post-operative morbidity after 48 h. In agreement with a previous study, it is concluded that spinal anaesthesia is not a suitable technique for the young day care patient.