American journal of surgery
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To clarify the widespread practice of preoperative transfusion to attain a 10 g/dL level of hemoglobin, the relationship between preoperative hemoglobin level, operative blood loss, and mortality was studied by analyzing the results of 113 operations in 107 consecutive Jehovah's Witness patients who underwent major elective surgery. Ninety-three patients had preoperative hemoglobin values greater than 10 g/dL; 20 had preoperative hemoglobin levels between 6 to 10 g/dL. ⋯ More importantly, there was no mortality if estimated blood loss was less than 500 mL, regardless of the preoperative hemoglobin level. From these data, we conclude that: (1) Mortality in elective surgery appears to depend more on estimated blood loss than on preoperative hemoglobin levels; and (2) Elective surgery can be done safely in patients with a preoperative hemoglobin level as low as 6 g/dL if estimated blood loss is kept below 500 mL.
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Securing an endotracheal tube on patients with facial burns or trauma can pose difficulties. A nasotracheal support splint, made of materials commonly used by occupational therapists, can facilitate safe anchoring of a nasotracheal tube.
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Exposure of the right adrenal gland can be a problem with a transabdominal approach because of the overlying liver. The usual method of handling the liver to gain access to the right adrenal gland is to retract the liver superiorly and laterally, but when the right adrenal gland or tumor within it is high lying, exposure may be inadequate. In this situation, mobilization of the right lobe of the liver will provide direct access to the right adrenal gland and vein.