The American surgeon
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The American surgeon · May 1995
Randomized Controlled Trial Clinical TrialInteraction of vecuronium with piperacillin or cefoxitin evaluated in a prospective, randomized, double-blind clinical trial.
Interactions between beta-lactam antibiotics, particularly acylaminopenicillins, and vecuronium, a widely used muscle relaxant, leading to prolonged neuromuscular blockade have been reported in studies of experimental animals and in a few clinical case reports. In the clinical reports, however, confounding factors always existed. A clinical trial to evaluate interactions between vecuronium and cefoxitin or piperacillin was conducted. ⋯ Cefoxitin and piperacillin administered pre- or intra-operatively are not associated with clinically important prolongation of muscle relaxation induced by vecuronium. The potential for prolongation of neuromuscular blockade induced by vecuronium through concomitant administration of piperacillin or cefoxitin as antibiotic prophylaxis was investigated in a clinical trial of 30 patients having major abdominal operations. Quantitative measurement of neuromuscular blockade was done using the electromyographic twitch response to a supramaximal current stimulus.
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The American surgeon · May 1995
Comparative StudyPenetrating cardiac wounds: predictive value of trauma indices and the necessity of terminology standardization.
The authors evaluated the usefulness of different trauma indices in the prediction of outcome following penetrating cardiac wounds. Sixty-three patients were retrospectively reviewed. Age, mechanism of injury, Physiologic Index (PI) on admission, site of injury, associated injuries, ISS, RTS, Penetrating Cardiac Trauma Index (PCTI), Penetrating Thoracic Trauma Index (PTTI), Penetrating Trauma Index (PTI), TRISS and mortality rate were reviewed. ⋯ We conclude that physiologic impairment, shock, and GSW are variables with high significance on mortality. Trauma indices such as PI, RTS, PCTI, PTTI, PTI, and ISS are good predictors of outcome. Trauma indices are an important tool to objectively compare results among different institutions.
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The American surgeon · May 1995
Comparative StudyDoes oxygen delivery-directed resuscitation worsen outcome of head injured patients with multisystem injuries?
There is concern that oxygen delivery-directed resuscitation in patients with multiple trauma, including severe head injury, may worsen neurologic recovery. To study this, we retrospectively examined 31 patients admitted over an 18-month period who met the inclusion criteria of having suffered blunt trauma, were between 15 and 65 years of age, had an admission Glasgow coma scale of < or = 8, intact corneal and gag reflexes, and extracranial injury with an Abbreviated Injury score of > or = 3. All patients were placed on intracranial pressure monitors. In comparing the 14 patients whose resuscitation was guided by oxygen delivery (DO2) with the 17 who were resuscitated by standard fluid restriction (FR), we found that despite the DO2 group's having received a significantly greater volume of resuscitation fluids in the first 48 hours after injury, there was no difference in the neurologic recovery between the two groups.