The American surgeon
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The American surgeon · Aug 2003
Analyzing prophylactic antibiotic administration in procedures lasting more than four hours: are published guidelines being followed?
Published guidelines for surgical antibiotic prophylaxis recommend that an appropriately selected and administered antibiotic should be repeated in a timely manner in lengthy procedures. To assess concordance with published guidelines we reviewed the prophylactic antibiotic usage in procedures lasting more than 4 hours at a 500-bed university hospital. The records of 300 procedures longer than 4 hours in duration from the gastrointestinal, neurosurgery, and vascular surgery services were retrospectively reviewed. ⋯ One hundred ninety cases (63.3%) received the correct antibiotic, but only 96 (32%) received it in a timely manner before surgery. Nine patients (3%) in 300 cases received repeat doses at the correct time for the entire duration of the surgery in complete compliance with the published guidelines. We conclude that antibiotic prophylaxis of lengthy procedures is rarely in accordance with published guidelines.
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The American surgeon · Aug 2003
Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair.
Transabdominal sutures (TAS) used for mesh fixation in laparoscopic ventral hernia repair (LVHR) are an occasional source of prolonged postoperative pain. We sought to analyze the incidence of TAS site pain and the efficacy of local treatment methods. A retrospective review of patients who underwent LVHR from January 1999 to August 2002 was performed to identify patients experiencing suture site pain. ⋯ Increasing mesh size is associated with a greater chance of suture site pain. It appears to be effectively treated postoperatively with the injection of a local anesthetic at the TAS site. The mechanisms by which short-duration anesthetics relieve chronic pain are not fully understood.
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The American surgeon · Aug 2003
Inferior vena cava filter placement: preinsertion inferior vena cava imaging.
Imaging of the vena vava prior to the insertion of an inferior vena vava (IVC) filter is mandatory to assess IVC diameter and patency, delineate anatomy and venous anomalies, and to direct filter placement for appropriate deployment and avoidance of complications. The standard imaging technique is vena cavography, although alternative methods to evaluate the inferior vena cava include carbon dioxide venography, transabdominal duplex ultrasound, and intravascular ultrasound. This manuscript will review the anatomical features, technique, and complications of pre-insertion inferior vena cava imaging and discuss alternative methods to evaluate the inferior vena cave prior to filter insertion.