The American surgeon
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The American surgeon · Mar 2008
Resuscitation of hypotensive head-injured patients: is hypertonic saline the answer?
Hypertonic saline (HTS) may decrease intracranial pressure (ICP) in severe traumatic brain injury (STBI) and effectively resuscitates hypotensive patients. No data exist on institutional standardization of HTS for hypotensive patients with STBI. It remains unclear how HTS affects brain tissue oxygenation (PbtO2) in STBI. ⋯ Institutional use of HTS in STBI can be safely implemented in a center caring for neurotrauma patients. HTS infusion in hypotensive STBI reduces ICP and raises CPP. Brain tissue oxygenation tends to improve after HTS infusion.
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Decompressive fasciotomy for preservation of lower extremity function and salvage is an essential technique in trauma. The wounds that result from the standard two incision four-compartment leg fasciotomy are often accompanied by a wide soft tissue opening that in the face of true compartment syndrome are often impossible to close in a delayed primary fashion. We describe a technique using a device that allows for dissipation of the workload across the wound margin allowing for successful delayed primary closure. ⋯ All patients were able to undergo primary wound closure of the medial incision and placement of the Canica device over the lateral incision. Ten of the 11 patients (91%) could be closed in delayed primary fashion after application of the device. In our series of patients with penetrating wartime injuries and compartment syndrome of the leg we have found the use of this dynamic wound closure device to be extremely successful and expedient.
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Few diagnostic modalities in medicine have been the subject of greater debate for as long after their inception as the pulmonary artery catheter. Placement of a Swan-Ganz catheter is associated with various complications, one of which is knotting. ⋯ The case reported is a rare case of Swan-Ganz catheter knotting resulting from inserting an excessive length of Swan-Ganz catheter into the heart. Knotting can be prevented by following the principle rule in floating Swan-Ganz catheters by correlating the inserted length of pulmonary artery catheter (PAC) with the expected change in waveform.
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The American surgeon · Mar 2008
Randomized Controlled TrialPost-laparoscopic cholecystectomy pain: effects of intraperitoneal local anesthetics on pain control--a randomized prospective double-blinded placebo-controlled trial.
Postoperative pain after laparoscopic cholecystectomy (LC) is generally less than open cholecystectomy; however, the postoperative shoulder and abdominal pain experienced by patients still causes preventable distress. Intraperitoneal irrigation of the diaphragmatic surface and gallbladder fossa using normal saline, bupivacaine, or lignocaine may effectively control visceral abdominal pain after an LC. Two hundred patients with similar demographics undergoing elective LC were randomized to one of four groups of 50 patients each, including Group A placebo control, Group B with isotonic saline irrigation, Group C with bupivacaine irrigation, and Group D with lignocaine irrigation. ⋯ Bowel function recovery was similar in all patients, and there were no significant complications. We conclude that intraperitoneal irrigation with either saline, bupivacaine, or lignocaine can significantly reduce visceral abdominal pain after LC. Lignocaine was the most efficacious local anesthetic in this trial and has a high safety profile when used at recommended doses.
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The American surgeon · Mar 2008
Recurrence after laparoscopic ventral hernia repair: a prospective pilot study of suture versus tack fixation.
Mesh fixation in laparoscopic ventral hernia repair requires the use of tacks and/or permanent transabdominal sutures. Sutures pass through all fascial and muscle layers of the anterior abdominal wall, whereas tacks secure the mesh simply to peritoneum. Controversy exists regarding the optimal fixation method. ⋯ In multivariate analyses, fixation method did not significantly affect recurrence. In this pilot study, patients undergoing laparoscopic ventral hernia repair with primarily transabdominal sutures or tacks experienced similar recurrence rates. Future studies will be needed to validate these findings.