The American surgeon
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The American surgeon · Jul 1996
Penetrating chest trauma: should indications for emergency room thoracotomy be limited?
A total of 160 patients underwent emergency room thoracotomy (ERT) from January 1988 to June 1995. There were 142 male and 18 female patients with ages ranging from 15 months to 72 years old with a mean age of 31 years. Blunt trauma was the mechanism of injury in 11 patients; none of them survived, and they were excluded from further analysis. ⋯ Of the four survivors, three were in Scene Class III and one was in Scene Class IV. This study confirms a previous report that, overall, ERT has a very low survival rate. ERT should be abandoned in patients sustaining blunt trauma, and should probably be limited to patients sustaining penetrating chest injuries who fall into the physiologic Classes III or IV at the scene.
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The American surgeon · Jun 1996
Review Randomized Controlled Trial Clinical TrialEvaluation of intrapleural analgesia in the management of blunt traumatic chest wall pain: a clinical trial.
Intrapleural analgesia (IPA) has been successfully used for the relief of chest wall pain. Previous studies investigating its use have yielded conflicting results and have often suffered from design defects. The theoretical lower incidence of respiratory and circulatory depression with IPA suggests significant advantages over epidural analgesia. ⋯ The addition of IPA to the more traditional use of opioid analgesics was not more effective for management of blunt chest wall pain. Despite our small patient population (n = 16), the crossover design should have allowed clinically significant differences to become evident (alpha value = 0.95). A review of the literature and a historical basis for the evolution in the management of this type of pain is included.
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The American surgeon · Jun 1996
Case Reports Comparative StudyThe impact of implementation of neuromuscular blockade monitoring standards in a surgical intensive care unit.
The purpose was to determine whether implementation of standards for peripheral nerve monitoring could decrease the incidence of neuromuscular dysfunction related to the administration of paralytic agents. Over a 2-year period, consecutive patients admitted to a surgical intensive care unit who received continuously-infused or >6 daily doses of neuromuscular blocking agents were subjected to train-of-four (TOF) monitoring of the adductor pollicis. Therapy was titrated to the maintenance of one to two twitches at all times. ⋯ After implementation of the TOF protocol, no instances of paralytic-associated neuromuscular dysfunction occurred (0/90), despite the same incidence of risk factors (100%) (P < 0.05). A protocol for neuromuscular blockade monitoring is efficacious in preventing paralytic-associated neuromuscular dysfunction. This can be a cost-effective measure, minimizing the prolonged mechanical ventilation and intensive rehabilitation required secondary to unmonitored use of neuromuscular blocking agents.
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The American surgeon · Jun 1996
Comparative StudyEffect of epidural analgesia on postoperative ileus after ileal pouch-anal anastomosis.
Epidural analgesia has been reported to enhance gastrointestinal motility and shorten postoperative ileus. Postoperative ileus can be influenced by many factors, including the operative procedure. Our aim was to evaluate the effect of supplemental epidural anesthesia and postoperative analgesia on ileus after ileal pouch-anal anastomosis (IPAA). ⋯ Mean duration of nasogastric suction, tube reinsertion, and interval to taking liquid and regular diets was similar in the two groups. Mean pain scores for the first 24 hours were significantly lower in the epidural group (1.9 +/- 1.0 vs 2.5 +/- 0.6, P < 0.05). Supplemental epidural anesthesia and analgesia does not shorten clinical postoperative ileus after a complex colorectal procedure (IPAA).
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Exercise-induced rhabdomyolysis is a frequent event occurring after severe forms of exercise. This is usually a short-lived, uncomplicated phenomenon that is seldom of any clinical significance. ⋯ To our knowledge, this is the only description of this complication occurring in a multicompartment, bilateral distribution. The combination of the rarity and morbidity of this condition, as well as the multitude of very common benign injuries that present in the same manner as the problem discussed, make this insult especially dangerous.