The American surgeon
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The maximum surgical blood order schedule (MSBOS) is a viable option for reducing unnecessary crossmatching and achieving significant cost savings in the blood bank. A MSBOS specifies, and thus limits, the amount of blood normally crossmatched for elective surgical procedures. During the first 10 months after introducing MSBOS at our hospital, there was a 33 per cent drop in the number of units of blood crossmatched for elective surgical procedures. ⋯ Patient care was not adversely affected. Institution of MSBOS can be accomplished without difficulty by gaining input from surgeons and anesthesiologists. After implementation, follow-up is advisable to attain optimal blood use.
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Impedance cardiography is a highly reproducible, rapid and safe method for the evaluation of cardiac performance in the clinical setting. Measurements of stroke volume (SV), end diastolic volume (EDV), and end systolic volume (ESV) with calculation of cardiac output (CO) were obtained in normal, healthy people (group 1, n = 21) and in patients with congestive heart failure (group 2, n = 18). Individuals were placed on a tilt table and cardiac profiles (measurements of CO, SV, EDV, and ESV) were performed at 45 degrees head up, 15 degrees head up, and supine. ⋯ In addition, while the EDV increased at each position in group 1 (45 degrees: 71 +/- 21 cc/M2, 15 degrees: 88 +/- 26 cc/M2, Supine: 102 +/- 29 cc/M2), no such increase was evident in group 2 (45 degrees: 57 +/- 29 cc/M2, 15 degrees: 52 +/- 20 cc/M2, Supine: 60 +/- 24 cc/M2). The inability of group 2 patients to elevate CI and the absence of any discernible change in EDV suggests an insufficiency of cardiac reserve with noncompliant ventricles. This information is currently being used to assess operative risk and to study effects of treatment modalities.
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Gastric stapling for morbid obesity has been popularized, in part, because of an apparent lack of metabolic sequelae. Of our series of prospectively studied gastric bypass patients, 74 patients have been followed for more than 1 year. Anemia developed in more than one-third of the patients. ⋯ While prompt recognition and treatment has prevented development of a clinical deficiency syndrome in most patients, 12 per cent became anemic most likely because of micronutrient deficiency related to the bypass. More than 10,000 gastric restriction operations are carried out for morbid obesity each year in this country. Previous reports of thiamine deficiency-related neurologic sequelae, immune paralysis, and marrow suppression, together with the micronutrient deficiencies and anemia herein reported make long-term frequent metabolic assessment of these patients essential.
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New guidelines on tetanus prophylaxis in wound management have been prepared by the American College of Surgeons and are available in a poster format or in bulletins. The purpose of this study was to determine the impact of these educational brochures on tetanus prophylaxis in a hospital setting. The results of this study indicate that these informational brochures and posters had insignificant impact on the quality of prophylaxis against tetanus in our hospital. Innovative programs of information exchange and quality assurance are urgently needed to improve the delivery of health care.