Medicina
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Randomized Controlled Trial Clinical Trial
[Bupivacaine for continuous interscalene brachial plexus analgesia after shoulder surgery].
This study evaluates clinical efficacy of continuous interscalene brachial plexus block with bupivacaine 0.15% for postoperative analgesia after shoulder surgery. ⋯ Continuous interscalene brachial plexus analgesia is a reliable and effective method of providing postoperative pain relief after shoulder surgery and is superior to the systemic analgesia.
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Comparative Study
The influence of cardiopulmonary bypass on respiratory dysfunction in early postoperative period.
Pulmonary dysfunction is one of the most serious problems in an early postoperative period after cardiac surgery. This study was designed to reveal the impact of performed cardiopulmonary bypass on pulmonary function during early postoperative period by evaluating the intrapulmonary shunt. ⋯ Arterial hypoxemia and increase in intrapulmonary shunt (due to atelectasis) have proven that alterations in pulmonary function are found more often and are more pronounced in patients after surgery on cardiopulmonary bypass.
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It has been estimated that 50-70% of cardiac arrests are caused by acute myocardial infarction or fulminant pulmonary embolism. Thrombolysis could be the treatment of choice during cardiopulmonary resuscitation given its ability to treat the underlying cause of the condition. Traditionally thrombolysis during cardiopulmonary resuscitation has been contraindicated because of risk of life-threatening bleeding complications. ⋯ This condition causes inadequate reperfusion of the brain. Experimental studies demonstrate that besides dissolving coronary thrombus or pulmonary emboli, thrombolytic therapy improves microcirculatory flow resulting in better reperfusion of the brain which translates into better neurological outcome after resuscitation. Should the currently ongoing "Thrombolysis In Cardiac Arrest - TROICA Study" confirm the results of the earlier trials, thrombolytic therapy may soon become part of the resuscitation guidelines.
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Peripheral, especially central venous catheters, are used with increasing frequency in the intensive care unit and in general medical wards to administer intravenous fluids and blood products, drugs, parenteral nutrition, and to monitor hemodynamic status. Catheter infection is associated with increased morbidity, mortality, and duration of hospital stay. ⋯ Reducing catheter infections rates requires a multiple-strategy approach. Therefore, intensive care units and other locations where catheters are used should implement strict guidelines and protocols for catheter insertion, care, and maintenance.
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This study evaluated effectiveness of hypotensive epidural anesthesia in decreasing blood loss, operation and extubation time, opiates use and stay in intensive care unit. ⋯ Hypotensive epidural anesthesia is an effective method to decrease blood loss and blood transfusions in thoracic surgery. It creates better conditions for surgery and reduces stay in intensive care unit. Also there were no serious cardiac, neurological and renal intra-operative and post-operative complications that could be conditioned by the use of hypotension.