Canadian journal of surgery. Journal canadien de chirurgie
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Aortobifemoral bypass (ABF) has been available as a method for treating patients with aortoiliac occlusive or aneurysmal disease for 40 years. ABF has been successful in alleviating the symptoms of claudication and critical ischemia. The long-term patency rates have been excellent with low operative morbidity and mortality. ⋯ With careful follow-up the natural history of a patient who undergoes ABF is known. Predicting outcome is now possible and a cost:benefit analysis can be made. ABF has proved to be a successful and enduring procedure.
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The introduction of laparoscopic techniques into standard intracavitary surgery has received widespread acceptance in North American surgical practice in a very short time. To complete these procedures successfully a basic armamentarium is required by surgeons. The equipment should provide safe conduct of the procedure and maximum flexibility in the types of surgical procedures to be undertaken. The basic laparoscopic equipment needed to facilitate minimal-access-site surgery is reviewed, from the operating table and lighting in the operating room through optics, cameras and television monitors to the instruments and agents needed for the surgical techniques and for securing hemostasis.
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Randomized Controlled Trial Clinical Trial
Cardiac compliance and effects of hypertonic saline.
To demonstrate the advantages of a 1.8% hypertonic saline solution (HS) over a Ringer's lactate solution (RL) during and after major intra-abdominal surgery, 28 patients were randomly allocated to one of two groups as follows: 13 patients received RL and 15 patients received HS. All patients were studied preoperatively, peroperatively and postoperatively for 72 hours. Peroperatively RL or HS were infused at a rate sufficient to maintain a pulmonary capillary wedge pressure (PCWP) and central venous pressure (CVP) within 3 mm Hg of the initial value. ⋯ The HS group received significantly (p = 0.002) less liquid than the RL group. At the end of surgery, the LVEDVI dropped in both groups. This drop was significantly (p = 0.04) more important in the RL group than in the HS group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Surgical educators are facing changes in residency training that have a direct impact on the opportunity that surgeons and residents have for clinical teaching and learning. The knowledge required of residents continues to escalate. Further, as resident positions are reduced, the opportunity for inter-resident education is decreased. ⋯ The purpose of this study was to examine the educational activities that occur during the operating-room experience. Technical training in the procedure being done was the primary educational activity, but there were long periods when no form of education was taking place. The operating room provides the teacher and learner with uninterrupted time together, and this time can and should be used for clinical teaching and learning.
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Case Reports
Cardiopulmonary bypass for resuscitation of patients with accidental hypothermia and cardiac arrest.
Hypothermic patients have been successfully rewarmed by a number of methods. However, when cardiac arrest occurs, as it frequently does at core temperatures of less than 27 degrees C, prolonged cardiopulmonary resuscitation (CPR) is required, because defibrillation can rarely be achieved until the patient has been rewarmed to 30 degrees to 34 degrees C. Five cases of accidental hypothermia with cardiac arrest treated with cardiopulmonary bypass are discussed. ⋯ In the last three patients, high-flow cardiopulmonary bypass was rapidly achieved using a no. 28 French chest tube for femoral venous cannulation, and they recovered completely. In cases of accidental hypothermia with cardiac arrest, rapid institution of full cardiopulmonary bypass provides excellent circulatory support and rapid rewarming. This avoids the complications of prolonged inadequate circulation that occur when closed-chest cardiac massage and external rewarming are used.