S Afr J Surg
-
Comparative Study
Haemodynamic response to tracheal intubation or laryngeal mask insertion in hypertensive patients.
The haemodynamic response to laryngeal mask insertion and tracheal intubation was studied in 27 hypertensive patients who underwent elective ophthalmic surgery. Both groups received alfentanil 15 micrograms/kg, thiopentone 3-4 mg/kg and vecuronium 0.1 mg/kg and were ventilated with oxygen, nitrous oxide and isoflurane for 3 minutes prior to laryngeal mask insertion or tracheal intubation. ⋯ Heart rate, but not blood pressure, increased above baseline levels in the tracheal intubation group. The anaesthetic technique used blunted the haemodynamic response to tracheal intubation, but completely blocked the response to laryngeal mask insertion.
-
A total of 446 patients with liver trauma were treated over a 10-year period: 295 (66%) had penetrating injuries (204 stab wounds, 91 gunshot wounds) and 151 (34%) blunt trauma. Seventeen patients died during resuscitation before laparotomy. In 344 (80%) of the 429 patients who underwent laparotomy, injuries were managed by simple methods such as temporary packing, diathermy, sutures or vessel ligation. ⋯ Complications occurred in 151 of 392 survivors (38.5%) and correlated with type and severity of the liver injury (31% in stab wounds, 43% in gunshot wounds, 57% in blunt injuries) and the number of associated injuries. As many as 80% of liver injuries can be managed by simple surgical techniques. In major liver injuries perihepatic packing may be life-saving, allowing control of bleeding before a logical sequential strategy is instituted to isolate and repair the injury.