S Afr J Surg
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A young man underwent anaesthesia and surgery after multiple fractures. After 2 hours of anaesthesia, the patient developed hypercapnia, acidosis, hyperpyrexia and mild muscle rigidity. ⋯ Muscle tension studies with caffeine-halothane and muscle histology proved normal. The differential diagnosis of this abnormal metabolic response is briefly discussed.
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Quality assurance in trauma care is of major importance in assessing the efficacy of a trauma service and in identifying areas for improvement. Trauma scores and the TRISS methodology are at present the most accurate tools for quality assurance purposes. In this prospective study, the TRISS methodology was used to analyse the results in a group of 629 patients with penetrating trauma.
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Peri-operative cardiac events are the leading cause of death following anaesthesia and surgery. We attempt to put into perspective the various methods of pre-operative assessment of patients at risk, and suggest a logical sequence for the use of potentially costly investigations such as 12-lead ECG, exercise stress ECG, ambulatory ECG monitoring, myocardial perfusion imaging, radionuclide ejection fraction, and coronary angiography. Important principles are given for the management of patients at risk of peri-operative cardiac incidents if the decision is made to proceed with non-cardiac surgery despite the potential risk or because of inoperable coronary disease.
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Randomized Controlled Trial Comparative Study Clinical Trial
Occlusive versus semi-open dressings in the management of skin graft donor sites.
In a prospective, randomised study we compared the efficacy of a new occlusive dressing (Granuflex-E) with a semi-open dressing (tulle gras) in the management of skin-graft donor sites. The study examined 10 patients with burns, each with two donor sites. ⋯ One donor site was dressed with Granuflex-E and the other with tulle gras. The sites dressed with the occlusive dressing healed significantly faster and were more comfortable than the sites with the semi-open dressing.
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Adequate treatment of pain after surgery is central to the care of postoperative patients. Preventing pain or reducing its impact makes subsequent pain management easier. The establishment of 'acute pain relief services' will improve relief offered. Recent pharmacological, psychological and technical advances in this field are briefly discussed.