Dan Med Bull
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Randomized Controlled Trial Comparative Study Clinical Trial
Anesthesia related hypoxemia. The effect of pulse oximetry monitoring on perioperative events and postoperative complications.
The objectives of the present investigation were to evaluate the extent of perioperative hypoxemia and to investigate the impact of pulse oximetry monitoring on the extent of hypoxemia and on perioperative morbidity in adults. To accomplish these objectives a number of prospective studies were carried out. The incidence, duration, and severity of hypoxemia were evaluated in two single blinded observer studies in the operating room (N = 296) (I) and in the Postanesthesia Care Unit (N = 200) (II). ⋯ Several changes in PACU care were observed in association with the use of pulse oximetry. These included higher flow rates of supplemental oxygen (P < 0.00001), increased use of supplemental oxygen at discharge (P < 0.00001), and increased use of naloxone (P < 0.02). One or more postoperative complications occurred in 10% of the patients in the oximetry group and in 9.4% in the control group (NS).(ABSTRACT TRUNCATED AT 400 WORDS)
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Prevention of injury-induced functional alterations in the central nervous system by pre-emptive analgesia or other techniques is a fascinating working hypothesis based on substantial scientific evidence. Although experimental data may provide a rationale for this concept, translation into clinical practice has led to some debate, especially about interpretation of results from studies in postoperative patients (Katz et al. 1992a, 1993; Dahl et al 1992a, 1993b; Dahl & Kehlet 1993a). This may partly be due to a difference in experimental versus clinical benefits from pre-emptive analgesia and furthermore, clinicians may ask if preoperative administration of morphine or other opioids is really a "novel approach" (Katz 1993) to the management of postoperative pain. ⋯ Thus, the idea originates from experimental studies, often with anaesthetized or decerebrated animals, and with nociceptive stimuli which did not involve severe ongoing tissue damage. The various types of noxious stimuli (C-fiber stimulation, heat-, chemical-, inflammatory- and neuronal lesions) may differ from the surgical injury, and the time-scale of the experiments, and the profiles of analgesic effects and efficacy may differ from the clinical situation. In a study of patients undergoing gynaecological laparotomy, increased sensitivity to noxious electrical stimulation of the sural nerve was observed postoperatively, with a corresponding trend in the nociceptive flexion reflex.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Plasma cholecystokinin in obese patients before and after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio--no role in the increased risk of gallstone formation.
Jejunoileal bypass surgery for obesity increases the risk of gallstone formation, and, contrary to expectations, the incidence is greater in patients with a long as compared to a short ileum left in continuity. Impaired gallbladder motility due to reduced cholecystokinin (CCK) stimulation could be an explanation. The aim of this study was to investigate the CCK levels in such patients. ⋯ Postoperative changes in plasma CCK levels neither explain the increased risk of gallstone formation after bypass surgery nor the higher incidence with a long compared to a short ileum left in continuity in the bypass.
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The present study describes risk factors, the incidence of complications and mortality in the anaesthetized patient. The aims were further to identify additional patient-, anaesthesia-, technique-, and surgery-related factors associated with cardiopulmonary complications and mortality, to describe the value of preoperative radionuclide cardiography in patients with cardiopulmonary insufficiency, and to evaluate the importance of perioperative manual evaluation of the response to train-of-four nerve stimulation for the occurrence of residual neuromuscular blockade in the recovery room. Complications attributable to anaesthesia-complications caused mainly by the anaesthetic procedure-occurred in 0.6% (1:170) of the patients, and mortality attributable to anaesthesia was found to be 0.04% (1:2500). ⋯ Postoperative pulmonary complications in comparable groups of patients depend primarily on the type of surgery, as major abdominal surgery was related to the highest incidence of pulmonary complications. Regional anaesthesia may be a superior technique to general anaesthesia, especially in elderly patients with chronic obstructive lung disease admitted to major orthopaedic surgery. Furthermore, in avoidance of postoperative complications such as residual neuromuscular blockade, the choice of muscle relaxant was more decisive than was manual evaluation of the response to train-to-four nerve stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)
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Comparative Study
Short- and long-term survival after aortic balloon valvuloplasty for calcified aortic stenosis in 137 elderly patients.
Percutaneous transluminal balloon aortic valvuloplasty was performed in 137 patients with symptomatic severe calcified aortic stenosis (50 men and 87 women, mean age 77 years) between December 1986 and September 1990. The purpose of the study was to evaluate short- and long-term survival after balloon aortic valvuloplasty, mean follow-up was 19 months. At the time of balloon aortic valvuloplasty congestive heart failure (NYHA III-IV) was present in 89%, angina pectoris in 47%, and syncope in 31% of the patients. Aortic balloon dilatation produced significant decreases in peak pressure gradient from 91 +/- 34 mmHg to 40 +/- 26 mmHg (p < 0.001). The procedure related mortality was 8% (11 pts) and the 30-days mortality 17% (23 pts). Severe complications occurred in 25% of the patients during the procedure and within the first 24 hours. Immediate clinical improvement was noted in 68% of the patients surviving the treatment. The overall survival rate was at one, two, three and four years follow-up 63%, 40%, 28%, and 21%, respectively. These survival rates were all statistically different from the survival rates in an age- and sex-matched background population (p < 0.001). A multivariate Cox analysis revealed that only female sex and angina before treatment seemed to improve survival. ⋯ The long-term outcome after aortic balloon valvuloplasty for severe aortic stenosis is so poor that we recommend aortic valve replacement as the initial treatment in these patients, if at all possible.