Journal of perioperative practice
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Safe surgery is a world-wide recognised issue. The World Health Organization statistics show that the occurrence of major complications is between 3 and 16%, and the occurrence of disability and death is between 0.4 and 0.8% (WHO 2009). ⋯ The National Patient Safety Agency (NPSA) has collated over 1 million reports of surgical incidences in England and Wales between October 2006 and September 2007. Weiser et al (2008) quote a world-wide figure of 7 million individuals affected with a disabling complication, and a death rate of 1 million.
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To the lay public, the very idea of an operation on that vital structure, the heart, seems to be out of the question. (In fact, the heart muscle is an incredibly tough machine that can go on pumping, without a single service, for 90 or more years!) Even to the surgeons of the end of the 19th century, who, thanks to the twin discoveries of anaesthesia and antiseptic surgery, were beginning to operate on all the other major organs of the body, heart surgery seemed to remain an impossible dream. Even that great pioneer of modern scientific surgery, Theodor Billroth, Professor of Surgery in Vienna, who had himself already performed the first successful partial gastrectomy for a stomach cancer and the first laryngectomy, wrote, in 1893, 'Any surgeon who would attempt an operation on the heart should lose the respect of his colleagues'.
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The use of Intraoperative Cell Salvage (ICS) in obstetrics has been slow to develop as a result of theoretical concerns relating to amniotic fluid embolism and fetal red cell contamination. In this article we examine the current UK position on the use of ICS in this clinical speciality and the recommendations for its safe and appropriate use.