Journal of perioperative practice
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As our elderly population increases, theatre staff are frequently presented with the challenges of caring for patients with co-morbidities who are undergoing surgery. This article aims to educate the reader about Parkinson's disease, and suggest interventions that perioperative practitioners may want to consider in order to improve the patient's experience in the operating department.
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Gas gangrene is a painful, rapidly developing and potentially fatal infection despite antibiotic treatment. During the First World War thousands of soldiers died from this disease. Dr Alexis Carrel pioneered a controversial method of irrigating wounds with Dakin's solution to destroy Clostridium perfringens, a bacterium found in heavily fertilised soils that causes gas gangrene. Although this method is no longer used due to the discovery of antibiotics, many of his other ideas, such as scientifically determining the type and number of bacteria and delaying the closure of a wound until the bacteria had been eradicated, are still used today.
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Plain cervical spine radiographs are the first line investigation in trauma patients to exclude cervical spine fractures and dislocations. Adequate views are essential to reduce the risk of missing diagnoses. Injuries may however not be visible on plain cervical spine radiographs despite adequate views. Additional imaging such as computer tomography scanning is indicated in the event of a normal plain radiograph if there is any clinical suspicion of injury.
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The decision to transfuse patients perioperatively is made on an individual basis and should consider factors such as duration and severity of anaemia, symptoms, physiological parameters and comorbidities. Autologous blood transfusion has the benefit of avoiding some of the immunological and infective complications associated with allogenic blood transfusion. Pharmacological agents as well as anaesthetic and surgical techniques have a role in avoiding the need for blood transfusion.
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If you should ask me to name the most important date in the whole history of surgery, I would reply, without a moment's hesitation, Friday October 16th 1846. The operation was a simple, almost trivial procedure, the removal of a small benign lump in the neck, but it marked the watershed between the past agonies of surgery and the modern era, where our patients enjoy the blissful oblivion of anaesthesia.