Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Apr 1984
ReviewThe importance of acid-base management for cardiac and cerebral preservation during open heart operations.
The basic physiologic characteristics of acid-base equilibria during hypothermia were briefly reviewed. By graphic analysis, four possible clinical strategies for managing the acid-base status of the patient undergoing H-CPB were documented. The effect of hemodilution on buffer capacity was charted in a manner applicable to common current operative procedures. ⋯ However, the need for preservation of the hypoxic heart is overwhelming and, thus, the best acid-base management for cardiac hypothermic operations is significant respiratory alkalosis. The most appropriate sites for the collection of blood samples for gas analysis and measuring temperatures were discussed; "body temperature" is the most unreliable parameter measured. The major characteristics of an "ideal" cardiopreservative solution were described.(ABSTRACT TRUNCATED AT 400 WORDS)
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Controlling seroma formation by the use of closed suction drainage and flap attachment to the chest wall lowered the incidence of seroma formation after mastectomy and axillary dissection below that in other reports. The presumed advantage would be fewer seroma-associated complications, such as infection, impaired shoulder motion and lymphedema.
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Surg Gynecol Obstet · Apr 1984
Comparative StudyA clinical evaluation of chlorhexidine gluconate spray as compared with iodophor scrub for preoperative skin preparation.
In a prospective, randomized study, 737 patients who were evaluated had the operative site prepared preoperatively by either a 0.5 per cent chlorhexidine gluconate spray or povidone-iodine scrub. The wound infection rate in these two comparable groups was not statistically different, although slightly favoring the spray technique (6.0 versus 8.1 per cent). The spray technique challenges the conventional preoperative scrub and offers further advantages of increased effectiveness while also offering savings of time and expense.