Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Sep 1984
Randomized Controlled Trial Clinical TrialImprovement in amino acid use in the critically ill patient with parenteral formulas enriched with branched chain amino acids.
To assess the value of BCAA enriched solutions in patients under stress, we studied five critically ill, intensive care unit patients requiring total parenteral nutrition. Two complete feeding solutions were compared: one containing 15.6 per cent of the amino acids as BCAA and the other enriched to contain 50 per cent as BCAA. These solutions were prepared to be isocaloric and isonitrogenous and were administered in consecutive 24 hour periods. ⋯ Plasma leucine, isoleucine and valine concentrations were also significantly increased with administration of the BCAA enriched solution, whereas plasma levels of glycine, tyrosine and phenylalanine were significantly reduced. These changes represent a normalization of plasma amino acid levels with administration of BCAA enriched solution. In addition, the improved net leucine balance observed during administration of BCAA suggests patients have an improved protein balance while receiving BCAA enriched solutions.
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Surg Gynecol Obstet · Sep 1984
Comparative StudyComparison of analgesic activity of buprenorphine hydrochloride and morphine in patients with moderate to severe pain postoperatively.
Since buprenorphine has been reported to be effectively analgesic yet free of addiction potential, two single-dose, double-blind, parallel studies were conducted to compare its analgesic activity and safety with those of morphine. The patients in each study consisted of patients experiencing moderate to severe postoperative pain. ⋯ The degree of sedation, vital signs and side effects were evaluated. Buprenorphine generally appeared comparable to morphine in the onset and duration of action and in side effect liability.
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Surg Gynecol Obstet · Sep 1984
Percutaneous catheterization of the brachial vein for central venous access.
A method of percutaneous central venous catheterization involving the brachial vein is described. A constant anatomic location and large diameter of brachial vein render a high chance of successful veinpuncture. The gradual increasing size of venous catheters with initial small needle puncture minimizes the possibility of a complication. This technique is recommended when usual percutaneous central venous access is not available.
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Air embolism--the most dangerous complication of central venous catheterization--may occur in several ways. The most frequent is from disconnection of the catheter from the related intravenous tubing. An embolism may present with a sucking sound, tachypnea, air hunger, wheezing, hypotension and a "mill wheel" murmur. ⋯ Immediate treatment includes placing the patient in the left lateral and Trendelenberg positions, administration of oxygen and aspiration of air from the heart. Cardiac massage and emergency cardiopulmonary bypass may be necessary. Most instances can be prevented by inserting the cannula with the patient in the Trendelenberg position, occluding the cannula hub except briefly while the catheter is inserted, fixation of the catheter hub to its connections and occlusive dressing over the track after removal of the catheter.