Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Dec 1991
The role of anesthetic induction agents and neuromuscular blockade in the endotracheal intubation of trauma victims.
Management of extensive trauma often requires immediate tracheal intubation and mechanical ventilation. The role of anesthetic induction agents and neuromuscular blockade in the airway management of the trauma victim is disputed. To better define the role of these agents in the acute management of trauma, the adult trauma registry of The Johns Hopkins Hospital was reviewed to determine the frequency of use of these agents in acute airway management and to assess the effect of these agents on the incidence of complications. ⋯ None of these patients received drugs prior to the first attempt at intubation. No hemodynamic or neurologic complications, related to relaxant or induction agent use, were observed. These findings suggest that oral intubation with drugs to facilitate airway management is most likely to result in successful intubation on the first attempt and that drug use in the trauma setting is safe.
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Surg Gynecol Obstet · Dec 1991
Effects of early tangential excision and grafting on survival after burn injury.
This report quantifies the increase of burn survival, which we believe is associated with the use of early tangential excision and grafting as opposed to conventional therapy in adult patients with burns. To quantify the increase, we compared the lethal area 50 of various age groups with that of previous historical studies that used other techniques. These data suggest that early excision and grafting are associated with a marked improvement in survival in patients 41 to 60 years of age with 20 to 65 per cent total body surface area burns.
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Surg Gynecol Obstet · Dec 1991
Randomized Controlled Trial Clinical TrialThe use of bupivacaine in elective inguinal herniorrhaphy as a fast and safe technique for relief of postoperative pain.
The intraoperative use of local anesthetic agents to decrease postoperative pain has been used in many types of procedures. Most of these techniques involve needle injection of anesthetic and result in a low but troublesome incidence of complications. In this study, we evaluated the reliability, safety, and efficacy of a technique emphasizing bathing of tissues with anesthetic rather than needle injection for relieving postoperative pain. ⋯ Objectively, groups 1 and 2 required fewer total doses of pain medication and waited longer before requesting oral pain medication postoperatively compared with those in the control group. No complications occurred that could be attributed to the technique. The results of this study indicate that the bathing of wounds with 0.5 per cent bupivacaine with or without epinephrine 1:200,000 is a safe and effective method of decreasing postoperative pain for several hours in patients undergoing elective inguinal herniorrhaphy.(ABSTRACT TRUNCATED AT 400 WORDS)
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Surg Gynecol Obstet · Dec 1991
Base deficit as a sensitive indicator of compensated shock and tissue oxygen utilization.
To determine the relationship of the arterial base deficit (BD) to physiologic indicators of shock and resuscitation--heart rate, mean arterial pressure (MAP), cardiac output (CO), arteriovenous oxygen difference (AVO2), mixed venous oxygen saturation (VSAT) and oxygen delivery to consumption ratio (RATIO)--16 swine were monitored invasively, bled 40 per cent of their calculated blood volume and resuscitated with crystalloid and blood. During hemorrhage, the MAP, CO, VSAT and RATIO decreased and the BD and AVO2 increased. One hour after hemorrhage, but before crystalloid infusion, the MAP, VSAT and RATIO had increased significantly from previous levels and the AVO2 had narrowed significantly, while the BD showed no significant change. ⋯ BD accurately reflected the hemodynamic and tissue perfusion changes associated with hemorrhagic shock and resuscitation in this model. BD can be used as an indicator of the severity of the shock state and the efficacy of resuscitation when invasive monitoring is impractical or not available. BD was more reflective of the true volume deficit during compensated shock than other physiologic variables in this study.