Surgery, gynecology & obstetrics
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To identify predictors of postoperative congestive heart failure (CHF), a high-risk population, mainly hypertensive and diabetic patients undergoing elective general operations, was studied. Of the 254 patients, 6 per cent had postoperative CHF. Among patients with preoperative cardiac disease (that is, previous myocardial infarction, valvular disease or CHF), 17 per cent had postoperative CHF; in contrast with less than 1 per cent of those without cardiac disease (p less than 0.001). ⋯ Of note, postoperative failure rates were highest among patients with less than 500 milliliters per hour of net intake (input and output) (p less than 0.03). Risk for postoperative CHF was restricted to patients with preoperative symptomatic cardiac disease and was especially high if patients also had diabetes. Intraoperative fluctuations in mean arterial pressure increased the probability of postoperative failure, while the intraoperative administration of higher net volumes of fluid was associated with decreased risk.
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Surg Gynecol Obstet · Feb 1991
Simple technique for long term central venous access in the patient with thrombocytopenic carcinoma.
A technique for the insertion of a central venous access device in the patient with thrombocytopenia is described. Using the Seldinger technique, a wire is placed into the internal jugular vein. A catheter tunneled from the anterior part of the chest is inserted through a peel-away sheath into the central venous system. The incision is then closed.
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Victims of penetrating trauma often arrive at a trauma center within minutes of sustaining their injury but nevertheless are in a state of deep circulatory shock. Such patients require extensive resuscitative efforts; in particular, some benefit from rapid, massive normothermic fluid resuscitation. During an initial one year period, 153 of 730 patients required immediate operation and, of these, 33 required rapid infusion defined as greater than 5 liters per hour during the first hour. ⋯ There was a statistically significant improvement in clinical flow rates, decrement in resuscitation times and unexpected survival. In particular, the latter group (nine survivors) included four who were clinically dead in the field or on arrival at the trauma center, or both. Rapid infusion of normothermic fluids may be of benefit not only in penetrating trauma but also more generally in the management of massive hemorrhage.
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Surg Gynecol Obstet · Oct 1990
Comparative StudyImmediate preoperative phlebotomy with autologous blood donation for aortic replacement.
The preferential use of autologous blood provided by phlebotomy can reduce the need for homologous blood transfusion in patients undergoing extensive elective operations. This blood is usually provided either by intraoperative isovolemic hemodilution or phlebotomy one to two weeks preoperatively. To minimize the intraoperative time delay or preoperative period between phlebotomy and operation required in these patients, we performed preoperative isovolemic hemodilution in 69 patients one to two days prior to elective aortic replacement for infrarenal aneurysmal disease. ⋯ Surgical treatment of large aortic aneurysms is frequently performed on an urgent basis; thus, provision of autologous blood for this operation in a short period of time may be beneficial. Isovolemic hemodilution performed during the immediate preoperative period can reduce homologous blood requirements and be safely performed without adverse effects on mortality, morbidity and myocardial performance. Exclusion aneurysmorrhaphy may further reduce dependence on homologous blood.
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Surg Gynecol Obstet · Sep 1990
Tourniquet technique for reduced blood loss and wound assessment during excisions of burn wounds of the extremity.
Our surgical technique incorporates the advantages of previous techniques with some additional advantages described herein. We have found it a safe and effective method to reduce intraoperative bleeding, allow for intraoperative inspection of excised wounds and prevent the need for massive transfusions during excisions of burn wounds of the extremity.