Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Dec 1976
Factors influencing the ionization of calcium during major surgical procedures.
The existence of a clinically feasible calcium electrode makes it possible to obtain rapid, accurate levels of ionized calcium. It is now possible to study the actual ionization of calcium under normal and abnormal physiologic conditions. The present investigation was directed at changes in ionized calcium during major surgical procedures. ⋯ Twenty patients in the series had ionized calcium levels below 1.25 milliequivalents per liter, range of 0.51 to 1.24 milliequivalents per liter. With the possible exception of one patient, no adverse cardiovascular effects could be attributed to the low levels of ionized calcium. The results in this series confirm our previous conclusion that the administration of exogenous calcium is not necessary during massive transfusion, with the possible exception of bypass open heart procedures and exchange transfusions in children.
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Surg Gynecol Obstet · Nov 1976
Case ReportsOxygen transport during extracorporeal oxygenation for the treatment of adult respiratory distress syndrome.
An inventory of hemodynamic and respiratory measurements was obtained in two patients with acute respiratory failure syndrome prior to and during venoarterial extracorporeal membrane oxygenation for study of oxygen transport. As the inspired oxygen concentration fraction was reduced from 1.0 to 0.5 and paO2 was increased from less than 50 to physiologic ranges during extracorporeal membrane oxygenation, tachycardia and pulmonary hypertension were reversed. Total oxygen transport was reduced rather than increased. ⋯ After reversal of anoxemia, the total of the cardiac output of the patient and the extracorporeal membrane oxygenation flow were less than the cardiac output of the patient prior to extracorporeal membrane oxygenation. These observations provide evidence that the beneficial effects of extracorporeal membrane oxygenation stem, at least in part, from a reduction of the work load on the heart. Since high cardiac output failure is observed during progression of adult respiratory distress syndrome, mechanical support of circulation during extracorporeal membrane oxygenation may be of primary therapeutic benefit.
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Surg Gynecol Obstet · Oct 1976
Continuous positive airway pressure in the prophylaxis of the adult respiratory distress syndrome.
After an operation upon the abdomen, certain patients have a high risk of developing acute respiratory failure or the adult respiratory distress syndrome. These patients at high risk have been mechanically ventilated during the postoperative period in an attempt to prevent the onset of respiratory insufficiency. As a method of prophylaxis, continuous positive airway pressure has the advantages of increasing the functional residual capacity with minimal effects on the cardiac output, low potential for barotrauma and simplicity of equipment. ⋯ In ten controls, adult respiratory distress syndrome developed, and three died in respiratory failure. Only one of the group receiving continuous positive airway pressure met standard criteria for the diagnosis of adult respiratory distress syndrome. In addition, in 25 patients serving as controls, respiratory complications other than adult respiratory distress syndrome developed compared with the development in only 11 receiving continuous positive airway pressure9
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The records of 98 patients with trauma of the bladder were reviewed. Eighty per cent were injured as a result of blunt trauma, and 72 per cent of these patients had an associated fracture of the pelvis. ⋯ While all patients with intraperitoneal ruptures of the bladder were treated by surgical repair, half of those with extraperitoneal ruptures were successfully managed by catheter drainage alone. Complications of therapy consisted of bacterial cystitis, presumably as a result of catheter drainage.