Annales chirurgiae et gynaecologiae
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Randomized Controlled Trial Clinical Trial
The effect of thoracic epidural analgesia on postoperative stress and morbidity.
A hundred patients scheduled for cholecystectomy were randomized to either thoracic epidural anaesthesia and analgesia for 24 h with bupivacaine intraoperatively about 100 mg and 15 mg/h thereafter (TEA) for postoperative analgesia, TEA combined with general anaesthesia (low dose fentanyl) (TEA + GA) and general anaesthesia (GA) (low dose fentanyl). During TEA and TEA + GA the arterial pressure was significantly decreased as compared with GA. TEA was associated by an intense haemodilution in comparison with GA. ⋯ The postoperative alleviation of the alteration of the above mentioned parameters by TEA was slightly diminished in the TEA + GA group. However, we found no significant reduction in cardiac dysrhythmias (TEA 7%, TEA + GA 7% and GA 10%), ST-segment depression (TEA 17%), TEA + GA 3.3% and GA 12.5%), wound complication (TEA 3%, TEA + GA 0%, GA 0%), pneumonia (TEA 3%, TEA + GA 3% and GA 0%), subphrenic abscess (TEA 6%, TEA + GA 0%, GA 3%), mortality (TEA 0%, TEA + GA 3%, GA 0%), and urinary tract infect (TEA 17%, TEA + GA 7% and GA 2.5%). Since an equal number of patients in each group, about 30%, suffered one or more of the postoperative complications this epidural analgesia was not effective in reducing postoperative morbidity albeit the significant alleviation of the postoperative stress response.
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Comparative Study
Prevention of fat embolism syndrome in patients with femoral fractures--immediate or delayed operative fixation?
From January 1976 until August 1980, femoral fractures in our department were initially stabilized with tibial traction and fixed operatively after 4-7 days. From August 1980 the fractures were treated with immediate operative fixation. ⋯ Eleven patients (10.4%) developed fat embolism syndrome in the group treated with delayed fixation, compared with two patients (1.8%) in the immediate osteosynthesis group (p less than 0.02). We concluded that early operative fixation of femoral fractures seems beneficial for the prevention of fat embolism syndrome.
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Randomized Controlled Trial Clinical Trial
Minor complications following anaesthesia in young adults for orthopaedic surgery of the lower extremity.
In all, 175 young (15-40 yr) patients received either spinal anaesthesia with bupivacaine (104 patients) or general, balanced anaesthesia (71 patients) for orthopaedic surgery of the lower extremities. Each patient was interviewed before the operation, problems that arose during the operation were recorded and all patients were interviewed on the first postoperative day. One hundred and seven patients were interviewed after being discharged, 1-3 months after the operation. ⋯ All these problems had ceased at the interview 1-3 months later. Eight (six spinal and two general anaesthesia patients) were not satisfied with the method of anaesthesia used. This study revealed that an appreciable number of young patients have complications after anaesthesia, but the complications are minor and self-limited.
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In 1980 there were 1296 emergency hospitalizations for burn injuries in Finland, averaging 27 per 10(5) inhabitants. The incidence varied from 20 to 58 per 10(5) by central hospital district, 70% of the patients were men. The incidence was higher among men than women at all ages. ⋯ The average duration of the emergency hospital stay was 14.3 days. Causes of regional variation and high incidence among old men require further research. The establishment of burn units in high risk areas should be considered.