Annales chirurgiae et gynaecologiae
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Randomized Controlled Trial Clinical Trial
Continuous interscalene brachial plexus block during and after shoulder surgery.
Continuous interscalene brachial plexus block with a single dose of 0.75% bupivacaine (150-210 mg) with adrenaline, continued with an infusion of plain 0.25% bupivacaine 0.25 mg/kg/h, was performed on 20 patients to provide analgesia during shoulder surgery and in the postoperative period. The control group included 20 patients who were given general anaesthesia for surgery after starting a continuous interscalene brachial plexus block; test dose of 0.75% bupivacaine (22.5 mg) with adrenaline, continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h. Surgery was performed successfully under regional anaesthesia in 16/20 patients; 4/16 were given one dose of fentanyl during the surgery, and diazepam or midazolam as supplementary sedation were given in 13/16 cases. ⋯ There was a statistically significant difference in the mean plasma bupivacaine concentrations between the groups, concentrations in the regional anaesthesia group being higher at 5, 30, 60 min and 3 h (maximum 2.3 micrograms/ml at 60 min), but there was no difference between the values at 24 h. One infusion of local anaesthetic was discontinued because of probable treatment-related side-effects (breathing difficulties, nausea). Mild local anaesthetic toxicity (dizziness, tinnitus) was noticed in four patients.
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A retrospective analysis is presented of 195 consecutive patients with chest trauma, hospitalized from 1976 to 1984 at the Institute of Pathology and Surgery of the University of Cagliari. The most frequent causes were traffic accidents. In 11 patients the trauma was penetrating while 184 presented with blunt trauma. ⋯ Early osteosynthesis was performed in the 22 patients with flail chest and in 15 with multiple depressed fractures. Total mortality was 4.1%, and 13.6% in patients with flail chest. All deaths were associated with significant extrathoracic injuries.
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The investigation is a report of postoperative fever in 608 patients, who had been subjected to major abdominal surgery. There were 259 patients (259/608: 43%) who developed fever, defined as a temperature higher than or equal to 38 degrees C, on at least two consecutive measurements. ⋯ In those patients where a focus was present the maximum temperature as well as the duration of fever was longer than in patients without a focus. The time from operation to onset of fever did not differ in the two groups.
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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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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.