Surgery
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Randomized Controlled Trial
Long-term oxandrolone treatment increases muscle protein net deposition via improving amino acid utilization in pediatric patients 6 months after burn injury.
We recently showed that mechanisms of protein turnover in skeletal muscle are unresponsive to amino acid (AA) infusion in severely burned pediatric patients at 6 months postinjury. In the current study, we evaluated whether oxandrolone treatment affects mechanisms of protein turnover in skeletal muscle and whole-body protein breakdown in pediatric burn patients 6 months postinjury. ⋯ Long-term oxandrolone treatment increased net deposition of leg muscle protein during AA infusion by attenuating protein breakdown, but did not affect whole-body protein breakdown.
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Randomized Controlled Trial
Intensive insulin treatment increases donor site wound protein synthesis in burn patients.
In the treatment of burns, patients' own skin is the preferred material to cover burn wounds, resulting in the need to create a donor site wound. Enhancement of healing of the donor site wound would be beneficial in burn patients. Insulin, an anabolic agent, is used routinely to treat hyperglycemia after injury. We investigated whether intensive insulin treatment increases fractional synthesis rate (FSR) of the donor site wound protein and decreases the length of hospitalization normalized for total body surface area burned (LOS/TBSA). ⋯ Insulin treatment increased FSR of the donor site wound protein in the early period of wound healing; FSR correlated with LOS/TBSA independent of the treatment regimen.
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Randomized Controlled Trial Comparative Study
A comparative study between 1 and 2 effective doses of rocuronium for intraoperative neuromonitoring during thyroid surgery.
The goal of this study was to explore an ideal application of rocuronium to enable adequate muscle relaxation for intubation without significantly affecting the evoked potentials measured by intraoperative neuromonitoring during thyroid surgery. ⋯ A total of 1 ED(95) of rocuronium (0.3 mg/kg) is an optimal dose for intraoperative neuromonitoring during thyroid surgery. Positive and high EMG signals were obtained in all patients at an early stage of operation, and satisfactory intubating conditions were achieved in most patients.
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Randomized Controlled Trial
Propranolol decreases cardiac work in a dose-dependent manner in severely burned children.
Severe burn is followed by profound cardiac stress. Propranolol, a nonselective β(1,) β(2)-receptor antagonist, decreases cardiac stress, but little is known about the dose necessary to cause optimal effect. Thus, the aim of this study was to determine in a large, prospective, randomized, controlled trial the dose of propranolol that would decrease heart rate ≥15% of admission heart rate and improve cardiac function. Four-hundred six patients with burns >30% total body surface area were enrolled and randomized to receive standard care (controls; n = 235) or standard care plus propranolol (n = 171). ⋯ The data suggest that propranolol is an efficacious modulator of the postburn cardiac response when given at a dose of 4 mg/kg per day, and decreases and sustains heart rate 15% below admission heart rate.
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Randomized Controlled Trial Multicenter Study Comparative Study
Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial.
The aim of this trial was to confirm previous results demonstrating the efficacy and safety of a fixed combination tissue sealant versus argon beam coagulation (ABC) treatment in liver resection. ⋯ This trial confirmed that TachoSil achieved significantly faster hemostasis after liver resection compared with ABC. Postoperative morbidity and mortality remained unchanged between both groups.