Langenbecks Archiv für Chirurgie
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Penetrating cardiac injuries provide the surgeon until nowadays with a challenging problem due to a high mortality rate. Depending on the mechanism of trauma and the time interval less than 20% of the patients with severe wounds of the heart reach the hospital alive. ⋯ Emergency thoracotomy will help reduce the mortality even in agonal and decompensation patients. With respect to the literature and 31 own cases the diagnosis, the operative management and the results will be discussed.
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Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (each 20 having undergone abdominal or orthopaedic operations). Pentazocine bolusses of each 8 mg were available via a hand-button whenever the patients felt pain relief necessary, and delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). ⋯ Side effects (nausea, emesis, sweating) occurred in about 10-18% but were usually of minor intensity. Circulatory or respiratory problems were not observed during the PCA period. Patient-controlled analgesia is discussed as a promising concept for the treatment of acute pain and clinical pain research.
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An indication for respiratory treatment is given in manifest and for prophylactic mechanical ventilation in expected pulmonal insufficiency. The mortality rate can be reduced by an early respiratory treatment, therefore prophylactic mechanical ventilation should be performed liberally. Mainly patients after abdomino-thoracal operations and major vascular or upper abdominal surgery are at risk for lethal postoperative pulmonary complications.
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In general there are two distinguishable methods of artificial ventilation: assisted spontaneous ventilation and controlled ventilation. Spontaneous ventilation can be supported by CPAP or PEEP, in order to improve oxygenation, and by IMV to improve CO2 elimination. ⋯ In special cases IRV may be applied. High frequency low pressure ventilation methods may be used intra- and postoperatively as well as post-traumatically.
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Langenbecks Arch Chir · Jan 1984
[Psychiatric stress tolerance of acute and chronic surgical patients].
The surgical patient is subjected to psychological stress through fear of pain, operation, anesthesia and finally death. The exact definition of psychic stress and the patient's resistance to it is even more problematic than the definition of somatic stress. It is the doctor's task to alleviate the psychic stress of the patient, to instill confidence and to recognise the limits of his resistance and finally to take all this into consideration in planning his treatment.