Langenbecks Archiv für Chirurgie
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Langenbecks Arch Chir · Jan 1981
Randomized Controlled Trial Comparative Study Clinical Trial[Parenteral antibiotic prophylaxis or oral antimicrobial bowel preparation for colorectal surgery (author's transl)].
A prospective randomized trial was designed to establish whether parenteral antibiotic prophylaxis was as effective as oral antimicrobial bowel preparation in preventing sepsis after colorectal surgery. Patients scheduled for elective resection of colorectal cancer received metronidazole and kanamycin either orally in the preoperative phase or parenterally as a short-term perioperative prophylaxis. The former regimen resulted in reduction of the microbial concentrations in the bowel contents in the absence of therapeutic serum concentrations at the time of operation, whereas the latter achieved therapeutic intraoperative serum levels without altering the colonic microflora. 72 patients were studied. ⋯ This difference was most probably due to an overgrowth of kanamycin-resistant coliforms during the period of oral antibiotic preparation. The presence of resistant organisms did not, however, result in failure of systemic prophylaxis. The authors conclude that short-term parenteral application is the safer method of antibiotic prophylaxis in colorectal surgery and is to be preferred to oral antimicrobial bowel preparation.
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The newest resuscitation methods are summarized, and the time to train is now. Time can be saved by mouth-to-mouth artificial respiration. Adjuncts for opening the airway should be avoided as an initial measure (masks, bellow devices, S tube, esophageal tube, endotracheal tube). ⋯ If there is no diastolic pressure, there is no flow in the coronary system. Use 6 J/kg body wt. for defibrillation. Drugs and blood-volume increase (dextran 60) should be used alternatively to maintain a stable blood pressure and adequate circulation in the brain as well.