The Surgical clinics of North America
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Organ donation and successful retrieval of life-saving organs is a complex process involving coordination of multiple transplant teams. Once brain death has been declared, assessment of the medical suitability of the donor and the arrangement of appropriate retrieval teams of surgeons is the responsibility of the organ procurement organization. A meticulous operative approach to the multiple organ donor is necessary to maximize the benefits to potential recipients of cadaveric organs.
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The surgeon should be cognizant of both the intraoperative and postoperative consequences of intraoperative fluid administration. Optimal fluid management should take into consideration the patient's overall condition and should not be based solely on the cardiovascular response to volume loading. The selection of a particular fluid for resuscitation solution should be tailored to the patient's individual situation. ⋯ Colloid preparations should not be avoided for fear of inducing pulmonary edema, and the use of hypertonic solutions should not be precluded by fear of potential metabolic complications. The judicious use of both hypertonic solutions and colloids is safe. For the vast majority of routine surgical cases, where the patient is hemodynamically stable and postoperative fluid overloading is not a significant problem, isotonic crystalloids such as lactated Ringer's are both sufficient and cost effective.
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Surg. Clin. North Am. · Apr 1993
ReviewDifferential diagnosis and management of unexplained bleeding.
A brief overview of normal hemostasis is reviewed. Congenital and acquired causes of bleeding are discussed. Methods for evaluation of the coagulation system of the patient prior to an operative procedure are outlined. A strategy for characterizing intraoperative bleeding disorders and appropriate interventions are discussed.
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Surg. Clin. North Am. · Apr 1993
ReviewEmpiric antibiotic therapy of abdominal sepsis and serious perioperative infections.
This article discusses empiric therapy for several serious infections in surgical patients. The accepted antibiotic treatment for purulent peritonitis, the empiric treatment of postsurgical wound infection, and the empiric treatment of postsurgical pneumonia are discussed. The cost of the various regimens is listed. Recommendation of the various regimens is based on the seriousness of the infection, peculiarities of the hospital flora, effectiveness of the regimens, and cost.
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Surg. Clin. North Am. · Feb 1993
ReviewPreoperative evaluation and postoperative surveillance for patients with colorectal carcinoma.
As the understanding of the biology of carcinoma of the colon and rectum increases and the effectiveness of adjuvant therapy for patients with such carcinoma improves, preoperative staging of disease has assumed an increasingly important role. The rationale and specifics of preoperative evaluation and the role, rationale, and controversies regarding postoperative surveillance after curative resection of colorectal carcinoma are discussed.