Journal of the Royal College of Surgeons of Edinburgh
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Major alteration in respiratory mechanics occur in all patients following anaesthesia and thoracotomy because of a decrease in the functional residual capacity with minimal change in the closing volume leading to airway closure during tidal breathing and atelectasis. Diminished pulmonary reserve, because of non-pulmonary and pulmonary risk factors before operation, and/or restrictive ventilation and abnormal pattern of breathing due to postoperative pain sustain and aggravate these changes. ⋯ Effective postoperative regional analgesia minimizes impairment of pulmonary function, aids in its recovery, and prevents postoperative pulmonary complications. The adjuvant use of chest physiotherapy and incentive spirometry should also help in decreasing the adverse affects of anaesthesia and surgery on the chest and thereby reduce the frequency and severity of postoperative complications.
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A retrospective analysis of the deaths in the Bangour Burn Unit over a 10-year period is given. Factors involved include the age of the patient and the percentage area of the burn, but concomitant medical conditions are of importance. Smoke inhalation represents a significant additional risk.
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J R Coll Surg Edinb · Jun 1989
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia following inguinal herniotomy or orchidopexy in children: a comparison of caudal and regional blockade.
The effectiveness of postoperative analgesia was compared in 44 children undergoing inguinal surgery, 19 of whom received caudal analgesia (1 ml 0.2% bupivacaine/kg) and 25 ilioinguinal block (0.25 ml 0.5% bupivacaine/kg). The requirement for supplementary analgesia (intramuscular morphine) was less in the caudal group, although this did not reach statistical significance in the number studied. Ilioinguinal and caudal blockade both provide useful postoperative analgesia for children following ilioinguinal surgery.