ANZ journal of surgery
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ANZ journal of surgery · May 2004
Randomized Controlled Trial Clinical TrialEarly oral feeding after colorectal resection: a randomized controlled study.
Nasogastric (NG) intubation is widely used following elective abdominal operations although it is associated with morbidity and discomfort. The present study is a randomised controlled trial on the effect of early oral feeding without NG decompression following elective colorectal resection for cancer. ⋯ Patients undergoing elective colorectal resection can be managed without postoperative NG catheters, starting oral feeding on the first postoperative day. Albeit, no reduction in postoperative hospital stay or patients' well being could be detected, abolition of postoperative NG intubation with early oral feeding was a safe approach, with only 20% of patients requiring NG decompression because of repeated episodes of vomiting.
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The accurate initial assessment and management of burn injuries influences subsequent clinical outcome. The purpose of the present study was to evaluate, over a 12-year period (1989-2001), changes in the practices of referring hospitals in terms of early management of patients with burn injuries prior to transfer to a burns unit. ⋯ Over this 12-year period, there has been marked improvement in referral practices and appropriate initial fluid resuscitation for patients with burn injuries. Referring hospitals' assessment of burn size has not improved. Possible reasons for the observed changes include: increased postgraduate education programmes by the Royal Australasian College of Surgeons and the Australian and New Zealand Burns association; the formalization of emergency medicine training programmes by the Australasian College of Emergency Medicine and increasing awareness within the medical community of the presence of dedicated burns units.
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ANZ journal of surgery · May 2004
Protocol-based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics.
There is evidence that antibiotics can be used as primary treatment for appendicitis, however, delayed surgical treatment might still be associated with perforation. Most patients at risk of perforation have high Alvarado scores. We designed a protocol-based approach to suspected appendicitis, in which the Alvarado score was used to select patients for early treatment with surgery or outpatient antibiotics. ⋯ This protocol-based approach to suspected appendicitis is feasible. A prospective controlled study would be required to confirm potential benefits (in terms of short hospital stay) and to confirm that there is not an increase in adverse outcomes.
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The submental route for endotracheal intubation is an alternative to nasal intubation or tracheostomy in the surgical management of patients with complex craniomaxillofacial injuries. The critical indication for submental intubation is the requirement for intraoperative maxillomandibular fixation (MMF) in the presence of injuries that preclude nasal intubation and in a situation where a tracheostomy is not otherwise required. MMF to re-establish dental occlusion is essential for a normal functional result in dentate patients with fractures involving alveolar segments of the jaws. ⋯ These cases have been retrospectively reviewed and there have been no significant complications. The indications and technique used are described. Submental intubation is a simple and useful technique with low morbidity in selected cases of craniomaxillofacial trauma and the author's clinical experience with this technique is described.