Articles: surgery.
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At present, intramuscular application of opioids given on request is the most widespread form of postoperative analgesia. This method is widely recognized as often being inadequate, however. As advanced techniques of pain management, such as patient-controlled analgesia, are not generally available, the question arises as to whether non-opioid analgesics should routinely be used in order to improve this situation. ⋯ Despite these results, it must be borne in mind that most studies have been carried out on patients of ASA groups I and II and that conclusions drawn from the literature are not necessarily representative for the elderly and for patients with organ failure. Alternative substances have received relatively little attention. Of these, the pyrazolone derivative, metamizol, may well prove to be of value for patients in whom the use of NSAIDS is contraindicated or relatively ineffective such as after biliary tract surgery.
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Annals of plastic surgery · Jun 1993
The role of alloplastic skeletal modification in the reconstruction of facial burns.
The external appearance of the face is largely dictated by its supporting facial skeleton. After an extensive thermal injury, the underlying facial skeleton may need to be either augmented or restored to maintain the functional and aesthetic appearance of the face. The factors that make a structural reconstruction difficult are poor vascularity and compliance of the scar tissue, extreme contractile forces of the scar, and unstable skin coverage. ⋯ There were no other implant-related complications. We believe that skeletal modification is an important step for a successful facial burn reconstruction. Porous polyethylene offers a promising solution for the complex reconstructive problem of using an alloplast in the environment of a facial burn.
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Many studies investigated patient-controlled analgesia (PCA) in the postoperative period in recovery rooms under anaesthesiologic monitoring but reports on the advantages and indications of PCA in surgical wards are scarce. The aim of this prospective study therefore was to investigate PCA as a routine technique in surgical wards. In particular we were interested in safety and in the efficacy of analgesia. ⋯ We conclude that PCA with piritramide is a safe technique when performed under routine conditions on surgical wards. However, standardized monitoring is mandatory. PCA leads to effective analgesia and consequently to greater comfort of surgical patients in the postoperative period. These conclusions hold only for patients with ASA status I-II who have undergone operations of the types listed above.
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The aim of this study was to investigate the relationship between preoperative oral fluids and gastric pH and volume in women undergoing sterilization between one and five days postpartum. Fifty postpartum patients received 150 ml water approximately two to three hours before surgery while 50 postpartum and 50 non-pregnant women were fasted from midnight. After induction of anaesthesia, gastric contents were aspirated using a Salem sump tube and the gastric pH and volume were measured. ⋯ There was no correlation between postpartum interval, 60 (12-120) hr, and intragastric pH or volume. It is concluded that oral water may be given safely two to three hours preoperatively to patients more than one day postpartum. Intragastric volume and acidity were not increased and the findings in postpartum patients were similar to those found in non-pregnant patients.
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Am. J. Obstet. Gynecol. · Feb 1993
Comparative StudyA five-year experience with second-trimester induced abortions: no increase in complication rate as compared to the first trimester.
Our purpose was to compare the complication rate of first-trimester suction curettage with that of second-trimester dilation-and-evacuation abortions in the same clinical setting. ⋯ A careful approach to second-trimester dilation-and-evacuation procedures can make them comparatively as safe as suction curettages, contrary to common belief derived from large surveys done in the late 1970s.