Articles: surgery.
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Intravenous conscious sedation is currently being widely utilized for outpatient surgery including dermatologic surgery. Even though this type of anesthesia is typically administered by a trained, licensed anesthetist, it is important for dermatologists who either intend to or are currently utilizing this type of anesthesia to be familiar with some of the methods and agents that are commonly employed. ⋯ Propofol when used in conjunction with fentanyl appears to be a safe, quick, and effective method of providing conscious sedation.
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Clostridium perfiringens may cause myonecrosis (i.e. gas gangrene), acute food poisoning or necrotic enteritis (e.g. enteritis necroticans or Pig Bel). We describe a case of enteritis necroticans in a 33 year old man with acute myeloid leukaemia. ⋯ Treatment of enteritis necroticans requires urgent surgery to remove dead bowel and in adults intravenous penicillin (1g 2-hourly) and metronidazole (500 mg 8-hourly) or clindamycin (600 mg 6-hourly). While antibiotics may also reduce toxin formation, beta toxoid has not been found to be of benefit in established disease.
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To assess the effects of preoperative aspirin and/or intravenous heparin therapy on perioperative coagulation tests and postoperative blood loss for 24-hour after coronary artery bypass surgery. ⋯ There was no significant difference in either coagulation tests or postoperative blood loss (median of 860 mL with a range of 275 to 2800 mL, versus 833 ml with a range of 500-1380 mL) between the aspirin and no-aspirin patients. Preoperative heparin therapy affected most coagulation tests (e.g. international normalised ratio, activated partial thromboplastin time, thrombin clotting time, prothrombin time, activated clotting time and coagulation time of thrombelastography) before anaesthesia. The effects disappeared following protamine administration and after skin closure. Post operative blood loss was not significantly increased for the heparin group compared with the no-heparin group (median of 850 mL with a range of 700-1400 mL, versus 856 mL with a range of 275-2800 mL, respectively). Similar results were seen in patients receiving preoperative co-administration of aspirin and heparin compared with patients receiving aspirin alone. There was no suppression of platelet activity in patients receiving preoperative heparin or co-administration of aspirin and heparin. However, such suppression was found in patients receiving aspirin only. Conclusion: This study suggests that preoperative aspirin ingestion and intravenous heparin therapy should be administered as indicated and that concerns about the risk of postoperative bleeding should not lead to modification or cessation of such therapy.
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In 1992, Winston published the first large series of patients undergoing cranial neurosurgery without hair removal (Winston KR: Hair and neurosurgery. Neurosurgery 31:320-329, 1992). Prompted by this report, the senior author began a prospective trial in 1992 of cranial neurosurgery without hair removal. ⋯ Cranial surgery without hair removal is safe and is not associated with a discernible increased risk of infection. There are simple techniques for keeping hair out of the wound. Patients are highly desirous of keeping their hair and react very positively to this option. We advocate a greater practice of this technique in neurosurgery.
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Plast. Reconstr. Surg. · Jun 1999
Changes in compliance predict pulmonary morbidity in patients undergoing abdominal plication.
The incidence and severity of the effects of pulmonary compliance changes were investigated in patients undergoing abdominal plication surgery. A total of 20 healthy adults scheduled for abdominal plication surgery who had no significant history of pulmonary disease and 20 adults scheduled for nonabdominal, nonthoracic surgery (control group) underwent general endotracheal anesthesia; neuromuscular blockade was confirmed with electrical twitch monitoring. Before abdominal plication, the mean airway compliance was measured under total neuromuscular blockade at 33.4 +/- 2.1 ml/cm water, which was not significant when compared with control patient values. ⋯ Patients with airway compliance changes of less than 4 ml/cm water (when compared with preplication pulmonary mechanics) had far less incidence of atelectasis, requirements for supplemental oxygen at 24 hours or longer, or hypoxia when compared with patients with compliance changes of greater than 4 ml/cm water. Patients with compliance changes greater than 9 ml/cm water had the highest incidence of pulmonary morbidity. These data suggest that significant changes in pulmonary compliance occur after abdominal plication and that these airway compliance changes are associated with a clinically increased incidence of pulmonary morbidity in the postoperative period.