Articles: surgery.
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A fluid therapy plan for a patient is developed prior to surgery and is designed to meet each patient's needs. The volume and type of fluid are dependent on the patient's physical status; the acid-base, fluid, and electrolyte status; the surgical procedure; and the expected losses occurring during the procedure. No one fluid regimen is ideal for all patients. ⋯ Balanced replacement fluids may be used to replace blood loss at a ratio of 3:1 and are added to maintenance and replacement requirements. Blood loss of 20% to 25% of the calculated blood volume or hematocrit values less than 20% are indications for colloids or blood replacement at a ratio of 1:1. The optimal fluid therapy regimen for a patient may involve a combination of crystalloids as well as natural and synthetic colloids, using each type of fluid to obtain and maintain perfusion and oxygenation to the tissues.
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There has been a substantial increase in the use of analgesics for pain management in the last 10 years. Traditionally, veterinarians have not been trained in the identification of or monitoring of patients that are in pain, even though an evaluation of pain is inherent in assessing improvement in many medical and surgical diseases. Until recently, the physiology and pharmacology of opioids, NSAIDs, local anesthetics, and alpha 2 agonists were taught, but the therapeutic role of these drugs was generally believed to be related to restraint, anesthesia, or control of inflammation rather than to pain management.
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Dent. Clin. North Am. · Apr 1999
ReviewMedicolegal considerations for office-based anesthesia in dentistry.
Over the past decade, there has been a virtual explosion in the demand and utilization of office-based ambulatory anesthesia services in dentistry. Not surprisingly, with this increased demand has come an increased exposure to medicolegal risks and concerns for the unwary or unprepared dental practitioner. This article provides the practitioner with a brief overview of the potential medicolegal risks and recent trends in litigation that may arise in today's office-based anesthesia practice.
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Ann Chir Plast Esthet · Feb 1999
Case Reports[Humanitarian surgery of the hand. Our experience in Vietnam].
After a general presentation of the geographical and social aspects of Vietnam, the authors describe the conditions of their surgical work during short time humanitarian hand surgery missions. These missions, lasting 7 to 10 days are dedicated to the care of children, and a half-day of teaching for Vietnamese corresponding surgeons. The technical and material limits, the constraints for the patients to travel to the hospital, to pay for care and the difficulties of follow-up, require the selection of patients in whom the disease can be treated in a single stage procedure. ⋯ For reason of complexity and unreliability of electromyographic examination, brachial plexus injuries cannot be treated, except the simplest cases needing one or two tendon transfers. Concerning skin coverage and reconstructive surgery, our experience has shown that pedicled local and locoregional flaps, and even microsurgical transfers are adapted and reliable techniques due to the imperative of single stage procedure. The education and teaching of young surgeons in European teams and regular relation-ships with corresponding surgeons from developing countries are certainly the best way to promote humanitarian hand surgery.