Articles: surgery.
-
Biography Historical Article
Edlich drive: a metaphor for the Edlich tradition.
Richard F. Edlich, MD, the Raymond F. Morgan Professor of Plastic Surgery and Professor of Biomedical Engineering, has been honored with the naming of a new road at North Fork Business Park: Edlich Drive. ⋯ Edlich's unparalleled contributions to his community include the establishment of the Emergency Department at the University of Virginia, the implementation of a regional emergency medical system, and the development of the Pegasus Emergency Flight Operations. Other accomplishments include the founding of the Ira DeCamp Regional Burn Center and the Department of Rehabilitation Medicine. "Drive" aptly characterizes Dr. Edlich's unfailing commitment to his many roles as physician, research scientist, community leader, and mentor for medical students and residents.
-
Annals of plastic surgery · Jul 1997
Randomized Controlled Trial Clinical TrialClinical features and outcome of patients admitted to the intensive care unit after plastic surgical procedures: implications for cost reduction and quality of care.
Recent interest in cutting cost and improving utilization and delivery of perioperative services has prompted surgeons to identify patient populations that would benefit from care in an intensive care unit as opposed to intermediate or standard care. The purpose of this study was to evaluate patients admitted to the surgical intensive care unit (SICU) after major plastic/reconstructive surgical procedures in order to determine appropriate perioperative management strategies for these patients. We reviewed retrospectively the data from 2,805 consecutive admissions to the SICU between 1990 and 1996. ⋯ Based on severity of illness scoring and eventual mortality, patients admitted to our SICU after major reconstructive surgery were selected appropriately for that setting. In contrast, the patients who stayed in the PACU for perioperative monitoring did not require life-supporting therapy and, therefore, were overmonitored. Care could be provided in a specialized unit with dedicated nursing specifically trained for that purpose.
-
Continuous epidural infusion of bupivacaine with the opioid fentanyl represents an effective analgesic method in the therapy of strong postoperative pain after major surgery. Preparation of the required infusion solution in syringes with a volume of 50 ml immediately prior to administration is routinely performed by nursing staff in Germany. The effort required for the preparation is associated with logistical and pharmaceutical difficulties. ⋯ The pH baseline value had decreased from 5.48-5.52 to 0.5-0.7 units. The measured values confirm the physicochemical stability of the mixture of bupivacaine hydrochloride 0.06% and fentanyl 0.0002% over a period of 32 days. The infusion bag can be stored for 4 weeks at room temperature.
-
Journal of anesthesia · Jun 1997
Comparison of circulatory and respiratory responses between supplementary epidural buprenorphine and eptazocine administration during and immediately after total intravenous anesthesia.
Opioid supplements are often required in total intravenous anesthesia (TIVA). Most ϰ-opiate receptors are found in the spinal cord, wherea μ-opiate receptors are widespread throughout the brain and spinal cord. Buprenorphine has a strong μ-action with a minute ϰ-action, while eptazocine stimulates ϰ-receptors only. ⋯ A significant analgesic effect (P<0.01) of epidural eptazocine without circulatory and respiratory depression was observed. With epidural buprenorphine, circulatory and respiratory depression during and immediately after anesthesia were significant (P<0.05). These results suggest that medullary μ-stimulation by an epidural opioid induces circulatory (hypervagotonicity and hypervagosensitivity) and respiratory depression, while ϰ-stimulation produces only minimal effects on circulatory and respiratory systems.