Articles: surgery.
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The spectrum of perioperative pain treatment is discussed in the present review. The analgesic efficacy of various drugs and the dosage methods of administration and side effects reported for them in such reference works as the practical guide on the management of acute pain recently published by the International Association for the Study of Pain (IASP) are described. Effective postoperative analgesia can diminish stress reactions following surgery. ⋯ Investigations performed by the author of this review have shown that epidural infusion of highly diluted mixtures of bupivacaine/fentanyl is highly effective in the analgesic treatment of patients undergoing prostatectomy, providing excellent physical mobilization. The potential dangers of drug combinations and contraindications are also discussed. The concept of using balanced analgesia to induce additive or synergistic effects following the administration of analgesic drugs requires further clinical studies.
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The use of caesarean section (C. S.) has been analysed in the 12 hospitals of the Midlands Province of Zimbabwe during a 2-year period. Maternal mortality rate, perinatal mortality rate, low birthweight rate, percentage of high risk pregnancy, C. ⋯ S. differentiated the 12 hospitals into two groups. Although there was no difference in the number of high risk patients in these two groups, outcomes were much better in the hospitals with a high ID rate than in the hospitals with a high C. S. rate, suggesting that attitudes of medical staff can influence both the mode of delivery and the perinatal outcome in a developing country.
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Journal of anesthesia · Jul 1993
Differences in the assessment of postoperative pain when evaluated by patients and doctors.
This study was undertaken to compare the assessment of pain intensity by 59 patients and by their doctors according to a visual analogue scale (VAS) at rest and when coughing at 5 and 20 hr after major abdominal surgery. The rating given by the patients, who received epidural analgesia to relieve postoperative pain, was significantly above, and moreover, significantly correlated with that given by the doctors at any time or under any condition of the assessment. ⋯ Our findings indicate that the assessment of postoperative pain may be associated with some unreliability, especially during early periods, when using the subjective or objective-rated VAS at rest separately, and thus requires the combined use or the concomitant use of the VAS when coughing. Substitutional use of the objective-rated VAS for the subjective-rated VAS is not advised.
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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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Postoperative pain can intensify the sympathoadrenergic reaction, which is commonly seen after surgery, and thus possibly pave the way for certain complications, such as coronary ischemia, bronchopneumonia, intestinal stasis, thromboembolism, infection, sepsis, and metabolic disturbances. Investigations of cardiovascular, respiratory, gastrointestinal, metabolic, and immunologic function indicate that high-quality pain relief can diminish postoperative organ impairment and failure. Some aspects of the improvements attributed to the quality of analgesia, such as prevention of tachycardia and hypertension, attenuation of hyperglycemia and catabolism, improvement of gastrointestinal motility and cellular immunity cannot be definitely distinguished from the effects of sympathetic blockade due to epidural analgesia with local anesthetics, however. ⋯ Some studies indicate that better analgesia is advantageous for the patient, especially with respect to postoperative complications, hospital stay, long-term well being, and costs. In other clinical trials incorporating more patients, however, this hypothesis had to be rejected. At present, therefore, we cannot state that effective pain relief influences postoperative morbidity and mortality.