Articles: surgery.
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J. Oral Maxillofac. Surg. · Feb 1991
ReviewPreoperative laboratory testing for the oral and maxillofacial surgery patient.
Studies estimate that approximately 60% of preoperative testing could be eliminated without adversely affecting patient care. Unnecessary testing tends to cause extra risk to the patient, inefficient operating room schedules, and unnecessary costs. ⋯ Furthermore, extra testing may also increase medicolegal risk, because the abnormalities that are discovered are usually not noted on the chart. A reliable and effective method for ordering laboratory tests to assess patients preoperatively and reduce morbidity and cost is presented.
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The effectiveness of local anesthetics is improved by the addition of a vasoconstrictor with an increased duration of action and the ability to decrease both systemic toxic reactions and local bleeding. Epinephrine, the standard drug for vasoconstriction, has some limitations due to potential cardiac and local toxic effects. Using an animal model, we compared the effects of various concentrations of epinephrine and two other vasoconstrictors, phenylephrine hydrochloride and felypressin, on local blood flow. ⋯ We found that felypressin was as effective a vasoconstrictor as epinephrine, with fewer potential toxic reactions. Phenylephrine (Neo-Synephrine), on the other hand, was less effective, with a shorter duration of action. As expected, bupivacaine produced vasodilation, while ropivacaine was found to have vasoconstrictive properties.
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Anaesthesiol Reanim · Jan 1991
Review Comparative Study Clinical Trial Controlled Clinical TrialCardiac dysrhythmias during dental surgery. Comparison of hyoscine, glycopyrrolate and placebo premedication.
The incidence of cardiac dysrhythmias was investigated in 60 patients undergoing dental operations under halothane anaesthesia following either hyoscine, glycopyrrolate or placebo as a supplement to nalbuphine for premedication. Forty-five percent of the patients given 6 micrograms/kg hyoscine exhibited cardiac dysrhythmias compared to 25 percent of the group given 4 micrograms/kg glycopyrrolate and to 5 percent in the placebo group. ⋯ There was neither a connection between the frequency of cardiac dysrhythmias and the demographic characteristics of the patients nor with their PaCO2. The author recommends to avoid premedication with anticholinergic combined with halothane anaesthesia with spontaneous respiration during dental operations.
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Gynecol. Obstet. Invest. · Jan 1991
Comparative StudySerum lipoperoxides in induced and spontaneous abortions.
Abortion, primarily as a measure of population control, certainly continues to be an emotional, frustrating and stressful event. In continuation of our work on stressful situations in the female life span and biochemical parameters, serum lipid peroxide levels in terms of malondialdehyde (nmol/ml) have been determined in females undergoing abortion [suction curettage (n = 30), Emcredil-induced abortion (n = 30) and spontaneous abortion (n = 40)] and were compared with appropriate gestational controls. ⋯ The levels of serum lipid peroxide encountered before abortion were found to be significantly elevated in case of Emcredil-induced abortion and spontaneous abortion when compared with controls (second trimester mean levels 1.82 and first trimester 2.4) whereas the levels before suction curettage were found to be nonsignificant in comparison with controls, indicating a lesser degree of stress. It is felt that monitoring of serum lipid peroxide levels in serum and tissues (placenta), backed by scavenging enzyme superoxide dismutase, can be more helpful for corroborating safety and the risk of free radical toxicity in pregnancy and abortion.