ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

CommentLower extremity surgery and tourniquet application produce complex changes in coagulation and fibrinolytic activity. On one hand, thromboprophylaxis with low molecular weight heparin (enoxaparin) the evening before surgery and continued until the patient is mobilized would seem prudent to counteract the effects of tourniquet-induced venous stasis in patients undergoing total knee replacement or tibial osteotomy. Alternatively, tourniquet-induced enhancement of fibrinolytic activity, because of release of tissue-type plasminogen activator from the vascular endothelium, might prevent deep venous thrombosis. But does this benefit come with the price of increased postoperative blood loss?Tranexamic acid, an antifibrinolytic agent, reduced perioperative blood loss and blood transfusion requirements associated with total knee arthroplasty compared with a control group in this study. Similar observations have been made in patients undergoing prostate surgery and after cardiac-surgery. Considering the thrombogenic nature of tranexamic acid, would clinicians consider a reduction in blood transfusion requirements and postoperative blood loss sufficient benefit to justify the inherent risks? In this study, one patient in the treatment groups suffered a myocardial infarction on the fourth postoperative day. Given the small patient population, the risk of thrombotic complication must be a major concern. I would await confirmation of the study findings in a large clinical trial before administering an antifibrinolytic agent, such as tranexamic acid, to patients undergoing lower limb surgery.

ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

CommentPreoperative gastric fluid volume and acidity have been widely discussed in recent years, especially with respect to fasting protocols. This paper examines the effect of chewing gum on the morning of surgery and also the effect of nicotine gum on the preoperative well-being of smokers.The gastric fluid volume (GFV) of the nonsmoking group who used chewing gum was significantly higher than the control group (30 ±19 ml) and, in its upper range, approaches the at-risk criterion for aspiration (i.e., > 50 ml). The authors' conclusion that chewing regular gum is probably best avoided is, therefore, reasonable. However, it is worth noting the origin of the at-risk criteria to give them some practical perspective.The traditional criteria were published by Roberts and Shirley in 1974.1The figures of > 0.4 ml/kg and pH <2.5 were based on a single monkey experiment. Acid aspirate was introduced into the right main bronchus of the monkey, and the volume producing significant pneumonitis and death was noted. This experiment was repeated with groups of monkeys by Raidoo et al. in the 1980s.2Varying volumes of aspirate were introduced, this time into the trachea of the monkeys, and the occurrence and severity of pneumonitis were noted. This produced the revised at-risk volume of 0.8 mL/kg at pH 1. After a case report of severe pneumonitis occurring with particulate aspirate of pH 3.5, the pH level was revised to <3.5.These data from monkeys have been extrapolated to humans. The relationship between the volume of

ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

CommentGranisetron is a new selective antagonist of the 5-hydroxytryptamine receptor and is used for the prevention of postchemotherapy and postoperative nausea. Granisetron is more potent and longer acting than ondansetron. The authors demonstrated that both 20 and 40 μg/kg were essentially equally effective in reducing the incidence and severity of nausea.The authors are to be commended for their experimental design. By excluding intraoperative narcotics and using postoperative epidural infusions, they were able to eliminate the contribution of variable amounts of postoperative narcotics to the incidence of nausea. Interestingly, in their epidural infusions they used buprenorphine, an agonist-antagonist opioid with high analgesic potency and high lipid solubility. When administered epidurally, buprenorphine possesses excellent analgesic properties with no increase in the incidence of nausea.1This low incidence is attributed to its high lipid solubility producing limited cephalic spread. My only criticism of the study is their lack of comment on the quality of pain relief and the amount of epidural analgesic administered. To only include one factor, nausea and vomiting, makes one wonder whether nausea was associated with inadequate pain control.

ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Let us divide the topic of defamation into two separate categories: defaming patients and defaming other physicians.

ISSN:0039-6206    

出版商:OVID    

年代:1996

数据来源: OVID