ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00335.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A controlled, prospective, double‐blind trial of wound infiltration with bupivacaine in elective open cholecystectomy was performed to determine if this was an effective method of pain relief and reduced respiratory complications. Additionally, dextran was added to the bupivacaine in an attempt to prolong the effect. The solutions used were, bupivacaine alone 0.25% (n= 14), bupivacaine 0.25% with dextran 70 (n= 16) and saline (n= 16) as a control. To determine the effect of each solution, the subjects were assessed for pain perception and respiratory function before and after surgery. Pain was assessed using a visual analogue scale and narcotic usage, and respiratory function was assessed by spirometry, chest X‐rays and arterial blood gases.The study did not demonstrate any objective improvement in either pain relief or respiratory function. This may reflect inadequate infiltration by the surgeons in the study or that infiltration should have been performed prior to incis

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00336.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This survey aimed to determine what type of information patients want about the risks of postoperative pain management and whether this corresponded to the information that doctors and nurses wished to provide. Seventy‐four patients scheduled for elective surgey, 50 nurses and 48 doctors completed a questionnaire asking about perceived risks of analgesia, level of acceptable risk and information that should be provided to patients. Compared to doctors and nurses, patients underestimated the risks associated with postoperative pain relief, except for the risk of drug addiction, which they rated higher. Ninety‐one per cent of patients wanted information about the side effects of analgesia. The preferred means of obtaining this information was by discussion with their surgeon or anaesthetist. Doctors were willing to accept a greater risk of minor side effects to achieve excellent pain relief than were patients. In contrast, patients were willing to accept a greater risk of serious side effects. The results obtained in this survey will facilitate the preparation of guidelines for obtaining informed consent from patients to receive postoperative analge

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00337.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

With the increasing application of certain surgical procedures to ‘day surgery’ cases, there has been greater utilization of local anaesthetic agents. Such procedures are undertaken using single infiltration dosage recommendations for lignocaine, both with and without adrenaline. The present paper describes results obtained from a sheep model that considers the role of the regional blood flow of the injected site as a determinant of lignocaine absorption and resultant pharmacokinetics. The peak concentration of lignocaine in plasma following administration to two selected sites of different vascularity (as determined by a technetiumwwashout method), as well as the effect of concomitant adrenaline administration, was shown to correlate with the regional blood flow to the site (rs= 0.73,P =0.008). Extrapolating these animal data to the clinical situation suggests that larger dosages of lignocaine could be used safely for infiltration anaesthesia in regions of poor regional blood flow without posing a threat of lignocaine‐induced toxicity, and that the current dosage recommendations could be modified in respect of the regional blood flow of the particular site to be infilt

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00338.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A ten year review of penetrating thoracic and abdominal trauma examined pattern of injury, patient management and outcome. Ninety‐six patients were included in the study, 55 with injury to the abdomen, 31 the thorax and 10 with injury to both areas.Fifty‐eight cases were managed non‐operatively; 5 combined abdominal and thoracic injuries, 26 thoracic and 27 abdominal. Two cases went on to require operative management for intra‐abdominal injury.Thirty‐eight cases were managed operatively; 5 combined cavity injuries, 5 thoracic and 28 abdominal. Injuries were found in all of the combined cavity and thoracic cavity cases. Of the 28 abdominal cases, nine were found on laparotomy to have no significant visceral or vessel injury, one, however, was performed for omentum protruding through the wound.While a negative laparotomy was a relatively safe procedure, non‐operative management had the advantages of a shorter hospital stay without wound‐related morbidity. Selective non‐operative management was found to be a relatively safe approach

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00339.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A total of 76 patients with traumatic extradural haematoma were treated within a period of 3 years. Four patients developed delayed extradural haematomas. These cases are reported in view of the unusual sequence and the importance of early diagnosis.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00340.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

One hundred and thirty‐seven patients with sports‐related facial fractures were reviewed. These made up 16.3% of 839 patients with facial fractures seen at the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, between June 1989 and June 1992. Males made up 93.4% of patients and 89.1% were aged below 35 years. There was an intent to injure in 11%. Australian Rules football was the causative sport in 52.6%, all the injuries being the result of human contact. Orbitozygomatic fractures were the most frequently observed overall (62%) as well as in Australian Football (58.3%). Cricket contributed to 14.6%, the ball being the agent of injury in all but one of the patients. Horse‐riding injuries were the most severe. 89.1% of the patients required surgery and hospital stays ranged from 0 to 18 days with an average stay of 4.7 days. Sports activities, although a significant source of enjoyment, are a significant cause of facial fractures with their attendant morb

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00341.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

All trauma cases flown over a 3.5 year period by the Metropolitan Helicopter Ambulance (MHA) from the accident scene to the Alfred Hospital were analysed. The MHA carries paramedics trained in advanced life support and is not under direct medical control. There were 254 patients (226 males, 28 females, mean age 34 years) of whom 242 had sustained blunt trauma. The mean distance from the accident scene to hospital was 28 nautical miles. The mean time from dispatch of the MHA to arrival at the Alfred was 82 min. The mean ground time at the scene was 32 min.Major trauma (an injury severity score (ISS) of 15 or more) was present in 62% of patients, and the mean ISS was 22.4. The major treatments at the accident scene by the paramedics were insertion of an intravenous (i.v.) cannula (242 cases), application of splints (197 cases), endotracheal intubation (35 patients) and needle thoracostomy to exclude tension pneumothorax (18 cases). There were 25 patients with a Glasgow Coma Score (GCS) less than 8 who were not intubated at the scene. Review of paramedic management identified four cases where prehospital care could have been improved but it is unlikely the final outcome would have changed: delay in transport (1 case), inadequate i.v. fluid resuscitation (2 cases) and delay in intubation (1 case). There was 1 case of undiagnosed tension pneumothorax that contributed to the patient's death and 1 case of non‐intubation where the outcome may have been altered. Overall there were 38 deaths (14% mortalitjl), which was not significantly different from the predicted mortality of 17%.Paramedics who followed specific protocols, but who were unable to communicate directly with the Alfred Hospital, performed well in the selection of injured patients most likely to benefit from helicopter transport. The prehospital treatment of major trauma patients was good, except for the high (42%) non‐intubation rate in patients with a GCS less tha

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00342.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

One hundred and twenty patients with acute hip fractures treated operatively were randomized into two groups. In the ‘drape’ group (n =65) the operation site was covered with plastic adhesive drape after preparation. In the ‘no drape’ group (n= 55) the operation site was left uncovered. The two groups were otherwise matched. Swabs for culture were taken from skin adjacent to the wound before closure. The drape group had four positive wound swabs. There was only one positive wound swab for the no‐drape group. There was no difference in the post‐operative wound infe

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00343.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Fourteen cases of Mirizzi's syndrome are presented here. Clinical presentation was pain (14), jaundice (14), fever (10) and peritonitis (1). A clinical diagnosis of choledocholithiasis was considered in all the patients. Pre‐operative diagnosis of Mirizzi's syndrome was made in five patients on the basis of cholangiogram and the remaining cases were diagnosed at surgery. The stage (type) of Mirizzi's syndrome was based on the extent of erosion of the common bile duct. Four patients had type I, seven type II and three type III lesions. Associated choledocholithiasis was present in five and acute free perforation of the gall‐bladder in one. The operative procedures performed were partial cholecystectomy for type I, partial cholecystectomy, choledochoplasty and T‐tube choledochostomy for type II and bilioenteric anastomosis for type III lesions. Two patients had retained common bile duct stones. Mean follow up was 14 months (range 1–27 months). One patient with secondary biliary cirrhosis continues to have persistently elevated serum alkaline phosphatase levels without any demonstrable biliary obstruction. Diagnostic and operative strategies are discussed and a follow up protocol for such patients is su

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1993.tb00344.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY