International journal of surgery
-
Evidence suggests that switch from spinal/general anaesthesia (SA/GA) to perianal block (PAB) may prove advantageous for proctologic surgeries. This study evaluates the practicability of this evidence based switch. ⋯ Perianal block is a safe, feasible, reliable, and reproducible mode of anesthesia for ano-rectal surgeries. Its evident efficacy justifies its adoption as anesthesia of choice.
-
Comparative Study
Peri-operative blood glucose management in general surgery - a potential element for improved diabetic patient outcomes - an observational cohort study.
Hyperglycaemia impairs many of the physiological processes involved in recovery from surgery but there is limited research on the effect of optimal peri-operative glucose control in diabetic general surgery patients. The objectives of this study were to assess blood glucose management in diabetic general surgical patients and to determine if protocol deviations were associated with adverse outcomes. ⋯ Although not statistically significant, optimal glucose homeostasis according to hospital protocol was associated with a 25.4% reduction in peri-operative complications. We recommend careful blood glucose management according to pre-defined guidelines in all diabetic patients undergoing general surgical procedures.
-
Diagnostic evaluation and management of patients with rectus sheath hematoma. A retrospective study.
Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain. It may mimic a wide variety of intraabdominal disorders thus frequently leading to delay in treatment, increased morbidity or even in an unnecessary surgery. ⋯ RSH should be considered in the differential diagnosis of the elderly patients under anticoagulation therapy presenting with acute abdominal pain and a palpable mass. CT is the diagnostic modality of choice. Conservative treatment is feasible in most cases. Early diagnosis is mandatory in order to avoid morbidity or unnecessary surgery. In order to prevent a traumatic RSH, trocar insertion under direct vision during laparoscopic surgery and careful attention in the abdominal administration of LMWH are essential.
-
The effect of vasopressors on the healing of gastrointestinal anastomoses is still controversial. The purpose of our study was to research the relationship between dose of dopamine, which is used generally as a vasopressor in shock status, and anastomotic leak in colonic surgery. ⋯ Although vasopressors appeared to increase the risk of anastomotic leakage as a result of splanchnic vasoconstriction, deterioration of microcirculation, and local hypoxia, we found that BPA were increased with high doses of vasopressor. We speculated that the use of vasopressors without shock might increase blood supply to the anastomotic line by increasing cardiac output.