Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · May 1995
Comparative StudyUse of hand-held Doppler to identify 'difficult' forearm veins for cannulation.
Intravenous cannulation is a necessary procedure in many hospital patients. Some patients are regarded as having 'impossible' veins that are invisible and impalpable despite venous tourniquet. We investigated the use of a hand-held Doppler to identify veins suitable for percutaneous cannulation in such patients. ⋯ All 4 (100%) described as 'poor' on Doppler signal had diameters of 1.4-1.7 mm (mean 1.6 mm). Hand-held Doppler, used as described, can accurately identify forearm veins larger than 2.0 mm in diameter in patients with invisible and impalpable veins with venous tourinquet. These veins should be amenable to percutaneous cannulation.
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Ann R Coll Surg Engl · May 1995
Randomized Controlled Trial Clinical TrialHas postoperative pain been eradicated?
Recent evidence suggests that surgical trauma induces a process of central nervous system sensitisation that contributes to and enhances postoperative pain. These changes are also thought to be the underlying cause of much chronic pain. Central sensitisation is generated not only during surgery, but also postoperatively as a result of the inflammatory response to the damaged tissue. ⋯ Evidence that effective perioperative analgesia reduces the incidence of chronic post-thoracotomy chest wall pain was found in a retrospective study of 1000 consecutive thoracotomies. The endpoints of a zero pain score, complete preservation of preoperative lung function and prevention of the stress response to trauma are currently achievable and should be provided for virtually all patients undergoing chest surgery. Pre-empting pain must be the goal for all those involved in the postoperative care of patients.
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Ann R Coll Surg Engl · May 1995
Theatre delay for general surgical emergencies: a prospective audit.
A prospective audit of emergency theatre use for general surgery has been undertaken. Two month periods were studied before and after the introduction of a fully staffed 24-hour emergency theatre. Data were collected using a proforma documenting the time of the decision to operate, the actual time of the operation and the reason for and duration of any delay. ⋯ There was no significant difference in the seniority of the surgeon making the decision to operate. In the first part of the audit we identified problems with regard to delay which were addressed by the introduction of the emergency theatre. The audit cycle has been successfully closed improving the care of general surgical emergencies requiring urgent or emergency operations.
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Some achievements in the treatment of congenital heart defects are discussed. Special comments are made about the persistent ductus arteriosus, atrial septal defect, transposition of the great arteries and the Fontan operation. The differences and similarities between 'corrective' and 'palliative' operations are discussed. ⋯ Current and future training of paediatric cardiac surgeons is discussed and proposals made for the future organisation of care for children with congenital heart defects. The author speculates about how these problems will be solved in view of the decreasing number of children with congenital heart defects. Impact of treatment on the families of patients with congenital heart defects is also considered.