Folia medica Cracoviensia
-
Perioperative medicine is a new approaches for quicker and better preparation all patients for surgery and postoperative treatment. Perioperative medicine should fulfilled following problems: a) Preoperative assessment, b) Postoperative pain treatment, c) Postoperative intensive therapy. Anaesthesiologists are interested in above problems, except prolonged preoperative treatment, which is normally provided by other specialists. Perioperative medicine needs a new approach for training new type of anaesthesiologists well prepared for new type of responsibility.
-
Folia medica Cracoviensia · Jan 2001
[Principles of qualifying children for planned surgical procedures].
Children are prone to greater preoperative stress and more frequent accidents during anaesthesia. To reduce stress--a preoperative visit, information for child and parents, premedication and parental presence during induction of anaesthesia have all been successfully used. ⋯ There is less emphasis on minimal hemoglobin level of 10 g/dl, the physician assessment of circulatory status is preferred rather than stiff laboratory values. Less stress for children means also less problems during induction and recovery as well as less need for prolonged postoperative care.
-
Folia medica Cracoviensia · Jan 2001
ReviewEvaluation on the effectiveness of perioperative nutritional therapy.
In the last three decade very important advances in venous access, enteral feeding techniques and parenteral and enteral nutrient formulations have made it possible to provide sufficient nutritional support to almost all patients. The clinical nutritional therapy became a progressive medical subspecialty. Despite the widespread use of nutritional management of different patient groups, many fields of nutritional support remain controversial. ⋯ The historical background and development of perioperative artificial nutritional therapy are cited. Whenever possible, prospective randomised clinical trials (PRCTs) are evaluated because this is the most reliable method for evaluating clinical efficacy of a treatment. The incidence of postoperative complications, the length of postoperative hospitalisation and the mortality are considered good general indicator of effectiveness of perioperative nutritional therapy.
-
Folia medica Cracoviensia · Jan 2001
Review[The role of infusion fluids and blood derived preparations during the perioperative period].
The treatment with infusion fluids in perioperative period is a basic therapeutic method. Depending on clinical situation, the doctor has various fluids available, both blood-replacing, and blood-derived. The number of crystaloid and colloidal fluids used has been systematically growing in two last decades. ⋯ The use of fresh frozen plasma (FFP) is the first step in the treatment of pathological bleeding in surgically treated patients. The occurrence of thrombocytopenia shows great individual variability. Thrombocyte concentrate transfusion should be performed after laboratory determination of thrombocyte count.
-
Folia medica Cracoviensia · Jan 2001
Clinical Trial Controlled Clinical Trial[The effect of small doses of 7.5% NaCl on brain bulk during elective craniotomies].
In 16 patients (ASA I i II) aged 16-76 years (48 +/- 15; mean +/- SD) operated on because of intracranial expanding mass, the effect of hypertonic saline (7.5%--1 ml/kg b.w.) on brain bulk (BB) was evaluated. Patients were anaesthetised with a slight hypocarbia (PaCO2 = 33.3 +/- 3.5 mmHg). BB was scored after opening the dura (T0) and 15 min. (T15) after hypertonic saline (HS) infusion. ⋯ We can conclude that 7.5% saline in a dose of 1 ml/kg b.w. reduces brain bulk during craniotomy in patients with supratentorial mass lesions. In patients with a solid brain tumor this effect correlates negatively with a size of expanding mass. A slight changes in blood pressure and heart rate due to HS as well as moderate decrease in SK are within limits of clinical acceptance.