British medical journal
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Evidence of wide variability in the immediate results of large-bowel surgery stimulated self-assessment during 1979. The hazards of large-bowel surgery can usually be avoided by good bowel preparation, sound anastomotic technique, primary resection in large bowel emergencies, avoidance of anastomosis when hazardous, and antibiotic lavage for extant or potential peritoneal and wound contamination.
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British medical journal · Apr 1980
Treatment of accidental hypothermia: a prospective clinical study.
A 15-year prospective study was carried out of 44 patients with accidental hypothermia (mean age 60 years) admitted to an intensive therapy unit. The lowest core temperature recorded in each patient ranged from 20.0 to 34.3 degrees C. The precipitating factors were poisoning (by drugs, alcohol, or coal gas) in 25 cases and various illnesses in 19. ⋯ Thus rewarming may be consistently and safely achieved irrespective of the cause of hypothermia, and normal body temperature may be regained as rapidly as is compatible with adequate tissue perfusion and oxygenation. Surface rewarming of the torso is perhaps the simplest technique available, but internal rewarming procedures may be desirable or essential in the presence of, for example, profound hypothermia, severe hypotension, or ventricular fibrillation. Mortality was attributable to underlying factors or disease and not to hypothermia.
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A survey of obstetric anaesthetic services in Wales covering 21 major units in which over 31 000 deliveries take place annually showed inadequacies in staffing at consultant and resident anaesthetist level. At least 20 additional consultant sessions were required to meet the recommendations of the Association of Anaesthetists of Great Britain and Ireland. If patients' requests for epidural analgesia are to be met some reorganisation and centralisation of facilities is needed.
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During cuffed intubation, damage to the trachea is least likely when the lateral wall pressure exerted by the cuff does not exceed the mean capillary perfusion pressure of the mucosa. A study was carried out of eight different types of endotracheal tubes. At the seal point the traditional red rubber tube and the armoured latex and Softway tubes exerted pressures above the mean systemic arterial pressure. ⋯ The Lanz tube, however, with its over-pressure safety balloon, maintained a lateral wall pressure below the mean capillary perfusion pressure even when inflated considerably beyond the seal point. Endotracheal cuffs are often overinflated in clinical practice. Since cuff-induced tracheal damage is most influenced by the lateral wall pressure, these results suggest that the use of Lanz-type tubes should be mandatory in intensive care units or when a cuffed tracheostomy tube is required and they should also be considered for use in more routine anaesthetic practice.