Surgery
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Randomized Controlled Trial Clinical Trial
Continuous epidural infusion for analgesia after major abdominal operations: a randomized, prospective, double-blind study.
We performed a prospective, randomized, double-blind study of continuous epidural analgesia for 72 hours after major abdominal procedures. Patients were randomly assigned to one of five treatment groups: epidural morphine, epidural bupivacaine, a combination of morphine and bupivacaine, epidural saline solution, and no epidural catheter. All patients received supplemental morphine sulfate or meperidine hydrochloride, intramuscularly or intravenously, as needed. ⋯ The group that received the combination of morphine and bupivacaine did best on all measures; in most instances the difference between the results seen with the combination regimen and those seen with saline solution or no catheter were significant at the 0.05 level. With the exception of pruritus, complications were evenly distributed among all treatment groups, including noncatheterized controls. We conclude that epidural analgesia with the combination of morphine and bupivacaine is safe, is easily managed, and gives pain relief superior to that provided by traditional, systemic administration of narcotics.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized, prospective trial of cimetidine and ranitidine for control of intragastric pH in the critically ill.
Forty-eight critically ill patients in an intensive care unit were enrolled in a prospective study of stress ulcer prophylaxis. The H2-receptor antagonists cimetidine and ranitidine were used, patients being randomized on hospital number. Response was assessed by measuring gastric pH every 2 hours. ⋯ However, even with much lower plasma concentrations of ranitidine, similar amounts of both drugs were present in the gastric juice, suggesting a possible explanation for the greater efficacy of ranitidine. We conclude that, although ranitidine is more effective than cimetidine, neither of these drugs is adequate for stress ulcer prophylaxis. If they ae used for this purpose in the critically ill patient, regular monitoring of gastric pH is essential to allow detection of therapeutic failures.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hypertonic sodium lactate versus lactated ringer's solution for intravenous fluid therapy in operations on the abdominal aorta.
Fifty-eight patients who were to undergo aortic reconstruction were prospectively randomized into two groups to compare the effects of perioperative fluid replacement with isotonic and hypertonic crystalloid solutions. Blood loss was replaced with packed red blood cells, and additional fluid was given as either Ringer's lactate solution (RL, 130 mEq sodium/L, 274 mOsm/L) or a hypertonic balanced salt solution (HSL, 250 mEq sodium/L, 514 mOsm/L). Fluid was administered to maintain the cardiac filling pressure within 3 torr of the preoperative level and the cardiac output (CO) at or above the preoperative level. ⋯ Two patients in the HSL group had a persistent elevation in serum osmolarity (greater than 320 mOsm/L) during operation, for which they received RL for the balance of the resuscitation. There were no complications that could be attributed to the hypertonicity of the solution. HSL is effective for resuscitation of patients with extracellular fluid deficit and is safe provided that the serum sodium and osmolarity are monitored during periods of large volume administration.
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Randomized Controlled Trial Clinical Trial
Colloid or crystalloid in the resuscitation of hemorrhagic shock: a controlled clinical trial.
The object of this article is to assess the value of human serum albumin (HSA) in the initial resuscitation of hypotensive trauma victims. Thirty-six patients (mean age = 30 years) in shock from trauma who underwent laparotomies were randomly assigned to either Ringer's lactate solution (RL) resuscitation or 4% HSA in RL resuscitation. Both groups received approximately 8L of test fluid and 6U of washed red cells. ⋯ Two patients in each group required mechanical ventilation for longer than 24 hours. No differences were noted in a battery of pulmonary function tests performed daily for 5 days. These results demonstrate that HSA is not essential in this clinical setting for safe and effective resuscitation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cerium nitrate-silver sulfadiazine cream in the treatment of burns: a prospective evaluation.
In a prospective, randomized study of patients with major burns, the efficacy of cerium nitrate-silver sulfadiazine cream was compared with that of silver sulfadiazine cream alone. Sixty patients were studied, in two groups, with matching mean ages and mean burns sizes. Patients with associated injuries, smoke inhalation, or major medical illnesses were excluded from the study. ⋯ The distribution of bacterial isolates by organism was similar in both groups. In vitro sensitivity determinations indicated a comparable efficacy between the two agents. In this study no clear-cut superiority of one topical agent over the other could be demonstrated.