Articles: prospective-studies.
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The mortality associated with 240 483 anaesthetics administered over 10 years at Groote Schuur Hospital, Cape Town, is reported. The frequency of death to which anaesthesia contributed was 0.22 per 1000 anaesthetics (compared with 0.33 per 1000 in the previous 10 years). These deaths were responsible for 2.2% of the total mortality from surgery. Two-thirds of the "anaesthetic" deaths were attributable to (in order of frequency): (a) hypovolaemia; (b) respiratory inadequacy following myoneural blockade; (c) complications of tracheal intubation; (d) inadequate postoperative care and supervision.
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Randomized Controlled Trial Clinical Trial
Steroids in the treatment of clinical septic shock.
A prospective (Part I) and a retrospective (Part II) study were used to determine the safety and efficacy of corticosteroids in the treatment of septic shock. In Part I, 172 consecutive patients in septic shock admitted over an 8-year period were treated with either steroid or saline: 43 received dexamethasone (DMP), 43 received methylprednisolone (MPS), and 86 received saline. The study was double-blind and randomized, and the three groups were compared for age, severity of shock, presence of underlying disease, and year of study. ⋯ Again, the two groups of patients were compared for severity of shock, underlying disease, age, and year of study. Mortality among patients treated without steroid was 42.5% (68/160) and among patients treated with steroid was 14% (24/168); there was no significant difference in mortality rate between DMP- and MPS-treated patients. In Parts I and II combined, complications occurred in 6% of steroid-treated patients with no significant difference between DMP- and MPS-treated groups.