Articles: postoperative-complications.
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Acta Anaesthesiol Scand · Nov 1985
Randomized Controlled Trial Comparative Study Clinical TrialA controlled study on the effect of epidural analgesia with local anaesthetics and morphine on morbidity after abdominal surgery.
A hundred patients scheduled for elective abdominal surgery were randomized to either general anaesthesia (low-dose fentanyl) and systemic morphine for postoperative pain or combined general anaesthesia and epidural analgesia with etidocaine 1.5% intraoperatively (T4-S5) and bupivacaine 0.5% 5 ml/4 h for 24 h and morphine 4 mg/12 h for 72 h. Postoperative pain was better controlled by the epidural regimen (P less than 0.0001). We found no significant reduction in postoperative mortality (6% to 2%), pneumonia (28% to 20%), cardiac dysrhythmia (10% to 5%) and wound complications (14% to 11%) by the epidural analgesic regimen. ⋯ Postoperative weight loss and decrease in serum-albumin and serum-transferrin, as well as the reduction in haemoglobin and the need for postoperative transfusions, were similar in the two groups. Convalescence, as assessed by postoperative fatigue, restoration of bowel function (flatus, bowel movement and food intake) and the time until the patients were self-aided at their preoperative level, was not reduced by epidural analgesia. Since 50% of the patients in each group suffered from one or more of the above-mentioned postoperative complications, this epidural regimen was not effective in reducing postoperative morbidity after major abdominal surgery despite the achievement of adequate pain relief.
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In the literature, postoperative calcified epidural hematoma is not common. The authors report a case of calcified epidural hematoma after ventriculoperitoneal shunt, and radiotherapy for pinealoma. A 14-year-old boy was admitted to author's department on December 9, 1983, complaining of headache. ⋯ No inflammatory finding was seen on histological examination. The postoperative course was uneventful. Etiology of calcified intracranial hematoma was discussed in relation to the present report, the relevant literature reviewed.
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J. Am. Coll. Cardiol. · Oct 1985
Case ReportsAtrial level right to left intracardiac shunt associated with postoperative hypoxemia: demonstration with contrast two-dimensional echocardiography.
Transient hypoxemia is not uncommon after major cardiac or thoracic surgery. The differential diagnosis includes atelectasis, pulmonary embolus, pneumonitis, congestive heart failure and several other diverse cardiovascular and pulmonary problems. ⋯ Three cases of clinically important hypoxemia associated with right to left shunting after aortocoronary bypass surgery are presented. The right to left shunting was documented with contrast-enhanced echocardiography, which is a simple, inexpensive and accurate means of screening patients for intracardiac right to left shunts and may play a valuable role in the postoperative management of patients.
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Surg. Clin. North Am. · Aug 1985
Review Clinical TrialTherapy of critically ill postoperative patients based on outcome prediction and prospective clinical trials.
An objective physiologic approach to therapy of high-risk postoperative patients was developed using survival as the criterion to determine the relative importance of variables and optimal goals for these variables. A protocol, based on a branch chain decision tree, also was developed from outcome data. When tested prospectively against the standard of care, this protocol markedly reduced mortality and morbidity.