Articles: postoperative-complications.
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General practitioners as well as surgeons should be aware that there is a high recurrence rate after the "standard" operation (vagotomy and pyloroplasty) for duodenal ulcer. Recognition of recurrence is much delayed. ⋯ The high overall recurrence rate, the not inconsiderable operative morbidity and occasional mortality, and the high postoperative morbidity rate for peptic ulcer surgery indicate that such surgery is not to be undertaken without positive indications, such as the presence of complications. An operation undertaken solely because an ulcer recurs within, say, two years can no longer be justified.
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Anesthesia and analgesia · May 1976
Case ReportsProlonged neuromuscular blockade with pancuronium in the presence of acute renal failure: a case report.
Prolongation of neuromuscular block following pancuronium administration to anephric patients has been reported. A patient is described whose postoperative course after resection of gangrenous bowel was complicated by acute renal failure and prolonged neuromuscular blockade. A large intraoperative dose of pancuronium was administered without monitoring neuromuscular transmission with a peripheral nerve stimulator. ⋯ The absence of renal excretion considerably increases the duration of action of curare when given in high doses. It has been suggested that doses of pancuronium greater than 3.6 mg/sq m or multiple doses would result in prolonged neuromuscular block in patients without renal function. The case reported illustrates the importance of monitoring neuromuscular transmission during administration of pancuronium in the presence of renal insufficiency to avoid this complication.
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Tracheal stenosis following assisted ventilation is becoming recognized as a major complication of tracheostomy, and the use of cuffed tracheostomy tubes. The possible causes and surgical management of this condition are discussed together with recommendations to minimize the possibility of post-tracheostomy tracheal stenosis.
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The incidence of postoperative venous thrombosis and pulmonary embolism was assessed in 87 patients undergoing 96 major lower extremity amputations for ischemia. Prospective surveillance for deep leg vein thrombosis was carried out by Doppler ultrasound in 35 patients. ⋯ This study suggests that clinically significant venous thromboembolism following current techniques of lower extremity amputation is not as common as previously reported. Doppler ultrasound is the most suitable technique for surveillance of venous thrombosis in these patients.