ABSTRACT
Guidelines are presented for the organisational and clinical management of anaesthesia for day-case surgery in adults and children. The advice presented is based on previously published recommendations, clinical studies and expert opinion.
Subject(s)
Ambulatory Surgical Procedures , Anesthesia , Adult , Child , Humans , Ambulatory Surgical Procedures/methods , Anesthesia/methods , Anesthesiology/methods , Societies, Medical , United KingdomABSTRACT
We describe the development of a technique of combined rectus sheath and ilioinguinal blocks for patients undergoing abdominal gynaecological surgery, and its use in a series of 37 patients (21 midline and 16 transverse incisions). Up to 60 ml of bupivacaine 0.25% with adrenaline 1:400,000 was used, depending on the patient's weight. Median (interquartile range) total morphine requirement (including 0.15 mg x kg(-1) given intra-operatively) up to 48 h after surgery was 0.34 (0.2-0.38) [corrected] mg x kg(-1) for midline incisions and 0.47 (0.35-0.64) [corrected] mg x kg(-1) for transverse incisions; no other systemic opioids were given. Six-hourly pain scores within the first 48 h after surgery were < or =1 (mild pain) in 11 out of 21 (52%) and < or =2 (moderate pain) in 18 out of 21 (86%) patients with midline incisions and in 5 out of 16 (31%) and 13 out of 16 (81%) patients with transverse incisions, respectively. No patient had emetic symptoms worse than mild nausea during the 48-h postoperative study period.
Subject(s)
Gynecologic Surgical Procedures , Nerve Block/methods , Pain, Postoperative/prevention & control , Adult , Aged , Analgesia, Patient-Controlled , Analgesics, Opioid/administration & dosage , Anesthetics, Local/therapeutic use , Bupivacaine/therapeutic use , Drug Administration Schedule , Female , Humans , Middle Aged , Morphine/administration & dosage , Postoperative Nausea and Vomiting/chemically inducedABSTRACT
In the Emergency Center of the Neurosurgical Intensive Care Unit Belgrade, in the one-year period (from January, 1st 1992 to December, 31st 1992), 54 injured patients with severe head injuries associated with chest trauma were treated. In all injured patients the following parameters were considered: sex, age, mechanism of injury, surgical procedures, and fatal outcome. Thirty-nine patients (72.22%) survived.
Subject(s)
Craniocerebral Trauma/therapy , Multiple Trauma/therapy , Thoracic Injuries/therapy , Adolescent , Adult , Craniocerebral Trauma/complications , Female , Humans , Male , Middle Aged , Thoracic Injuries/complicationsABSTRACT
Unilateral pulmonary Oedema after re-expansion during intercostal drainage of pneumothorax is a serious complication. The article deals with a 72-year-old woman who was admitted to Intensive Ward in haemorrhagic shock for haematemesis and melena. The first examinations established pronounced hypovolaemia, secondary anaemia, extra-renal azotaemia, hypoproteinaemia and respiratory insufficiency. During puncture of the right subclavical vein for insertion of a catheter iatrogen pneumothorax was performed. After thoracic drainage with negative pressure the patients' condition aggravated. Radiographical examination of the lungs revealed a total re-expansion of the right lung with changes characteristic of unilateral pulmonary oedema. Thanks to an appropriate treatment the patient recovered. Unilateral pulmonary oedema was provoked by rapid re-expansion of the right lung due to increase of negative pressure in the pulmonary interstitum and increase of permeability of the capillary and alveolar barriers. The attentive follow-up of clinical signs, auscultation of the lungs, monitoring of vital parameters of the patient, gas analyses, RTG control examinations are of great importance in the detection of pulmonary oedema. Thus, an appropriate treatment can prevent undesirable consequences.
