Biomedical subjects
Publications and source records attributed to A A Dow.
Proper anesthetic care begins with a thorough preoperative assessment. This can rarely be performed in the acute trauma victim. Specific disease states in the cardiovascular, endocrine, hematologic, and respiratory systems are considered here. Substance abuse is also discussed. A better understanding of the interactions between pre-existing disease and traumatic injury should result.
A randomised, single-blinded study was conducted to compare patient-controlled epidural analgesia with continuous infusion epidural analgesia for the treatment of pain following post-traumatic pelvic reconstruction. The patient-controlled group (n = 11) received a background infusion of 4 ml.h-1 of bupivacaine 0.125% with fentanyl 1 microgram.ml-1, and 3-6 ml bolus doses, self administered, as required (with a 15 min lockout interval). The continuous infusion group (n = 12) received a continuous infusion of the same solution through an identical apparatus, but with the demand button deactivated. This was started at 10 ml.h-1 and adjusted by the anaesthetist, as required, up to a maximum of 25 ml.h-1. Pain scores, side effects, and the volumes of drug infused were recorded over the first 3 postoperative days. One patient from each group was withdrawn because of catheter-related problems. Pain scores were similar and the incidence of nausea and pruritus was low in both groups. There was no recorded instance of respiratory depression or hypotension and there was no significant difference between the groups in the volumes of drug solution received. Patient satisfaction was equally very good in both groups. Patient-controlled epidural analgesia is an effective means of providing pain relief after post-traumatic pelvic reconstruction, but did not significantly reduce analgesic requirements in comparison with continuous infusion epidural analgesia.
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The world has to cope with the results of an increasing number of disasters. If the planning and preparation for these disasters are to be effective, then national and international organizations are necessary to integrate the sources of advice and relief. Studies of disaster management have consistently highlighted coordination of resources as an essential element of effective response. These organizations, both governmental and voluntary, aim to do just that, and awareness of them and their work will add support.
112 patients operated on for an intracranial aneurysm were surveyed. The immediate (up to 3 days from surgery) and late (from 3 days onwards and up to 2 years) outcome was examined in relation to the level and duration of per-operative hypotension as well as technical difficulties. The risk of both immediate and late post-operative neurological deficit was increased when the systolic blood pressure was pharmacologically reduced below the level of 60 mm Hg. The duration of such hypotension had a similar influence. A proportion of patients, following subarachnoid haemorrhage, respond poorly to hypotension and identification of these "vulnerable perfusers" by bedside cerebral blood flow or other monitoring procedures may be useful.