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Biomedical subjects

C G Mixter

Publications and source records attributed to C G Mixter.

9 recordsLinked to original sources
PubMed1998

Preemptive pain control in patients having laparoscopic hernia repair: a comparison of ketorolac and ibuprofen.

OBJECTIVES: To determine if nonsteroidal anti-inflammatory drugs provide adequate pain control for patients having laparoscopic hernia repair and to compare the effectiveness of ketorolac tromethamine with ibuprofen in reducing postoperative laparoscopic hernia pain. DESIGN AND SETTING: Prospective double-blind randomized study at a 100-bed community hospital. PATIENTS: Seventy patients ranging in age from 16 to 83 years scheduled for elective laparoscopic inguinal hernia repair. INTERVENTIONS: Patients undergoing laparoscopic hernia repair were enrolled in a double-blind randomized study to compare the 2 treatments. Group 1 received a placebo capsule 1 hour before surgery and ketorolac tromethamine, 60 mg intravenously, at the time of trocar insertion. Group 2 received ibuprofen, 800 mg an hour before surgery, and isotonic sodium chloride solution, 2 mL intravenously, at the time of trocar insertion. In addition, all patients received local infiltration of 30 mL of bupivacaine hydrochloride into their trocar sites. All patients were discharged within 5 hours of the operation and were instructed to take 400 mg of ibuprofen orally every 4 hours for 24 hours whether or not they were experiencing pain. A 24-hour supply of ibuprofen was provided to all study patients. Pain was assessed using the Visual Analog Pain Scale with a maximum pain rating of 100. Assessments were done at the time of and 18 hours after discharge. MAIN OUTCOME MEASURE: Postoperative pain 18 and 24 hours after discharge was assessed using a standardized questionnaire in a telephone interview by a registered nurse from the Outpatient Surgical Unit. RESULTS: There was no significant difference in the level of pain experienced by 35 patients who received ketorolac intravenously and 35 who received ibuprofen orally. There was no significant difference between the 2 treatment groups in the amount of pain experienced at discharge and 18 hours after discharge. CONCLUSIONS: Pain relief from ibuprofen, 800 mg, administered orally an hour before laparoscopic hernia repair was not statistically different from that obtained with intravenous ketorolac, 60 mg, administered intraoperatively when comparing the hospital discharge pain score and the mean and highest pain scores 18 hours after discharge. Ibuprofen offers equivalent pain control at a lower cost and reduced potential for adverse drug events compared with intravenous ketorolac in patients having laparoscopic hernia repair. No patient required narcotic supplementation, and pain control was judged satisfactory by all the patients.

Administration, Oral↗
PubMed1998

Laparoscopic cecectomy for massive appendiceal stump bleeding.

Massive bleeding from an appendiceal stump is extremely rare and typically requires emergency laparotomy and resection. We describe a case of severe gastrointestinal hemorrhage from an inverted appendiceal stump in a 20-year-old man 1 year after appendectomy. This was successfully managed by an urgent totally intracorporeal laparoscopic cecectomy. The patient benefited from the laparoscopic excision and made an uneventful and speedy postoperative recovery. The postoperative discomfort, morbidity, and long hospitalization typically associated with laparotomy were avoided. For appendiceal stump bleeding, totally intracorporeal laparoscopic excision offers a viable alternative to open laparotomy.

Adult↗
PubMed1997

Preemptive analgesia in the laparoscopic patient.

BACKGROUND: One hundred consecutive laparoscopic patients were prospectively followed in the Post-anesthesia Recovery Unit (PAR) in a community hospital. METHODS: Data was collected regarding (1) intraoperative administration of ketorolac, (2) instillation of local anesthesia into the wound, and (3) requirements for analgesic administration in the PAR. Those patients receiving both forms of preemptive analgesia required less narcotic administration in the PAR. The results were highly significant. RESULTS: Based on these data and the observance of markedly reduced pain in patients during the early postoperative period, an institutional plan of care was developed which has resulted in the virtual elimination of the need to administer narcotics to patients undergoing routine laparoscopic surgical procedures. CONCLUSIONS: The resultant plan of care, which includes preemptive analgesia, rapid ambulation, early feeding, and routine timed administration of non-narcotic pain medications, is presented. Data is also presented which demonstrates a more rapid discharge of patients from the hospital.

Analgesics, Non-Narcotic↗
PubMed1997

Laparoscopic resection of heterotopic gastric pancreatic tissue.

This report describes a laparoscopic approach for the treatment of a benign gastric mass. A 15-year-old female presented with recurrent epigastric pain. Preoperative endoscopic and x-ray evaluation demonstrated a submucosal tumor of the greater curvature. The patient underwent a laparoscopic resection of a heterotopic pancreatic tumor in the stomach. A description of our technique and a review of the pathophysiologic features of this disease is included.

Adolescent↗
PubMed1992

Control of proximal gastric bleeding: combined laparoscopic and endoscopic approach.

Dieulafoy's lesion (exulceratio simplex) of the proximal gastric corpus is a more frequent cause of massive upper gastrointestinal hemorrhage than previously appreciated. Recent management has focused on interventional endoscopic and radiologic techniques, but these have been plagued by high rebleeding rates. The traditional surgical approach of suture control of the bleeding or wedge resection is effective but entails significant morbidity and mortality. This article describes endoscopically guided laparoscopic ligation of the feeding vessels in a patient with massive hemorrhage from a Dieulafoy's ulcer.

Aged↗
PubMed1980

Resection of the abdominal aorta for recurrent colon cancers. 18 year survival.

(1) An 18 year survival after resection of a recurrent colon cancer involving the aortic bifurcation is reported. (2) Involvement of major intraabdominal vessels by malignant tumors should not categorically be considered a contraindication to curative resection. (3) After extended radical resections for colonic cancer, 40 to 100 percent of the adhesions will contain malignant cells. Curative en bloc resection of these primary tumors together with their organs and tissues, particularly if the adhesions are dense, can achieve 5 year survival in 34 percent of cases. (4) Colonic tumors recur locally in 4 to 28 percent of patients who are resected for cure; recurrence at the primary site may be the sole evidence of recurrent disease in 28 to 60 percent of these cases. These patients may be candidates for exploratory laparotomy and 30 to 40 percent may be amenable to reresection for cure with an anticipated 5 year survival rate of 23 percent.

Adenocarcinoma↗