Biomedical subjects
Publications and source records attributed to L Isabel.
Over a 10 year period, four patients with paraduodenal hernia were encountered. Two had small hernias that were incidental findings at the time of surgery for an unrelated abdominal condition; these were managed by suture closure of the neck of the sac. The other two patients presented with intestinal obstruction and are discussed here with a review of the literature.
Ergonomic analysis of the tasks of endosurgery helps in the design of instruments and tasks, and in decreasing the mismatch between human capacities and technology. It requires the study of the constraints of working through narrow fixed ports and an understanding of how the processes of gripping and dividing tissue are determined by its mechanical properties. This formal approach may offer more than trial-and-error evolution and haphazard solutions to problems by quicker general answers, with shorter learning curves, greater productivity and fewer errors, and decreased operator frustration. The first and ultimate benefit is for patients undergoing endosurgery.
The efficacy of aspiration of gastric contents to reduce postoperative nausea and vomiting was investigated in a controlled randomized, double-blind study of 265 outpatients. Patients in the treated group had their stomachs aspirated with an orogastric tube. In the control group no tube was inserted. Data on the incidence of nausea and vomiting were collected in the recovery room, the day surgery unit and the day after surgery. The overall incidence of postoperative nausea and vomiting was comparable in the two groups. It was also comparable in the recovery room and the day surgery unit. However, treated patients had a higher incidence of both nausea (26.5% vs 12.0%, P < 0.005) and vomiting (16.7% vs 6.8%, P < 0.02) after their discharge from the day surgery unit. We conclude that aspiration of gastric contents with an orogastric tube does not decrease postoperative nausea and vomiting in outpatients and may increase it after discharge of the patient.
In a 12-month period, five cases of pyogenic psoas abscess presented to the Townsville General Hospital. These cases are presented, together with a review of the literature to illustrate the clinical features of this condition and the therapeutic challenge it may pose.
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The durability and function of reusable and disposable laparoscopic instruments are compared, and the relative advantages and disadvantages of each are illustrated. Familiarity with the relevant issues described should allow surgeons to make informed choices on the most suitable instruments for their specific situation.
BACKGROUND AND OBJECTIVES: Combinations of bupivacaine and fentanyl are popular for postoperative epidural analgesia. However, there are little data from which to select a rational dose of bupivacaine. The study examined the effects of increasing amounts of epidural bupivacaine on postoperative analgesia, epidural fentanyl consumption, and side effects after thoracotomy. METHODS: Twenty-four patients were randomized in a double-blind manner to receive intra- and postoperative epidural infusions of either saline, 0.01% bupivacaine, 0.05% bupivacaine, or 0.1% bupivacaine at 10 mL/h. All patients received a standardized combined epidural (120 mg lidocaine and 1.5 micrograms/kg of fentanyl) and general anesthesia. Further postoperative analgesia was provided with fentanyl patient-controlled epidural analgesia (PCEA) only. RESULTS: There were no differences between groups in visual analog scale (VAS) pain scores at rest or cough, but 10 and 5 mg/h of bupivacaine provided better analgesia during physiotherapy (P < .05). The use of 10 and 5 mg/h of bupivacaine led to significant opioid sparing (50% decrease) when compared to saline and 1 mg/h bupivacaine (P < .03). There was a trend toward a greater incidence of orthostasis with the use of bupivacaine at 10 mg/h (P = .09). Incidences of opioid side effects were not different between groups. CONCLUSIONS: The results demonstrate improved analgesia with physiotherapy and significant opioid sparing when 10 and 5 mg/h doses of bupivacaine are used. However, the incidence of orthostasis may be increased with the use of 10 mg/h. Thus, 5 mg/h of epidural bupivacaine (.05% at 10 mL/h) improved analgesia, decreased opioid requirements, and did not have detectable hemodynamic effects.