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Results for “Prophylactic Surgical Procedures”

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PubMed1997

American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients.

OBJECTIVES: To determine the frequency of the proposed definitions for the systemic inflammatory response syndrome (SIRS), sepsis and septic shock, and to further define severe SIRS and sterile shock as determined at 24 hrs of admission to an intensive care unit (ICU) in critically ill trauma patients without head injury, and their relationships to mechanism of injury, Acute Physiology and Chronic Health Evaluation (APACHE) II score, risk of death, Injury Severity Score (ISS), number of organ failures, and mortality rate. DESIGN: Prospective, inception cohort analysis. SETTING: Sixteen-bed surgical ICU in a teaching hospital. PATIENTS: Four hundred fifty critically injured patients without associated head trauma. Penetrating trauma accounted for 70% (gunshot 202; stab 113) and nonpenetrating trauma for 30% (motor vehicle collision 103; blunt 32) of admissions. Three hundred ninety-four (88%) patients underwent surgical procedures. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Infective and noninfective insults were distinguished by the need for therapeutic or prophylactic antibiotics, respectively, based on an established antibiotic policy. Three hundred ninety-five (87.8%) patients fulfilled a definition of the SIRS criteria. The frequency of the definitive categories was SIRS 21.8%, sepsis 14.4%, severe SIRS 8.4%, severe sepsis 13.6%, sterile shock 9.3%, and septic shock 20.2%. Patients with penetrating trauma had a significantly higher frequency of sepsis, severe sepsis, and septic shock (p < .01). The APACHE II score, risk of death, and number of organ failures increased significantly in both infective and noninfective groups with increasing severity of the inflammatory response. Sterile shock was associated with a significantly higher APACHE II score (p < .02), risk of death (p < .01), and number of organ failures (p = .03) compared with septic shock. Only sterile shock was associated with a significantly higher ISS (p < .01). Organ system failure was significantly (p < .001) higher in nonsurvivors compared with survivors in all categories. The only significant (p < .001) difference in mortality rate was found between patients in shock and all other categories. CONCLUSIONS: The current definitions of SIRS, sepsis, and related disorders in critically injured patients without head trauma show a significant association with physiologic deterioration and increasing organ dysfunction. The only significant association with mortality, however, is the presence of shock. The definitions require refinement, with the possible inclusion of more objective gradations of organ system failure, if they are to be used for stratifying severity of illness in seriously injured patients.

APACHE↗

PubMedDate not supplied

DDAVP therapy controls bleeding in Ehlers-Danlos syndrome.

PURPOSE: Patients with Ehlers-Danlos syndrome (EDS), especially types IV, VI, and VIII, are at increased risk of bleeding, and most do not have specific hemostatic deficiencies that would be amenable to replacement therapy. We have investigated the ability of DDAVP (desmopressin acetate) to control bleeding in EDS. PATIENTS AND METHODS: Two children with EDS, types VIII and VI, presented with hemorrhagic symptoms and scheduled surgical procedures. Ivy bleeding times (BTs) were measured before and after intravenous (i.v.) DDAVP challenge, and i.v. DDAVP was used prophylactically for their procedures. Laboratory testing was performed to rule out other hemostatic disorders. RESULTS: Both patients had prolonged BTs that corrected following i.v. DDAVP therapy; all other laboratory values were normal. Both patients had excellent clinical hemostasis with surgery, and one has continued to use intranasal DDAVP to control epistaxis and gingival bleeding. CONCLUSIONS: The bleeding time in both patients was corrected with DDAVP, and the patients did not have any postoperative bleeding. DDAVP should be considered in other patients who have EDS with bleeding tendencies.

Bleeding Time↗

PubMed1990

Patients' retrospective preference for extraction of asymptomatic third molars.

The purpose of this study was to determine the personal utility of asymptomatic third molar removal in military patients. From 1 to 30 days (mean = 7.4) after the extraction of one or more third molars, 100 returning patients (all male, mean age = 20.1) were asked to respond to hypothetical questions concerning the extraction of asymptomatic third molars. If the likelihood of third molars ever having to be removed was given as 10%, 50%, and 100%, then 45%, 61%, and 88% of responses, respectively, showed preference for immediate extraction. When respondents chose to delay treatment until there was a problem, no likelihood group would tolerate more than 2.77 additional days of post-extraction pain before changing their preference to immediate extraction. 87% of respondents preferred extractions prior to a deployment which would make treatment delivery difficult, and 89% prior to becoming a civilian at which time treatment might no longer be free. The results indicate general acceptance of the strategy of prophylactic third molar removal among a sample of military patients who have undergone pre-treatment counseling and the surgical procedure. A question remains as to the personal utility that might be measured prior to surgery.

Adult↗

PubMed1988

Disposition of cefonicid in orthopedic surgery patients.

Ten patients undergoing hip reconstructive procedures were given a single prophylactic dose of cefonicid 15 mg/kg to evaluate intraoperative and perioperative drug disposition in the surgical setting. Timed postinfusion serum samples were collected over 24 hours and resulting concentration versus time data were subjected to noncompartmental pharmacokinetic analysis. Bone samples were obtained in eight of ten patients with mean bone concentrations of 13.3 micrograms/g (range 8.2-25.1). Postinfusion serum concentrations at five minutes postinfusion ranged from 200.8 to 316.7 micrograms/ml; the 12-hour mean was 19.1 micrograms/ml (range 4.0-48) and the 24-hour mean was 4.3 micrograms/ml (range 0.0-13.8). Protein binding at three sampling times ranged from 88 to 96.5 percent, increasing over time as total cefonicid concentrations fell. The mean half-life in our patients was 3.5 hours, compared with 4.8 hours in our four controls. These data indicate that altered protein binding and intraoperative events alter the disposition of cefonicid. Although differences in disposition parameters between patients and controls were not statistically significant, suboptimal serum cefonicid concentrations were observed in four orthopedic patients.

Adult↗

PubMed1988

Cefotaxime single-dose surgical prophylaxis in a prepaid group practice. Comparisons with other cephalosporins and ticarcillin/clavulanic acid.

The prophylactic efficacy of a single 1g dose of cefotaxime for a wide variety of clean and clean-contaminated surgical procedures was studied in a large prepaid medical practice setting. Regimens were evaluated in 3 successive prospective, randomised comparative trials involving 1950 evaluable patients between November 1983 and March 1986. Single-dose cefotaxime was initially compared with standard multiple-dose regimens of cephazolin and cefoxitin, and subsequently used as the control regimen for comparisons with single-dose cefoperazone and ticarcillin/clavulanic acid. Patients were observed for the development of wound infection, non-wound morbidity, and adverse reactions. The single-dose prophylaxis regimens resulted in fewer surgical wound infections (p less than 0.05) compared with multi-dose prophylaxis if colorectal procedures were excluded from the analyses. The limited effectiveness of single-dose prophylaxis in colorectal surgery occurred despite the co-administration of erythromycin and neomycin. More than half the infections in all groups were discovered after hospital discharge and were inconsequential. Organisms isolated from the various infections generally remained susceptible to the administered antimicrobial agents. Adverse reactions occurred significantly (p less than 0.001) less often in the patients receiving single-dose prophylaxis. Non-wound morbidity was comparable in all trial groups. The costs associated with single-dose regimens were much lower than those of the FDA-approved multiple-dose regimens. These data confirm that single-dose, broad spectrum beta-lactam agents such as cefotaxime provide safe, effective and economical prophylaxis for a wide variety of surgical procedures.

Adolescent↗

PubMed1990

[Antibiotic prophylaxis of early infection in otorhinolaryngology surgery].

The authors draw attention to the urgency of antibiotic prophylaxis of early infection in surgical disciplines and emphasize the main principles of its expedient implementation. In otorhinolaryngology antibiotic prophylaxis proves useful in a number of surgical procedures; the authors submit, however, also examples when they do not consider antibiotic prophylaxis expedient. Among antibiotics used for prophylactic administration they consider at present for the majority of ENT operations cephalosporins of the first generation most useful. Their spectrum is roughly equal to the action of penicillin, oxacillin and ampicillin combined. When selecting an antibiotic, however, always ain individual approach must be used and its selection must be adjusted to the epidemiological situation in different areas and health institutions. The prophylactic use of different types of antibiotics cannot have permanent validity, we have to foresee rotation of antibiotics and the introduction of further new preparations.

Anti-Bacterial Agents↗

PubMed1985

[Treatment results following compound osteosyntheses. Pathological fractures and osteolyses in the extremities].

65 combined osteosyntheses were applied to 49 patients for existent or imminent pathological fractures. The most frequent reason was carcinoma of the breast in 2/3 of the cases. Surgical intervention was done palliatively non radical in 52 cases as a posttraumatic and in 13 cases as a prophylactic procedure. Surgery was well tolerated by all patients with a primary hospital mortality of 10,2%. On an average the survival time for 10 patients still living was 22 1/2 months, for 39 patients who had died 8 1/2 months. In all cases a substantial increase in quality of life was gained, both by enabling the patient to use the extremity concerned almost without pain and by greatly relieving bedside care. These results indicate that combined osteosyntheses should be applied on a broader basis.

Adult↗

PubMed1984

Prophylactic mastectomy with immediate reconstruction for the high-risk woman.

Prophylactic mastectomy should provide the woman at high risk for breast cancer with some degree of assurance that the surgical procedure is of benefit in preventing the occurrence of cancer. The so-called subcutaneous mastectomy fails because too much breast parenchyma is left to preserve the blood supply to the undisturbed nipple-areola complex. The procedure of choice described here removes the nipple-areola complex, thins and cores it, and replaces it as a free graft when the breast parenchyma is removed. A high-profile silicone breast implant is inserted into a pocket made of pectoralis major muscle, serratus anterior muscle, and a deepithelialized skin flap.

Adult↗

PubMed1993

Prediction of nosocomial infections in cardiac patients: a pilot study.

The purpose of this descriptive pilot study was to discover and correct problems with data collection in the identification of variables that are the strongest predictors of the occurrence of four nosocomial infections in cardiac patients. Data from 29 subjects who were admitted to a critical care unit (CCU) were tracked at a health care facility located in upstate New York. Data were obtained from daily care flow sheets and patients' charts. Although most results were not statistically significant, trends were identified in the data. The 7 patients who developed nosocomial infections were men who were older than 50 years, underwent a cardiac surgical or other invasive procedure, had more than one intravenous catheter, experienced a significant event in the CCU, and received prophylactic antibiotics. It is recommended that the number of independent variables tracked be reduced to 20. In addition, readmission of subjects whose data are being tracked should be included.

Adult↗

PubMed1968