[Modernization of anesthesia in gynecological surgery].
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OBJECTIVE: How to prevent severe complications of lower leg compartment syndrome following gynecologic operations in the lithotomy position? MATERIAL AND METHODS: Two cases of lower leg compartment syndrome following long lasting gynecologic operations are presented. RESULTS: Early diagnosis by clinical signs, measurement of compartment pressure and creatine kinase activity and undelayed surgical intervention can avoid acute renal failure due to rhabdomyolysis and damage of neuromuscular function. CONCLUSIONS: Early diagnosis and undelayed surgical intervention can prevent severe complications of lower leg compartment syndrome following gynecologic operations in the lithotomy position.
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The paper reports on the application of suprapubic bladder drainage in 86 women who had undergone gynecologic operations. After describing the advantages and complications of this method of draining off urine, it is found that, if urine drainage is required over a longer period, in a great number of cases suprapubic urine drainage is to be preferred to the permanent transurethral catheter.
The results obtained in 80 patients hospitalized at the University of Obstetrics and Gynecology Clinic in Perugia for abdominal and vaginal hysterectomy are reported and evaluated in a prospective and randomized study of perioperative antibacterial prophylaxis. In the 75 patients available to study a single intravenous dose of 2 g cefotetan was compared with a triple dose of 1 g intravenous cephazolin. A reduction in the incidence of post-operative infections both in abdominal hysterectomy from 24% (cephazolin group) to 11.53% (cefotetan group) and in vaginal hysterectomy from 40% (cephazolin group) to 71.4% (cefotetan group) was noted. These results show that a single intravenous dose of 2 g cefotetan can be considered a valid therapeutic support for antibacterial prophylaxis. In addition the absence of alterations in the parameters considered (haematological, biochemical and urinary) points to the safety, effectiveness and non-toxicity of the drug.
The various effects have been examined against the anaerobes by administering tinidazole when the operations of gynecology and obstetrics and the following results were obtained. 1. The serum concentrations after the single administration of 1,000 mg of TDZ showed 56.6 micrograms/ml of the peak value (3 hours) and 27.7 micrograms/ml of 24 hours value, and the antibacterial potency was maintained for a long duration. The concentration in the vaginal secretions was 21.8 micrograms/tampon within 24 hours. 2. The detections of anaerobes were made in 74 cases, before the administration, with the results of 1 case alone and 73 cases mixed with aerobes, 10 species and 133 strains being detected, which comprise 33 cases with 1 species, 27 cases with 2 species mixed, 10 cases with 3 species mixed and 4 cases with 4 species mixed. The main species detected were Bacteroides fragilis in 46 strains (34.6%), Peptostreptococcus spp. in 31 strains (23.3%) and Peptococcus spp. in 26 strains (19.5%). 3. The MIC values of the detected bacteria to the TDZ centered upon 0.78 micrograms/ml for Bacteroides fragilis, 3.13 micrograms/ml for Peptococcus spp. and 0.78 micrograms/ml for Peptostreptococcus spp. and those of the others were low, a lot of those being of sensitive strains. 4. The bacteriological effects on the anaerobes were, after the medication, observed to be 71.4% and found significantly more effective than 33.3% of natural eradication and decrease observed in the not administered group. 5. Clinically, no anaerobic infections were observed often operation and the therapeutical effects were observed. A little side effect was observed. 6. According to the above-mentioned results, it was observed possible to prevent from the anaerobic infections after operation in gynecology and obstetrics by administration of TDZ.
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