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Prevention of deep vein thrombosis in potential neurosurgical patients. A randomized trial comparing graduated compression stockings alone or graduated compression stockings plus intermittent pneumatic compression with control.

In a randomized trial of neurosurgical patients, groups wearing graduated compression stockings alone (group 1) or graduated compression stockings plus intermittent pneumatic compression (IPC) (group 2) were compared with an untreated control group in the prevention of deep vein thrombosis (DVT). In both active treatment groups, the graduated compression stockings were continued for 14 days or until hospital discharge, if earlier. In group 2, IPC was continued for seven days. All patients underwent DVT surveillance with iodine 125-labeled fibrinogen leg scanning and impedance plethysmography. Venography was carried out if either test became abnormal. Deep vein thrombosis occurred in seven (8.8%) of 80 patients in group 1, in seven (9.0%) of 78 patients in group 2, and in 16 (19.8%) of 81 patients in the control group. The observed differences among these rates are statistically significant. The results of this study indicate that graduated compression stockings alone or in combination with IPC are effective methods of preventing DVT in neurosurgical patients.

Clinical Trials as Topic↗

Prophylactic methods against thromboembolism.

Deep vein thrombosis and pulmonary embolism are significant hazards of surgery, especially in orthopedic procedures. However, the true incidence of these complications is unknown. Many surgeons are now using prophylactic methods to prevent the postoperative occurrence of thromboembolic disease. Pneumatic compression devices are recommended in some instances, especially in cases where increased bleeding could be devastating. Several pharmacologic agents are also used, alone or in combination with pneumatic devices. These include subcutaneous heparin, warfarin, dextran, and aspirin. Each agent has advantages and disadvantages. The US National Institutes of Health (NIH) and numerous ongoing clinical trials are attempting to establish recommendations and guidelines for the use of prophylaxis against postoperative deep vein thrombosis and pulmonary embolism.

Anesthesia, Epidural↗

Mechanisms and management of anaphylactic shock not responding to traditional therapy.

Anaphylaxis results from the generation and release of a variety of mediators and their effects on various organs. Involvement of the respiratory and cardiovascular systems is of primary importance to the attending physician. Prompt recognition and initial therapy directed to maintenance of an effective airway and circulatory system is critical. Cardiovascular collapse may involve the parallel operation of several mechanisms including hypovolemia, alterations in pulmonary or systemic vascular resistance, depressed myocardial contractility, dysrhythmias, and exogenous drug administration. Although epinephrine is the mainstay of therapy, improvement in cardiovascular status may require aggressive fluid administration, and additional pharmacologic and non-pharmacologic aids.

Anaphylaxis↗

Effects of intermittent pneumatic calf compression in normal and postphlebitic legs.

The changes in common femoral vein flow produced by three different intermittent pneumatic compression devices were recorded with a Doppler velocity detector in 20 normal legs and 20 with postphlebitic syndrome. Mean and peak velocity increases were measured and expressed as a percent of resting baseline values. There was no significant difference in the peak velocity increase produced by the three devices in normals and abnormals; however, there were differences in the mean velocity increases. The devices worked as well on postphlebitic legs as on normal ones. Correct cuff application was more critical than indicated by the manufacturers, suggesting that some of the failures of intermittent pneumatic compression may have resulted from improper cuff placement. The results show that different designs of intermittent pneumatic compression equipment accelerate venous flow in the leg.

Adult↗

Control of intractable abdominal bleeding by external counterpressure.

Pressure of 20 to 25 mm Hg circumferentially applied to the abdomen and legs for periods up to 48 hours is a safe, effective, and practical adjunct to standard medical and surgical techniques for controlling intra-abdominal hemorrhage. Pressure is distributed uniformly through the abdominal cavity and aids hemostasis by decreasing transmural pressure and blood flow in arteries and veins. Compression of the venous capacitance reservoir causes shunting of blood to vital organs above the diaphragm. The mechanism of action, optimal pressures, physiological effects, indications, contraindications, and possible harmful effects of circumferential pneumatic compression are discussed.

Abdomen↗

Management of orthostatic hypotension in the elderly.

Orthostatic hypotension (OH) is a common problem in old age that can seriously affect the quality of life, leading to a progressive decline in health. In the elderly, the literature suggests that multiple causes predominate. This article proposes a stepped-care approach to the management of OH. A stepped-care therapy applied appropriately allows maximum benefit with the least number of drugs, thereby minimizing side effects.

Aged↗