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At least 811 records · Page 45Linked to original sources
PubMed1997

Preemptive analgesia in patients undergoing appendectomy.

OBJECTIVE: To evaluate the use of preemptive analgesia in patients who were undergoing an operation for acute appendicitis. DESIGN: Double-blind, randomized control trial. SETTING: Public hospital. PATIENTS: Patients who presented with presumed appendicitis. INTERVENTION: Patients received 1 of the following treatments: group 1, preemptive analgesia with a combination of lidocaine hydrochloride and bupivacaine hydrochloride; group 2, preemptive analgesia with saline solution; or group 3, nothing. MAIN OUTCOME MEASURES: The Wong-Baker FACES Pain Rating Scale, analgesic requirements, number of analgesic doses required, and length of hospital stay. RESULTS: No differences were noted in postoperative pain, the total number of analgesic doses per day, the quantity of narcotic medication administered, and the length of hospital stay. CONCLUSIONS: Compared with healthy control subjects, preemptive analgesia did not reduce postoperative pain, reduce analgesic requirements, or shorten the length of hospital stay in patients who underwent an appendectomy. Premptive analgesia may be applicable only for patients without preoperative pain.

Acute Disease↗
PubMed1987

Plasma atrial natriuretic peptide and blood pressure during chronic salt loading in spontaneously hypertensive rats with right atrial appendectomy.

Spontaneously hypertensive rats (SHR) were subjected to right atrial appendectomy (ATRX) or sham operated. Five days after this procedure the rats were put on tap water or 1.5% NaCl as drinking water for 1 week. The blood pressure (carotid artery), 24 hours urinary sodium and kalium excretion, plasma levels of immunoreactive atrial natriuretic peptide (ir-ANP) and the rise in plasma ir-ANP concentrations after an acute volume expansion by homologous whole blood (10%) were evaluated after 1 week on the different diets. At the start of the dietary period the rise in plasma ir-ANP values was blunted in ATRX rats. After 1 week the salt loaded animals excreted tenfold more sodium than control rats. At this time basal ir-ANP values in plasma were not significantly influenced by the ATRX and/or the high salt diet but the rise in plasma ir-ANP concentrations to acute volume expansion was blunted in the salt loaded rats. However, the basal blood pressure was not influenced by the salt diet and/or the ATRX. These data do not support the notion that an alleged deficiency in ANP release mechanisms in the SHR is a major determinant for the blood pressure development in this rat strain.

Animals↗
PubMedDate not supplied

Repair of McBurney incisional hernias after open appendectomy.

Incisional herniation after appendectomy through a right lower quadrant muscle-splitting (McBurney) incision is rare, occurring in less than 0.12% of operations for appendicitis. Primary repair of this form of hernia is particularly difficult as a result of the attenuated fascia created by the herniation. By using synthetic mesh, it is possible to effectively repair this type of hernia. Three cases of postoperative incisional herniation treated by different surgical approaches are reviewed.

Journal Article↗
PubMedDate not supplied

[LAPAROSCOPIC APPENDECTOMY: EXPERIENCE IN THIRTY CASES]

Between September 1994 and February 1997, 30 patients with clinical diagnosis of acute appendicitis were subject of laparoscopic appendectomy (LA) at the "Stella Maris" Clinic in Lima - Peru. Only one conversion to an open procedure was practiced to a 69 years old woman with an appendiculate plastron. Out of the other 29 LA cases, 17 were women (58.6%) and 12 were men (41.4%) with an average age of 23 years, average surgery time of 94 minutes, average time of restablishment of food in-take 15 hr. and average post-operation time of hospitalization 27,1 hr. The anatomo-pathologic diagnosis revealed 11 cases of acute appendicitis, 1 case of suppurative acute appendicitis, 6 cases of acute appendicitis + peritonitis, 1 case of chronic periappendicitis, 6 cases of vascular congestion and/or follicular hyperplasia. There were also reported 3 cases of vascular congestion and/or follicular hyperplasia associated to gynecological pathologies that were solved laparoscopycally. A minor wound infection was registered as a post-operative complication. Thus, it is concluded that the LA is a save method of low morbidity, applicable to children, very advantageous in women in fertile age, in obese or fat patients, in the cases of diagnostic doubt and in patients with complicated appendicitis.

Journal Article↗
PubMed1991

Effect of right atrial appendectomy on the release of atrial natriuretic hormone.

Atrial natriuretic hormone is released from the right atrial appendage in response to atrial distention. During cardiac operations the right atrial appendage is usually partially removed or ligated for venous cannulation. To evaluate the effect of right atrial appendectomy on the release of atrial natriuretic hormone and its natriuretic and diuretic responses, we prospectively randomized into two groups 23 patients undergoing elective coronary artery bypass operations. There were 16 male and 7 female patients with a mean age of 62 +/- 7 years. Group A (n = 11) had the right atrial appendage removed, and group B (n = 12) had the right atrial appendage preserved and venous cannulation done lateral to the appendage. The two groups were comparable for sexual distribution, age, number of grafts, and extracorporeal bypass time. All patients had normal left ventricular and renal functions, and they did not receive any diuretics during the study period. The patients were studied both preoperatively and postoperatively whereby the atrial natriuretic hormone serum levels, urine volume per minute, fractional excretion of sodium, amount of sodium excreted, and central venous pressure were measured before and after volume expansion with 5% albumin, 7.5 ml/kg. There was no statistical difference in these parameters preoperatively. In the postoperative period, however, group B patients had higher atrial natriuretic hormone levels after volume expansion than group A patients (376 +/- 84 versus 184 +/- 31 pg/ml; p less than 0.05), higher urine volume per minute (4.4 +/- 1.0 versus 2.0 +/- 0.4 ml/min; p less than 0.05), higher fractional excretion of sodium (2.30 +/- 0.66 versus 0.64 +/- 0.19; p less than 0.02), and higher amount of sodium excreted (511.1 +/- 150.9 versus 83.9 +/- 22.8 mmol/min; p less than 0.02). The central venous pressure was similar both before (9 +/- 1 versus 9 +/- 1 mm Hg) and after (16 +/- 1 versus 15 +/- 1 mm Hg) volume expansion in both groups. We conclude that preserving the right atrial appendage during cardiac operations significantly increased the release of atrial natriuretic hormone, resulting in increased urinary sodium excretion and better diuresis in the postoperative period.

Aged↗