[Causes of death on the operating table].
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Cerebral protection combines techniques aimed 1) to avoid death of neurones which sustained primary ischemic of traumatic insults and 2) to prevent secondary insults to the brain. The chemical brain retractor concept includes the use of a total intravenous anesthesia technique, mild hypocapnia and mannitol with strict monitoring and maintenance of the global cerebral homeostasis. This contributes to decrease brain volume and intracranial pressure and allows the best possible access to the operating site, while avoiding excessive pressure under the surgical brain retractors. Neuronal protection is based on a better understanding of the biological basis of secondary brain damage; therapeutic or prophylactic techniques include the use of specific pharmacological agents, hypothermia, hemodilution and maintenance of an elevated cerebral perfusion pressure. In short, although the favourable effects of such techniques are nor easy to demonstrate in man, their use in today's clinical practice, in association with the concept of the chemical brain retractor, is an effective way to prevent ischemic cerebral insults during neurosurgical procedures.
Inquests following death on the table present the expert with a number of problems: he has to assess not only the causal connection between therapeutic or surgical procedures and death of the patient, but also the part played by anaesthesia in the fatal outcome. A number of cases are reported and an attempt is made to provide some objective guide-lines for the expert.
The aim of this article is to suggest and justify the hypothesis that theatre tables and trolleys are probably the root cause of a large proportion of pressure sores in surgical areas. Pressure sores are also known as decubitus ulcers or bed sores, and are caused by the death of tissue when the blood supply to the capillary bed and/or deep tissue is occluded. This occlusion stops the tissue from being supplied with nutrients and also prevents waste products from being removed. Ways will be suggested of how the risk of developing these painful, costly -40,000 pounds plus for a serious pressure sore--and very largely preventable sores can be reduced. In order to do this, the article will attempt to cover aspects of the whole problem and not just concentrate on the theatre area.
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