Patients In Immediate Postoperative Period Research Articles

Immediate jejunostomy feeding. Its use after major abdominal trauma.

Jejunostomy feedings were used in the immediate postoperative period in patients with massive abdominal and retroperitoneal injuries. Patients were selected for early feeding if they had two or more major visceral injuries. Over a six-month period, 30 such patients were studied: ten had blunt trauma, 11 had gunshot wounds, and nine had stab injuries. The injuries included 11 pancreatic, ten small-bowel, six colon, and six major retroperitoneal vascular injuries. A 16-gauge intracatheter was placed in the proximal jejunum. The constant infusion of nutritional solution (Vivonex HN) was begun 18 hours postoperatively, and within 72 hours all patients were receiving 2,400 calories per day. Feedings were maintained for an average of eight days. Serum albumin and transferrin levels, total lymphocyte count, and delayed hypersensitivity were maintained or improved during jejunal feeding. Patients with pancreatic injuries received supplemental nutrition without evidence of pancreatic stimulation. Needle-catheter jejunostomy can provide early, safe nutritional support after major abdominal trauma. Further investigation is needed to determine who will benefit from this early feeding.

Intravesical Thio-tepa in the Immediate Postoperative Period in Patients with Recurrent Transitional Cell Carcinoma of the Bladder

AbstractRecurrent transitional cell carcinoma was treated with prophylactic intravesical thio-tepa in 22 cases. Group 1 patients were treated with 30mg. twice daily for the first 3 days postoperatively. Group 2 patients were given additional treatment at increasing intervals indefinitely. Before therapy control patients averaged 1 recurrence every 9.5 months. Group 1 patients avçraged 1 recurrence per 33 months. Group 2 patients averaged 1 recurrence per 41 months. Leukopenia occurred in only 2 patients. Thio-tepa can be given safely in the immediate postoperative period and is effective in decreasing the recurrence rate of superficial bladder tumors.

Effects of preoperative teaching upon patients with differing modes of response to threatening stimuli

The appearance of Janis’ classic study (Janis, 1958) of preoperative psychological stress focused the attention of many health professionals on the importance of psychological preparation for the surgical experience. In formulating the concept of the ‘work of worrying,’ Janis emphasized the potentially positive value of moderate anticipatory fear in preparing for and responding to the surgical experience. The facilitating effects of’moderate anticipatory fear were also seen by Deutsch in what he termed ‘assimilation’ of the anxiety. He assumed that learning of the need for a surgical procedure evoked some degree of anxiety which served as a signal of the perception of danger initiating a readjustment of psychological defenses and physiological processes to meet the threat. Emotional disorder results from failure to perceive the danger signal or to make a readjustment. When risk is denied, the existence of fear is unrecognized, or anxiety if repressed, then anxiety cannot be assimilated and the perception of anxiety will not bring about readjustment in preparing for stress. The views of Janis and Deutsch are supported by the findings of Layne and Yudofsky (1971) that those patients relying heavily on denial found this to be an inadequate defense mechanism postoperatively. In addition, these patients were noted to develop postoperative psychosis more frequently than those who did not utilize this mechanism. Abram (1965) reported the frequent occurrence of panic, depression, and confusion in the immediate postoperative period in patients who did not receive information about what to expect during this period. Preoperative teaching has been shown to favorably influence such postoperative variables as length of hospital stay and narcotic requirement (Healy, 1968; Egbert et al., 1964). A contradictory finding was reported by Morse and Litin (1969) in a study of postoperative delirium. Denial was found significantly more often among the nondelirious patients. Gilberstandt and Sako (1967) utilizing Minnesota Multiphasic Personality Inventory studies on patients who had undergone open-heart surgery, reported that the

Oxalic acid excretion after methoxyflurane and halothane anaesthesia.

Oxalic acid excretion was measured in nine patients receiving methoxyflurane and six patients receiving halothane. Oxalic acid excretion increased from 5 to 23 times in the immediate postoperative period in patients receiving methoxyflurane, whereas no increase was noted in those receiving halothane. Despite the striking increase in oxalic acid excretion, no alteration in renal function and no polyuric state developed. The renal failure that occasionally develops after methoxyflurane anaesthesia appears to be multifactorial in origin and a hyperoxaluric state may play a role in some instances.

Physiologic studies following surgical correction of ventricular septal defect.

Sixteen patients were studied immediately and for 3 days following surgical closure of ventricular septal defect. In eight patients with absent or mild pulmonary vascular disease, convalescence was uneventful and only small deviations from normal in cardiac output, blood gas levels, and acid-base profile were observed. The remaining eight patients had pre-existing moderate or severe pulmonary vascular disease. Values for cardiac output were abnormally low at some time in the postoperative period in all but two of these eight patients. Failure to survive was clearly related to a low cardiac output in four of the five nonsurvivors. Reduction in cardiac output observed in this group of patients is believed to be based in major part on the pre-existing increased resistance to blood flow through the pulmonary vascular bed and also to impaired right ventricular function following operation. No evidence was obtained to suggest that major changes in pulmonary vascular resistance occurred in the immediate postoperative period in patients with moderate or severe pulmonary vascular disease following closure of ventricular septal defect. Right ventricular function following atriotomy or transverse ventriculotomy was less impaired than after vertical ventriculotomy.