Thyroid storm as a cause of loss of consciousness following anaesthesia for emergency Caesarean section

A previously undiagnosed thyrotoxic patient was anaesthetised for an emergency Caesarean section. The recovery period was complicated by an acute thyroid crisis resulting in loss of consciousness following an apparently normal recovery from general anaesthesia.     

Clinical experience of quetiapine in 24 elderly patients with delirium

Background: A recent study reported that patients with delirium responded well to the administration of atypical antipsychotic agents. In the present study we administered quetiapine to patients with delirium and obtained good results. Methods: This study included 24 patients (10 men, 14 women), referred to the psychiatry department during admission to other hospital departments, who were diagnosed as having delirium according to the diagnostic and statistical manual of mental disorders (4th edition) (DSM‐IV) between April 2001 and September 2002. The mean age of the patients was 76.5 years (men 71.0 years; women 80.5 years). An initial dose of quetiapine was established at 25–50 mg/day. Depending on the symptoms, the dose and frequency were increased as required. According to Trzepacz's delirium rating scale (DRS), the treatment response was evaluated prior to the administration of quetiapine and 1, 3, 5 and 7 days after administration began. Results: Prior to the administration of quetiapine, the mean DRS score was 18.1. The mean scores were 12.2, 10.8, 9.7 and 8.9 after 1, 3, 5 and 7 days of quetiapine administration, respectively. These values were significantly lower than the value before administration (P < 0.001). Seven days after the administration of quetiapine commenced, the total DRS score was lower than the cutoff point (12) in 20 patients (83.3%). In 18 patients (75.0%), delirium was clinically relieved. Doses ranged from 25 mg/day to 125 mg/day, with a mean dose of 54.7 mg/day. With respect to the administration method, the majority of patients (i.e. 13 patients) received quetiapine once per day (after dinner). Somnolence was observed in three patients as a side‐effect of quetiapine administration. However, this side‐effect improved after 1–2 days, without decreasing the dose. Conclusions: Quetiapine may be useful for controlling delirium and concerning side‐effects and extrapyramidal symptoms were not recorded in the present study. Thus, it is appropriate to trial quetiapine in the treatment of delirium.     

24例骨折术后深部感染的原因及对策

目的 探讨骨折术后深部感染的原因、预防和治疗方法。方法 对骨折术后深部感染病灶行扩创后置管闭合灌洗。结果 24例经清创闭合灌洗平均27．5d后，感染均得以控制，效果满意。结论 骨折手术后深部感染原因是多方面的，宜积极预防，早期发现，及时扩创闭合灌洗，遗留肢体功能障碍者留待后期治疗。     

硬膜外控自动镇痛泵用于剖宫产术后临床观察

目的 :观察硬膜外腔自动镇痛泵 (AFA)用于剖宫产术后镇痛效果及对产后各项生理指标的影响。方法 :选择剖宫产术后患者 10 0例 ,随机分为两组 ,每组各 5 0例。硬膜外腔自动镇痛泵内含有 0 75 %布比卡因 15ml,0 5 %布比卡因 0 5ml,氟哌啶醇 5mg ,吗啡 8mg ,麻黄素 15mg ,生理盐水 80ml,以每小时 2ml速度给药 ,持续给药 48小时 ,对照组则不给任何药物。采用视觉模拟评分法 ,分别观察 2组患者术后的疼痛情况 ,肠蠕动恢复时间 ,拔尿管后排尿情况 ,产后出血、子宫复旧、泌乳情况及下床活动早晚情况 ,以及是否有恶心、呕吐、呼吸抑制等。结果 :①术后镇痛泵组患者术后无明显疼痛感 ,镇痛效果好 ,而对照组患者术后有明显疼痛感 (P <0 0 1) ;②镇痛泵组患者术后肠蠕动恢复时间为 (16 68±9 3 2 )h ,对照组 (16 2 3± 10 1)h ,两者比较无明显差异 (P >0 0 5 ) ;③术后尿管拔除后尿潴留发生率 ,镇痛泵组 8例 ,对照组 2例 ,差异有显著性 (P <0 0 5 ) ;④镇痛泵组下床活动时间为 (19± 5 )h ,明显早于对照组 (2 7± 8)h ,两组比较差异有显著性 (P <0 0 5 ) ;⑤ 2组患者产后出血、泌乳情况、子宫复旧、术后恶心呕吐、呼吸抑制发生情况比较 ,差异均无显著性(P >0 0 5 )。结论 :硬膜外自动镇痛泵具有良好的镇痛     

Survey of postoperative analgesia following ambulatory surgery

Background: The quality of pain relief during the first 48 hours following ambulatory surgery has been poorly documented. This questionnaire study was performed to evaluate the nature and severity of pain after the patient leaves the hospital. Methods: 1100 patients in the age group 5–88 years who underwent ambulatory surgery during a period of 6months were asked to complete a questionnaire 48 h after the end of the operation. In thecase of children, parents were asked to complete a similar questionnaire. The questions were related to pain experienced during the first 48 h after surgery and to the nature andseverity of postoperative complications. Results: A total of 1035 out of the 1100 patients returned the questionnaire, 94.1%. Overall the majority (65%) of patients had only mild pain at home; however, patients undergoing certain types of surgery had moderate-to-severe pain: inguinal hernia surgery (62% patients), orthopaedic surgery (41%), hand surgery (37%) and varicose vein surgery (36%). In these patients the severity of pain did not decrease during the 2-day study period. About 10% patients had more severe pain than they had anticipated, and 20% had difficulty in sleeping at night due to severe pain. Despite this, over 95% of patients were satisfied with man-agement of postoperative pain. Nausea (20%), tiredness (20%) and vomiting (8%) were the commonest complications reported during the first 48 h. A significant association was found between the administration of a general anaesthetic and the incidence of nausea postoperatively. A large number of patients were alone at home after the operation (28.4%); some (3.8%) had no access to a relative or friend in case of need. Conclusion: Our results show that about 35% of day-surgery patients experience moderate-to-severe pain at home in spite of analgesic medication. About 20% of patients had sleep problems due to severe pain. However, only 5% of patients were dissatisfied. Better analgesic techniques are necessary for patients undergoing certain types of surgery. Patient information and follow-up routines need to be improved.     

Postoperative pulmonary complication rate and long-term changes in respiratory function following esophagectomy with esophagogastrostomy

Upper abdominal surgery has a high incidence of postoperative respiratory complications. Although operations involving a thoracic as well as an upper abdominal incision as encountered in esophageal surgery are likely to be associated with an even higher complication rate and perhaps permanent alterations of respiratory function, only a few studies have addressed this problem. We evaluated the postoperative course of patients undergoing thoracoabdominal esophagectomy with esophagogastrostomy. Twenty patients were evaluated, of whom 10 (50%) developed respiratory complications as defined by our criteria, which were the simultaneous occurrence of rectal temperature over 38 degrees C on the first postoperative day and radiographic evidence of pulmonary infiltration. Although there is no general consensus regarding the diagnostic criteria of a postoperative pulmonary complication, we were able to validate the clinical relevance of our definition by showing that these patients suffered from a more severe and more prolonged impairment of global oxygen exchange than those who did not fulfill the criteria. They also required a longer period of respiratory support (median duration of intubation 12 vs. 3 days, P less than 0.005). A comparison of the preoperative pulmonary function with that determined at least 6 months after the operation showed that only vital capacity (VC) and total lung capacity (TLC) were significantly (P less than 0.05) reduced following the operation, but not to a clinically relevant degree (VC-6%, TLC-7%).     

腹腔镜手术并发症27例相关因素分析

目的 探讨腹腔镜手术的并发症及其相关因素。方法 回顾性研究西南医院妇产科近2年的2214例腹腔镜手术病例及27例出现并发症的病例情况。手术包括附件手术1721例，子宫肌瘤挖除术150例，子宫次全切术210例，子宫全切133例。并发症指术中出现的需额外处理或术后出现的因手术本身引起需进行再次手术或保守治疗的情况。结果 并发症发生率为1.22%，需手术处理者2例（0.09%)。附件手术、子宫肌瘤挖除、子宫次全切除术、子宫全切术的并发症发生率分别为0.52%、2.00%、3.33%及6.01%。与穿刺及气腹有关的并发症14例（51.9%)，包括腹壁血管损伤、严重皮下气肿及气腹针断裂；术中并发症3例（11.1%)，其中肠管损伤2例，1例改开腹手术，另1例为电极胸部皮肤烧伤；术后并发症10例（37.0%)，为术后发热。结论 妇科腹腔镜手术并发症不容忽视，并发症的发生与手术难度有关。