ABSTRACT
One hundred two patients undergoing abdominal aortic reconstructive surgery were prospectively, randomly allocated to two groups, one of which was monitored with a central venous catheter and the other with a pulmonary artery catheter. Patients with uncompensated cardiopulmonary or renal disease were excluded from the study. General anesthesia was administered for the surgical procedure, and the patients were followed through hospital discharge. No statistically significant differences occurred between the two groups with regard to morbidity (perioperative cardiac, pulmonary or renal sequelae), mortality rate, duration of intensive care, postoperative hospital stay, or cost of hospitalization. The one statistically significant difference between groups was the professional fee charged for anesthetic care, which was higher for patients with pulmonary artery catheters than for those with central venous catheters. In conclusion, we prospectively gathered data from most patients presented for abdominal aortic reconstructive surgery. Our data seem to indicate that the choice of central venous catheter or pulmonary artery catheter monitoring makes little difference in outcome after abdominal aortic reconstructive surgery, and that for many patients pulmonary artery catheters are not necessary to give appropriate, adequate care. Because of the size of the sample, however, declarations of epidemiologic significance would be unfounded. Therefore large-scale, multicenter studies addressing such outcomes remain necessary.
Subject(s)
Aorta, Abdominal/surgery , Central Venous Pressure , Monitoring, Intraoperative/methods , Pulmonary Artery/physiopathology , Anesthesia, General , Aortic Diseases/economics , Aortic Diseases/physiopathology , Aortic Diseases/surgery , Coronary Disease/diagnosis , Costs and Cost Analysis , Evaluation Studies as Topic , Hemodynamics , Humans , Monitoring, Intraoperative/economics , Prospective Studies , Random AllocationABSTRACT
Urinary output has been used as a measure of adequate renal perfusion during anesthesia and surgery. In this study, 40 consecutive patients undergoing elective aortic reconstruction were studied to determine whether intraoperative urinary output was predictive of postoperative renal function as measured by blood urea nitrogen (BUN) and creatinine concentrations on postoperative days 1, 3 and 6, or 7. Pulmonary capillary wedge pressures or central venous pressures were kept at or above preoperative values. All patients received 22.5 g of mannitol IV prior to aortic crossclamping. No significant correlation was noted between either mean intraoperative urine output or lowest hourly urine output and postoperative BUN and creatinine concentrations. Complete interruption of renal blood flow in nine of the 40 patients had no significant effect on the correlations. Consequently, intraoperative urine output does not appear predictive of postoperative renal insufficiency in patients undergoing elective aortic reconstruction.
Subject(s)
Anuria/physiopathology , Aorta, Abdominal/surgery , Blood Urea Nitrogen , Creatinine/blood , Intraoperative Complications , Postoperative Complications , Aged , Aged, 80 and over , Anuria/etiology , Female , Humans , Male , Renal Circulation , Vascular Surgical ProceduresABSTRACT
Classroom lectures in medical schools have traditionally employed a blackboard and slides. We have developed a compact, durable, and relatively low-priced system for computer-assisted instruction which introduces audiovisual material in a random-access manner. When this system was used in the classroom to provide flexible, clinical simulations, it promoted a high level of audience-instructor interaction and facilitated problem-based learning. The system has been used successfully in lectures in our medical school, at other medical schools, at community hospitals and at national scientific meetings.
