Abstract:
:INTRODUCTION While clinical guidelines stress the importance of the judicious perioperative intravenous fluid administration, data show that adherence to these protocols is poor. The reasons have not been identified. We therefore audited the magnitude and indications of fluid and electrolyte administration in a teaching hospital. We hypothesised that epidural analgesia is associated with excessive fluid therapy. MATERIALS AND METHODS Intravenous fluid and electrolyte administration during the day of surgery and the subsequent 2 days in consecutive patients undergoing elective gastrointestinal surgery between November 2013 and May 2014 were retrospectively audited. Timing, volumes and indications were recorded. RESULTS One hundred patients undergoing elective gastrointestinal resection were studied. Patients received 9030 ml ± 2860 ml (mean ± standard deviation) intravenous fluids containing a total of 1180 ml ± 420 mmol sodium and resulting in a cumulative fluid balance of +5120 ml ± 2510 ml; 44% ± 14% of total volumes were given in theatre. Nearly all fluid was given for maintenance, 100% (96-100%, interquartile range), with 17 patients only receiving replacement or resuscitation. Independent predictors of increased volumes included open surgery, upper gastrointestinal surgery, increased duration and epidural analgesia but not body weight. Postoperative fluid volume was the only independent predictor of postoperative complication grade (P = 0.0044). CONCLUSIONS Despite published guidelines, perioperative fluid and electrolyte administration were excessive and were associated with postoperative morbidity. Substantial volumes were administered in theatre. Nearly all administration was for maintenance, yet patients received approximately five times the amount of sodium required. Epidural analgesia was an independent predictor of fluid volumes but body weight was not.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Simpson RG,Quayle J,Stylianides N,Carlson G,Soop Mdoi
10.1308/rcsann.2017.0077subject
Has Abstractpub_date
2017-07-01 00:00:00pages
497-503issue
6eissn
0035-8843issn
1478-7083journal_volume
99pub_type
杂志文章abstract::Apposition of skin edges in plastic surgical procedures can be achieved by sutures or stainless steel staples. This retrospective study reviews 45 skin falp operations and finds that 20.6% of sutured flaps are complicated by partial necrosis or slow healing. These complications occur in 62.5% of stapled flaps. It is p...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract:INTRODUCTION:Necrotising fasciitis is a life-threatening illness that is often difficult to diagnose. Immediate debridement and intravenous antibiotic therapy are required to limit the spread of infection. This five-year audit aimed to review the number and outcomes of all cases of necrotising fasciitis admitted to a ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588413X13511609956093
更新日期:2013-01-01 00:00:00
abstract:INTRODUCTION:Surgical intervention has become a common component in the management of patients infected with the human immunodeficiency virus (HIV) or suffering from the clinical consequences of acquired immunodeficiency syndrome (AIDS). We investigated the evolution of this involvement at a tertiary referral centre fo...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588407X183436
更新日期:2007-05-01 00:00:00
abstract:INTRODUCTION:This observational study investigated the incidence of distal radius fractures in children, to determine whether the rate is rising, the effect of seasonal variation on incidence and whether fracture type and rate of surgical intervention has changed, to help in determining costs for secondary care and to ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2019.0023
更新日期:2019-04-01 00:00:00
abstract::Seatbelt associated blunt trauma to the rectum is a rare but well recognised injury. The exact mechanism of hollow visceral injury in blunt trauma is unclear. Stress and shear waves generated by abdominal compression may in part account for injury to gas containing structures. A 'seatbelt sign' (linear ecchymosis acro...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:10.1308/rcsann.2016.0050
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVE:To ascertain whether a written information sheet is acceptable to patients and improves recall of the consent interview. DESIGN:Prospective randomised controlled study using questionnaires, comparing a group of patients given information in a written sheet with appropriate explanation to a group given verbal...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1308/003588402760978201
更新日期:2002-11-01 00:00:00
abstract:INTRODUCTION:Non-attendance in the out-patient department has financial costs for the NHS and clinical implications to the non-attender and those awaiting an appointment. The aim of this audit was to quantify the percentage of non-attenders at colorectal clinics in a UK teaching hospital, assess which factors affected ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588408X301172
更新日期:2008-07-01 00:00:00
abstract::We report a 91% accuracy with fine needle aspiration cytology in 46 patients found to have a mass in the pancreas at laparotomy. Results were compared with conventional biopsy at operation which was accurate in only 56% of an earlier group of 48 patients with a localised mass compared with 97% in 33 patients with diss...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1984-11-01 00:00:00
abstract::Twenty-one patients have been studied in the 48 h after valve replacement to determine the possible contribution of abnormalities of left ventricular myocardial blood flow and oxygen consumption to the impaired cardiac performance which is sometimes evident in such patients. In the 14 patients making an uneventful rec...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1975-08-01 00:00:00
abstract::Patients with extensive chronic Crohn's disease of the small bowel, who may have had repeated excisional surgery, sometimes develop intestinal obstruction due to the development of a stricture. Surgery is usually thought to be contraindicated since further resections would leave the patient with insufficient small int...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1982-07-01 00:00:00
abstract::To assess and compare the safety and efficiency of a surgical unit at a District General Hospital and a Community Hospital for elective cold surgery. A retrospective survey was made using regional computer Hospital Activity Analysis data and monthly audit meeting records of all inpatients having selected elective gene...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1991-07-01 00:00:00
abstract::A summary of its uses in mitral valve surgery and coronary artery revascularisation. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:10.1308/rcsann.supp2.22
更新日期:2018-09-01 00:00:00
abstract::The recording of medical data has developed from crude non-specific classifications to complex systems tailor-made for individual practices. The development of the Read Clinical Classification has produced a complex classification which is user friendly and covers the whole of medicine. The classification allows uniqu...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1994-05-01 00:00:00
abstract::General anaesthesia is infrequently requested for bronchography in small children. The clinical indications, recommendations for the anaesthetic technique, and problems associated with the investigation are discussed. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1980-05-01 00:00:00
abstract::We describe the largest reported case of pilomatrixoma in the literature. While pilomatrixomas typically present as small soft-tissue nodules of the head, neck and upper extremities, they can also present as much larger masses in atypical locations. When they present in their usual size, pilomatrixomas have typical im...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2017.0196
更新日期:2018-02-01 00:00:00
abstract::The successful treatment of major burns depends upon accurate and early fluid replacement in the first 36 h. A burns calculator has been designed, based upon the Muir and Barclay formula, which should facilitate the estimation of fluid requirements in burned patients and therefore improve their immediate management in...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1982-09-01 00:00:00
abstract::First reported two decades ago, isolated incisional recurrence of hepatocellular carcinoma is an extremely rare clinical entity. We present two cases of recurrence: one recurring over 10 years after initial resection, and the second presenting with a port site recurrence 3.5 years following laparoscopic radiofrequency...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2017.0097
更新日期:2017-07-01 00:00:00
abstract::Parathyromatosis is a rare entity and usually appears as a consequence of the seeding on previous parathyroid surgery which was applied for the secondary hyperparathyroidism. A 63-year-old woman presented with a history of subtotal thyroidectomy 20 years ago and parathyroidectomy due to primary hyperparathyroidism (PH...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:10.1308/rcsann.2019.0105
更新日期:2019-11-01 00:00:00
abstract::Introduction While surgery is the cornerstone of bowel cancer treatment, it comes with significant risks. Among patients aged over 80 years, 30-day mortality is 13%-15%, and additionally 12% will not return home and go on to live in supportive care. The question for patients and clinicians is whether operative surgery...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2016.0146
更新日期:2016-07-01 00:00:00
abstract::Isaac Newton, among others, observed that 'we see so far because we are standing upon the shoulders of giants'. In vascular surgery most of the giants have been European, and this is a heritage which we as Europeans can take pride in and build upon if we chose to do so. As in other areas of life, commitment is essenti...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 历史文章,杂志文章
doi:
更新日期:1999-09-01 00:00:00
abstract:INTRODUCTION:The increased use of diagnostic laparoscopy for management of right iliac fossa pain may have lowered the threshold for removing normal appendices, particularly as there is a perception that this practice carries little additional morbidity. The aim of this retrospective audit was to determine the negative...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588414X13946184903801
更新日期:2014-10-01 00:00:00
abstract::A patient with phyllodes tumour of the breast is discussed. During follow-up, she presented with intestinal obstruction caused by ileocaecal intussusception. The cause of the intussusception was metastatic phyllodes tumour, which is a unique presentation. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/147870810X12699662981357
更新日期:2010-09-01 00:00:00
abstract::The results of the secretin-pancreozymin test, duodenal aspirate cytology and hypotonic duodenography (the Triple Test), performed during a single duodenal intubation in patients with pancreatic or ampullary carcinoma, chronic pancreatitis and non-pancreatic disease were analysed retrospectively. Thirty-five of 36 car...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1983-05-01 00:00:00
abstract::Introduction Pseudoaneurysm formation following ankle arthroscopy is a rare but potentially catastrophic complication. The placement of anterior ankle portals carries inherent risk to the superficial and deep peroneal nerves, as well as to the dorsalis pedis artery. Anatomical variations in the dorsalis pedis and the ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2016.0288
更新日期:2017-04-01 00:00:00
abstract::Introduction Angiolipoma is a histological variant of lipoma and is the most common neoplasm in the trunk and extremities of young adults. It is extremely rare in elderly people, and its size is ≤4cm. Few data are available for large angiolipomas. Case History An 86-year-old patient was admitted to our surgical depart...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2016.0150
更新日期:2016-07-01 00:00:00
abstract::Forty-eight patients treated for haemorrhoids by Lord's procedure have been followed up for 5 years. Preoperative anal pressure and motility studies suggest that the best long-term results occur in patients with an active internal sphincter. Anal pressure was reduced by dilatation and remained static over the next 5 y...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1982-11-01 00:00:00
abstract::The technique of regional anaesthesia for hand surgery is described. This has been successfully carried out in a series of 179 patients treated as day cases. The advantages and disadvantages of the technique are discussed. Emphasis is placed on careful patient selection and attention to detail in applying the techniqu...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1983-11-01 00:00:00
abstract:INTRODUCTION:Preliminary studies show that device assisted intravesical therapies appear more effective than passive diffusion intravesical therapy for the treatment of non-muscle invasive bladder cancer (NMIBC) in specific settings, and phase III studies are now being conducted. Consequently, we have undertaken a non-...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:10.1308/003588414X13946184901001
更新日期:2014-09-01 00:00:00
abstract::During a 10-year period (December 1984 to December 1994), 1500 cases of frostbite were treated at a tertiary care medical facility. They were all males with their ages ranging from 17 to 43 years. All the patients sustained the frostbite injury in the northeastern part of Pakistan known as the Karakoram range of mount...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1998-03-01 00:00:00
abstract::Twenty-one knees with isolated chronic deficiency of the anterior cruciate ligament have been treated by reconstruction using the ABC carbon and polyester bioprosthetic composite ligament; 16 were reviewed at an average of 34.6 months. The Lysholm score indicated a good or excellent result in nine knees (56%) with a s...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1995-09-01 00:00:00