Blended anesthesia in major urological surgery

The Authors report the results of a retrospective analysis of two groups of patients, who underwent major urological surgery, (extensive nephrectomies, radical prostatectomies, retroperitoneal lymphadenectomies and radical cystectomies with urinary diversion according to Bricker, VIP, US). Improvementiv surgery and clinical results is largely due to the improvement of the combined anaesthesiologic action — a light general and at the same time selective peridural anaesthesia — considering that both groups of patients were treated equally, in that they were nourished in the same way in the pre and post-operative phases and underwent the same intensive cures immediately after the operation, which was invasive and aggressive.

Heparin Prophylaxis Combined with DHE or Dextran in HIP Operations

162 elective hip operation patients were randomly allocated to: Group I: 5 000 U heparin injected s.c. 10 and 2 hours pre-operatively, then 8 hourly; Group II: heparin as above plus dextran 40 on three days; Group III: heparin as in group I combined with dihydroergotamine (DHE). The 125-I-fibrinogen test was routinely used for diagnosis of deep vein thrombosis (DVT), when positive, phlebography was performed. DVT occurred in 8/55 patients in group I, in 9/54 in group II and in 2/53 in group III. (Chi-square test: I vs. III p = 0.054; II vs. III p = 0.028) . Pulmonary embolism (confirmed at autopsy) occurred in one patient in both group I and II.In the three groups, the intra-operative transfusions, wound blood loss at the pre- and post-operative haematocrit did not differ.Platelet aggregation was only significantly lowered in group II.Heparin/DHE were most effective in preventing thromboemboli, dextran infusions did not improve heparin prophylaxis.Peridural anaesthesia performed in 83 - 87% of patients in all groups led to no complications following pre-operative heparin.