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Acute Surgical Management by Senior Registrar Department of Anaesthesia Nian Chih Hwang,

By Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi

Global specialists in illnesses of the adrenal glands current new clinical information and functional directions for surgeons, citizens, endocrinologists and working towards physicians. The ebook covers all points of adrenal gland ailments in nice aspect. comprises approx. two hundred illustrations reminiscent of radiographs, CTMRI photographs, graphs and microscopic pathological slides, and so on. numerous tables and colour illustrations of surgical recommendations with emphasis at the laparoscopic strategy are integrated.

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Blood pressure is considered to be the most important factor in determining the risk of rapid expansion of a cerebral haematoma or rehaemorrhage. The aim of treatment is to achieve systolic blood pressures of or less than 160 to 180 mmHg and diastolic blood pressures of or less than 95 to 100 mmHg initially and allow slow correction thereafter, over several days, to the ideal long term levels for the patient. The common agents used in the acute situation include sublingual nifedipine, intravenous labetolol and, in refractory cases, intravenous trinitroglycerin (GTN).

8 It is important to exclude neurosurgically-related causes because rapid neurosurgical intervention may be required, and because unnecessary delays which lead to poorer outcomes, can be reduced. Temporising Measures While waiting for the neurosurgeon to arrive, or for the transfer to a neurosurgical unit, several important measures can be initiated to protect the brain and improve the patient. The overwhelming need is to reduce intracranial pressure (ICP) until definitive treatment can be provided.

Priorities in management are as follows: (1) Resuscitation of the patient Airway protection, ventilation and circulatory support, depending on the GCS and haemodynamics. (2) Stabilisation of the blood-brain barrier As a temporising measure, high-dose steroids (dexamethasone) should be given according to body weight. (3) Reduction of ICP Osmotherapy with mannitol is a reasonable temporising measure, but not very effective. (4) CSF diversion This requires transfer to a paediatric neurosurgical unit for definitive treatment.

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