THE OSTIA VENAE HEPATICAE AND THE RETHROHEPATIC ...

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WHEN SHOULD WE ORDER PREOPERATIVE CHEST RADIOGRAPHY :
A SYSTEMATIC REVIEW AND CLINICAL PRACTICE GUIDELINES
Pitimana-aree S, 1
Lertakayamanee J, 2
Somprakit P, 2
Santawat U, 2
Neti T, Soontranan P, 1
Chulachata D, 1
Tritrakarn T, 1
Charoenratanakul S, 3
Kongpattnakul S, 4
1
Department of Anesthesiology, 2
Department of Anesthesiology and Clinical Epidemiology Unit,
3
Department of Medicine, 4
Department of Pharmacology, Faculty of Medicine Siriraj Hospital,
Mahidol University
Routine preoperative investigation consumes much resource while Thailand suffers severe
financial crisis. Objectives of the study were to apply a systematic review to answer the question
whether routine preoperative investigation affected health outcomes; and to construct clinical practice
guidelines for preoperative chest radiography (CXR). The guidelines were prepared for elective, noncardiothoracic
surgery in adult patients. Methods of the study were Medline search (1980-1998) and
search from studies published in Thailand. Criteria for high validity and reliability were applied to paper
selection. The results of the systematic review were discussed among anesthesiologists and other specialists
and the guidelines were drawn by consensus. Results from the systematic review, there were no
randomized controlled trials to answer the question and no studies reported health outcomes. Routine
preoperative investigations yielded few positive results and were not very useful for patient care. From
this review and the consensus, we proposed the guidelines, which consisted of a history questionnaire,
physical examination and indication for investigation. For the preoperative CXR the indications were:
age > 45 years, history of cardiovascular and respiratory diseases, autoimmune deficiency syndrome
(AIDS), heavy smoking, chronic cough or fever, malignancy and findings of abnormal breath sounds on
examination. This study recommends and prefers preoperative CXR as indicated by history and physical
examination to routine.
(Siriraj Hosp Gaz 1999;51: 669-681.)
HEMODYNAMIC RESPONSES TO CAPTOPRIL DURING SPLENECTOMY
IN THALASSEMIC CHILDREN
Vorapa Suwanchinda 1
, Voravarn Tanphaichitr 2
, Sangsom Pirayavaraporn 1
, Pradit Somprakit 1
,
Mongkol Laophpensang 3
1
Department of Anesthesiology, 2
Department of Pediatrics, 3
Department of Surgery, Faculty of
Medicine Siriraj Hospital, Mahidol University.
Key words : thalassemia, splenectomy, hypertension
Faculty of Medicine Siriraj Hospital
Splenectomy in β-thalassemic children is frequently accompanied by perioperative hypertension
which occasionally is followed by convulsion. The efficacy of captopril in attenuating the
hypertensive response to splenectomy was investigated in 82 thalassemic children. The control group,
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