Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 2004
Clinical TrialTroponin T-values provide long-term prognosis in elderly patients undergoing non-cardiac surgery.
The aim of this study was to evaluate the significance of elevated postoperative Troponin T (TnT) levels in an elderly population undergoing non-cardiac surgery. ⋯ We conclude that elevated TnT levels in the postoperative period confer a 15-fold increase in mortality during the first year after surgery. Our findings also provide evidence that silent myocardial ischemia is common in an elderly population. Routine perioperative surveillance for TnT might therefore be of use in detecting patients at an increased risk of mortality during the first postoperative year.
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Acta Anaesthesiol Scand · Oct 2004
Comparative StudyNitrous oxide diffusion into tracheal tube cuffs: comparison of five different tracheal tube cuffs.
The aim of this study was to investigate cuff compliance and cuff pressure during nitrous oxide exposure in the recently introduced Microcuff tracheal tube with a polyurethane cuff (Microcuff GmbH, Weinheim, Germany), and to compare it to conventional tracheal tubes with PVC cuffs. ⋯ The ultra-thin polyurethane tube cuff demonstrated higher permeability for nitrous oxide than conventional PVC cuffs and led to a rapid cuff pressure increase when exposed to N(2)O. Routinely checking of cuff-pressure or filling the cuff with nitrous oxide are more important than the brand of tube used.
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Acta Anaesthesiol Scand · Oct 2004
Clinical TrialPredictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: a prospective clinical trial in critically ill patients with subarachnoid haemorrhage.
After head trauma, hypertonic saline lowers intracranial pressure (ICP) and preserves or increases cerebral perfusion pressure (CPP). Hypertonic saline has not been studied in patients with increased ICP due to subarachnoid haemorrhage (SAH). The aim of this study was to evaluate the effects on elevated ICP and on CPP in patients critically ill from SAH. ⋯ 7.2% saline in 6% hydroxyethyl starch is an effective and safe therapy for intracranial hypertension after SAH. We demonstrate that an infusion of 2 ml kg(-1) during 20 min has a predictable and clinically significant beneficial effect on ICP and CPP. The effect was still present 3 h after end of infusion. Rebound ICP-increase was not observed within 3 h.
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Acta Anaesthesiol Scand · Oct 2004
Clinical TrialExpiratory flow limitation in morbidly obese postoperative mechanically ventilated patients.
Although obesity promotes tidal expiratory flow limitation (EFL), with concurrent dynamic hyperinflation (DH), intrinsic PEEP (PEEPi) and risk of low lung volume injury, the prevalence and magnitude of EFL, DH and PEEPi have not yet been studied in mechanically ventilated morbidly obese subjects. In 15 postoperative mechanically ventilated morbidly obese subjects, we assessed the prevalence of EFL [using the negative expiratory pressure (NEP) technique], PEEPi, DH, respiratory mechanics, arterial oxygenation and PEEPi inequality index as well as the levels of PEEP required to abolish EFL. ⋯ Application of 7.5 +/- 2.5 cm H2O of PEEP (range: 4-16) abolished EFL with a reduction of PEEPi and DH and an increase in FRC and the PEEPi inequality index but no significant effect on gas exchange. The present study indicates that: (a) on zero PEEP, EFL is present in most postoperative mechanically ventilated morbidly obese subjects; (b) EFL (and concurrent risk of low lung volume injury) is abolished with appropriate levels of PEEP; and (c) impaired gas exchange is common in these patients, probably mainly due to atelectasis.
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Acta Anaesthesiol Scand · Oct 2004
Clinical TrialPostoperative cognitive dysfunction: true deterioration versus random variation.
Postoperative cognitive dysfunction (POCD) is a common complication, especially in the elderly. The aim of this study was to describe how variability in neuropsychological testing could lead to the detection of cognitive improvement and poor consistency of POCD between postoperative test sessions. ⋯ Variability in neuropsychological test data contributes to a low consistency between postoperative test sessions but it does not explain the detection of cognitive dysfunction after major surgery.