Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Aug 2004
Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines.
Adrenaline does not appear to improve the outcome after cardiac arrest in clinical trials in spite of beneficial effects in experimental studies. The objective of this study was to determine whether adrenaline was administered in accordance with advanced cardiac life support (ACLS) guidelines during adult cardiopulmonary resuscitation (CPR). ⋯ In the majority of cases adrenaline did not appear to be administered according to current ACLS guidelines.
-
Acta Anaesthesiol Scand · Aug 2004
Randomized Controlled Trial Clinical TrialIntrathecal morphine provides effective and safe analgesia in children after cardiac surgery.
The purpose of this prospective, randomized, blinded to observer study was to assess the analgesic effect and safety of intrathecal morphine (ITM) in post-operative pain control in children after heart surgery with a sternotomy incision. ⋯ An ITM dose of 20 micrograms/kg had a significant (P = 0.03) intravenous morphine-sparing effect after cardiac surgery. Effective analgesia was observed for 12 h after administration of intrathecal morphine.
-
Acta Anaesthesiol Scand · Aug 2004
Randomized Controlled Trial Clinical TrialArginine vasopressin and serum nitrite/nitrate concentrations in advanced vasodilatory shock.
Arginine-vasopressin (AVP) can successfully stabilize hemodynamics in patients with advanced vasodilatory shock. It has been suggested that inhibition of cytokine-induced nitric oxide production may be an important mechanism underlying AVP-induced vasoconstriction. Therefore, serum concentrations of nitrite/nitrate (NOx), the stable metabolite of nitric oxide, were measured in patients suffering from advanced vasodilatory shock treated with either AVP in combination with norepinephrine (NE) or NE alone. ⋯ Cardiovascular effects of AVP infusion in advanced vasodilatory shock are not mediated by a clinically relevant reduction in serum NOx concentrations. Therefore, hemodynamic improvement of patients in advanced vasodilatory shock during continuous infusion of AVP has to be attributed to other mechanisms than inhibition of nitric oxide synthase. In addition, the magnitude of pressure response to AVP is not correlated with baseline concentrations of NOx.
-
Acta Anaesthesiol Scand · Aug 2004
Multicenter StudyEffectiveness and efficiency of intensive care medicine: variable costs in different diagnosis groups.
To establish the effectiveness of ICU treatment and the efficiency in the use of resources in patients stratified according to 10 diagnosis and two levels-of-care. To propose strategies aimed at reducing costs and improving efficiency in each patient group. ⋯ Analysis of variable patient-specific cost was used as a tool to assess intensive care performance in patient subgroups with different diagnosis and levels-of-care.
-
Acta Anaesthesiol Scand · Aug 2004
Randomized Controlled Trial Clinical TrialEfficacy of the A-line AEP monitor as a tool for predicting successful insertion of a laryngeal mask during sevoflurane anesthesia.
The use of clinical signs for assessing depth of anesthesia is unreliable during periods with little noxious stimulation. A patient may appear adequately anesthetized at one moment at a given level of stimulation, but may later, when facing other more intense stimuli, show signs of insufficient anesthesia. In order to prevent under- or overdosing of anesthetics, an anesthesia depth monitor that is able to predict responses to noxious stimulation would therefore be useful. Auditory evoked potentials (AEP) is one of several physiological parameters under investigation. The method has been improved by rapid extraction and conversion of the AEP curve into an index (A-Line ARX Index = AAI). We aimed to determine the clinically required depth of anesthesia, measured by the A-line AEP Monitor, for at least 90% probability of acceptable insertion conditions for a laryngeal mask airway (LMA). ⋯ AAI indicates the level of depth of anesthesia necessary for acceptable laryngeal mask insertion conditions. End-expiratory sevoflurane concentration was the better predictor.