Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2006
Multicenter StudyReturn hospital visits and morbidity within 60 days after day surgery: a retrospective study of 18,736 day surgical procedures.
As day surgery includes more extensive procedures focus should be put on late outcome. The frequency of day surgery-related return visits and the associated morbidity were examined to identify suitable indicators of quality. ⋯ Day surgery in Denmark is a safe practice. Readmission rates, haematomas and wound infections are likely future indicators of outcome quality after day surgery.
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Acta Anaesthesiol Scand · Sep 2006
Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section.
To identify parturients at risk of inability to extend labor epidural analgesia in whom alternative methods of anesthesia should be considered for Cesarean section (CS). ⋯ Younger, more obese parturients at a higher gestational week, requiring more top-ups during labor, having a higher VAS in the 2 h before CS are at risk of inability to extend labor epidural analgesia to epidural anesthesia for CS.
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Acta Anaesthesiol Scand · Sep 2006
Prone position in mechanically ventilated patients with reduced intracranial compliance.
Prone position has been used for several years to treat acute lung insufficiency, but in previous studies patients with unstable intracranial pressure (ICP) are mostly excluded. The aim of this study was to investigate if prone position is a safe and useful treatment in patients with reduced intracranial compliance. ⋯ Turning NICU patients from the supine to the prone position did not influence ICP, CPP or MABP, but significantly improved patient PaO(2), SaO(2) and respiratory system compliance.
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Acta Anaesthesiol Scand · Sep 2006
Oxygenation and cerebral perfusion pressure improved in the prone position.
Treatment of patients in the prone position is a well-established method to improve oxygenation in general intensive care unit (ICU) practice. This method is rarely used in a neurosurgical ICU, considering the risk of intracranial hypertension. The aim of this study was to analyse the effect of prone position on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and systemic oxygenation in patients with reduced intracranial compliance. We hypothesize that the beneficial effects of prone position can outweigh the hazardous effects on the intracranial pressure. ⋯ The prone position can be used to improve the oxygenation as well as CPP in patients with traumatic brain injury or SAH. However, this method results in raised ICP, and should be used cautiously in patients with reduced intracranial compliance.
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Acta Anaesthesiol Scand · Sep 2006
Activated protein C (Xigris) treatment in sepsis: a drug in trouble.
Drotrecogin alfa (activated) or recombinant human activated protein C (rhAPC) has been registered for use as adjuvant treatment in severe sepsis since 2001 under the trade name Xigris essentially based on the results from one large clinical trial (the PROWESS trial). In a recently published second randomized clinical trial (the ADDRESS trial), enrolling patients with severe sepsis but with less risk of death, no effect of the treatment was shown, not even a trend to a positive effect in the subgroup of patients with a high risk of death that would match the present prescription label for Xigris. ⋯ A confirmatory clinical trial is required before rhAPC can be used with confidence. The side-effects and the cost of rhAPC are well documented but its efficacy is not.