Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2007
Management of incomplete regional anaesthesia in Germany: results of a nation-wide survey.
Regional anaesthesia (RA) provides well-defined benefits with known attendant risks. However, incomplete blockade may introduce unanticipated risks depending on the compensatory measures employed. Until now, no data were available characterizing the pattern of response of German anaesthesiologists in this situation. This study analyses interventions in response to incomplete RA in a nation-wide setting. ⋯ In Germany, anaesthesiologists manage incomplete RA using a widespread spectrum of measures. Some might introduce specific risks, which potentially outweigh the benefits of RA in comparison to GA techniques.
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Acta Anaesthesiol Scand · May 2007
Case ReportsAnaesthetists should be aware of delayed hypersensitivity to phenylephrine.
Delayed reactions to phenylephrine, used as a mydriatic agent during ophthalmological surgical procedures, are well known. We diagnosed a delayed hypersensitivity reaction to phenylephrine included in an ophthalmic insert in a woman presenting, 24 h after surgery, with an acute blepharoconjunctivitis associated with eyelid eczema of the operated eye. The diagnosis was supported by the recognition of clinical symptoms associated with a positive patch test to phenylephrine. ⋯ Intravenous phenylephrine is increasingly being used in the operating room to treat hypotension. This case report confirms the need for systematic allergological investigation of all drugs and substances administered during the peri-operative period in order to avoid a delayed hypersensitivity reaction occurring after the peri-operative period. Anaesthetists should be aware of the possibility of delayed hypersensitivity reactions involving phenylephrine.
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Acta Anaesthesiol Scand · May 2007
Male preponderance of patients testing positive for malignant hyperthermia susceptibility.
Malignant hyperthermia susceptibility is diagnosed using an in vitro contracture test (IVCT). In families in which the mutation is known, genetic tests are also available. The inheritance pattern is regarded as autosomal dominant, which predicts equal proportions of men and women affected. The aim of this study was to investigate whether there were sex differences in the diagnostic outcome of the 1407 patients tested for malignant hyperthermia in Sweden between 1985 and 2005. ⋯ A significant difference was observed in the sex distribution of outcome of IVCT, with significantly more males revealing a pathological IVCT. This indicates the influence of one or several factors related to sex in the outcome of IVCT, for example different expression of calcium handling proteins in the sexes, a complex pattern of inheritance or unknown environmental factors.
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Acta Anaesthesiol Scand · May 2007
Case ReportsManagement of persistent post-dural puncture headache after repeated epidural blood patch.
We report a case of persistent post-dural puncture headache (PDPH) in a patient despite two epidural blood patches (EBPs). Successful resolution of headache was achieved with a third EBP performed under computed tomography (CT) guidance. A 38-year-old female had a total abdominal hysterectomy under combined spinal-epidural anesthesia with no complications. ⋯ The patient continued to have a persistent headache. A computed tomography (CT) myelogram demonstrated cerebrospinal fluid (CSF) leak at L3-4 level. A "directed" CT-guided blood patch was then performed successfully with resolution of the headache.
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Acta Anaesthesiol Scand · May 2007
Stroke volume variation during hemorrhage and after fluid loading: impact of different tidal volumes.
Previous studies have shown that stroke volume variation (SVV) may be used to assess preload and fluid responsiveness. It is currently under debate, if SVV reliably displays changes in preload during ventilation with clinically used tidal volumes. This study was designed to evaluate whether the predictive value of SVV depends on the tidal volume applied particularly during acute changes of preload. ⋯ In this animal model, SVV was not sensitive to acute changes in preload during ventilation with a tidal volume of 5 ml/kg. Moreover, ventilation with high tidal volume may suggest volume loading even after sufficient volume resuscitation.