Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2008
ReviewObstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment.
The incidence of obesity has been dramatically increasing across the globe. Anesthesiologists, are increasingly faced with the care for these patients. Obesity in the pregnant woman is associated with a broad spectrum of problems, including dramatically increased risk for cesarean delivery, diabetes, hypertension and pre-eclampsia. A thorough understanding of the physiology, associated conditions and morbidity, available options for anesthesia and possible complications is therefore important for today's anesthesiologist. ⋯ The anesthetic management of the morbidly obese parturient is associated with special hazards. The risk for difficult or failed intubation is exceedingly high. The early placement of an epidural or intrathecal catheter may overcome the need for general anesthesia, however, the high initial failure rate necessitates critical block assessment and catheter replacement when indicated.
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Acta Anaesthesiol Scand · Jan 2008
Comparative StudyTime- and dose-related regional fluxes of tissue-type plasminogen activator in anesthetized endotoxemic pigs.
Acute endotoxinemia elicits an early fibrinolytic response. This study analyzes the effects of the dose and duration of endotoxin infusion on arterial levels of tissue-type plasminogen activator (tPA) and pulmonary, mesenteric and hepatic plasma tPA fluxes. ⋯ Endotoxemia induces an early increase in mesenteric tPA release and hepatic tPA uptake related to the severity of endotoxemia. The time patterns of changes in mesenteric and hepatic tPA fluxes are similar in acute high-dose endotoxemia and sustained low-dose endotoxemia.
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Acta Anaesthesiol Scand · Jan 2008
Randomized Controlled Trial Comparative StudyBispectral index monitoring: appreciated but does not affect drug dosing and hypnotic levels.
Bispectral index (BIS) has been associated with benefits from less-deep anesthesia as well as preventing awareness, albeit not at the same time. We investigated how increasing experience from BIS in clinical practice affect the hypnotic level, drug consumption, as well as subjective opinions on this monitoring. ⋯ Although BIS became considerably appreciated, growing experience and repeated education had no impact on drug dosing and BIS levels.
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Acta Anaesthesiol Scand · Jan 2008
Randomized Controlled TrialAdministration of fentanyl before remifentanil-based anaesthesia has no influence on post-operative pain or analgesic consumption.
Remifentanil's short-acting analgesic effect and the potential of producing hyperalgesia is a challenge to post-operative pain control. This study investigated whether pre-treating the patients with fentanyl before remifentanil-based anaesthesia could reduce post-operative pain or analgesic consumption. ⋯ Pre-treatment with fentanyl 1.5 microg/kg IV yielded no reduction in post-operative pain or analgesic consumption after 90 min of remifentanil-based anaesthesia with 0.43 microg/kg/min of remifentanil.
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Acta Anaesthesiol Scand · Jan 2008
Randomized Controlled Trial Comparative StudyInhaled iloprost to control pulmonary artery hypertension in patients undergoing mitral valve surgery: a prospective, randomized-controlled trial.
Pulmonary hypertension (PHT) is common in patients undergoing mitral valve surgery and is an independent risk factor for the development of acute right ventricular (RV) failure. Inhaled iloprost was shown to improve RV function and decrease RV afterload in patients with primary PHT. However, no randomized-controlled trials on the intraoperative use of iloprost in cardiac surgical patients are available. We therefore compared the effects of inhaled iloprost vs. intravenous standard therapy in cardiac surgical patients with chronic PHT. ⋯ In patients with pre-existing PHT undergoing mitral valve surgery, inhaled iloprost is superior to intravenous nitrogylycerine by acting as a selective pulmonary vasodilator, reducing RV afterload and moderately improving RV-pump performance.