Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 2008
Visualization of the course of the sciatic nerve in adult volunteers by ultrasonography.
The sciatic nerve block by the posterior approaches represents one of the more difficult ultrasound-guided nerve blocks. Our clinical experiences with these blocks indicated a point slightly distal to the subgluteal fold as an advantageous position to allow good ultrasonic visibility. In this study, we systematically scanned the sciatic nerve from the subgluteal fold to the popliteal crease, to determine an optimal point for ultrasonographic visualization. ⋯ Between 5.4 and 10.8 cm from the subgluteal fold seems to be the best area to scan the sciatic nerve in terms of superficial nerve position and good ultrasonic visibility.
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Acta Anaesthesiol Scand · Oct 2008
Controlled Clinical TrialInfluence of pre-operative fluid infusion on volume status during oesophageal resection--a prospective trial.
Perioperative fluid therapy is controversially debated in surgery. In malnourished and hypovolaemic patients, a restrictive fluid regimen may lead to hypoperfusion and increased incidence of complications. The present prospective cohort study was performed to assess whether pre-operative i.v. fluid administration improves intraoperative cardiac preload in patients undergoing oesophageal resection. ⋯ Pre-operative i.v. fluid loading with crystalloid solutions could not be shown to improve the intraoperative volume status and cardiac function in this study. Randomised trials with other volume replacement techniques are recommended.
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Acta Anaesthesiol Scand · Oct 2008
Controlled Clinical TrialSepsis-related acute kidney injury: a protective effect of drotrecogin alpha (activated) treatment?
Drotrecogin alpha activated (DrotAA) is licensed for treatment of patients with severe sepsis and organ failure. Among the latter, acute kidney injury (AKI), defined as the persistence of oligo-anuria following adequate resuscitation, is one of the most apprehended. We conducted a prospective, observational, and controlled study to test the hypothesis that DrotAA beneficially affected the evolution and outcome of AKI, complicating acute sepsis-induced cardiopulmonary failure. ⋯ In this small cohort of patients with severe sepsis who received adjuvant DrotAA treatment, no effect on urine output, tubular function, or mortality could be demonstrated.
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Acta Anaesthesiol Scand · Oct 2008
Establishment of a porcine right ventricular infarction model for cardioprotective actions of xenon and isoflurane.
Right ventricular (RV) function is an important determinant of post-operative outcome. Consequences of RV infarction might be limited by pre-conditioning with volatile anesthetic drugs. Therefore, we used a porcine model of RV ischemia and reperfusion (IR) injury to study the influence of isoflurane and xenon on the extent and degree of myocardial injury. ⋯ It could be demonstrated for the first time in a model of RV infarction that the continuous application of isoflurane or xenon before, during and after ischemia reduced the extent (size) and severity (inflammation) of myocardial injury.
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Acta Anaesthesiol Scand · Oct 2008
Prognostic merit of N-terminal-proBNP and N-terminal-proANP in mechanically ventilated critically ill patients.
Amino-terminal fragments of type-A and type-B natriuretic peptide prohormones (NT-proBNP, NT-proANP) are powerful prognostic markers in patients with cardiac disease, and NT-proBNP has been demonstrated to predict outcome in severe sepsis and septic shock. We assessed the prognostic value of NT-proBNP and NT-proANP in a consecutive series of mechanically ventilated intensive care patients and compared their prognostic merit. ⋯ High NT-proANP and NT-proBNP levels associated with decreased short-term survival in unselected, mechanically ventilated ICU patients. NT-proANP performed equally well as a prognostic indicator as NT-proBNP, and may represent a clinically useful alternative to NT-proBNP.