Acta anaesthesiologica Scandinavica
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Brain death itself impairs organ function in the potential donor, thereby limiting the number of suitable organs for transplantation. In addition, graft survival of kidneys obtained from brain-dead (BD) donors is inferior to that of kidneys obtained from living donors. Experimental studies confirm an inferior graft survival for the heart, liver and lungs from BD compared with living donors. ⋯ However, it remains uncertain whether the inflammation is induced by brain death itself or by events before and after becoming BD. The purpose of this study is to discuss the risk factors associated with brain death in general and the inflammatory response in the organs in particular. Special attention will be paid to the heart, lung, liver and kidney and evidence will be presented from clinical and experimental studies.
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Acta Anaesthesiol Scand · Apr 2009
Randomized Controlled TrialIntrathecal neostigmine with bupivacaine for infants undergoing lower abdominal and urogenital procedures: dose response.
Intrathecal (IT) neostigmine produces dose-dependent analgesia in adults. However, the dose of spinal neostigmine has not been investigated in infants. The purpose of this study was to assess spinal anesthesia (SA) duration provided by four doses of spinal neostigmine added to bupivacaine for lower abdominal and urogenital procedures in infants. ⋯ IT neostigmine at a dose of 0.75 microg/kg added to bupivacaine significantly prolonged SA duration with reduced postoperative pain scores and rescue analgesic requirements in infants undergoing lower abdominal and urogenital procedures. No additional benefits were provided on increasing it to 1 microg/kg.
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Acta Anaesthesiol Scand · Apr 2009
Automated pre-ejection period variation indexed to tidal volume predicts fluid responsiveness after cardiac surgery.
Reliable continuous monitoring of fluid responsiveness is an unsolved issue in patients ventilated with low tidal volume. We hypothesised that variations in the pre-ejection period (PEP) defined as the time interval between electrocardiogram (ECG) R-wave and onset of systolic upstroke in arterial blood pressure could reliably predict fluid responsiveness in patients ventilated with moderately low tidal volume. Furthermore, we hypothesised that indexing dynamic parameters to tidal volume would improve their prediction. The aim was to refine and automate a previously suggested algorithm for PEP variation (DeltaPEP) and to test this new parameter indexed to tidal volume (PEPV), as a marker of fluid responsiveness along with central venous pressure (CVP), pulse pressure variation (PPV) and DeltaPEP. Additionally, the aim was to evaluate the concept of indexing dynamic parameters to tidal volume. ⋯ In this study in post-cardiac surgery patients, a refined parameter, PEPV, predicted fluid responsiveness better than PPV and DeltaPEP. Our results suggest that dynamic parameters using variations in PEP should be indexed to tidal volume.
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Acta Anaesthesiol Scand · Apr 2009
Randomized Controlled TrialAcceleromyography and mechanomyography for establishing potency of neuromuscular blocking agents: a randomized-controlled trial.
Acceleromyography (AMG) is increasingly being used in neuromuscular research, including in studies establishing the potency of neuromuscular blocking and reversal agents. However, AMG is insufficiently validated for use interchangeably with the gold standard, mechanomyography (MMG) for this purpose. The aim of this study was to compare AMG and MMG for establishing dose-response relationship and potency, using rocuronium as an example. ⋯ Our results indicate that any possible difference between AMG and MMG is so small that it justifies AMG to be used for establishing the potency of neuromuscular blocking agents. However, the wide CIs show that we cannot rule out a 13% higher ED(50) and a 26% higher ED(95) for AMG.
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Acta Anaesthesiol Scand · Apr 2009
Attenuation of a rocuronium-induced neuromuscular block in patients receiving prednisolone.
This study tested the influence of continuous medication (more than 4 weeks) with prednisolone on a rocuronium-induced neuromuscular block. ⋯ Prednisolone treatment in patients with inflammatory bowel disease is associated with a delayed onset and a shorter duration of action of rocuronium. The presence of an inflammatory bowel disease did not influence the neuromuscular block.