Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 2010
Randomized Controlled Trial Comparative StudyGravity is an important determinant of oxygenation during one-lung ventilation.
The role of gravity in the redistribution of pulmonary blood flow during one-lung ventilation (OLV) has been questioned recently. To address this controversial but clinically important issue, we used an experimental approach that allowed us to differentiate the effects of gravity from the effects of hypoxic pulmonary vasoconstriction (HPV) on arterial oxygenation during OLV in patients scheduled for thoracic surgery. ⋯ The relative position of the ventilated vs. the non-ventilated lung markedly affects arterial oxygenation during OLV. These data suggest that gravity affects ventilation-perfusion matching independent of HPV.
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Acta Anaesthesiol Scand · Jul 2010
Randomized Controlled Trial Comparative StudyOndansetron is as effective as diphenhydramine for treatment of morphine-induced pruritus after cesarean delivery.
Subarachnoid (SA) morphine, highly effective for the management of pain after a cesarean delivery, is associated with a significant incidence of pruritus in up to 80% of patients. No previous study has compared the effectiveness of ondansetron (5-HT(3) antagonist) vs. diphenhydramine (H(1) receptor blocker) for the treatment of this side effect. ⋯ Ondansetron is as effective as diphenhydramine in relieving pruritus caused by SA morphine in patients undergoing a cesarean delivery. However, up to 50% of patients required naloxone either for primary failure or for recurrence.
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Acta Anaesthesiol Scand · Jul 2010
ReviewMeasurement of post-operative cognitive dysfunction after cardiac surgery: a systematic review.
Post-operative cognitive dysfunction (POCD) is a decline in cognitive function from pre-operative levels, which has been frequently described after cardiac surgery. The purpose of this study was to examine the variability in the measurement and definitions for POCD using the framework of a 1995 Consensus Statement on measurement of POCD. Electronic medical literature databases were searched for the intersection of the search terms 'thoracic surgery' and 'cognition, dementia, and neuropsychological test.' Abstracts were reviewed independently by two reviewers. ⋯ Four definitions of POCD emerged: per cent decline (n=15), standard deviation decline (n=14), factor analysis (n=13), and analysis of performance on individual tests (n=12). There is marked variability in the measurement and definition of POCD. This heterogeneity may impede progress by reducing the ability to compare studies on the causes and treatment of POCD.
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Acta Anaesthesiol Scand · Jul 2010
Randomized Controlled Trial Comparative StudyComparison of the incidence and severity of cough after alfentanil and remifentanil injection.
Intravenous administration of fentanyl derivatives can induce cough paradoxically. This study examined the incidence and severity of cough after a bolus of alfentanil and remifentanil. ⋯ This study demonstrated that equipotent boluses of alfentanil and remifentanil induced coughing, even though the incidence of cough after alfentanil administration was lower than that after remifentanil administration.
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Acta Anaesthesiol Scand · Jul 2010
Review Case ReportsStuck long-term indwelling central venous catheters in adolescents: three cases and a short topical review.
We present three cases of fixated vascular injection ports. Two patients had cystic fibrosis and one had an immunological defect. All catheters were made from polyurethane and implanted in adolescent patients. ⋯ In the other two cases, catheters were removed with great difficulty by the interventional radiologists. These cases raise important questions concerning the maximum indwelling time and the choice of catheter material when implanting permanent central venous catheters (CVCs) in adolescents. Furthermore, it highlights the importance of not breaking a CVC in the attempt to remove it.