Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 2012
Review Meta AnalysisWound infiltration with local anesthetics for post-operative pain relief in lumbar spine surgery: a systematic review.
In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery. ⋯ Interpretation of the results was difficult because of diversity of the studies. However, clinical significance was in general questionable, with only a few trials showing a small or a modest reduction in pain intensity, which was observed mainly immediately after the operation. Similarly, although more frequently observed, only a minor and probably not clinically relevant reduction in opioid consumption was shown.
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Acta Anaesthesiol Scand · Mar 2012
Review Meta AnalysisPercutaneous tracheostomy, a systematic review.
Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units and the identification of the best technique is very important. We performed a systematic review and meta-analysis of randomized studies comparing different PDT techniques in critically ill adult patients to investigate if one technique is superior to the others with regard to major and minor intraprocedural complications. ⋯ Among the six analyzed techniques, single-step dilatation technique appeared the most reliable in terms of safety and success rate. However, the number of available randomized trials was insufficient to confidently assess the best PDT technique.
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Constituents of vascular endothelial surface layer (glycocalyx), e.g. an anchor protein syndecan-1 (SDC-1), can be detected in plasma in many inflammatory conditions. In inflammation, vascular adhesion protein-1 (VAP-1) is rapidly translocated to the apical side of the endothelial cells and may be released to plasma in a soluble form. We hypothesized that glycocalyx injury coincides with VAP-1 activation on endothelial cells. To test the hypothesis, we measured SDC-1 and VAP-1 levels in 20 patients with septic shock. ⋯ We found increased VAP-1 activity and SDC-1 content in critically ill patients with septic shock. Based on our results, the role of VAP-1 in shock pathogenesis should be studied with semicarbazide-sensitive amine oxidase activity blocking agents and substrate affinity testing.
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Acta Anaesthesiol Scand · Mar 2012
Abnormal pre-operative tests, pathologic findings of medical history, and their predictive value for perioperative complications.
Laboratory tests, electrocardiogram (ECG) and chest X-rays still serve as part of the routine assessment before elective surgery in many institutions, even though there is little evidence of their predictive value relating to perioperative complications. This study investigates the correlation of abnormal findings in pre-operative tests and pathologic findings in the medical history with perioperative complications. ⋯ Our results indicate that age, type of surgery and medical history are appropriate predictors of perioperative complications, whereas abnormalities in laboratory tests seem to have restricted ability in predicting adverse perioperative outcome.
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Acta Anaesthesiol Scand · Mar 2012
Role of active nitrogen molecules in progression of septic shock.
Active nitrogen molecules are formed as a result of cell metabolism. They are essential for cell metabolism, but when produced in excess, they contribute to the pathogenesis of several disease processes. These nitrogen molecules play an important role in vascular instability of septic shock. This study was planned to detect the role of active nitrogen molecules in the progression of septic shock. ⋯ Plasma No₂-/No₃- and TNF-α levels were high in patients with sepsis and septic shock, which increased with severity of sepsis.