Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 2012
Randomized Controlled Trial Comparative StudyDiclofenac-tramadol vs. diclofenac-acetaminophen combinations for pain relief after caesarean section.
We compared the analgesic efficacy of diclofenac-acetaminophen combination with diclofenac-tramadol combination to optimize multimodal post-operative analgesia in women undergoing caesarean section. ⋯ Both diclofenac-tramadol and diclofenac-acetaminophen combinations can achieve satisfactory post-operative pain control in women undergoing caesarean section. The diclofenac-tramadol combination was overall more efficacious but associated with higher incidence of post-operative nausea.
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Acta Anaesthesiol Scand · Jul 2012
Thiopental dose requirements for induction of anaesthesia and subsequent endotracheal intubation in patients with complete spinal cord injuries.
Dose requirements of thiopental depend on patient characteristics and infusion rate. We determined thiopental dose requirements for induction of anaesthesia, and the effects of remifentanil on cardiovascular and bispectral index (BIS) responses to tracheal intubation in spinal cord-injured (SCI) patients undergoing general anaesthesia. ⋯ These results suggest that the dose requirements of thiopental for induction of general anaesthesia and subsequent tracheal intubation are reduced in the SCI patients.
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Acta Anaesthesiol Scand · Jul 2012
Case ReportsEmergency extracorporeal membrane oxygenation to treat massive aspiration during anaesthesia induction. A case report.
Since first described in 1946 by Mendelson, aspiration of gastric content resulting in severe pulmonary complications is a known hazard of general anaesthesia. We report on a case of massive aspiration of gastric content during induction of general anaesthesia, resulting in severe prolonged hypoxaemia with cardiac arrest, followed by rapid onset of an acute respiratory distress syndrome (ARDS) associated with severe global respiratory insufficiency and severe hypoxia. ARDS was successfully treated using emergency extracorporeal membrane oxygenation within 3 h after the incident.
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Acta Anaesthesiol Scand · Jul 2012
Lung elastance and transpulmonary pressure can be determined without using oesophageal pressure measurements.
The aim of the present study was to demonstrate that lung elastance and transpulmonary pressure can be determined without using oesophageal pressure measurements. ⋯ A PEEP increase resulted in a less than expected increase in end-expiratory oesophageal pressure, indicating that the chest wall and abdomen gradually can accommodate changes in lung volume. The rib cage end-expiratory spring-out force stretches the diaphragm and prevents the lung from being compressed by abdominal pressure. The increase in transpulmonary pressure following a PEEP increase was closely related to the increase in PEEP, indicating that lung compliance can be calculated from the ratio of the change in end-expiratory lung volume and the change in PEEP, ΔEELV/ΔPEEP.
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Acta Anaesthesiol Scand · Jul 2012
Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery.
Few data exist on dynamic variables predicting fluid responsiveness during laparoscopic surgery. The aim of this study was to explore the effects of laparoscopy on four dynamic variables: respiratory variations in pulse pressure (ΔPP), stroke volume variation by Vigileo/FloTrac (SVV (Vigileo) ), pleth variability index (PVI) and respiratory variations in pulse oximetry plethysmography waveform amplitude (ΔPOP), and their relation to fluid challenges during laparoscopic surgery. ⋯ ΔPP and SVV (Vigileo) did not change as pneumoperitoneum was established, whereas PVI increased and ΔPOP tended to increase. All four dynamic variables predicted fluid responsiveness relatively poor during ongoing laparoscopic surgery. ΔPP and SVV (Vigileo) tracked changes in stroke volume induced by fluid challenges during ongoing laparascopic surgery, whereas ΔPOP and PVI did not.