Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · Jul 2012
Impact of shed blood products on stimulated cytokine release in an in vitro model of transfusion.
Blood transfusion is reported to suppress the recipient's immune system. To avoid allogenic transfusion, post-operative shed blood retransfusion is a commonly used method. The aim of this study was to investigate the dose-related impact of post-operatively collected shed blood products on the stimulated cytokine release in an in vitro model of transfusion. ⋯ Shed blood and its components caused a dose-independent immunomodulation as indicated by a suppressed stimulated TNF-α release. Leukocytes seem to play a minor role, as we observed a sustained suppression after transfusion of γ-irradiated shed blood. Only the elimination of soluble factors by centrifugation and followed by an additional washing step prevented the observed suppression of TNF-α. Thus, we assume that washing of shed blood can prevent potential detrimental effects.
-
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.
-
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.
-
Acta Anaesthesiol Scand · Jul 2012
Positive fluid balance is associated with reduced survival in critically ill patients with cancer.
There are no studies that describe the impact of the cumulative fluid balance on the outcomes of cancer patients admitted to intensive care units ICUs. The aim of our study was to evaluate the relationship between fluid balance and clinical outcomes in these patients. ⋯ A cumulative positive fluid balance higher than 1100 ml/24 h was independently associated with mortality in patients with cancer. These findings highlight the importance of improving the evaluation of these patients' volemic state and indicate that defined goals should be used to guide fluid therapy.
-
Acta Anaesthesiol Scand · Jul 2012
Effect of a fluid challenge on the Surgical Pleth Index during stable propofol-remifentanil anaesthesia.
The Surgical Pleth Index (SPI), derived from pulse amplitude and heartbeat interval, is proposed to monitor anti-nociception during anaesthesia. Its response to noxious stimulation can be affected by the intravascular volume status. This study investigated the effect of a fluid challenge (FC) on SPI during steady-state conditions. ⋯ During stable anaesthesia and surgery, SPI may change in response to FC. The effect of FC on SPI is influenced by volaemia and Ce(PPF) through pulse wave amplitude modifications. These situations may confound the interpretation of SPI as a surrogate measure of the nociception-anti-nociception balance.