Acta anaesthesiologica Scandinavica
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Transfusion of red blood cells (RBCs) remains controversial in patients with septic shock, but current practice is unknown. Our aim was to evaluate RBC transfusion practice in septic shock in the intensive care unit (ICU), and patient characteristics and outcome associated with RBC transfusion. ⋯ Most patients with septic shock received RBCs during shock, and these patients had higher disease severity and lower haemoglobin levels than those not transfused. In spite of this, mortality did not differ between groups neither in the unadjusted or adjusted analyses. However, neither the design nor the sample size allows us to make inferences about treatment effects, which underlines the need for large randomised, clinical trials on transfusion in septic shock.
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Acta Anaesthesiol Scand · Jul 2012
Randomized Controlled Trial Comparative StudyLight levels of anaesthesia after relaxation for tracheal intubation - comparison of succinylcholine and cis-atracurium.
Use of a single bolus of a hypnotic together with non-depolarizing muscle relaxants for anaesthesia induction may cause inappropriate light levels of anaesthesia (ILLA). The purpose of this study was to compare the incidence of ILLA during anaesthesia induction using either cis-atracurium (CIS) or succinylcholine (SUC). ⋯ The onset time of a muscle relaxant has substantial impact on the incidence of ILLA during induction of anaesthesia. Entropy and SEF may indicate the presence of ILLA.
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Acta Anaesthesiol Scand · Jul 2012
Randomized Controlled Trial Comparative StudyLocal infiltration analgesia with levobupivacaine compared with intrathecal morphine in total hip arthroplasty patients.
Recently, local infiltration analgesia (LIA) has been promoted for pain control after total hip arthroplasty (THA). We hypothesized that LIA would offer equal analgesic efficacy but less adverse effects, e.g., nausea and vomiting, when compared with an established regimen [intrathecal morphine (it-M)] after THA. ⋯ While LIA might enable earlier mobilization after THA, it was not associated with less nausea as compared with it-M. Less rescue oxycodone was given early after it-M, but urinary retention was more common in that group.
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Acta Anaesthesiol Scand · Jul 2012
ReviewOxygen and anesthesia: what lung do we deliver to the post-operative ward?
Anesthesia is safe in most patients. However, anesthetics reduce functional residual capacity (FRC) and promote airway closure. Oxygen is breathed during the induction of anesthesia, and increased concentration of oxygen (O(2) ) is given during the surgery to reduce the risk of hypoxemia. ⋯ A continuous PEEP of 7-10 cm H(2) O may not necessarily improve oxygenation but should keep the lung open until the end of anesthesia. Inspired oxygen concentration of 30-40%, or even less, should suffice if the lung is kept open. The goal of the anesthetic regime should be to deliver a patient with no atelectasis to the post-operative ward and to keep the lung open.
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Acta Anaesthesiol Scand · Jul 2012
Post-operative pain treatment in Denmark from 2000 to 2009: a nationwide sequential survey on organizational aspects.
In Denmark, the first acute pain service (APS) was introduced in 1993. An important objective became to facilitate implementation of accelerated post-operative rehabilitation programmes (ACC) in selected procedures in abdominal, gynaecological and orthopaedic surgery. Therefore, it is of considerable interest to study the association between the developments of post-operative pain management and the ACC by sequential analyses from 2000 to 2009. ⋯ The study, spanning nearly a decade, illustrates that following an increase in number of APSs from 2000 to 2006, followed by a significant decline, a steadily increasing number of departments implemented ACC.