Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 2013
Randomized Controlled TrialTransversus abdominis plane block or subcutaneous wound infiltration after open radical prostatectomy: a randomized study.
Open radical retropubic prostatectomy (ORRP) is associated with moderate pain. We hypothesized that a transversus abdominis plane (TAP) block would reduce post-operative pain, morphine consumption and opioid-related side effects compared with wound infiltration and placebo in this population. ⋯ Neither TAP block nor wound infiltration with ropivacaine improved a basic multimodal analgesic regimen with paracetamol, ibuprofen and gabapentin after ORRP.
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Acta Anaesthesiol Scand · Apr 2013
Pain characteristics and management of inpatients admitted to a comprehensive cancer centre: a cross-sectional study.
This prospective, cross-sectional study aimed to assess cancer pain and its management in an inpatient setting at a comprehensive cancer centre in Denmark. ⋯ Approximately two thirds of inpatients reported pain and one third had breakthrough pain. A substantial number of patients with pain were left untreated. Opioid-treated patients reported highest pain intensity and number of breakthrough episodes; however, analgesic medication seemed to be underused. Measures to improve pain assessment and management are highly required.
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Acta Anaesthesiol Scand · Apr 2013
Cortisol levels are influenced by sedation in the acute phase after subarachnoid haemorrhage.
Subarachnoid haemorrhage (SAH) is a life-threatening condition that may be aggravated by acute pituitary damage and cortisol insufficiency. Robust diagnostic criteria for critical illness-related corticosteroid insufficiency (CIRCI) are lacking. The aim of this study was to assess the frequency of CIRCI in the acute phase (0-240 h) after SAH and to evaluate associations between cortisol levels and clinical parameters (sedation, circulatory failure, gender, age, severity of disease, treatment). CIRCI was defined as a single morning serum cortisol (mSC) < 200 nmol/L. The lower limit for calculated free cortisol (cFC) was set at < 22 nmol/L, and for saliva cortisol at < 7.7 nmol/L. ⋯ Continuous intravenous sedation was significantly associated with cortisol values under defined limits (mSC < 200, cFC < 22 nmol/L). The possibility that sedating drugs per se may influence cortisol levels should be taken into consideration before CIRCI is diagnosed.
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Acta Anaesthesiol Scand · Apr 2013
Association between inotrope treatment and 90-day mortality in patients with septic shock.
Administration of inotropes in septic patients with low cardiac output or low central/mixed venous saturation is recommended in current guidelines. However, the impact of inotrope use on the outcome of these patients is controversial. We aimed to analyse the association of inotrope treatment with 90-day mortality. ⋯ The use of inotrope treatment in septic shock was associated with increased 90-day mortality without and after adjustment with propensity to receive inotrope. To differentiate between non-observed biases of severity of septic shock and an unfavourable effect of inotropes, prospective studies are needed.
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Acta Anaesthesiol Scand · Apr 2013
The effect of the molecular adsorbent recirculating system on moxifloxacin and meropenem plasma levels.
Adequate plasma antibiotic concentrations are necessary for effective elimination of invading microorganism; however, extracorporeal organ support systems are well known to alter plasma concentrations of antibiotics, requiring dose adjustments to achieve effective minimal inhibitory concentrations in the patient's blood. ⋯ Our data provide evidence that moxifloxacin and meropenem are effectively removed from the patient's blood by MARS, leading to low plasma levels. Dose adjustments of both antibiotic compounds may be required.