Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2013
ReviewPerioperative glucocorticoids in hip and knee surgery - benefit vs. harm? A review of randomized clinical trials.
Glucocorticoids are frequently used to prevent post-operative nausea and vomiting (PONV), and may be part of multimodal analgesic regimes. The objective of this review was to evaluate the overall benefit vs. harm of perioperative glucocorticoids in patients undergoing hip or knee surgery. A wide search was performed in PubMed, Embase, and Cochrane Central to identify relevant randomized clinical trials. ⋯ Due to clinical heterogeneity and poor scientific quality, no meta-analysis was performed. In conclusion, in addition to PONV reduction with low-dose systemic glucocorticoid, this review supports high-dose systemic glucocorticoid to ameliorate post-operative pain after hip and knee surgery. However, large-scale safety and dose-finding studies are warranted before final recommendations.
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Acta Anaesthesiol Scand · Aug 2013
ReviewStress ulcer prophylaxis in the intensive care unit: is it indicated? A topical systematic review.
Stress ulcer prophylaxis (SUP) is regarded as standard of care in the intensive care unit (ICU). However, recent randomized, clinical trials (RCTs) and meta-analyses have questioned the rationale and level of evidence for this recommendation. The aim of the present systematic review was to evaluate if SUP in the critically ill patients is indicated. ⋯ The best intervention for SUP is yet to be settled by balancing efficacy and harm. In essence, it is unresolved if intensive care patients benefit overall from SUP. The following clinically research questions are unanswered: (1) What is the incidence of GI bleeding, and which interventions are used for SUP in general ICUs today?; (2) Which criteria are used to prescribe SUP?; (3) What is the best SUP intervention?; (4) Do intensive care patients benefit from SUP with proton pump inhibitors as compared with other SUP interventions? Systematic reviews of possible interventions and well-powered observational studies and RCTs are needed.
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Acta Anaesthesiol Scand · Aug 2013
Multicenter StudyAcute kidney injury in patients with severe sepsis in Finnish Intensive Care Units.
Severe sepsis is one of the leading causes of acute kidney injury (AKI). Patients with sepsis-associated AKI demonstrate high-hospital mortality. We evaluated the incidence of severe sepsis-associated AKI and its association with outcome in intensive care units (ICUs) in Finland. ⋯ More than half of the patients with severe sepsis had AKI according to the KDIGO classification, and AKI stage 3 was independently associated with 90-day mortality.
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Acta Anaesthesiol Scand · Aug 2013
Randomized Controlled TrialAssessment of intraoperative microaspiration: does a modified cuff shape improve sealing?
Intra-operative aspiration of oropharyngeal secretions is associated with post-operative pneumonia. The use of endotracheal tubes (ETTs) with a modified cuff shape could be one preventive action. In this clinical, prospective, randomised controlled trial, we hypothesised that altering the cuff shape to a tapered shape could reduce the aspiration incidence. The primary outcome was aspiration of dye solution into the trachea. ⋯ Short-term use of tapered-shaped polyvinylchloride cuffs in surgical patients results in more effective sealing of the tracheal lumen in comparison with a traditional barrel-shaped polyvinylchloride cuffs. Further evaluation is needed to determine whether a reduction in post-operative pneumonia can be demonstrated when these cuffs are used.
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Acta Anaesthesiol Scand · Aug 2013
Randomized Controlled Trial Comparative StudyThe disposable Ambu aScope vs. a conventional flexible videoscope for awake intubation -- a randomised study.
A new disposable flexible videoscope, the Ambu® aScope, has several potential advantages compared with reusable devices, but it is a prerequisite for its widespread use that it functions sufficiently well in the management of patients in whom difficulty with airway management is anticipated and awake intubation is indicated. ⋯ Both the disposable aScope and the reusable Olympus videoscope allowed safe awake intubation in our elective patients with severely difficult, but uncompromised, airways. The occasional need to employ a spare scope because of malfunctioning would make the disposable aScope less suitable in patients with acutely compromised airways.