Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2014
Observational StudyMinimal impairment in pulmonary function following laparoscopic surgery.
Pulmonary function may be impaired in connection with laparoscopic surgery, especially in the head-down body position, but the clinical importance has not been assessed in detail. The aim of this study was to assess pulmonary function after laparoscopic hysterectomy and laparoscopic cholecystectomy. We hypothesised that arterial oxygenation would be more impaired after hysterectomy performed in the head-down position than after cholecystectomy in the head-up position. ⋯ Minimal impairment in pulmonary gas exchange was found after laparoscopic surgery. Pulmonary shunt was larger after laparoscopic cholecystectomy, but no clinically significant differences in postoperative pulmonary gas exchange or spirometry were found between laparoscopic hysterectomy and laparoscopic cholecystectomy.
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The work hours of Norwegian physicians are under scrutiny because of an increased public focus on patient safety. Ample international research indicate harmful effects of doctor fatigue based on studies on physicians working long weeks and on-call shifts of more than 30 consecutive hours. There is a lack of research on effects relevant for short or intermediate length of work weeks and call shifts. This study intended to study cognitive effects of short or intermediate duration in-hospital calls. ⋯ Reaction times were increased after 18 h night calls and non-significant increases in reaction times were apparent after the other on-call shifts. Self reported sleepiness was increased post-call. We were not able to conclude whether executive function or memory was negatively affected post-call.
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Acta Anaesthesiol Scand · Feb 2014
Case ReportsA prehospital use of ITClamp for haemostatic control and fixation of a chest tube.
We here present three cases in which a new device, the ITClamp Hemorrhage Control System (Innovative Trauma Care, Inc., Edmonton, Canada), was used for bleeding control and for securing a chest tube.
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Acta Anaesthesiol Scand · Feb 2014
Case ReportsPost-operative hyponatraemic encephalopathy: a successful outcome despite hypoxia.
Hyponatraemia is the most common electrolyte disorder encountered in clinical practice. Symptomatic hyponatraemia reflects brain damage because of cerebral swelling. Some coexisting factors such as extreme ages, hypoxia and female sex are associated with poor prognosis. ⋯ Serum sodium level was 108 mmol/l. She also presented hypoxia, considered an aggravating factor, which was probably caused by the combination of benzodiazepine intake and cerebral oedema. However, fast raise of serum sodium level was achieved by immediate treatment with hypertonic saline, and she was discharged home without any sequelae.
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Pneumothorax (PTX) is common after blunt chest injury, and failure to diagnose and rapidly treat an enlarging PTX may cause patient death. Occult PTXs missed on supine chest X-ray (CXR) may subsequently be found by computed tomography (CT) scans, but both of these diagnostic tools are not readily available for the patient. Furthermore, other problems associated with these techniques include the radiation hazard, the time delay after ordering, and obtaining the specialized radiologist's dictation of the CXR and CT results. Contrary, lung ultrasonography (US) is a harmless point-of-care examination to accurately diagnose PTX. The debate is whether lung US should replace CXR as the preferred diagnostic study of injured patients with suspected PTX. This study sought to answer the following remaining questions: Research questions Does lung US perform better than supine CXR and does it have the potential to diagnose even small amounts of intrapleural air? Could lung US be used to assess PTX progression during positive pressure ventilation? What is the optimal training method to accurately perform these lung US examinations? We studied experimentally induced PTX in porcine models to answer these questions. ⋯ Lung US is a safe and very accurate diagnostic tool that can be used to diagnose small-sized PTXs otherwise undetectable on supine CXRs. Lung US can also assess PTX progression, known to be an independent factor of a patient's later need for chest tube insertion. This is potentially helpful in real clinical settings, as it may enable clinicians to use US to make treatment decisions. With the appropriate training, all clinicians can perform lung US examinations to detect PTXs, which suggests that this approach should be used as a valuable adjunctive to the clinical examination of patients with blunt chest trauma.