Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2014
Controlled Clinical TrialIntrathecal fentanyl decreases the optimal effect site concentration of propofol during spinal anaesthesia.
The aim of this study was to assess the possible difference in the optimal effect site concentration of propofol for conscious sedation during spinal anaesthesia with or without intrathecal fentanyl in patients undergoing urologic surgery. The hypothesis was that intrathecal fentanyl would decrease the effect site concentration of propofol needed for conscious sedation. ⋯ The EC50 of the effect-site concentration of propofol for sedation decreased from 1.67 ± 0.28 mcg/ml to 0.87 ± 0.15 mcg/ml with the addition of 25 mcg fentanyl to a spinal anaesthetic in patients undergoing urologic surgery.
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Acta Anaesthesiol Scand · May 2014
Randomized Controlled Trial Comparative StudyKetamine and magnesium association reduces morphine consumption after scoliosis surgery: prospective randomised double-blind study.
Intraoperative ketamine and magnesium improves post-operative analgesia after scoliosis surgery when compared to ketamine alone.
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Acta Anaesthesiol Scand · May 2014
Practice GuidelineClinical guidelines on central venous catheterisation.
Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. ⋯ Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.
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Acta Anaesthesiol Scand · May 2014
Observational StudyThromboelastometry as a supplementary tool for evaluation of hemostasis in severe sepsis and septic shock.
Sepsis leads to disruption of hemostasis, making early evaluation of coagulation essential. The aim of this study was to provide a detailed investigation of coagulation and the use of blood products in patients with severe sepsis or septic shock, admitted to a multidisciplinary intensive care unit. ⋯ ROTEM(®) demonstrated an overall normo-coagulation, whereas the conventional coagulation tests and thrombin generation analyses mainly reflected hypocoagulation. Given the dynamic and global features of ROTEM(®), this analysis may be a relevant supplementary tool for the assessment of hemostasis in patients with severe sepsis or septic shock.
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Acta Anaesthesiol Scand · May 2014
Adrenaline increases blood-brain-barrier permeability after haemorrhagic cardiac arrest in immature pigs.
Adrenaline (ADR) and vasopressin (VAS) are used as vasopressors during cardiopulmonary resuscitation. Data regarding their effects on blood-brain barrier (BBB) integrity and neuronal damage are lacking. We hypothesised that VAS given during cardiopulmonary resuscitation (CPR) after haemorrhagic circulatory arrest will preserve BBB integrity better than ADR. ⋯ Resuscitation with ADR as compared with VAS after haemorrhagic circulatory arrest increased the ICP and impaired cerebrovascular autoregulation more profoundly, as well as exerted an increased BBB disruption though no significant difference in neuronal injury was observed.