Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2014
Observational StudySimple manoeuvre to reduce the overlap between the internal jugular vein and carotid artery in infants.
Catheterisation of the internal jugular vein (IJV) can be difficult in infants. We aimed to evaluate whether a simple manoeuvre, a slight caudo-lateral traction of the ipsilateral arm (CLTIA), could decrease the head rotation-induced overlap of the IJV to the carotid artery (CA) in infants. ⋯ The CLTIA successfully reduced the overlap between the IJV and the CA in infants. However, further study should be needed to evaluate the clinical usefulness of the CLTIA during the IJV catheterisation.
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Acta Anaesthesiol Scand · May 2014
Heparin-binding protein (HBP/CAP37) - a link to endothelin-1 in endotoxemia-induced pulmonary oedema?
Vascular leakage and oedema formation are key components in sepsis. In septic patients, plasma levels of the vasoconstrictive and pro-inflammatory peptide endothelin-1 (ET-1) correlate with mortality. During sepsis, neutrophils release heparin-binding protein (HBP) known to increase vascular permeability and to be a promising biomarker of human sepsis. As disruption of ET-signalling in endotoxemia attenuates formation of oedema, we hypothesized that this effect could be related to decreased levels of HBP. To investigate this, we studied the effects of ET-receptor antagonism on plasma HBP and oedema formation in a porcine model of sepsis. In addition, to further characterize a potential endothelin/HBP interaction, we investigated the effects of graded ET-receptor agonist infusions. ⋯ ET-receptor antagonism reduces porcine endotoxin-induced pulmonary oedema and plasma levels of the oedema-promoting protein HBP. Moreover, direct ET-receptor stimulation distinctively increases plasma HBP. Together, these results suggest a novel mechanism by which ET-1 contributes to formation of oedema during experimental sepsis.
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Acta Anaesthesiol Scand · May 2014
Case ReportsDabigatran anticoagulation and Stanford type A aortic dissection: lethal coincidence: Case report with literature review.
Novel oral anticoagulants are now encountered in patients needing emergency surgery. Knowledge and treatment options are limited. ⋯ After reviewing the literature, we summarize the limited treatment options and show possible approaches for patients treated with dabigatran needing emergency surgery.
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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.
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Acta Anaesthesiol Scand · May 2014
Central venous oxygen saturation and carbon dioxide gap as resuscitation targets in a hemorrhagic shock.
Fluid resuscitation is still a major challenge. We aimed to describe changes in central venous oxygen saturation (ScvO2 ) and venous-to-arterial carbon dioxide gap (dCO2 ) during an experimental stroke volume (SV) index (SVI)-guided hemorrhage and fluid resuscitation model in pigs. ⋯ In this SV-guided bleeding and fluid resuscitation model, both ScvO2 and dCO2 correlated well with changes in SV, but only the dCO2 returned to its baseline, normal value, while ScvO2 remained significantly lower than at baseline. These results suggest that dCO2 may be a good hemodynamic endpoint of resuscitation, while ScvO2 is not strictly a hemodynamic parameter, but rather an indicator of the balance between oxygen delivery and consumption.