Acta anaesthesiologica Scandinavica
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The aim of this PhD thesis was to provide a continuous method to monitor myocardial function during cardiac surgery with the superior sensitivity of ultrasonic technique and the continuity of electrocardiographic (ECG) monitoring. ⋯ The provided ultrasound system could give continuous real-time monitoring of myocardial function, and detect myocardial dysfunction with superior sensitivity than ECG or hemodynamic monitoring. This could be used for improved monitoring of myocardial function during cardiac surgery.
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Acta Anaesthesiol Scand · Jul 2014
Randomized Controlled Trial Comparative StudyDexamethasone for pain after outpatient shoulder surgery: a randomised, double-blind, placebo-controlled trial.
Preoperative IV dexamethasone reduces pain after arthroscopic shoulder surgery.
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Acta Anaesthesiol Scand · Jul 2014
Randomized Controlled Trial Comparative StudyPost-operative atelectasis - a randomised trial investigating a ventilatory strategy and low oxygen fraction during recovery.
Atelectasis is common during and after general anaesthesia. We hypothesized that a ventilation strategy with a combination of 1) continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) and 2) a reduced end-expiratory oxygen concentration during recovery would reduce post-operative atelectasis. ⋯ Inducing anaesthesia with CPAP/PEEP and FIO2 1.0 and deliberately reducing FIO2 during recovery before removal of the LMA did not reduce post-operative atelectasis compared with FIO2 1.0 before removal of the LMA.
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Acta Anaesthesiol Scand · Jul 2014
ReviewNew oral anticoagulants: clinical indications, monitoring and treatment of acute bleeding complications.
New oral anticoagulants like the direct thrombin inhibitor, dabigatran (Pradaxa®), and factor Xa-inhibitors, rivaroxaban (Xarelto®) and apixaban (Eliquis®) are available for prophylaxis and treatment of thromboembolic disease. They are emerging alternatives to warfarin and provide equal or better clinical outcome together with reduced need for routine monitoring. Methods for measuring drug concentrations are available, although a correlation between plasma drug concentrations and the risk of bleeding has not been firmly established. ⋯ Further challenges regarding patients receiving new oral anticoagulants who presents with major bleeding or need for emergency surgery pose a unique problem. No established agents are clinically available to reverse the anticoagulant effect, although preclinical data report prothrombin complex concentrate as more efficient than fresh frozen plasma or other prohaemostatic agents. This review summaries current knowledge on approved new oral anticoagulants and discusses clinical aspects of monitoring, with particular focus on the management of the bleeding patient.
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Acta Anaesthesiol Scand · Jul 2014
Pharmacokinetics of dexmedetomidine combined with therapeutic hypothermia in a piglet asphyxia model.
The highly selective α2 -adrenoreceptor agonist, dexmedetomidine, exerts neuroprotective, analgesic, anti-inflammatory and sympatholytic properties that may be beneficial for perinatal asphyxia. The optimal safe dose for pre-clinical newborn neuroprotection studies is unknown. ⋯ Dexmedetomidine clearance was reduced almost tenfold compared with adult values in the newborn piglet following hypoxic-ischaemic brain injury and subsequent therapeutic hypothermia. Reduced clearance was related to cumulative effects of both hypothermia and exposure to hypoxia. High plasma levels of dexmedetomidine were associated with major cardiovascular complications.