Acta anaesthesiologica Scandinavica
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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
Observational StudyConcentrations of remifentanil, propofol, fentanyl, and midazolam during rewarming from therapeutic hypothermia.
The clearance of sedatives and analgesics may be reduced by therapeutic hypothermia. However, little is known about the concentrations of such drugs during rewarming. The aim of this study was to describe the serum concentrations of sedatives and analgesics during rewarming from therapeutic hypothermia. ⋯ Concentrations of remifentanil, propofol, and midazolam decreased during rewarming from therapeutic hypothermia when adjusting for rates of infusion. No changes were demonstrated for fentanyl.
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Acta Anaesthesiol Scand · Jul 2014
Comparative Study Clinical TrialEffect of sitting position on equal-dose spinal anaesthetic for caesarean section and post-partum tubal ligation.
We studied the hypothesis that an equal spinal anaesthetic dose administered in the sitting position to patients undergoing post-partum tubal ligation (PPTL) and caesarean section (CS) would yield similar sensory block characteristics and analgesic efficacy. ⋯ The same dose of hyperbaric bupivacaine 12 mg and morphine 100 μg administered in the sitting position to both PPTL and CS parturients yielded similar maximal sensory blocks, but PPTL exhibited faster block regression and less hypotension/vasopressor requirement.
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Acta Anaesthesiol Scand · Jul 2014
Comparative StudyKnee surgery recovery: Post-operative Quality of Recovery Scale comparison of age and complexity of surgery.
Initial validation and feasibility for the Post-operative Quality of Recovery Scale (PQRS) was published in 2010. Ongoing validation includes studies to determine whether this scale can discriminate differences in recovery between cohorts. ⋯ Knee replacement had a large effect on recovery compared with knee arthroscopy. Age had minimal effect on recovery after knee arthroscopy. The study showed the ability of the PQRS to discriminate recovery in different domains.