Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2014
Randomized Controlled Trial Comparative StudyThe influence of glucose load on metabolism during minor surgery using remifentanil-induced anesthesia.
During perioperative fasting, lipid metabolism gradually increases, resulting in free fatty acids (FFA) and/or ketone bodies. Suppression of surgical stress by remifentanil may allow the safe administration of glucose infusions, avoiding both hyperglycemia and ketogenesis. The effects of glucose infusion on glucose and lipid metabolism were therefore investigated in patients undergoing minor surgery with remifentanil anesthesia. ⋯ Infusion of low-dose glucose attenuated fat catabolism without causing hyperglycemia, indicating that infusion of low-dose glucose during remifentanil-induced anesthesia may be safe for patients.
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Acta Anaesthesiol Scand · Sep 2014
Randomized Controlled Trial Comparative StudyThe effects of propofol vs. sevoflurane on post-operative pain and need of opioid.
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Acta Anaesthesiol Scand · Sep 2014
Case ReportsUse of neuromuscular monitoring to detect prolonged effect of succinylcholine or mivacurium: three case reports.
Mutations in the butyrylcholinesterase gene can lead to a prolonged effect of the neuromuscular blocking agents, succinylcholine and mivacurium. If the anaesthesiologist is not aware of this condition, it may result in insufficient respiration after tracheal extubation. However, this can be avoided with the use of objective neuromuscular monitoring if used adequately. ⋯ Both patients had insufficient respiration. They were therefore re-sedated, transferred to the intensive care unit and the tracheas were extubated after full recovery from neuromuscular blockade. We recommend the use of monitoring every time these agents are used, even with short-acting drugs like succinylcholine and mivacurium.
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Elective knee and hip arthroplasty are common surgical procedures. Improved anaesthetic and nutritional care has the potential of increasing patient satisfaction and reducing length of hospital stay (LOS). The overall aim of this thesis was to evaluate the effect of perioperative nutrition and different anaesthetic techniques on per- and postoperative outcome after elective total hip arthroplasty (THA) or total knee arthroplasty (TKA). ⋯ Patients undergoing THA received an oral carbohydrate or placebo drink in a randomised controlled trial 90 min before and 120 min after surgery. The treatment resulted in less hunger and nausea and reduced pain compared with placebo. When intrathecal anaesthesia (ITA) and traditional intra- and postoperative care was compared with general anaesthesia (GA) combined with accelerated postoperative care for TKA, the LOS was reduced without adversely affecting pain or total satisfaction. TKA patients given identical perioperative treatment were randomised to either ITA or GA, and GA resulted in shorter LOS, less nausea, vomiting and dizziness. GA patients also required less postoperative analgesics and had lower pain scores. Patients receiving ITA indicated that they would like to change their method of anaesthesia in the event of a subsequent operation. THA patients receiving either ITA or GA resulted in similar findings as in the TKA study. In conclusion, this thesis shows that perioperative carbohydrate administration has a limited beneficial effect on THA patients. Accelerated postoperative care and GA has favourable recovery effects when compared with ITA and traditional postoperative care. When GA was compared with ITA in a Fast-Track set-up, GA resulted in a more favourable recovery profile for patients undergoing THA or TKA. Both TKA and THA patients preferred GA in case of a future operation.