Acta anaesthesiologica Scandinavica
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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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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.
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Acta Anaesthesiol Scand · Sep 2014
Review Meta AnalysisDefinition, prevalence, and outcome of feeding intolerance in intensive care: a systematic review and meta-analysis.
Clinicians and researchers frequently use the phrase 'feeding intolerance' (FI) as a descriptive term in enterally fed critically ill patients. We aimed to: (1) determine what is the most accepted definition of FI; (2) estimate the prevalence of FI; and (3) evaluate whether FI is associated with important outcomes. Systematic searches of peer-reviewed publications using PubMed, MEDLINE, and Web of Science were performed with studies reporting FI extracted. ⋯ In summary, FI is inconsistently defined but appears to occur frequently. There are preliminary data indicating that FI is associated with adverse outcomes. A standard definition of FI is required to determine the accuracy of these preliminary data.
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Acta Anaesthesiol Scand · Sep 2014
Randomized Controlled Trial Comparative StudyContinuous wound infiltration with ropivacaine for analgesia after caesarean section: a randomised, placebo-controlled trial.
We evaluated the analgesic effect of ropivacaine infiltration into the surgical wound after caesarean section. ⋯ Continuous wound infiltration with ropivacaine did not decrease the need for opioids and had no impact on pain scores or patient satisfaction after caesarean section.