Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2015
Randomized Controlled TrialEffects of levosimendan in patients with left ventricular hypertrophy undergoing aortic valve replacement.
Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac surgery. This may be facilitated by an increased oxygen demand and diastolic dysfunction. Levosimendan augments haemodynamics without further oxygen consumption and improves echocardiographic indices of diastolic dysfunction. This study aimed to describe the haemodynamic effects of short-term pre- and intra-operative levosimendan infusion including advanced echocardiographic measures of diastolic and systolic heart function. ⋯ Short-term levosimendan caused a transient relative increase in cardiac index, but no effect was seen on the first post-operative day and up to 6 months post-operatively with indices of systolic and diastolic heart function.
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Acta Anaesthesiol Scand · Jan 2015
Randomized Controlled TrialDoes small-dose fentanyl improve perioperative outcomes in the ambulatory setting? A randomized, double-blind, placebo-controlled study.
Despite its widespread use, the beneficial effect of low-dose fentanyl administered at induction of anesthesia on perioperative outcomes has not been studied in the ambulatory setting. Therefore, this study was designed to test the hypothesis that administration of small-dose fentanyl vs. saline during induction reduces coughing and movements without adversely affecting recovery after day-surgery. ⋯ Administration of a small-dose of fentanyl at induction of anesthesia significantly reduced purposeful movements during day-surgery under propofol-desflurane anesthesia. No significant difference was found in coughing or recovery times.
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Acta Anaesthesiol Scand · Jan 2015
Multicenter StudyPredictive value of NGAL for use of renal replacement therapy in patients with severe sepsis.
The predictive value of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy (RRT) and acute kidney injury (AKI) is not established in patients with severe sepsis. ⋯ In ICU patients with severe sepsis, plasma and urine NGAL had low predictive power for use of RRT, AKI and 90-day mortality. These results were supported by sensitivity and exploratory analyses.
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Acta Anaesthesiol Scand · Jan 2015
Effect of nicotine dependence on opioid requirements of patients after thoracic surgery.
This retrospective study investigated the effect of nicotine dependence on required postoperative opioid administration in patients undergoing thoracic surgery. ⋯ Smokers had more severe postoperative pain and required a higher quantity of postoperative opioid than nonsmokers. With increasing nicotine dependence, postoperative pain severity and postoperative opioid requirement increased.
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Acta Anaesthesiol Scand · Jan 2015
Determination of 'recruited volume' following a PEEP step is not a measure of lung recruitability.
It has been proposed that the analysis of positive end-expiratory pressure (PEEP)-induced volume changes can quantify alveolar recruitment. The potential of a lung to be recruited is expected to be high in acute respiratory distress syndrome (ARDS), where collapsed lung tissue is very common. The volume change that is beyond the delta volume because of the patient's compliance has been termed 'recruited volume' (RecV). However, data of patients with low and high RecV showed less severe lung disease in high 'recruiters', indicating that RecV may not equal the 'potentially recruitable lung tissue' seen in computed tomography scans. We hypothesized that RecV is higher in lung-healthy (LH) patients with little collapsed lung compared with ARDS patients. ⋯ Our findings suggest that RecV predominately measures a slow fraction of inflation of already aerated lung tissue and not recruitment of collapsed alveoli.