Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2015
Case ReportsIntraosseous access in neonates and infants: risk of severe complications - a case report.
Gaining vascular access in a neonate during cardiopulmonary resuscitation is crucial and challenging. Intraosseous (IO) access can offer a fast and reliable method for achieving emergency access for fluids and drugs when venous access fails in a critically ill child. IO access can however result in rare, but serious adverse events including compartment syndrome and amputation. ⋯ Regular observation of the circulation and possible swelling of the leg should be performed. The IO administration of inotropic infusions should also be avoided after the initial resuscitation phase. When treating with therapeutic hypothermia, it may be wise to remove the IO needle much earlier than the currently recommended 24 h because of the problems in peripheral circulation and its monitoring.
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Acta Anaesthesiol Scand · Nov 2015
Crew Resource Management in the Intensive Care Unit: a prospective 3-year cohort study.
Human factors account for the majority of adverse events in both aviation and medicine. Human factors awareness training entitled "Crew Resource Management (CRM)" is associated with improved aviation safety. We determined whether implementation of CRM impacts outcome in critically ill patients. ⋯ Our data indicate an association between CRM implementation and reduction in serious complications and lower mortality in critically ill patients.
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Acta Anaesthesiol Scand · Nov 2015
Case ReportsManagement of labour and delivery in congenitally corrected transposition of great arteries.
A descriptive case report of the labour and delivery management of a 28-year-old woman who presented with congenitally corrected transposition of great arteries, dextrocardia, systemic ventricular dysfunction and junctional tachycardia. Patients with congenitally corrected transposition have a thin-walled morphological right ventricle as the systemic circulatory pump. The stress of increased cardiac output can lead to congestive heart failure, systemic atrioventricular valve regurgitation and arrhythmias. We used minimally invasive continuous cardiac output monitoring, fluid balance optimization and good maternal pain control to prevent decompensation and achieve vaginal delivery with a good maternal and neonatal outcome.
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Acta Anaesthesiol Scand · Nov 2015
Case ReportsSevere hypoglycemia during methadone escalation in an 8-year-old child.
This case report describes hypoglycemia during methadone escalation in an 8-year-old girl with acute lymphatic leukemia. After a significant increase in the methadone dosage, the blood glucose decreased from 12 mmol/l to 1 mmol/l. ⋯ There are few reports from the adult palliative setting which describe this serious side effect. This is to our knowledge, the first described pediatric case.