Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 2015
Randomized Controlled TrialOptimising abdominal space with deep neuromuscular blockade in gynaecologic laparoscopy - a randomised, blinded crossover study.
Insufflation of the abdomen during laparoscopy improves surgical space, but may cause post-operative shoulder pain. The incidence of shoulder pain is reduced using a lower insufflation pressure, but this may, however, compromise the surgical space. We aimed at investigating whether deep neuromuscular blockade (NMB) would enlarge surgical space, measured as the distance from the sacral promontory to the trocar in patients undergoing gynaecologic laparoscopy. ⋯ Deep NMB enlarged surgical space measured as the distance from the sacral promontory to the trocar. The enlargement, however, was minor and the clinical significance is unknown. Moreover, deep NMB improved surgical conditions when suturing the abdominal fascia.
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Acta Anaesthesiol Scand · Apr 2015
Review Meta AnalysisPre-operative fibrinogen supplementation in cardiac surgery patients: an evaluation of different trigger values.
Pre-operative fibrinogen levels are negatively associated with postoperative bleeding in cardiac surgery patients. The guidelines of the European Society of Anaesthesiology consider the possibility of a prophylactic pre-operative supplementation in patients with fibrinogen levels<`3.8 g/l. The present study is a reanalysis of published data aimed to define the diagnostic accuracy of different values of pre-operative fibrinogen levels in predicting severe post-operative bleeding. ⋯ Correction of pre-operative fibrinogen levels below 3.8 g/l would lead to an excessive rate of inappropriate interventions. Values below 2.5 g/l could be considered.
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Acta Anaesthesiol Scand · Apr 2015
Observational StudyPeripheral venous lactate at admission is associated with in-hospital mortality, a prospective cohort study.
The prognostic value of blood lactate as a predictor of adverse outcome in the acutely ill patient is unclear. The aim of this study was to investigate if a peripheral venous lactate measurement, taken at admission, is associated with in-hospital mortality in acutely ill patients with all diagnosis. Furthermore, we wanted to investigate if the test improves a triage model in terms of predicting in-hospital mortality. ⋯ We found elevated admission peripheral venous lactate to be independently associated with in-hospital mortality in the acutely ill patient admitted to the emergency department. Patients with a lactate>4 mmol/l at hospital admission should be considered triaged to the most urgent triage category.
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Acta Anaesthesiol Scand · Apr 2015
Viscoelastic haemostatic assays and fibrinogen concentration tests during haemodilution.
The efficacy of concentrates of fibrinogen and factor XIII in hypothermia and haemodilution has not yet been completely investigated. Clauss fibrinogen measurement may overestimate fibrinogen concentrations during in vitro haemodilution with hydroxyethyl starch (HES). ⋯ Fibrinogen concentrate increased coagulation more after haemodilution with HA than synthetic colloids, but equal with or less than after crystalloid haemodilution. FXIII had an additional effect to that of fibrinogen. Hypothermia and haemodilution with HES interacted to decrease coagulation. Fibrinogen ± FXIII increased coagulation also at 33°C. Two Clauss methods after in vivo HES haemodilution did not overestimate fibrinogen; however, fibrinogen-dependent clot strength decreased more than fibrinogen concentration. Between-method variability with seven Clauss methods was high. These findings support the use of fibrinogen concentrate after resuscitation with HA, also at hypothermia, but question the use of colloids, especially HES, in resuscitation. Clauss fibrinogen methods need to improve.