Acta anaesthesiologica Scandinavica
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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.
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Acta Anaesthesiol Scand · Apr 2015
Observational StudyDeep neuromuscular block reduces intra-abdominal pressure requirements during laparoscopic cholecystectomy: a prospective observational study.
Laparoscopic surgery causes specific post-operative discomfort and intraoperative cardiovascular, pulmonary, and splanchnic changes. The CO2 pneumoperitoneum-related intra-abdominal pressure (IAP) remains one of the main drivers of these changes. We investigated the influence of deep neuromuscular blockade (NMB) on IAP and surgical conditions. ⋯ We found an almost 25% lower IAP after a deep NMB compared with no block in laparoscopic cholecystectomy. Younger and female patients appear to benefit more from deep neuromuscular blockade to reduce IAP.
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Acta Anaesthesiol Scand · Apr 2015
Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study.
Maternal intrapartum fever (MF) is associated with neonatal sequelae, and women in labour who receive epidural analgesia (EA) are more likely to develop hyperthermia. The aims of this study were to investigate if EA and/or a diagnosis of MF were associated to adverse neonatal outcomes at a population level. ⋯ Diagnosis of MF was associated with low AS and neonatal encephalopathy, whereas EA was only associated with low AS and not with neonatal encephalopathy. The found associations might be a result of confounding by indication, which is difficult to assess in a registry-based population study.
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Acta Anaesthesiol Scand · Apr 2015
Case ReportsSevere hoarseness associated with the streamlined liner of the pharyngeal airway (SLIPA(TM) ).
Hoarseness is a common post-operative complication in patients who receive general anesthesia. In most cases, the symptoms are temporary and improve within several days. This report describes two patients with prolonged hoarseness following use of the streamlined liner of the pharyngeal airway (SLIPATM). ⋯ In the second case, we report on a 65-year-old male patient who was scheduled for a laparoscopic cholecystectomy. Left vocal fold paralysis or paresis resulting from recurrent laryngeal nerve injury associated with use of a SLIPA™ caused persistent hoarseness. It should be noted that recurrent laryngeal nerve injury or arytenoid cartilage dislocation are possible complications associated with use of the SLIPATM in case of persistent hoarseness.
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Acta Anaesthesiol Scand · Apr 2015
Milrinone and esmolol decrease cardiac damage after resuscitation from prolonged cardiac arrest.
Long-term survival after cardiac arrest (CA) due to shock-refractory ventricular fibrillation (VF) is low. Clearly, there is a need for new pharmacological interventions in the setting of cardiopulmonary resuscitation (CPR) to improve outcome. Here, hemodynamic parameters and cardiac damage are compared between the treatment group (milrinone, esmolol and vasopressin) and controls (vasopressin only) during resuscitation from prolonged CA in piglets. ⋯ The combination of milrinone, esmolol and vasopressin decreased cardiac injury compared with vasopressin alone.