Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 2015
Randomized Controlled TrialTransversus abdominis plane block vs. wound infiltration in Caesarean section: a randomised controlled trial.
Transversus abdominus plane block after caesarean section does not reduce morphine consumption when compared to wound infiltration with equivalent local anaesthesia.
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Acta Anaesthesiol Scand · Apr 2015
Review Meta AnalysisIntravenous ketamine during spinal and general anaesthesia for caesarean section: systematic review and meta-analysis.
Intravenous ketamine has been used during general and regional anaesthesia for caesarean section. No systematic review and meta-analysis on the desired effects and adverse effects of ketamine administration during caesarean section have yet been performed. ⋯ We conclude that ketamine enhances post-operative analgesia after caesarean section under spinal anaesthesia. There is a paucity of data for several maternal adverse effects as well as for neonatal well-being. Further studies are needed for general anaesthesia.
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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
Randomized Controlled TrialDay-night variation in heart rate variability changes induced by endotoxaemia in healthy volunteers.
Morbidity and mortality in response to sepsis may be dependent on clock time for the initiation of sepsis. Endotoxaemia, an experimental model for systemic inflammation, induces alterations in sympatico-vagal balance in the autonomic nervous system (ANS). The activity of sympathetic and parasympathetic activity can be estimated by measuring heart rate variability (HRV). Based on the intimate link between ANS and the inflammatory response, we hypothesized, that HRV changes seen during endotoxaemia would be different based on time of the day the endotoxaemia is initiated. We investigated day/night variation in endotoxaemia-induced changes in HRV. ⋯ Endotoxaemia induced changes in HRV exhibit a day-night difference. This difference may have clinical consequences in patients with sepsis.