Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2016
Review Meta AnalysisTachyphylaxis to local anaesthetics. What is the clinical evidence? A systematic review.
Tachyphylaxis or acute tolerance to local anaesthetics has been reported, but the prevalence in clinical analgesia is obscure, and the mechanisms behind this phenomenon remain unclear. We sought to examine the clinical significance of tachyphylaxis from the available literature. ⋯ Studies documenting tachyphylaxis with clinical use of local anaesthetics are surprisingly scarce, and the mechanisms behind it remain unclear.
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Acta Anaesthesiol Scand · Jan 2016
Randomized Controlled TrialPreserved oxygenation in obese patients receiving protective ventilation during laparoscopic surgery: a randomized controlled study.
Venous admixture from atelectasis and airway closure impedes oxygenation during general anaesthesia. We tested the hypothesis that continuous positive airway pressure (CPAP) during pre-oxygenation and reduced fraction of inspiratory oxygen (FIO2 ) during emergence from anaesthesia can improve oxygenation in patients with obesity undergoing laparoscopic surgery. ⋯ A CPAP of 10 cmH2 O during pre-oxygenation and induction, followed by PEEP after intubation, seemed to preserve oxygenation during anaesthesia. Post-operative oxygenation depended on the FIO2 used during emergence.
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Acta Anaesthesiol Scand · Jan 2016
External validation of the Norwegian survival prediction model in trauma after major trauma in Southern Finland.
The Norwegian Survival Prediction Model in Trauma (NORMIT) is a newly developed outcome prediction model for patients with trauma. We aimed to compare the novel NORMIT to the more commonly used Trauma and Injury Severity Score (TRISS) in Finnish trauma patients. ⋯ NORMIT and TRISS showed good discrimination, but poor calibration, in this mixed cohort of severely injured trauma patients from Southern Finland. We found NORMIT to be a feasible alternative to TRISS for trauma patient outcome prediction, but trauma prediction models with improved calibration are needed.
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Acta Anaesthesiol Scand · Jan 2016
Oxytocin use during Caesarean sections in Denmark - are we getting the dose right?
In Denmark, an iv bolus of 10 IU oxytocin was traditionally given after delivery to prevent atony during caesarean sections. Randomized controlled trials have shown that lower iv bolus doses have same efficacy with fewer side effects and many countries now recommend a 5 IU maximum dose. The aims of this study were to investigate whether patients referred for allergy testing after oxytocin exposure had dose-related side effects to oxytocin rather than true allergic reactions and to investigate whether updated international recommendations on lower bolus doses had been implemented in practice. ⋯ Too high oxytocin doses are still used in Denmark leading to dose-related side effects mimicking allergic reactions. Coordination between obstetricians and anaesthesiologists on producing common updated guidelines on the administration of oxytocin and dissemination of this information to obstetric and anaesthetic departments in Denmark is needed.