Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2016
Helicopter-based emergency medical services for a sparsely populated region: A study of 42,500 dispatches.
The Helicopter Emergency Medical Service (HEMS) in Norway is operated day and night, despite challenging geography and weather. In Western Norway, three ambulance helicopters, with a rapid response car as an alternative, cover close to 1 million inhabitants in an area of 45,000 km(2) . Our objective was to assess patterns of emergency medical problems and treatments in HEMS in a geographically large, but sparsely populated region. ⋯ One third of the patients encountered were severely ill or injured, and more than two thirds of these received advanced treatment. HEMS use did not change over the 10-year period, however HEMS use peaked during daytime, weekends, and the summer. More than one third of all dispatches were declined or aborted.
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Acta Anaesthesiol Scand · May 2016
Vasopressin-induced changes in splanchnic blood flow and hepatic and portal venous pressures in liver resection.
To minimize blood loss during hepatic surgery, various methods are used to reduce pressure and flow within the hepato-splanchnic circulation. In this study, the effect of low- to moderate doses of vasopressin, a potent splanchnic vasoconstrictor, on changes in portal and hepatic venous pressures and splanchnic and hepato-splanchnic blood flows were assessed in elective liver resection surgery. ⋯ Short-term low to moderate infusion rates of vasopressin induced a splanchnic vasoconstriction without metabolic signs of splanchnic hypoperfusion or subsequent renal impairment. Vasopressin caused a centralization of blood volume and increased cardiac output. Vasopressin does not lower portal or hepatic venous pressures in this clinical setting.
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Acta Anaesthesiol Scand · May 2016
Observational StudyPersistent postsurgical pain after video-assisted thoracic surgery - an observational study.
The risk of persistent postsurgical pain (PPP) and subsequent pain-related functional impairment may potentially be reduced by video-assisted thoracic surgery (VATS) compared to thoracotomy. The aim of the study was therefore to assess in detail the incidence and consequences on activities of daily living of PPP after VATS. ⋯ The incidence of PPP, nerve damage (based on QST) and pain-related functional impairment following VATS was lower than reported following thoracotomy. No psychological or other factors predicted PPP. These findings call for further large-scale studies to support VATS to decrease PPP.
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Acta Anaesthesiol Scand · May 2016
Case ReportsSpontaneous intracranial hypotension following epidural anesthesia: a case report.
We report a case of refractory spontaneous intracranial hypotension (SIH) following epidural anesthesia. In this case, typical clinical symptoms and concomitant use of regional anesthesia led to the misdiagnosis of SIH as post-dural puncture headache (PDPH). A 56-year-old man received a successful appendectomy under epidural anesthesia performed at a T11-T12 intravertebral space. ⋯ This case illustrates that SIH was misdiagnosed as PDPH because of the common clinical symptoms and potentially confounding events (epidural/spinal anesthesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. For a successful treatment of SIH, a timely epidural blood patch should be considered as soon as the diagnosis is established.
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Acta Anaesthesiol Scand · May 2016
Randomized Controlled TrialPressure-dependent changes in haematocrit and plasma volume during anaesthesia, a randomised clinical trial.
Induction of general anaesthesia has been shown to cause haemodilution and an increase in plasma volume. The aim of this study was to evaluate whether prevention of hypotension during anaesthesia induction could avoid haemodilution. ⋯ During anaesthesia induction, haematocrit decreases and plasma volume increases early and parallel to a decrease in blood pressure. This autotransfusion is blunted when blood pressure is maintained at pre-induction levels with norepinephrine.