Acta anaesthesiologica Scandinavica
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The prevalence of persistent post-sternotomy pain (PPSP) varies largely and has been mainly studied using questionnaires. We decided to perform a systematic qualitative and quantitative sensory examination study on a power-calculated sample of patients who had undergone sternotomy for cardiac surgery. Pain was diagnosed as PPSP if the patient complained of sternal pain that had developed after surgery together with corresponding sensory disturbances. ⋯ PPSP is a clinical diagnosis easily achieved using simple diagnostic tools and a medical history. Severity and extent of sensory abnormalities were found to be greater in the PPSP group.
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Acta Anaesthesiol Scand · Aug 2016
Teaching ultrasound-guided regional anesthesia remotely: a feasibility study.
Ultrasound-guided regional anesthesia (UGRA) requires acquisition of new skills. Learning requires one-on-one teaching, and can be limited by time and mentor availability. We investigate whether the skills required for UGRA can be developed and subsequently assessed remotely using a novel online teaching platform. This platform was developed at the University of Toronto to teach laparoscopic surgery remotely and has been termed Telesimulation. ⋯ This study demonstrates that UGRA can be taught remotely. Future research will focus on comparing this method to on-site teaching and its application in resource-restricted countries.
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Acta Anaesthesiol Scand · Aug 2016
CommentUsability of dexmedetomidine for deep sedation in infants and small children with respiratory morbidities.
Children with respiratory morbidities are at increased risk of developing adverse respiratory events while undergoing deep sedation. Dexmedetomidine possesses sedative properties with minimal respiratory depression. This report aimed to determine the usability of dexmedetomidine in children with significant respiratory morbidities who require deep sedation. ⋯ These data demonstrate that dexmedetomidine deep sedation was well-tolerated in children with significant respiratory morbidities. Moreover, children younger than 1 year of age were administered lower dexmedetomidine dose than children older than 1 year of age for the same sedation level.
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Acta Anaesthesiol Scand · Aug 2016
Observational StudyCerebral microemboli detected by transcranial doppler in patients treated with extracorporeal membrane oxygenation.
Cerebrovascular complications rate in patients treated with extracorporeal membrane oxygenation (ECMO) is about 7%. Ischemic stroke may be caused by solid or gaseous microemboli due to thrombosis within the circuit or cannula. Transcranial Doppler (TCD) is the only method able to detect microembolic signals (MES) in real time. The objective of this study was to detect possible MES by TCD in patients treated with veno-venous (VV) and veno-arterial (VA) ECMO and to test for a relation between the number of MES and the 6-month clinical outcome of these patients. ⋯ MES were found in both ECMO configurations; independently from their pathophysiology, MES do not seem to influence clinical outcome. Multicenter studies are still required with more extensive cases to confirm these results.
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Acta Anaesthesiol Scand · Aug 2016
CommentAssociation between fluid balance and mortality in patients with septic shock: a post hoc analysis of the TRISS trial.
Several studies have shown an association between a positive fluid balance and increased mortality in patients with septic shock. This may have led to a more restrictive use of intravenous fluids. The association between fluid accumulation and mortality in the setting of a more restrictive use of intravenous fluids, however, is uncertain. We therefore aimed to investigate the association between a cumulative fluid balance 3 days after randomization and 90-day mortality in a recent Nordic multicentre cohort of patients with septic shock. ⋯ In our cohort of patients with septic shock and a comparably low cumulative fluid balance, there was no association between fluid balance and mortality. However, the study design and the limited power preclude strong conclusions. There is an urgent need for high-quality trials assessing the benefit and harm of different fluid volume strategies in patients with septic shock.