Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2017
Quality of life following trauma before and after implementation of a physician-staffed helicopter.
Implementation of a physician-staffed helicopter emergency medical service (PS-HEMS) in Denmark was associated with lower 30-day mortality in severely injured trauma patients and less time on social subsidy. However, the reduced 30-day mortality in severely injured patients might be at the expense of a worse functional outcome and quality of life (QoL) in those who survive. The aim of this study was to investigate the effect of a physician-staffed helicopter on long-term QoL in trauma patients. ⋯ No significant difference in QoL among trauma patients was found after implementation of a PS-HEMS.
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Acta Anaesthesiol Scand · Jan 2017
Observational StudyContinuous ventilation during intubation through a supraglottic airway device guided by fiberoptic bronchoscopy: a observational assessment.
supraglottic airway devices remain, despite advances in video laryngoscopy, important tools in the management of unexpected difficult airways. Intubation through a functioning supraglottic airway device with the aid of a fiberoptic bronchoscope is a well-known technique usually performed in apnoea. With a simple modification, the patient can be ventilated during this procedure. ⋯ No adverse events were observed during this form of airway management in this small series of elective and fasted patient when performed by an anaesthesiologist experienced in fiberoptic intubation. A gap between fiberoptic bronchoscope and endotracheal tube inner lumen seems to be prerequisite for easy ventilation through the supraglottic airway. In trained hands, this technique can be a means to secure an airway with an intubating bronchoscope without pausing ventilations. A prerequisite for this is a well-functioning supraglottic airway device.
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Acta Anaesthesiol Scand · Jan 2017
Low degree of satisfactory individual pain relief in post-operative pain trials.
The majority of clinical trials regarding post-operative pain treatment focuses on the average analgesic efficacy, rather than on efficacy in individual patients. It has been argued, that in acute pain trials, the underlying distributions are often skewed, which makes the average unfit as the only way to measure efficacy. Consequently, dichotomised, individual responder analyses using a predefined 'favourable' response, e.g. Visual Analogue Scale (VAS) pain scores ≤ 30, have recently been suggested as a more clinical relevant outcome. ⋯ Our results indicate that for conventional, explanatory trials of post-operative pain, individual patient's achievement of a favourable response to analgesic treatment is rather low. Future pragmatic clinical trials should focus on both average pain levels and individual responder analyses in order to promote effective pain treatment at the individually patient level.
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Acta Anaesthesiol Scand · Jan 2017
Carotid Doppler flowmetry correlates poorly with thermodilution cardiac output following cardiac surgery.
It remains unclear whether measuring carotid arterial flow by the time velocity integral using vascular Doppler ultrasound can be used to monitor cardiac output and volume responsiveness. ⋯ Weak correlations between common carotid Doppler flow and cardiac output mean that the methods cannot be used interchangeably in post-operative cardiac surgery patients.
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Acta Anaesthesiol Scand · Jan 2017
Blister fluid and serum cytokine levels in severe sepsis in humans reflect skin dysfunction.
Knowledge of sepsis-related end-organ inflammation in vivo is limited. We investigated the cytokine response in skin and in serum in sepsis and its relation to multiorgan failure (MOF) and survival. ⋯ Cytokine responses in skin blister fluid in patients with sepsis differed from those in healthy controls.