Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2019
Randomized Controlled Trial Comparative StudyFiberoptic intubation of severely obese patients through supraglottic airway: A prospective, randomized trial of the Ambu® AuraGain™ laryngeal mask vs the i-gel™ airway.
Airway management in severely obese patients remains a challenging issue for anaesthetists and may lead to life-threatening situations. Supraglottic airway devices, such as the i-gel™ or the AuraGain™, were developed, with the possibility to ventilate the patient or use them as a conduit for endotracheal intubation. ⋯ Time for intubation through both supraglottic airway devices was similar. Attributed to fast possibility of securing the airway with both supraglottic airway devices, we believe that both, AuraGain™ and i-gel™, can be a good alternative in the airway management in obese patients.
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Acta Anaesthesiol Scand · Feb 2019
Randomized Controlled TrialAssociation between perioperative hyperoxia and cerebrovascular complications after laparotomy-A post-hoc follow-up study.
Perioperative hyperoxia has been linked to increased long-term mortality. Vasoconstrictive and cellular side effects to hyperoxia have been suggested to increase the risk of coronary and cerebral ischemia. The aim of this post-hoc analysis of a large randomized trial was to compare the effects of 80% vs 30% perioperative oxygen on the long-term risk of stroke or transient cerebral ischemia (TCI) in patients undergoing abdominal surgery. ⋯ Stroke or TCI did not seem related to perioperative inspiratory oxygen fraction. Due to few events, this study cannot exclude that perioperative hyperoxia increases risk of mortality, stroke, or TCI after abdominal surgery.
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Acta Anaesthesiol Scand · Feb 2019
Comparative Study Observational StudyNational Early Warning Score vs Rapid Response Team criteria-Prevalence, misclassification, and outcome.
The purpose of this study was to examine the prevalence of deviating vital parameters in general ward patients using rapid response team (RRT) criteria and National Early Warning Score (NEWS), assess exam duration, correct calculation and classification of risk score as well as mortality and adverse events. ⋯ Even with a mature RRT in place, we captured patients with failing physiology in general wards reflecting afferent limb failure. Manual calculation of NEWS is frequently incorrect, possibly leading to misclassification of patients at risk.
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Acta Anaesthesiol Scand · Feb 2019
Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection.
Orthostatic hypotension (OH) and intolerance (OI) are common findings in the early postoperative period after major surgery and may delay early mobilization. The mechanism of impaired orthostatic competence and OI symptoms is not fully understood, and specific data after colorectal surgery with well-defined perioperative care regimens and mobilization protocols are lacking. The aim of this study was to investigate the prevalence, possible risk factors and the impact of OI in patients undergoing elective minimal invasive colorectal cancer resection. ⋯ Postoperative orthostatic intolerance is a common problem during the first 24 hour following laparoscopic colorectal resection and may be followed by delayed recovery.
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Acta Anaesthesiol Scand · Feb 2019
Review Meta AnalysisThe effects of general anaesthesia on oxygen consumption: A meta-analysis guiding future studies on perioperative oxygen transport.
Increased oxygen extraction, the ratio of consumption to delivery, has been associated with poor outcome after surgery. Oxygen consumption (VO2) can change in several ways in the perioperative period, but is seldom monitored directly in routine care. This study investigates the effects of general anaesthesia on VO2. ⋯ General anaesthesia probably reduces oxygen consumption but the effect estimate is uncertain. Given the limited generalizability and low quality of the available evidence, new studies in modern perioperative settings and in today's older high-risk surgical patient populations are needed.