Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 2019
Randomized Controlled TrialRemote ischaemic preconditioning increases serum extracellular vesicle concentrations with altered micro-RNA signature in CABG patients.
Remote ischaemic preconditioning (RIPC) can attenuate myocardial ischaemia/reperfusion injury but its underlying mechanisms remain largely unknown. Recently, extracellular vesicles (EVs) containing microRNAs (miRNAs) were shown to mediate distant intercellular communication that may be involved in cardioprotection. We tested the hypothesis that RIPC in anaesthetized patients undergoing coronary artery bypass (CABG) surgery results in the release of EVs from the ischaemic/reperfused arm into the blood stream harbouring cardioprotective miRNAs. ⋯ Remote ischaemic preconditioning increases serum EV concentrations, most likely by early EV release from the patients' left (RIPC) arm, alters their miRNA signature, and is associated with myocardial protection. Thus, an increased EV concentration with an altered miR-signature may mediate the RIPC effect.
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Acta Anaesthesiol Scand · Apr 2019
Randomized Controlled TrialEffects of thoracic epidural analgesia on exercise-induced myocardial ischaemia in refractory angina pectoris.
Thoracic epidural analgesia (TEDA) was offered to patients with refractory angina pectoris. Our primary objectives were to evaluate TEDAs´ influence on quality of life (QoL, base for power analysis), and hypothesising that TEDA with bupivacaine during 1 month counteracts exercise-induced myocardial hypoperfusion and increase physical performance. ⋯ In refractory angina, TEDA with bupivacaine inhibits myocardial ischaemia in contrast to TEDA with saline. Regardless of whether bupivacaine or saline is applied intermittently every day, TEDA during 1 month improves the quality of life and reduces angina, even when physical performance remains low. A significant placebo effect has to be considered.
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Acta Anaesthesiol Scand · Apr 2019
Predictive performance of a new pharmacokinetic model for propofol in underweight patients during target-controlled infusion.
In a previous study, the modified Marsh and Schnider models respectively showed negatively- and positively-biased predictions in underweight patients. To overcome this drawback, we developed a new pharmacokinetic propofol model-the Choi model-for use in underweight patients. In the present study, we evaluated the predictive performance of the Choi model. ⋯ The new propofol pharmacokinetic model (the Choi model) developed for underweight patient showed adequate performance for clinical use.
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Acta Anaesthesiol Scand · Apr 2019
Observational StudyEffects of fibrinogen and platelet transfusion on coagulation and platelet function in bleeding cardiac surgery patients.
Excessive bleeding is a significant problem in cardiac surgery. Fibrinogen and platelet concentrate transfusion are used clinically to improve haemostasis and reduce bleeding but little is known about their functional effects on coagulation and platelet function in patients with ongoing bleeding. ⋯ The results demonstrate improved coagulation and platelet function following fibrinogen and platelet transfusion in patients bleeding after cardiac surgery.
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Acta Anaesthesiol Scand · Apr 2019
Observational StudySupplemental oxygen and hyperoxemia in trauma patients: A prospective, observational study.
Supplemental oxygen is recommended during the initial treatment of trauma patients according to several guidelines, but the supporting evidence is sparse. We aimed to describe the use of supplemental oxygen and occurrence of hyperoxemia in the initial phase of trauma management at two level 1 trauma centers, TC1 and TC2. ⋯ Approximately 50% of trauma patients received supplemental oxygen during the initial treatment. Hyperoxemia was a common finding for patients treated with supplemental oxygen, and it was more pronounced in intubated patients.