Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2020
Multicenter Study Observational StudyBlood pressure in Danish children during general anaesthesia: Hypotension in a Paediatric Population Observational (HIPPO) Study.
In Denmark, thousands of infants and children require general anaesthesia annually. Hypotension during general anaesthesia might reduce cerebral blood flow and oxygen delivery to the brain. Safe lower limits of blood pressure are ill defined. The Hypotension in Paediatric Populations Observational study objective was to assess blood pressure in Danish children during general anaesthesia. ⋯ This study presents pragmatic, multicentre, prospectively collected observations of blood pressure in children undergoing general anaesthesia in usual practice. In the youngest infants, variability in blood pressure appears to be large. Measurement of blood pressure is recommended during every general anaesthesia and in children of all ages. Safe ranges of blood pressure remain to be defined.
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Acta Anaesthesiol Scand · Nov 2020
ReviewCommon clinical thresholds of intraoperative hypotension and 30-day mortality following surgery: a retrospective cohort study.
A wide range of thresholds define intraoperative hypotension and can be used to guide intraoperative blood pressure management. Many clinicians use the systolic blood pressure (SBP) <80 mmHg, the mean arterial pressure (MAP) <60 mmHg and the SBP percent drop from baseline (ΔSBP) >20% as alarming limits that should not be exceeded. Whether these common thresholds are valid limits that can inform clinicians on a possible increased risk of post-operative complications, particularly 30-day mortality, is currently unclear. ⋯ Commonly accepted thresholds of intraoperative hypotension, such as an SBP of 80 mmHg and an MAP of 60 mmHg, are valid alarming limits that are significantly and independently associated with 30-day mortality.
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Acta Anaesthesiol Scand · Nov 2020
Randomized Controlled TrialComparing two airway management strategies for moderately sedated patients undergoing awake craniotomy: a single-blinded randomized controlled trial.
In the monitored anesthesia care (MAC) setting for awake craniotomy (AC), maintaining airway patency in sedated patients remains challenging. This randomized controlled trial aimed to compare the validity of the below-epiglottis transnasal tube insertion (the tip of the tube placed between the epiglottis and vocal cords) and the nasopharyngeal airway (simulated by the above-epiglottis transnasal tube with the tip of the tube placed between the epiglottis and the free edge of the soft palate) with respect to maintaining upper airway patency for moderately sedated patients undergoing AC. ⋯ The below-epiglottis tube insertion is a more effective method to maintain upper airway patency than the nasopharyngeal airway for moderately sedated patients undergoing AC.
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Acta Anaesthesiol Scand · Nov 2020
Randomized Controlled TrialLung volume changes in Apnoeic Oxygenation using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) compared to mechanical ventilation in adults undergoing laryngeal surgery.
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) using high-flow 100% oxygen during apnoea has gained increased use during difficult airway management and laryngeal surgery due to a slower carbon dioxide rise compared to traditional apnoeic oxygenation. We have previously demonstrated high arterial oxygen partial pressures and an increasing arterial-alveolar carbon dioxide difference during THRIVE. Primary aim of this study was to characterise lung volume changes measured with electrical impedance tomography during THRIVE compared to mechanical ventilation. ⋯ No difference in lung volume change over time, measured by electrical impedance tomography, was detected when using THRIVE compared to mechanical ventilation during laryngeal surgery.
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Acta Anaesthesiol Scand · Nov 2020
Randomized Controlled TrialProgrammed intermittent boluses vs continuous epidural infusion in labor using an adrenaline containing solution: a randomized trial.
Traditionally, epidural analgesia has been maintained using a continuous infusion (CEI) with the addition of patient-controlled boluses (PCEA). In recent years, programmed intermittent boluses (PIEB) has emerged as an alternative showing better efficacy in randomized studies. In this study, the aim was to test PIEB + PCEA vs CEI + PCEA using an epidural solution containing adrenaline. ⋯ For labor epidural analgesia infusions, to optimize the analgesic effect, additional programmed intermittent boluses can be used as an alternative to patient-controlled boluses only. In this clinical trial, no differences in drug consumption or analgesic effect was observed when comparing these two different epidural bolus controls programs.