Acta anaesthesiologica Scandinavica
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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
Preoperative anaesthesia triage with a patient-centred system - a prospective clinical study.
Increase in day surgery has challenged preoperative anaesthesia with need to identify a few high-risk patients requiring detailed preoperative intervention. We aimed to assess if a nurse-administered Preoperative Patient-centred Anaesthesia System (Pre-PAS) could identify high-risk patients, defined as ASA score III-IV, before surgery and allow triage in standard preanaesthesia care. We hypothesized that Pre-PAS ≥ 1 would identify ASA III-IV patients with high specificity. ⋯ A patient-centred preoperative triage system had high sensitivity for identifying ASA III-IV, and multiple Pre-PAS variables were associated with ASA III-IV, but the model had low specificity. Pre-PAS may guide triage of relevant patients to preanaesthetic visit.
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Acta Anaesthesiol Scand · Nov 2020
Accuracy of ultrasound to measure the cricoid cartilage diameter in children.
Ultrasonography is used to pre-operatively predict the endotracheal tube size required for intubation by measuring the cricoid cartilage diameter. This study aimed to determine the accuracy of ultrasound measurements of the transverse diameters of the cricoid cartilage in children. ⋯ Ultrasound is a reliable tool for measuring the transverse diameters of the cricoid cartilage in children.
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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
Observational StudyCognitive function and health-related quality of life one year after acute brain injury: an observational study.
Cognitive impairment and reduced health-related quality of life (HRQoL) are well-established sequelae of critical illness. Studies on survivors of critical illness have found delirium to be a predictor of these conditions, but evidence regarding survivors of acute brain injury is sparse. We aimed to explore if delirium duration was associated with 1-year cognitive impairment and reduced HRQoL in patients with acute brain injury. ⋯ Our sample did not demonstrate an association between delirium and 1-year cognitive impairment or reduced HRQoL. Still, a large proportion of the participants were cognitively impaired, and their quality of life was lower compared to norm. Larger studies are necessary to explore these associations further.