Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2020
Comparative StudyOnset time and duration of action of rocuronium 0.6 mg/kg in patients above 80 years of age: A comparison with young adults.
The number of elderly is increasing, and a large proportion of these people will require surgery and anaesthesia. However, little data exist regarding rocuronium in patients above 80 years of age. The aim of this study was to determine the onset time and duration of action for rocuronium 0.6 mg/kg in patients above 80 years compared with young adults. ⋯ Patients above 80 years had significantly prolonged onset time and duration of action after rocuronium 0.6 mg/kg compared with patients aged 18-40 years.
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Acta Anaesthesiol Scand · Sep 2020
Exposure to surgery is associated with better long-term outcomes in patients admitted to Swedish intensive care units.
Long-term outcomes of patients admitted to intensive care units (ICUs) after surgery are unknown. We investigated the long-term effects of surgical exposure prior to ICU admission. ⋯ Long-term ICU mortality was associated with known risk factors such as age and SAPS3. Transfer to other ICUs also appeared to be a risk factor and requires further investigation. Prior surgical exposure was associated with better outcomes, a noteworthy observation given limited ICU admissions after surgery in Sweden.
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Acta Anaesthesiol Scand · Sep 2020
Observational StudyIntensive care patient survival afterlimiting life-sustaining treatment-the FINNEOL*national cohort study.
Few studies have examined survival in intensive care unit (ICU) patients after the restriction of life-sustaining treatment (LST). We aimed to analyse independent factors associated with hospital and 12-month survival rates in ICU patients after treatment restrictions. ⋯ Survival among ICU patients with limited treatment was higher than expected. Advanced age was not associated with higher mortality, potentially because treatment restrictions may be set more easily for older patients.
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Acta Anaesthesiol Scand · Sep 2020
No evidence of cardiac stunningor decoupling immediately after cardiopulmonary bypass for elective coronarysurgery.
There is significant uncertainty regarding the timing of onset of cardiovascular stunning after cardiac surgery. Cardiovascular stunning is affecting both contractility (Ees) and arterial load. Arterial load may be represented by arterial elastance (Ea) and participates in ventriculo-arterial coupling through the Ea/Ees ratio, giving information on efficiency and performance. An alternative approach to ventriculo-arterial interaction is oscillatory power fraction (OPF). The aim of this study was to investigate the immediate beat-to-beat effects of on-pump coronary artery bypass graft (CABG) surgery on contractility, cardiac power parameters, arterial load and ventriculo-arterial coupling as well as classical haemodynamic parameters. ⋯ There was no evidence for clinically relevant cardiac stunning or altered arterial load immediately after cardiopulmonary bypass for CABG surgery. The unchanged Ea/Ees ratio and OPF are indicating unchanged cardiac efficiency before and after cardiopulmonary bypass. This indicates that in elective CABG patients cardiovascular stunning is perhaps a phenomenon of inflammation and not immediate ischaemia-reperfusion injury or mechanical handling.
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Acta Anaesthesiol Scand · Sep 2020
Determination of adequate positive end expiratory pressure level required for carbon dioxide homeostasis in an animal model of infant laparoscopy.
Capnoperitoneum provides a ventilatory challenge due to reduction in end-expiratory lung volume and peritoneal carbon dioxide absorption in both children and adults. The primary aim of this controlled interventional trial was to determine the positive end-expiratory pressure (PEEP) level needed to ensure for adequate carbon dioxide clearance and preservation of carbon dioxide homeostasis in an experimental model of infant laparoscopy. The secondary aim was to evaluate potential effects on cardiac output of PEEP and abdominal pressure level variations in the same setting. ⋯ The results promote a PEEP level of 9 cmH2 O in this model of infant capnoperitoneum to allow for adequate carbon dioxide removal with subsequent preservation of carbon dioxide homeostasis. The use of high PEEP was not associated with any decrease in cardiac output.