Acta anaesthesiologica Scandinavica
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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
Continuing epidural analgesia during the second stage andACOG definition of arrest of labor on maternal-fetal outcomes.
Despite an increase in the rates of epidural labor analgesia, continuation of epidural labor analgesia in the second stage of labor (CEADSSOL) was interrupted by care providers due to fears of increased risk of operative delivery and adverse neonatal outcomes. Therefore, we evaluated the effect of CEADSSOL and the newer American College of Obstetricians and Gynecologists (ACOG) definition of arrest of labor on the length of secondary stage of labor, newborn outcomes, and mode of delivery. ⋯ The important finding of this study was the improvement in neonatal outcomes by implementing two simultaneous interventions without a cost of increased operative delivery.
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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.
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Acta Anaesthesiol Scand · Sep 2020
Kinetics of crystalloid fluid in hyperglycemia; an open-label exploratory clinical trial.
Infusion with 0.9% saline is a mainstay in the treatment of severe hyperglycemia, but the kinetics of the saline volume in this setting has not been studied. ⋯ The excretion of 0.9% saline was increased depending on the degree of hyperglycemia. The kinetics was characterized by glucose-accelerated diuresis, and an intracellular uptake that occurred at two thirds the urine flow rate. These data could help to determine appropriate volumes and rates of infusion of crystalloids in hyperglycemia.
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Acta Anaesthesiol Scand · Sep 2020
Observational StudyIntroducing the "hip call"to facilitate early surgical treatment of hip fractures: A feasibility study.
Surgical treatment of hip fractures within 24-48 hours decreases morbidity and mortality, but goals for early surgery have not been widely achieved so far. The primary aim of this study was to investigate the feasibility of implementation of a hip call, and the secondary aim was to investigate the effect of the hip call on time for pre-operative preparation and surgery compared to a historical control cohort. ⋯ The implementation of a hip call was feasible with 83% of patients being ready for surgery within 4 hours, and 88% being operated within 24 hours. Future large-scale studies should clarify potential benefits on clinical outcome.