Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2022
Randomized Controlled TrialIntraoperative open-lung condition and postoperative pulmonary complications. A secondary analysis of iPROVE and iPROVE-O2 trials.
The preventive role of an intraoperative recruitment maneuver plus open lung approach (RM + OLA) ventilation on postoperative pulmonary complications (PPC) remains unclear. We aimed at investigating whether an intraoperative open lung condition reduces the risk of developing a composite of PPCs. ⋯ An intraoperative open lung condition was associated with a reduced risk of developing severe PPCs in intermediate-to-high risk patients undergoing abdominal surgery.
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Acta Anaesthesiol Scand · Jan 2022
Randomized Controlled TrialDextran-based priming solution during cardiopulmonary bypass attenuates renal tubular injury - a secondary analysis of randomized controlled trial in adult cardiac surgery patients.
Acute kidney injury (AKI) is a well-known complication after cardiac surgery and cardiopulmonary bypass (CPB). In the present secondary analysis of a blinded randomized controlled trial, we evaluated the effects of a colloid-based versus a conventional crystalloid-based prime on tubular injury and postoperative renal function in patients undergoing cardiac surgery with CPB. ⋯ In patients undergoing cardiac surgery with CPB, colloid-based priming solution (dextran 40) induced less renal tubular injury compared to a crystalloid-based priming solution. Whether a colloid-based priming solution will improve renal outcome in high-risk cardiac surgery, or not, needs to be evaluated in future studies on higher risk cardiac surgery patients.
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Acta Anaesthesiol Scand · Jan 2022
Randomized Controlled TrialProgrammed, intermittent boluses vs. continuous infusion to the sciatic nerve - a non-inferiority randomized, controlled trial.
Trials comparing programmed, intermittent boluses (PIB) and continuous infusion in catheter-based nerve blocks found no analgesic differences. However, as these trials used equal doses of local anesthetic (LA), the time of action of each bolus was not accounted for. Therefore, the dose-sparing benefits of PIB may have been overlooked. We compared the analgesic effect of boluses administered in intervals resembling the time of action of each bolus with continuous infusion. We hypothesized that PIB provided non-inferior analgesia despite consuming less LA. ⋯ PIB provided non-inferior analgesia compared to continuous infusion for 72 postoperative hours despite using significantly less LA.
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Acta Anaesthesiol Scand · Jan 2022
Randomized Controlled TrialInteractions in clinical trials: Protocol and statistical analysis plan for an explorative study of four randomised ICU trials on use of pantoprazole, oxygenation targets, haloperidol and intravenous fluids.
Intensive care unit (ICU) patients receive numerous interventions, but knowledge about potential interactions between these interventions is limited. Co-enrolment in randomized clinical trials represents a unique opportunity to investigate any such interactions. We aim to assess interactions in four randomized clinical trials with overlap in inclusion periods and patient populations. ⋯ This exploratory analysis will investigate the presence of any interactions between pantoprazole, oxygenation targets, haloperidol and amount of intravenous fluids in four international ICU trials using co-enrolment. Assessment of possible interactions represents valuable information to guide the design, statistical powering and conduct of future trials.
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Acta Anaesthesiol Scand · Jan 2022
Randomized Controlled TrialGeneral or regional anaesthesia for postpartum haemorrhage - a national population-based cohort study.
Anaesthesia is required to assist the treatment of postpartum haemorrhage (PPH) when manual removal of the placenta or emptying of the uterine cavity is required. The choice between general or regional anaesthesia may depend upon factors such as existing epidural, airway, hypovolaemia, and tradition. ⋯ Practice varies immensely between delivery centres with large centres preferring regional anaesthesia. Difference in practice might be explained by level of experience, here large centres might be more confident using regional anaesthesia. Knowledge is being extrapolated from literature on caesarean sections. Future studies should address the optimal choice of anaesthesia for PPH procedures.