Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 2024
ReviewRisks of serious adverse events with non-steroidal anti-inflammatory drugs in gastrointestinal surgery: A systematic review with meta-analysis and trial sequential analysis.
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly recommended for perioperative opioid-sparing multimodal analgesic treatments. Concerns regarding the potential for serious adverse events (SAEs) associated with perioperative NSAID treatment are especially relevant following gastrointestinal surgery. We assessed the risks of SAEs with perioperative NSAID treatment in patients undergoing gastrointestinal surgery. ⋯ In adult patients undergoing gastrointestinal surgery, there was insufficient information to draw firm conclusions on the effects of NSAIDs on SAEs. The certainty of the evidence was very low.
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Acta Anaesthesiol Scand · Apr 2024
The OPI•AID Zone Tool as a composite outcome for postoperative pain management quality-A protocol for an observational pilot study.
Managing postoperative pain while minimizing opioid-related adverse drug events (ORADEs) remains a significant challenge. The OPI•AID Zone Tool is proposed as a novel clinical decision support tool that - both graphically and in a scoring-system - represents the relationship between pain management and the occurrence of ORADEs, aiming to enhance patient outcomes in postoperative care. The OPI•AID Zone Tool places pain score on the x-axis and an ORADE score on the y-axis, and stratifies patients into five zones to reflect the composite impact of pain severity and ORADEs on the quality of postoperative patient care. The study will have two key aims: (1) to explore whether the OPI•AID Zone Tool can function as a composite outcome measure for postoperative pain and ORADEs, and (2) to evaluate the use of the OPI•AID Zone Tool in visual presentations and for evaluation of patients' postoperative pain management quality. ⋯ The OPI•AID Zone Tool could potentially be a valuable clinical decision-making tool for optimizing postoperative care by simultaneously addressing pain management and the risk of ORADEs. By computing a composite measure of these two critical outcomes, the tool could guide more nuanced and patient-centered analgesic regimens, potentially improving patient satisfaction and operational efficiency in postoperative settings. The tool's applicability will be explored in this observational pilot and followed up in a planned series of studies (opiaid.dk).
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Acta Anaesthesiol Scand · Apr 2024
More than just joy: A qualitative analysis of participant experiences during nitrous oxide sedation.
Nitrous oxide use is shifting from general anesthesia to sedation and pain control. Interest in novel uses of nitrous oxide in psychiatry is also growing. Thus, understanding the consequences of using nitrous oxide remains relevant. Previous quantitative research might not have fully captured the whole spectrum of nitrous oxide, whereas qualitative analysis can provide a more comprehensive description. This qualitative study aims to describe the subjective experiences of nitrous oxide use in healthy volunteers who have no prior history of recreational substance misuse. ⋯ Experiences under nitrous oxide sedation are extremely variable and not always pleasant. These findings can improve our understanding of the likes/dislikes of patients undergoing nitrous oxide sedation. Further qualitative studies should focus on the experiences of other groups, such as children or women in labor.
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Acta Anaesthesiol Scand · Apr 2024
Perioperative urinary ketosis and metabolic acidosis in patients fasted for undergoing gynecologic surgery.
Our bodies have adaptive mechanisms to fasting, in which glycogen stored in the liver and muscle protein are broken down, but also lipid mobilisation is triggered. As a result, glycerol and fatty acids are released into the bloodstream, increasing the production of ketone bodies in liver. However, there are limited studies on the incidence of perioperative urinary ketosis, the intraoperative blood glucose changes and metabolic acidosis after fasting for surgery in non-diabetic adult patients. ⋯ Perioperative urinary ketosis and intraoperative metabolic acidosis are common in patients undergoing gynecologic surgery, even with short-term preoperative fasting. The risks are notably higher in younger patients with lower body mass index. Optimization of preoperative fasting strategies including implementation of oral carbohydrate loading should be considered for reducing perioperative metabolic derangement due to ketosis.
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Acta Anaesthesiol Scand · Apr 2024
ReviewProton pump inhibitors for gastrointestinal bleeding prophylaxis in critically ill patients: A systematic review protocol.
Proton pump inhibitors (PPIs) are the most commonly prescribed drugs for preventing upper gastrointestinal bleeding in critically ill patients. However, concerns have arisen about the possible harms of using PPIs, including potentially increased risk of pneumonia, Clostridioides difficile infection, and more seriously, an increased risk of death in the most severely ill patients. Triggered by the REVISE trial, which is a forthcoming large randomized trial comparing pantoprazole to placebo in invasively mechanically ventilated patients, we will conduct this systematic review to evaluate the efficacy and safety of PPIs versus no prophylaxis for critically ill patients. ⋯ This systematic review will provide the most up-to-date evidence regarding the merits and limitations of stress ulcer prophylaxis with PPIs in critically ill patients in contemporary practice.