Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2012
Review Meta AnalysisThe role of dexamethasone in the treatment of bacterial meningitis - a systematic review.
Corticosteroids are used as an adjunct to antibiotics in the treatment of bacterial meningitis in an attempt to attenuate the intrathecal inflammatory response and thereby reduce mortality and morbidity. The purpose of the present paper is to provide a review of clinical studies of corticosteroids in the treatment of bacterial meningitis. ⋯ Taken together, dexamethasone treatment may be associated with a lower mortality in adults and fewer neurological and auditory sequelae in adults and children from high-income countries, in particular in adults suffering from pneumococcal meningitis. In contrast, studies conducted in developing countries have yielded less favourable results.
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Acta Anaesthesiol Scand · Oct 2012
Review Meta AnalysisThe present use of quality indicators in the intensive care unit.
Quality indicators (QIs) are increasingly used in medicine in order to compare and eventually to improve quality of delivered health care. During the last decade, QIs also have been used within intensive care medicine. This paper shortly describes this development and gives an overview of QIs in the intensive care unit (ICU) reported to be in use at national level. ⋯ All primarily used a physician-driven process to select national QIs. This survey reveals that the concept of QIs is perceived differently throughout countries, also within developed countries in Western Europe. At present, it will be difficult to use national QIs to compare the quality of intensive care between countries.
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Acta Anaesthesiol Scand · Sep 2012
Review Meta AnalysisSleep disturbances in critically ill patients in ICU: how much do we know?
Sleep disturbances in the intensive care unit (ICU) seem to lead to development of delirium, prolonged ICU stay, and increased mortality. That is why sufficient sleep is important for good outcome and recovery in critically ill patients. ⋯ There are no studies of level 1 evidence proving the positive impact of the tested interventions on the critically ill patients' sleep pattern. Thus, disturbed sleep in critically ill patients with all the severe consequences remains an unresolved problem and needs further investigation.
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Acta Anaesthesiol Scand · Aug 2012
Review Meta AnalysisVasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis.
Phenylephrine use has been recommended over ephedrine for the management of hypotension after spinal anesthesia for elective caesarean section. The evidence for this is rather limited because in previous trials, pH was significantly lower after ephedrine, but absolute values were still within normal range. We pooled the available data to define maternal and neonatal effects of the two vasopressors. ⋯ Our analysis could clearly demonstrate a decreased risk of fetal acidosis associated with phenylephrine use. In addition with our findings for BE, this suggests a favorable effect of phenylephrine on fetal outcome parameters. The mechanism of pH depression is not related to pCO(2) .
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Acta Anaesthesiol Scand · Aug 2012
Meta AnalysisBayesian enhanced meta-analysis of post-operative analgesic efficacy of additives for caudal analgesia in children.
The authors calculated the effect size for post-operative analgesia of three additives, clonidine, neostigmine, and tramadol to bupivacaine, ropivacaine, or levobupivacaine used for single-dose caudal extradural blockade in children. ⋯ Neostigmine provides the longest post-operative analgesia. With clonidine, the duration of analgesia is shorter and sedation is increased, but the probability for PONV could be decreased.