Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 2025
Impact of nitroglycerin-induced vasodilation on stroke volume and diuretic response in acute heart failure: A protocol for a mechanistic trial.
Acute heart failure is a clinical syndrome characterized by cardiac dysfunction and neurohumoral activation, encompassing complex underlying pathophysiology which may vary across phenotypes. Nitroglycerine is a nitrate donor with vasodilatory effects on both venous capacitance vessels and arterial resistance vessels in higher doses, typically used with the aim of reducing congestion, preload, and afterload. A limited number of studies have proposed that nitroglycerin could promote diuresis and natriuresis. However, the exact hemodynamic effects of nitroglycerin remain uncertain in the clinical setting of acute decompensated heart failure. We hypothesize that intravenous nitroglycerin induces a significant increase in stroke volume and urinary output while lowering cardiac filling pressures. ⋯ This study will assess the acute effects of vasodilation on stroke volume and urinary output in hospitalized patients with AHF. Furthermore, characterizing the hemodynamic profile of the patient prior to vasodilation may help explore which patients will benefit from vasodilation.
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Acta Anaesthesiol Scand · Mar 2025
Conus medullaris termination: Assessing safety of spinal anesthesia in the L2-L3 interspace.
Classic teaching is that spinal anesthesia is safe at or below the L2-L3 interspace. To evaluate this, we sought to determine the percentage of individuals with a conus medullaris termination (CMT) level at or below the L1-L2 interspace. Further, the relationship of CMT level to age, sex, body mass index (BMI), and spinal pathology was examined, as was the reliability of using Tuffier's line (TL) as an anatomical landmark. ⋯ Unlike previous smaller studies, this retrospective study included MRI data from a total of 944 patients. The present study confirms that spinal anesthesia at the L2-L3 interspace or below can be considered safe. The findings indicate that Tuffier's line can be used as a reliable anatomical landmark.
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Acta Anaesthesiol Scand · Mar 2025
Exploring management reasoning when discharging high-risk postoperative patients from the post-anaesthesia care unit.
Decision-support tools for detecting physiological deterioration are widely used in clinical medicine but have been criticised for fostering a task-oriented culture and reducing the emphasis on clinical reasoning. Little is understood about what influences clinical decisions aided by decision-support tools, including professional standards, policies, and contextual factors. Therefore, we explored management reasoning employed by anaesthesiologists and PACU nurses in the post-anaesthesia care unit during the discharge of high-risk postoperative patients. ⋯ While decision-support tools offer cognitive aid and help standardise patient trajectories, they also limit professional discretion in management reasoning and can potentially compromise care and treatment. This highlights the need for a balanced approach that considers both the benefits and limitations of these tools in clinical decision-making.
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Acta Anaesthesiol Scand · Mar 2025
Clinical practice and outcomes in European pediatric cardiac anesthesia: A secondary analysis of the APRICOT and NECTARINE studies.
Despite advancements in surgical techniques and perioperative care, pediatric cardiac patients remain at an increased risk of adverse events. The APRICOT (2017) study aimed to establish the incidence of severe critical events in children undergoing anesthesia in Europe, while the NECTARINE (2021) study aimed to assess anesthesia practices and outcomes in neonates and infants under 60 weeks postconceptual age. Our goal was to conduct a secondary analysis of the cardiac cohorts from these two studies to determine mortality rates and other outcomes after cardiac procedures at 30 and 90 days, identify factors influencing mortality, illustrate clinical practices, and assess the methodology of the two studies. ⋯ This secondary analysis of the APRICOT and NECTARINE studies focused on pediatric cardiac surgical cases. Outcomes differed according to weight and age of the children, where mortality risk was higher for very young and low-weight children.
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Acta Anaesthesiol Scand · Mar 2025
What matters to mothers: A qualitative exploration of pain and recovery after cesarean section.
Fast recovery after cesarean section is vital since the mother not only has to take care of herself but also the newborn. Recovery scores are useful tools to measure and compare recovery; however, standardized questionnaires may miss in-depth patient experiences. What is important to women in the postoperative period after cesarean section can vary in different populations, making it crucial to understand the specific needs of one's own population. This study aims to explore what matters most to Danish mothers during the early phase of recovery following elective cesarean section. ⋯ In this qualitative, explorative study, participants were interviewed by telephone 4-7 days following their elective cesarean section. The focus was the women's experience of recovery, pain, and mobilization, both in hospital and when going home. The findings identified a need for more information about the perioperative course, as most participants were surprised and unprepared both for the pain from other areas than the scar and for the surgery experience being unpleasant, and many requested physical rehabilitation plans.