Ugeskrift for laeger
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Ugeskrift for laeger · Nov 2015
Review[When muscle relaxants have unexpected prolonged duration during anaesthesia].
Muscle relaxation facilitates tracheal intubation and improves surgical conditions during anaesthesia. However, unexpected prolonged muscle relaxation may occur. ⋯ Drug interactions, incomplete reversal, co-morbidity, inaccurate neuromuscular monitoring and critical illness may prolong the effect of muscle relaxants. The anaesthetist must titrate the muscle relaxants using objective neuromuscular monitoring and proper reversal of the blockade when needed.
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Ugeskrift for laeger · Nov 2015
Case Reports[Thromboelastography-guided transfusion in a patient with amniotic fluid embolism and massive coagulopathic bleeding].
Amniotic fluid embolism is a serious and devastating complication in obstetrics. Despite a low incidence of 1-6:100.000, it remains one of the leading causes of maternal death in developed countries. ⋯ Despite early and aggressive treatment, mortality and risk of neurological impairment remain high. We present a classic case of amniotic fluid embolism during labour and briefly discuss the current recommendations for treatment.
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Ugeskrift for laeger · Oct 2015
Review[C-reactive protein as a tool in the diagnosis of anastomotic leak after colorectal surgery].
Anastomotic leak (AL) is one of the most severe complications after colorectal surgery. AL is often diagnosed late when the patient is presenting with septic symptoms. ⋯ CRP is proven to have a high negative predictive value which allows safe discharge of patients with low CRP measurements on day 3 or 4 after surgery. CRP can assist in the diagnosis of AL but cannot be used as a single parameter.
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Recent years have seen an increasing interest in the use of low dose naltrexone (LDN) for off-label treatment of pain in diseases as fibromyalgia, multiple sclerosis and morbus Crohn. The evidence is poor, with only few randomized double-blind placebo-controlled studies. The studies currently available are reviewed in this paper. LDN could be a potentially useful drug in the future for the treatment of pain in fibromyalgia, but more studies are needed to verify that it is superior to placebo, and currently it cannot be recommended as first-line therapy.
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In modern anaesthesiology fasting preoperatively has been introduced in order to minimise the incidence of aspiration to the lungs. Since the 1990's studies have confirmed the safety of the current fasting regime of six hours for solids and two hours for fluids. By allowing the intake of carbohydrate-rich fluids until two hours before induction of anaesthesia, it has been shown that the negative effects of fasting such as thirst, starvation and anxiety are minimised. In the future, ultrasound technology might be used to assess the gastric volume prior to induction of anaesthesia.