Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2004
Randomized Controlled Trial Clinical TrialEarly bioavailability of paracetamol after oral or intravenous administration.
Paracetamol is a peripherally acting analgesic commonly used in multimodal post-operative pain management to reduce the need for more potent analgesics with their unwanted side-effects. The dose and optimal galenical form for achieving analgesic concentrations is not well defined. The primary aim of this pilot project was to study the early bioavailability for two fixed doses of orally administrated paracetamol and one dose of intravenous propacetamol, all of which were given after minor surgery. ⋯ Oral administration of paracetamol as part of multimodal pain management immediately post-operatively resulted in a huge and unpredictable variation in plasma concentration compared with the intravenous administration.
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Acta Anaesthesiol Scand · Aug 2004
Randomized Controlled Trial Clinical TrialEfficacy of the A-line AEP monitor as a tool for predicting successful insertion of a laryngeal mask during sevoflurane anesthesia.
The use of clinical signs for assessing depth of anesthesia is unreliable during periods with little noxious stimulation. A patient may appear adequately anesthetized at one moment at a given level of stimulation, but may later, when facing other more intense stimuli, show signs of insufficient anesthesia. In order to prevent under- or overdosing of anesthetics, an anesthesia depth monitor that is able to predict responses to noxious stimulation would therefore be useful. Auditory evoked potentials (AEP) is one of several physiological parameters under investigation. The method has been improved by rapid extraction and conversion of the AEP curve into an index (A-Line ARX Index = AAI). We aimed to determine the clinically required depth of anesthesia, measured by the A-line AEP Monitor, for at least 90% probability of acceptable insertion conditions for a laryngeal mask airway (LMA). ⋯ AAI indicates the level of depth of anesthesia necessary for acceptable laryngeal mask insertion conditions. End-expiratory sevoflurane concentration was the better predictor.
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Acta Anaesthesiol Scand · Aug 2004
Case ReportsAnesthetic management for separation of craniopagus twins.
We report the anesthetic management of a case of separation of craniopagus twins with unbalanced cross circulation and one twin with renal dysfunction. After intravenous induction, anesthesia was maintained with isoflurane inhalation and propofol infusion. Twin A survived but Twin B died after the surgery. The anesthetic problems during the operation are discussed.
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Acta Anaesthesiol Scand · Aug 2004
Case ReportsSequential combined spinal-epidural anesthesia for cesarean section in a woman with a double-outlet right ventricle.
The number of women with complex cyanotic heart disease reaching childbearing age is continuously increasing. For anesthesiologists, management of this 'new' obstetric population is particularly challenging. We report the case of a parturient with a palliated double-outlet right ventricle, who underwent a cesarean section at 34 weeks with low-dose sequential combined spinal-epidural anesthesia with patient-controlled epidural postoperative analgesia. Anesthetic considerations and specific limitations of invasive monitoring are discussed, along with a review of recent literature on maternal and neonatal complications associated with pregnancies in women with cyanotic congenital heart disease.
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Acta Anaesthesiol Scand · Aug 2004
Multicenter StudyEffectiveness and efficiency of intensive care medicine: variable costs in different diagnosis groups.
To establish the effectiveness of ICU treatment and the efficiency in the use of resources in patients stratified according to 10 diagnosis and two levels-of-care. To propose strategies aimed at reducing costs and improving efficiency in each patient group. ⋯ Analysis of variable patient-specific cost was used as a tool to assess intensive care performance in patient subgroups with different diagnosis and levels-of-care.