Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2005
Randomized Controlled Trial Clinical TrialRequirements of propofol at different end-points without adjuvant and during two different steady infusions of remifentanil.
Some reports show no interaction between propofol and opioids, whereas others state such interactions. We evaluated the influence of remifentanil on propofol requirements at certain anesthesia end-points. ⋯ We conclude that remifentanil infusion started before induction of propofol anesthesia significantly reduces propofol requirements at all end-points. The results suggest that remifentanil accelerates the hypnotic onset of propofol.
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Acta Anaesthesiol Scand · Feb 2005
Case ReportsComputed tomography--a possible aid in the diagnosis of smoke inhalation injury?
Inhalation injury is an important contributor to morbidity and mortality in burn victims and can trigger acute lung injury and acute respiratory distress syndrome (ARDS) (1-3). Early diagnosis and treatment of inhalation injury are important, but a major problem in planning treatment and evaluating the prognosis has been the lack of consensus about diagnostic criteria (4). Chest radiographs on admission are often non-specific (5, 6), but indicators include indoor fires, facial burns, bronchoscopic findings of soot in the airways, and detection of carbon monoxide or cyanide in the blood (7). ⋯ The importance of CT scans in patients with ARDS has been reviewed recently (9), but unfortunately there has been no experience of CT in patients with smoke inhalation injury. To our knowledge, there are only two animal studies reporting that smoke inhalation injury can be detected by CT (4, 11); specific changes in human CT scans have not yet been described. Therefore, confronted with a patient with severe respiratory failure after a burn who from the history and physical examination showed the classic risk factors for inhalation injury, we decided to request a CT.
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Acta Anaesthesiol Scand · Feb 2005
Anaesthetic practice for groin hernia repair--a nation-wide study in Denmark 1998-2003.
Recent scientific data suggest that local infiltration anaesthesia for inguinal hernia surgery may be preferable compared to general anaesthesia and regional anaesthesia, since it is cheaper and with less urinary morbidity. Regional anaesthesia may have specific side-effects and is without documented advantages on morbidity in this small operation. ⋯ Use/choice of anaesthesia for groin hernia repair is not in accordance with recent scientific data. Use of spinal anaesthesia should be reduced and increased use of local anaesthesia is recommended to enhance recovery and reduce costs.
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Acta Anaesthesiol Scand · Feb 2005
Clinical TrialBi-level positive airway pressure ventilation reduces the oxygen cost of breathing in long-standing post-polio patients on invasive home mechanical ventilation.
Today, patients with chronic respiratory failure are commonly treated with non-invasive bi-level positive airway pressure ventilation, supporting spontaneous breathing. However, in conformity with previous clinical routine, many post-polio patients with chronic respiratory failure are still treated with invasive (i.e. via a tracheostomy) controlled mechanical ventilation (CMV). The aim of the study was to investigate the effect of invasive bi-level positive airway pressure ventilation on the work of breathing compared with that during the patients' ordinary CMV and spontaneous breathing without mechanical support. ⋯ Invasive bi-level positive airway pressure ventilation reduces the oxygen cost of breathing in long-standing tracheostomized post-polio patients, compared with CMV. Furthermore, the Harris-Benedict equation provides a reasonable prediction of energy expenditure in this group of patients.
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Acta Anaesthesiol Scand · Feb 2005
Clinical TrialFit and seal characteristics of a new paediatric tracheal tube with high volume-low pressure polyurethane cuff.
To evaluate a new paediatric tracheal tube (Microcuff, Weinheim, Germany) with an ultrathin high volume-low pressure polyurethane cuff. ⋯ Microcuff paediatric tracheal tubes provided tracheal sealing with cuff pressures considerably lower than usually accepted. The rate of tube exchange was very low (1.6%), as was the rate of airway morbidity (croup requiring therapy; 0.4%).