Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2005
Randomized Controlled Trial Clinical TrialSingle-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation.
The alpha agonist dexmedetomidine, a sedative and analgesic, reduces heart rate and blood pressure dose-dependently. We investigated whether it also has the ability to attenuate airway and circulatory reflexes during emergence from anaesthesia. ⋯ These findings suggest that a single-dose bolus injection of dexmedetomidine before tracheal extubation attenuates airway-circulatory reflexes during extubation.
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Acta Anaesthesiol Scand · Sep 2005
ReviewContinuous peripheral nerve blockade in lower extremity surgery.
Peripheral nerve blocks afford numerous benefits for lower extremity surgery. There is growing interest in continuous peripheral nerve blocks, mainly for treatment of postoperative pain, a field that represents a challenge to the anaesthesiologist. This paper seeks to review the efficacy of continuous lower limb blocks for postoperative pain relief. ⋯ New techniques and devices are increasingly appearing, and catheters are constantly being developed and improved; an example being the stimulating catheter, which represents one of the newest advances in this area. The above techniques show that continuous postoperative analgesia with catheters in the lower extremities is not only possible, but indeed provides sustained effective postoperative analgesia, reduces use of opioids, and improves rehabilitation and patient well-being with minimal side-effects. These techniques could prove an alternative to postoperative pain treatment following ambulatory surgery.
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Acta Anaesthesiol Scand · Sep 2005
Inter-observer agreement of tests used for prediction of difficult laryngoscopy/tracheal intubation.
Guidelines recommend pre-operative airway evaluation for the prediction of airway management difficulties. Combining tests for evaluation increases the accuracy of the assessment. One model including seven parameters transformed into a simplified airway risk index (SARI) has been proven to be valid. We determined the inter-observer agreement of the specific test combinations included in SARI as well as of the total score. ⋯ We demonstrated good inter-observer agreement using three tests from SARI and recommend the Mallampati classification, mouth opening and ability of jaw protrusion for pre-operative airway evaluation. A simplification of the assessment of TMD and neck mobility is warranted.
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Acta Anaesthesiol Scand · Sep 2005
Case ReportsTracheal intubation using a new CCD camera-equipped device: a report of two cases with a difficult intubation.
In two patients, one with Klippel-Feil syndrome and one with fibrous dysplasia of the maxilla, no part of the larynx could be visualized by direct laryngoscopy. In both cases, the use of an intubation device equipped with a charge-coupled device camera, the endotracheal intubation device (EID), allowed smooth tracheal intubation.
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Acta Anaesthesiol Scand · Sep 2005
Colloids decrease clot propagation and strength: role of factor XIII-fibrin polymer and thrombin-fibrinogen interactions.
Colloid-mediated hypocoagulability is clinically important, but the mechanisms responsible for coagulopathy have been incompletely defined. Thus, my goal was to elucidate how colloids decrease plasma coagulation function. Plasma was diluted 0% or 40% with 0.9% NaCl, three different hydroxyethyl starches (HES, mean molecular weight 450, 220 or 130 kDa), or 5% human albumin. ⋯ FXIIIa supplementation improved propagation in samples diluted with HES 450, HES 220 and albumin, and clot strength improved in HES 450 and albumin-diluted plasma. Considered as a whole, these data support compromise of FIIa-FI and FXIIIa--fibrin polymer interactions as the mechanisms by which colloids compromise plasma coagulation. Investigation to determine if clinical enhancement of FXIII activity and/or FI concentration (e.g. fresh-frozen plasma, cryoprecipitate) can attenuate colloid-mediated decreases in hemostasis is warranted.