Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 2009
Impact of a regional anesthesia rotation on ultrasonographic identification of anatomic structures by anesthesiology residents.
The specific aim of this study was to determine the ability of anesthesiology residents to independently identify a series of anatomic structures in a live model using ultrasound, both before and after a 4-week regional anesthesia rotation that incorporates a standardized ultrasound training curriculum for peripheral nerve blockade. ⋯ Ultrasound-naive anesthesiology residents, who received instruction and experience with ultrasound-guided peripheral nerve blocks on a 4-week regional anesthesia rotation, significantly improved their ability to independently identify relevant anatomic structures with ultrasonography.
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Acta Anaesthesiol Scand · Mar 2009
Randomized Controlled Trial Comparative StudyComparison of closed loop vs. manual administration of propofol using the Bispectral index in cardiac surgery.
In recent years, electroencephalographic indices of anaesthetic depth have facilitated automated anaesthesia delivery systems. Such closed-loop control of anaesthesia has been described in various surgical settings in ASA I-II patients (1-4), but not in open heart surgery characterized by haemodynamic instability and higher risk of intra-operative awareness. Therefore, a newly developed closed-loop anaesthesia delivery system (CLADS) to regulate propofol infusion by the Bispectral index (BIS) was compared with manual control during open heart surgery. ⋯ The automated delivery of propofol using CLADS was safe, efficient and performed better than manual administration in open heart surgery.
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Acta Anaesthesiol Scand · Mar 2009
Controlled Clinical TrialThe use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video-assisted thoracoscopic-extended thymectomy.
Although several studies of the use of desflurane in anesthesia have revealed many desirable qualities, there are no data on the use and effects especially on the neuromuscular function of desflurane on myasthenia gravis (MG) patients. The purpose of this study was to evaluate the use of either desflurane or propofol, both combined with remifentanil, in patients with MG undergoing a video-assisted thoracoscopic-extended thymectomy (VATET). ⋯ Our experience indicates that anesthesia with desflurane plus remifentanil in patients with MG could determine a reversible muscle relaxation effect, but with no clinical implication, allowing a faster recovery with no difference in extubation time and post-operative complications in the two groups.
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Acta Anaesthesiol Scand · Mar 2009
Randomized Controlled TrialDepth of anaesthesia monitoring in obese patients: a randomized study of propofol-remifentanil.
In obese patients, depth of anaesthesia monitoring could be useful in titrating intravenous anaesthetics. We hypothesized that depth of anaesthesia monitoring would reduce recovery time and use of anaesthetics in obese patients receiving propofol and remifentanil. ⋯ No significant reduction in time to eye opening could be demonstrated when a CSM was used to titrate propofol and remifentanil in obese patients undergoing a hysterectomy. A significant reduction in remifentanil consumption was found.
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Acta Anaesthesiol Scand · Mar 2009
Practice GuidelineScandinavian clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrest.
Sudden cardiac arrest survivors suffer from ischaemic brain injury that may lead to poor neurological outcome and death. The reperfusion injury that occurs is associated with damaging biochemical reactions, which are suppressed by mild therapeutic hypothermia (MTH). In several studies MTH has been proven to be safe, with few complications and improved survival, and is recommended by the International Liaison of Committee on Resuscitation. The aim of this paper is to recommend clinical practice guidelines for MTH treatment after cardiac arrest from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI). ⋯ Although proven beneficial only for patients with initial ventricular fibrillation (GOR A), the SSAITFTH also recommend MTH after restored spontaneous circulation, if active treatment is chosen, in patients with initial pulseless electrical activity and asystole (GOR D). Normal ethical considerations, premorbid status, total anoxia time and general condition should decide whether active treatment is required or not. MTH should be part of a standardized treatment protocol, and initiated as early as possible after indication and treatment have been decided (GOR E). There is insufficient evidence to make definitive recommendations among techniques to induce MTH, and we do not know the optimal target temperature, duration of cooling and rewarming time. New studies are needed to address the question as to how MTH affects, for example, prognostic factors.