Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2010
Spontaneous breathing during high-frequency oscillatory ventilation improves regional lung characteristics in experimental lung injury.
Maintenance of spontaneous breathing is advocated in mechanical ventilation. This study evaluates the effect of spontaneous breathing on regional lung characteristics during high-frequency oscillatory (HFO) ventilation in an animal model of mild lung injury. ⋯ This animal study demonstrates that spontaneous breathing during HFO ventilation preserves lung volume, and when combined with DF, improves ventilation of the dependent lung areas. No significant hyperinflation occurred on account of spontaneous breathing. These results underline the importance of maintaining spontaneous breathing during HFO ventilation and support efforts to optimize HFO ventilators to facilitate patients' spontaneous breathing.
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Acta Anaesthesiol Scand · Nov 2010
The effect of a simple checklist on frequent pre-induction deficiencies.
A substantial proportion of anaesthesia-related adverse events are preventable by identification and correction of errors in planning, communication, fatigue, stress, and equipment. The aim of this study was to develop and implement a pre-induction checklist in order to identify and solve problems before induction of anaesthesia. ⋯ It is possible to develop, introduce, and use a pre-induction checklist even in a hectic and stressful clinical environment. The checklist identified and reduced a surprisingly large number of missing items required in a standard induction protocol.
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Management of post-partum haemorrhage (PPH) involves the treatment of uterine atony, evacuation of retained placenta or placental fragments, surgery due to uterine or birth canal trauma, balloon tamponade, effective volume replacement and transfusion therapy, and occasionally, selective arterial embolization. This article aims at introducing pregnancy- and haemorrhage-induced changes in coagulation and fibrinolysis and their relevant compensatory mechanisms, volume replacement therapy, optimal transfusion of blood products, and coagulation factor concentrates, and briefly cell salvage, management of uterine atony, surgical interventions, and selective arterial embolization. Special attention, respective management, and follow-up are required in women with bleeding disorders, such as von Willebrand disease, carriers of haemophilia A or B, and rare coagulation factor deficiencies. We also provide a proposal for practical instructions in the treatment of PPH.
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Acta Anaesthesiol Scand · Nov 2010
Pulmonary haemodynamics and right ventricular function during cemented hemiarthroplasty for femoral neck fracture.
Bone cement implantation syndrome (BCIS) is characterised by hypoxia, hypotension and loss of consciousness occurring early after bone cementation. The haemodynamic perturbations during BCIS have not been extensively studied, particularly not in patients with femoral neck fracture. We evaluated the effects of cemented hemiarthroplasty, in these patients, on pulmonary haemodynamics, right ventricular performance, intrapulmonary shunting and physiological dead space. ⋯ Cemented hemiarthroplasty in patients with femoral neck fracture causes a pronounced pulmonary vasoconstriction and an impairment of RV function accompanied by pulmonary ventilation/perfusion abnormalities.
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Inappropriate withdrawal or continuation of medication in the perioperative period is associated with an increased risk for adverse events. To reduce this risk, it is important that patients take their regular medication as prescribed. We evaluated this treatment objective by studying the frequency and reasons for errors related to medication discontinuity in the perioperative period. ⋯ Medication errors occur frequently in the perioperative period, even in the era of an electronic medication file. Errors in prescription, administration and intake of medication are not easily solved because no single health care professional is responsible for adequate intake of medication in surgical patients. The anaesthesiologist should take on a more prominent role in regulating perioperative medication intake in surgical patients.