Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2011
Review Meta Analysis Comparative StudyMonitoring patients at risk of massive transfusion with Thrombelastography or Thromboelastometry: a systematic review.
Thrombelastography (TEG) and Thrombelastometry (ROTEM) are viscoelastic whole-blood assays evaluating the haemostatic capacity of blood. These devices are used in algorithms to guide transfusion of haemostatic blood components. ⋯ There is currently weak evidence to support the use of TEG/ROTEM as a tool to guide transfusion in patients with severe bleeding. Further studies need to address other clinical settings and with larger blood losses.
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Acta Anaesthesiol Scand · Nov 2011
Noninvasive tissue oxygen saturation determined by near-infrared spectroscopy following peripheral nerve block.
Noninvasive physiologic measurement of cutaneous tissue oxygenation using near-infrared spectroscopy (NIRS) has become increasingly common in cardiovascular and plastic surgery. The aim of this study was to determine whether clinically available NIRS-based monitors could detect changes in tissue oxygen saturation (rSO(2)) following a variety of peripheral nerve blocks. We hypothesize that peripheral nerve blocks will produce detectable changes in cutaneous tissue oxygenation levels that can be measured by noninvasive NIRS-based oximetry. ⋯ Our results demonstrated sustained increases in tissue rSO(2) values following peripheral nerve block placement, in addition to higher initial rSO(2) values in operative limbs prior to block placement. Further investigations are necessary to define the expected baseline rSO(2) values in operative and control limbs. Future efforts utilizing NIRS-based detection of tissue ischemia should consider the small but significant changes in rSO(2) resulting from a successful nerve block.
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Acta Anaesthesiol Scand · Nov 2011
Randomized Controlled TrialDexamethasone has additive effect when combined with ondansetron and droperidol for treatment of established PONV.
Prophylactic dexamethasone, ondansetron and droperidol have a documented effect on post-operative nausea and vomiting (PONV). Still, there is a lack of studies investigating the effect of adding dexamethasone to ondansetron and droperidol in order to treat established PONV. ⋯ Treatment of established PONV comprising ondansetron and droperidol, with or without dexamethasone, reduced PONV in both treatment groups. In those reporting PONV without active prophylaxis, the addition of dexamethasone resulted in a significant amplification of the PONV-reducing [corrected] effects of ondansetron and droperidol.
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Acta Anaesthesiol Scand · Nov 2011
A pilot study of the implementation of WHO surgical checklist in Finland: improvements in activities and communication.
World Health Organisation (WHO) has introduced a surgical safety checklist that has reduced post-operative morbidity and mortality. Prior to national checklist implementation, we assessed its possible impact on the operating room (OR) process, safety-related issues and communication among surgical staff in a high-income country. ⋯ The checklist increased OR teams' awareness of patient-related issues, the procedure and expected risks. It also enhanced team communication and prevented communication failures. Our findings support use of the WHO checklist in various surgical fields.
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Acta Anaesthesiol Scand · Nov 2011
Sonoanatomy of the vasculature at the supraclavicular and interscalene regions relevant for brachial plexus block.
Our aim in this observational study was to utilize ultrasound, as well as anatomic dissection, to document the frequency with which branches of the subclavian vessels are found in close association with the brachial plexus at the locations of supraclavicular and interscalene brachial plexus block. ⋯ Small branch vessels from the subclavian artery and vein were frequently evident, on ultrasound imaging, in close association with the nerve elements of the brachial plexus in the supraclavicular and interscalene regions. Appreciation of the presence of these vessels and their likely origin and course will aid the anesthesiologist in planning a safe nerve block.