Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2011
Randomized Controlled TrialEffect of PEEP on regional ventilation during laparoscopic surgery monitored by electrical impedance tomography.
Anesthesia per se and pneumoperitoneum during laparoscopic surgery lead to atelectasis and impairment of oxygenation. We hypothesized that a ventilation with positive end-expiratory pressure (PEEP) during general anesthesia and laparoscopic surgery leads to a more homogeneous ventilation distribution as determined by electrical impedance tomography (EIT). Furthermore, we supposed that PEEP ventilation in lung-healthy patients would improve the parameters of oxygenation and respiratory compliance. ⋯ The effect of anesthesia, pneumoperitoneum, and different PEEP levels can be evaluated by EIT-based COV monitoring. An initial recruitment maneuver and a PEEP of 10 cmH(2)O preserved homogeneous regional ventilation during laparoscopic surgery in most, but not all, patients and improved oxygenation and respiratory compliance.
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Acta Anaesthesiol Scand · Aug 2011
Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors.
Emergent conversion to an on-pump procedure during an off-pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of hemodynamic instability associated with mechanical heart displacement during OPCAB and the fate of these patients. ⋯ COPD and pre-operative creatinine level were identified as independent risk factors of mechanical heart displacement-induced hemodynamic instability during OPCAB. As these patients were associated with significantly lower SvO(2) even at the end of surgery and with adverse outcome, consideration may be given to initiate preemptive measures to increase SvO(2) before or during grafting.
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Acta Anaesthesiol Scand · Aug 2011
Patients' participation in and evaluation of a follow-up program following intensive care.
Patients' difficulties following critical illness and the willingness of intensive care units (ICU) to take an expanded responsibility during the recovery period have led to the development of different follow-up programs. The aim of this study was to explore and describe patients' participation in and evaluation of a follow-up program at a nurse-led clinic (NLC). ⋯ The current follow-up program, adjusted to individual patients' conditions and needs in terms of different types of contacts and continuity, was found to be of great value. Effects of the program other than the patient perspective are also relevant to evaluate.