Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2011
ReviewNeuraxial techniques in patients with pre-existing back impairment or prior spine interventions: a topical review with special reference to obstetrics.
Many anaesthetists consider neurological disorders of all kinds as a contraindication for regional anaesthesia particularly for neuraxial techniques. This hesitation is partly rooted in fears of medicolegal problems but also in the heterogeneous literature. Therefore, the present topical review is an attempt to describe the feasibility and the risks of neuraxial techniques in patients with spinal injury, anatomical compromise, chronic back pain or previous spinal interventions, ranging from 'minor' types like epidural blood patches to major surgery such as Harrington fusions. ⋯ When necessary, patients should have additional technical and clinical examinations as close as possible to surgery to establish the actual pre-operative status. Most patients may benefit more from spinal techniques rather than from less reliable epidural ones. High concentrations and volumes of local anaesthetics should be avoided at all times, especially in patients with nerve compression, large disc herniation or spinal stenosis.
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Acta Anaesthesiol Scand · Sep 2011
Randomized Controlled TrialSevere traumatic brain injury: consequences of early adverse events.
Several factors associated with an unfavourable outcome after severe traumatic brain injury (TBI) have been described: prolonged pre-hospital time, secondary referral to a level 1 trauma centre, the occurrence of secondary insults such as hypoxia, hypotension or low end-tidal carbon dioxide (ETCO(2)). To determine whether adverse events were linked to outcome, patients with severe TBI were studied before arrival at a level 1 trauma centre. ⋯ Early adverse events before arrival at a level 1 trauma centre were without significance for outcome after severe TBI in the trauma system studied.
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Acta Anaesthesiol Scand · Sep 2011
ReviewAnaesthesia for endoscopic retrograde cholangiopancreatography.
Endoscopic Retrograde Cholangiopancreatography is used for both diagnostic and therapeutic purposes. It is relatively more complex than routine endoscopies and requires adequate patient sedation. Furthermore the patients often have co-morbidities. This article provides an overview of various anaesthetic drugs and the type of anaesthesiological support.
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Acta Anaesthesiol Scand · Sep 2011
Blood transfusion after cardiac surgery: is it the patient or the transfusion that carries the risk?
The transfusion of red blood cells (RBCs) after cardiac surgery has been associated with increased long-term mortality. This study reexamines this hypothesis by including pre-operative hemoglobin (Hb) levels and renal function in the analysis. ⋯ When pre-operative Hb levels and renal function are taken into account, moderate transfusions of RBC after CABG surgery do not seem to be associated with reduced long-term survival.