Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 2012
Randomized Controlled Trial Comparative StudyLight levels of anaesthesia after relaxation for tracheal intubation - comparison of succinylcholine and cis-atracurium.
Use of a single bolus of a hypnotic together with non-depolarizing muscle relaxants for anaesthesia induction may cause inappropriate light levels of anaesthesia (ILLA). The purpose of this study was to compare the incidence of ILLA during anaesthesia induction using either cis-atracurium (CIS) or succinylcholine (SUC). ⋯ The onset time of a muscle relaxant has substantial impact on the incidence of ILLA during induction of anaesthesia. Entropy and SEF may indicate the presence of ILLA.
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Acta Anaesthesiol Scand · Jul 2012
Case ReportsEmergency extracorporeal membrane oxygenation to treat massive aspiration during anaesthesia induction. A case report.
Since first described in 1946 by Mendelson, aspiration of gastric content resulting in severe pulmonary complications is a known hazard of general anaesthesia. We report on a case of massive aspiration of gastric content during induction of general anaesthesia, resulting in severe prolonged hypoxaemia with cardiac arrest, followed by rapid onset of an acute respiratory distress syndrome (ARDS) associated with severe global respiratory insufficiency and severe hypoxia. ARDS was successfully treated using emergency extracorporeal membrane oxygenation within 3 h after the incident.
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Acta Anaesthesiol Scand · Jul 2012
Randomized Controlled Trial Comparative StudyIntubation of the morbidly obese patient: GlideScope(®) vs. Fastrach™.
Several potential problems can arise from airway management in morbidly obese patients, including difficult mask ventilation and difficult intubation. We hypothesised that endotracheal intubation of morbidly obese patients would be more rapid using the GlideScope(®) (GS) (Verathon Inc Corporate Headquarters, Bothell, WA, USA) than with the Fastrach™ (FT) (The Laryngeal Mask Company Ltd, Le Rocher, Victoria, Mahe, Seychelles). ⋯ No significant difference between the two methods was found. The GS and the FT may therefore be considered to be equally good when intubating morbidly obese patients.
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Acta Anaesthesiol Scand · Jul 2012
Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery.
Few data exist on dynamic variables predicting fluid responsiveness during laparoscopic surgery. The aim of this study was to explore the effects of laparoscopy on four dynamic variables: respiratory variations in pulse pressure (ΔPP), stroke volume variation by Vigileo/FloTrac (SVV (Vigileo) ), pleth variability index (PVI) and respiratory variations in pulse oximetry plethysmography waveform amplitude (ΔPOP), and their relation to fluid challenges during laparoscopic surgery. ⋯ ΔPP and SVV (Vigileo) did not change as pneumoperitoneum was established, whereas PVI increased and ΔPOP tended to increase. All four dynamic variables predicted fluid responsiveness relatively poor during ongoing laparoscopic surgery. ΔPP and SVV (Vigileo) tracked changes in stroke volume induced by fluid challenges during ongoing laparascopic surgery, whereas ΔPOP and PVI did not.
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Transfusion of red blood cells (RBCs) remains controversial in patients with septic shock, but current practice is unknown. Our aim was to evaluate RBC transfusion practice in septic shock in the intensive care unit (ICU), and patient characteristics and outcome associated with RBC transfusion. ⋯ Most patients with septic shock received RBCs during shock, and these patients had higher disease severity and lower haemoglobin levels than those not transfused. In spite of this, mortality did not differ between groups neither in the unadjusted or adjusted analyses. However, neither the design nor the sample size allows us to make inferences about treatment effects, which underlines the need for large randomised, clinical trials on transfusion in septic shock.