Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2013
Randomized Controlled Trial Comparative StudyHyperbaric articaine with or without fentanyl in spinal anaesthesia: patient and observer blinded comparison.
The rapid and short-acting local anaesthetic articaine is a feasible spinal anaesthetic for day-case open inguinal herniorrhaphy (OIH). We hypothesised that similarly to other spinal local anaesthetics, the addition of fentanyl may prolong articaine spinal analgesia without prolonging motor block. ⋯ Fentanyl 10 μg added to spinal hyperbaric articaine improved analgesia and reduced analgesic consumption during and after OIH. Fentanyl did not prolong motor block or delay recovery.
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Acta Anaesthesiol Scand · Jan 2013
Acute respiratory distress syndrome: nationwide changes in incidence, treatment and mortality over 23 years.
The aim of this study was to assess population-based changes in incidence, treatment, and in short- and long-term survival of patients with acute respiratory distress syndrome (ARDS) over 23 years. ⋯ The incidence of ARDS has almost doubled, but hospital mortality has decreased during the 23 years of observation. The 10-year survival of ARDS survivors is poor compared with the reference population.
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Acta Anaesthesiol Scand · Jan 2013
Predictors of laterality of motor block during epidural analgesia in a mixed surgical population.
Predictors of laterality of motor block during epidural analgesia are currently unknown, as studies so far have yielded conflicting results. We aimed to evaluate predictors of post-operative asymmetric lower extremity motor blockade in a mixed surgical population. ⋯ These results suggest that young patients with lumbar epidural analgesia or deep catheter insertion should be frequently monitored for the occurrence of laterality of motor block. Also, these results provide support for a prospective study to determine the optimal catheter insertion depth to decrease the risk of unilateral motor block.
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Acta Anaesthesiol Scand · Jan 2013
ReviewFluid therapy in uncontrolled hemorrhage--what experimental models have taught us.
Intravenous fluid is life-saving in hypovolemic shock, but fluid sometimes aggravates the bleeding. During the past 25 years, animal models have helped our understanding of the mechanisms involved in this unexpected effect. A key issue is that vasoconstriction is insufficient to arrest the bleeding when damage is made to a major blood vessel. 'Uncontrolled hemorrhage' is rather stopped by a blood clot formed at the outside surface of the vessel, and the immature clot is sensitive to mechanical and chemical interactions. ⋯ Uncontrolled hemorrhage models in rats, except for the 'cut-tail' model, confirm the results from swine. To avoid rebleeding, fluid programs should not aim to fully restore the arterial pressure, blood flow rates, or blood volume. For a hemorrhage of 1000 ml, computer simulations show that deliberate hypovolemia (-300 ml) would be achieved by infusing 600-750 ml crystalloid fluid over 20-30 min or 100 ml of HSD over 10-20 min in an adult male.