Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 2013
Review Meta AnalysisIs general anaesthesia for caesarean section associated with postpartum haemorrhage? Systematic review and meta-analysis.
Although general anaesthesia was associated with greater blood loss than regional anaesthesia in this meta-analysis (only ~100 mL), this is of questionable significance, and meta-analysis of RCTs showed there was no greater risk of blood transfusion.
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Acta Anaesthesiol Scand · Oct 2013
Randomized Controlled Trial Comparative StudyEpidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design.
Epidural fentanyl has direct neuraxial analgesic effects distinct from systemic analgesic effects.
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Total hip and knee arthroplasty (THA and TKA) are frequently performed surgical procedures with excellent long-term functional outcomes. However, pain is pronounced in the early post-operative phase, especially after TKA. Glucocorticoids have proven to relieve post-operative pain, but a higher dose might be needed, as compared with the lower dose recommended to reduce post-operative nausea and vomiting (PONV). Prior to this PhD study, procedure-specific data were limited on the effects of high-dose glucocorticoid on post-operative pain and recovery in THA and TKA. So, the following question remained to be answered: does high-dose glucocorticoid added to a multimodal analgesic regime reduce pain and improve recovery after THA and TKA? ⋯ This PhD thesis render new knowledge by demonstrating - for the first time - detailed procedure-specific beneficial effects of a single pre-operative dose of MP, 125 mg IV, on acute post-operative analgesia in THA, and on acute post-operative analgesia and on other immediate recovery aspects in TKA. Noteworthy, these benefits were observed with MP added to a comprehensive multimodal oral analgesic regime consisting of paracetamol, celecoxib and gabapentin - and in TKA also to an intra-operative local infiltration analgesia regimen. However, current data in hip and knee surgery preclude firm safety conclusions, and call for large-scale studies to definitively clarify the risk-benefit ratio, before final recommendations can be made. Also, the shortage of dose-finding data calls for studies to define the minimal effective dose to provide post-operative analgesia.
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Acta Anaesthesiol Scand · Oct 2013
Current use of nitrous oxide in public hospitals in Scandinavian countries.
The use of nitrous oxide in modern anaesthesia has been questioned. We surveyed changes in use of nitrous oxide in Scandinavia and its justifications during the last two decades. ⋯ The use of nitrous oxide has decreased in the Scandinavian countries, apparently because many now prefer other agents. Difference in practices between the five countries were unexpected and apparently not justified on anticipated evidence only.
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Acta Anaesthesiol Scand · Oct 2013
Sevoflurane causes neuronal apoptosis and adaptability changes of neonatal rats.
Neonatal exposure to sevoflurane can induce neurodegeneration and learning deficits in developing brain. We hypothesised that with the increase in the concentration and duration of sevoflurane, neurodegeneration of neonatal rats aggravates and causes behaviour changes as the rats grow. ⋯ Exposure to 2% sevoflurane causes neuronal apoptosis of neonatal rats, and long-time exposure aggravates that. The adaptability in new environment is transiently decreased when the anaesthesia rats are 5 weeks old.