Acta anaesthesiologica Scandinavica
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The World Health Organisation estimates that traumatic injuries are among the leading global causes of death. Studies have shown that a formalised and structured organisation of trauma care, termed trauma systems, have reduced mortality after injury. The centralisation of management to specialised trauma hospitals for the most severely injured patients is a key component of trauma systems. ⋯ The quarter of the population living in the most rural municipalities had 33% higher risk of dying from an injury compared with the remaining population. More patients also died before reaching hospital in rural areas. To ensure both quality and equality in a Norwegian trauma system, improving access to centralised care for rural populations is a challenge that must be prioritised.
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Acta Anaesthesiol Scand · Nov 2013
Post-operative Quality of Recovery Scale: the impact of assessment method on cognitive recovery.
We measured cognitive performance and recovery with the Post-operative Quality of Recovery Scale (PQRS) at 30 and 90 min after elective ambulatory or short-stay surgery under general anaesthesia. The aim was to study the impact of the assessment algorithm, comparing the original and modified more liberal score assessment. ⋯ The modified definition which includes a tolerance factor to account for performance variability has dramatic effects in increasing the number of patients assessed as recovered. It is from the present study not possible to comment on whether the more liberal assessment provides more or less accurate description of cognitive performance.
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Acta Anaesthesiol Scand · Nov 2013
Cerebral hyperaemia after isoflurane anaesthesia for craniotomy of patients with supratentorial brain tumour.
Few studies look into cerebral blood flow (CBF) changes during emergence from general anaesthesia for craniotomy. The purpose of this study was to assess CBF changes during emergence from general anaesthesia for craniotomy, through monitoring blood oxygen saturation of jugular vein bulb (SjvO2 ) and transcranial Doppler (TCD). ⋯ Cerebral hyperaemia occurs after supratentorial brain tumour resection surgery. The hyperaemia is more pronounced on the same side as the tumour.
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Acta Anaesthesiol Scand · Nov 2013
The stability of a sulphite-free epidural analgesic solution containing fentanyl, bupivacaine, and adrenaline.
Thoracic epidural infusion analgesia is optimised by using a triple component infusion containing a local anaesthetic, an opioid, and adrenaline. Adrenaline in solution is prone to oxidation, and stabilisers, such as antioxidants (e.g. sulphites) or chelators (edetates), are therefore commonly added. Sulphites may, however, have unwanted effects, especially allergic reactions. The aim of this study was to evaluate the stability of an analgesic infusion solution for epidural administration free of sulphites, containing adrenaline, fentanyl, bupivacaine, and disodium edetate. ⋯ The solution containing adrenaline, fentanyl, and bupivacaine, stabilised with disodium edetate, is stable for several months at 2-8°C, and at least for 7 days at room temperature without the addition of sulphites.
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Acta Anaesthesiol Scand · Nov 2013
Limitations of medical treatment among patients attended by the rapid response team.
Rapid response teams (RRTs) are called to deteriorating ward patients in order to improve their outcome. The involvement of the team also in end-of-life care issues needs to be addressed. Our objective was to evaluate the RRT with focus on limitations of medical treatment (LOMT). ⋯ Patients attended by the RRT have high short- and long-term mortality. Distinction of when deteriorations may be amenable to treatment or when focus should be laid on palliative care is not always made in the wards. Many decisions of limitations are taken in close conjunction to the call, although limitations do not preclude repeated visits from the team, indicating a need to support wards that care for patients at end of life.