Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2013
Review Meta AnalysisMaternal and foetal effects of remifentanil for general anaesthesia in parturients undergoing caesarean section: a systematic review and meta-analysis.
Remifentanil has been suggested for the induction of general anaesthesia for caesarean section. We aimed to define remifentanil effects on maternal stress response as well as neonatal effects. ⋯ Remifentanil was found to attenuate the maternal circulatory response to intubation and surgery. Higher base excess and pH suggest a beneficial effect on the neonatal acid-base status. A trial with adequate power is warranted that addresses neonatal side-effects of remifentanil.
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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
The LMA-Supreme™ as an intubation conduit in patients with known difficult airways: a prospective evaluation study.
Many extraglottic airway devices allow the direct passage of an adult-sized tracheal tube, but this is not possible with the LMA-Supreme(TM) . We evaluated the feasibility of using the LMA-Supreme(TM) as a conduit for intubation in patients with known difficult airways. ⋯ We conclude that the LMA-Supreme(TM) is a successful conduit for bronchoscopic/Aintree Intubation Catheter-guided intubation in patients with known difficult airway.
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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.