Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2013
Randomized Controlled TrialOptimising stroke volume and oxygen delivery in abdominal aortic surgery: a randomised controlled trial.
Post-operative complications after open elective abdominal aortic surgery are common, and individualised goal-directed therapy may improve outcome in high-risk surgery. We hypothesised that individualised goal-directed therapy, targeting stroke volume and oxygen delivery, can reduce complications and minimise length of stay in intensive care unit and hospital following open elective abdominal aortic surgery. ⋯ Perioperative individualised goal-directed therapy targeting stroke volume and oxygen delivery did not affect post-operative complications, intensive care unit or hospital length of stay in open elective abdominal aortic surgery.
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Regional anesthesia is the preferred technique for Cesarean delivery. Strict aseptic precautions should be taken; otherwise, infectious complications including abscess formation, meningitis and necrotizing fasciitis may result. We report a case of a 26-year-old post-partum female who presented with necrosis of the skin of back following spinal anesthesia, which was administered for Cesarean delivery 5 days prior at a private nursing home. ⋯ We considered each possibility, and the most likely cause in our case appears to be infection from an already-used vial of a local anesthetic agent. Local anesthetics have bacteriostatic properties, but infection may still be transmitted through contaminated solutions. The present case highlights the importance of maintaining strict aseptic precautions, avoiding reusing multidose vials and early recognition of this complication as timely intervention can be lifesaving.
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Acta Anaesthesiol Scand · Feb 2013
The frequency and nature of drug administration error during anaesthesia in a Chinese hospital.
Throughout the world, drug administration error remains a known and significant threat to patients undergoing anaesthesia. Estimates of the extent of the problem vary, but few are based on large prospectively collected datasets. Furthermore, little is known about whether differences in work culture are important in error rates. ⋯ Our results are comparable with other international prospective estimates indicating that drug administration error is of concern in China as elsewhere. These results will form a baseline from which to detect the effects of countermeasures.
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Acta Anaesthesiol Scand · Feb 2013
Body image and psychological outcome after severe skin and soft tissue infection requiring intensive care.
Patients with severe skin and soft tissue infection (SSTI) requiring intensive care unit (ICU) stay are commonly treated with antibiotics, surgery and in some centers also with hyperbaric oxygen therapy. Long-term follow-up of body image and psychological outcome has not been described despite extensive surgery, potentially altered body image and subsequent psychological problems. The aim was to describe perceived body image and its relation to anxiety, depression and post-traumatic stress disorder (PTSD)-related symptoms in patients with severe SSTI 1 year after ICU stay. Specifically, we aimed to assess potential differences related to gender and anatomic site of infection. ⋯ One year after severe SSTI requiring intensive care, women and patients with abdominoperineal SSTI reported significantly more body image problems. Negative body image was associated with anxiety, depression and PTSD-related symptoms. Specific follow-up for SSTI patients is warranted.
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Acta Anaesthesiol Scand · Feb 2013
Clinical impact of the publication of S3 guidelines for intensive care in cardiac surgery patients in Germany: results from a postal survey.
The development and implementation of practice guidelines might be an important tool to evaluate the different practices and to consider different local strategies. ⋯ Despite ongoing variability in the use of monitoring devices, volume replacement and vasopressor/inotrope use in cardiac surgery patients, there have been some changes in the therapy of these patients after publication of the guidelines. Because the guideline has been considered as clinically relevant, further interdisciplinary development and implementation support should be considered.