Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2013
Review Comparative StudyInconsistencies in clinical guidelines for obstetric anaesthesia for Caesarean section: a comparison of the Danish, English, American, and German guidelines with regard to developmental quality and guideline content.
Anaesthetists need evidence-based clinical guidelines, also in obstetric anaesthesia. We compared the Danish, English, American, and German national guidelines for anaesthesia for Caesarean section. We focused on assessing the quality of guideline development and evaluation of the guidelines' content. ⋯ Development of national guidelines might benefit from following standardised regulations, such as those used in the AGREE tool. Content of guidelines is not standardised. Recommendations for the content of guidelines might contribute to standardising clinical guidelines.
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Acta Anaesthesiol Scand · Feb 2013
Randomized Controlled Trial Comparative StudyUltrasound-guided infragluteal sciatic nerve block: a comparison between four different techniques.
Ultrasound guided sciatic block can be performed by different techniques. We compared namely short or long axis views of the sciatic nerve with in-plane or out-of-plane needle insertion techniques for the infragluteal sciatic nerve block (ISNB). ⋯ The LI approach required less time to complete the infragluteal sciatic nerve block procedure and it was more comfortable for the patients in comparison to the SO, SI and LO approaches.
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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
Randomized Controlled TrialHigh thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients.
Assuming that high thoracic epidural analgesia (HTEA) with the sympathetic block might decrease postoperative blood glucose (BG) level and reduce the need of insulin, the aim was to evaluate the effect of HTEA on the BG level and insulin requirement in patients undergoing cardiac surgery. ⋯ HTEA preserves glucose metabolism better and leads to a lesser degree of 'stress hyperglycaemia' in cardiac surgery patients.