Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 2013
Randomized Controlled Trial Comparative StudyLaryngeal morbidity after tracheal intubation: the Endoflex(®) tube compared to conventional endotracheal intubation with stylet.
Tracheal intubation may cause vocal fold damage. The trial was designed to assess laryngeal morbidity comparing the Endoflex(®) tube with a conventional endotracheal tube with stylet. We hypothesised that laryngeal morbidity within the first 24 h after extubation would be lower with the Endoflex tube than with the conventional endotracheal tube with stylet because of less rigidity. ⋯ No significant difference was found in the incidence of hoarseness or vocal fold injury using the Endoflex tube. However, the statistically significant lower increase in the shimmer values in that group implies that the Endoflex may be associated with less laryngeal morbidity.
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Acta Anaesthesiol Scand · Jul 2013
Comparative Study Clinical TrialLate sensory changes following chest drain insertion during thoracotomy.
It is well known that chest drains are associated with severe movement-related acute pain. These noxious stimuli could play a significant role in development and maintenance of persistent post-operative pain. Therefore we studied chest drain sites in post-thoracotomy pain syndrome (PTPS) patients, in regard to pain and sensory dysfunction. ⋯ Increased thresholds for thermal detection suggest that chest drain insertion is associated with late nerve injury. Because no significant differences in sensory thresholds between PTPS and pain-free patients were found, the pathophysiological role of small fibre nerve injury from chest drains in relation to PTPS remains unclear.
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Acta Anaesthesiol Scand · Jul 2013
ReviewTransfusion in critically ill children: an ongoing dilemma.
Transfusion of blood products is a cornerstone in managing many critically ill children. Major improvements in blood product safety have not diminished the need for caution in transfusion practice. In this review, we aim to discuss the interplay between benefits and potential adverse effects of transfusion in critically ill children by including 65 papers, which were evaluated based on previously agreed selection criteria. ⋯ Thus, transfusion in paediatrics should be considered a high-risk treatment and requires individual clinical assessment. Current level of evidence support the notion that in most stable cases, despite high severity of illness (cyanotic children and neonates excluded), a restrictive haemoglobin threshold of 70 g/l (4.3 mmol/l) is no more harmful than to transfuse at a liberal trigger, e.g. haemoglobin 95 g/l (5.9 mmol/l). Thus, balanced against potential benefits and often its necessity, a restrictive approach may be appropriate due to the associated risks of transfusion.
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Acta Anaesthesiol Scand · Jul 2013
Comparative StudyWhat is the importance of age on treatment of the elderly in the intensive care unit?
By 2050, the percentage of the population older than 80 years will double, and some data suggest that elderly patients receive less advanced treatment. Information of outcome in elderly (≥ 65 year), representing roughly half the intensive care unit (ICU) admissions, in Sweden is scarce. ⋯ Patients above 80 years received less treatment and obtained more limitations in life-sustaining treatments compared with patients aged 65-79, even after adjustment for severity of illness and comorbidity.
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Acta Anaesthesiol Scand · Jul 2013
Comparative Study Clinical TrialUpper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters.
Segmental dose reduction with increasing age after thoracic epidural anaesthesia (TEA) has been documented. We hypothesised that after a fixed loading dose of ropivacaine at the T3-T4 level, increasing age would result in more extended analgesic spread. In addition, other aspects of neural blockade and haemodynamic changes were studied. ⋯ We were unable to demonstrate an effect of age on the maximal number of spinal segments blocked after TEA; however, the caudad spread of analgesia increased with advancing age. In addition, reduction of heart rate was greater in the youngest group.