Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2014
Randomized Controlled Trial Comparative StudyIntrathecal chloroprocaine vs. lidocaine in day-case surgery: recovery, discharge and effect of pre-hydration on micturition.
Spinal chloroprocaine may be more suitable for day-case surgery than lignocaine because of faster block resolution and time to discharge.
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Acta Anaesthesiol Scand · Feb 2014
ReviewPopulation pharmacometrics in support of analgesics studies.
Population pharmacometric modeling is used to explain both population trends as well as the sources and magnitude of variability in pharmacokinetic and pharmacodynamics data; the later, in part, by taking into account patient characteristics such as weight, age, renal function and genetics. The approach is best known for its ability to analyze sparse data, i.e. when only a few measurements have been collected from each subject, but other benefits include its flexibility and the potential to construct more detailed models than those used in the traditional individual curve fitting approach. ⋯ In addition, the use of these models to design and optimize future studies is discussed. In this context, finding the best design factors, such as the sampling times or the dose, for future studies within pre-defined criteria using a previously constructed population pharmacokinetic model can help researchers acquire clinically meaningful data without wasting resources and unnecessarily exposing vulnerable patient groups to study drugs and additional blood sampling.
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Pneumothorax (PTX) is common after blunt chest injury, and failure to diagnose and rapidly treat an enlarging PTX may cause patient death. Occult PTXs missed on supine chest X-ray (CXR) may subsequently be found by computed tomography (CT) scans, but both of these diagnostic tools are not readily available for the patient. Furthermore, other problems associated with these techniques include the radiation hazard, the time delay after ordering, and obtaining the specialized radiologist's dictation of the CXR and CT results. Contrary, lung ultrasonography (US) is a harmless point-of-care examination to accurately diagnose PTX. The debate is whether lung US should replace CXR as the preferred diagnostic study of injured patients with suspected PTX. This study sought to answer the following remaining questions: Research questions Does lung US perform better than supine CXR and does it have the potential to diagnose even small amounts of intrapleural air? Could lung US be used to assess PTX progression during positive pressure ventilation? What is the optimal training method to accurately perform these lung US examinations? We studied experimentally induced PTX in porcine models to answer these questions. ⋯ Lung US is a safe and very accurate diagnostic tool that can be used to diagnose small-sized PTXs otherwise undetectable on supine CXRs. Lung US can also assess PTX progression, known to be an independent factor of a patient's later need for chest tube insertion. This is potentially helpful in real clinical settings, as it may enable clinicians to use US to make treatment decisions. With the appropriate training, all clinicians can perform lung US examinations to detect PTXs, which suggests that this approach should be used as a valuable adjunctive to the clinical examination of patients with blunt chest trauma.
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Acta Anaesthesiol Scand · Feb 2014
Time-varying spectral analysis revealing differential effects of sevoflurane anaesthesia: non-rhythmic-to-rhythmic ratio.
Heart rate variability (HRV) may reflect various physiological dynamics. In particular, variation of R-R peak interval (RRI) of electrocardiography appears regularly oscillatory in deeper levels of anaesthesia and less regular in lighter levels of anaesthesia. We proposed a new index, non-rhythmic-to-rhythmic ratio (NRR), to quantify this feature and investigated its potential to estimate depth of anaesthesia. ⋯ Our findings suggest that NRR provides complementary information to BIS regarding the differential effects of anaesthetics on the brain, especially the subcortical motor activity.