Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 2014
Pre-treatment of bupivacaine-induced cardiovascular depression using different lipid formulations of propofol.
Pre-treatment with lipid emulsions has been shown to increase lethal doses of bupivacaine, and the lipid content of propofol may alleviate bupivacaine-induced cardiotoxicity. The aim of this study is to investigate the effects of propofol in intralipid or medialipid emulsions on bupivacaine-induced cardiotoxicity. ⋯ We conclude that pre-treatment with propofol in intralipid, compared with propofol in medialipid or saline, delayed the onset of bupivacaine-induced cardiotoxic effects as well as reduced plasma bupivacaine levels. Further studies are needed to explore tissue bupivacaine levels of propofol in medialipid and adapt these results to clinical practice.
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Acta Anaesthesiol Scand · Mar 2014
Case ReportsDelayed quadriceps weakness after continuous adductor canal block for total knee arthroplasty: a case report.
Adductor canal catheters have been shown to improve analgesia while maintaining quadriceps strength after total knee arthroplasty. We describe a patient who underwent total knee arthroplasty that likely had delayed quadriceps weakness as a result of a standard continuous 0.2% ropivacaine infusion at 8 ml/h within the adductor canal. ⋯ Contrast subsequently injected through the adductor canal catheter under fluoroscopy revealed proximal spread approaching the common femoral nerve with as little as 2 ml of volume. This rare case of profound quadriceps weakness after a continuous adductor canal block reveals that local anaesthetic at the adductor canal can spread in a retrograde fashion towards the common femoral nerve, potentially resulting in quadriceps weakness.
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Acta Anaesthesiol Scand · Mar 2014
Recovery after nasal surgery vs. tonsillectomy: discriminant validation of the Postoperative Quality of Recovery Scale.
Initial validation and feasibility of the Post-Operative Quality of Recovery Scale (PQRS) was published in 2010. Ongoing validation includes studies to determine whether this scale can discriminate differences in recovery in similar patients having different surgery. ⋯ The study shows the ability of the PQRS to discriminate recovery in different domains. Tonsillectomy has a worse recovery profile over the first 3 days in nociceptive, activities of daily living and overall recovery, which is associated with poorer satisfaction than nasal surgery.
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Acta Anaesthesiol Scand · Mar 2014
Analysis of intraosseous samples in endotoxemic shock--an experimental study in the anaesthetised pig.
Intraosseous (IO) access is used in emergency situations to allow rapid initiation of treatment. IO access is also sometimes used for blood sampling, although data on accuracy of such sampling in critical illness are limited. There is also a potential risk that bone marrow fragments in IO samples may damage laboratory equipment. It is ethically questionable to perform a simultaneous comparison between IO and arterial/venous sampling in critically ill humans. We have, thus, studied the analytical performance of IO sampling in a porcine septic shock model using a cartridge-based analyser. ⋯ IO sample values should be treated with caution in this setting but may add useful information to the clinical picture. The tibia or humerus may be used for sampling. IO infusion decreases agreement, thus sampling during infusion should be avoided.