Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 2014
Observational StudyConcentrations of remifentanil, propofol, fentanyl, and midazolam during rewarming from therapeutic hypothermia.
The clearance of sedatives and analgesics may be reduced by therapeutic hypothermia. However, little is known about the concentrations of such drugs during rewarming. The aim of this study was to describe the serum concentrations of sedatives and analgesics during rewarming from therapeutic hypothermia. ⋯ Concentrations of remifentanil, propofol, and midazolam decreased during rewarming from therapeutic hypothermia when adjusting for rates of infusion. No changes were demonstrated for fentanyl.
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Acta Anaesthesiol Scand · Jul 2014
Case ReportsRecombinant human growth hormone improves cognitive capacity in a pain patient exposed to chronic opioids.
During recent decades, the increasing use of opioids for chronic non-cancer pain has raised concerns regarding tolerance, addiction, and importantly cognitive dysfunction. Current research suggests that the somatotrophic axis could play an important role in cognitive function. Administration of growth hormone (GH) to GH-deficient humans and experimental animals has been shown to result in significant improvements in cognitive capacity. ⋯ In the right hippocampus, the N-acetylaspartate/creatine ratio (reflecting nerve cell function) was initially low but increased significantly during rhGH treatment, as did subjective cognitive, physical and emotional functioning. This case report indicates that rhGH replacement therapy could improve cognitive behaviour and well-being, as well as hippocampal metabolism and functioning in opioid-treated patients with chronic pain. The idea that GH could affect brain function and repair disabilities induced by long-term exposure to opioid analgesia is supported.
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Acta Anaesthesiol Scand · Jul 2014
A calibration study of SAPS II with Norwegian intensive care registry data.
Mortality prediction is important in intensive care. The Simplified Acute Physiology Score (SAPS) II is a tool for predicting such mortality. However, the original SAPS II is poorly calibrated to current intensive care unit (ICU) populations because it draws on data, which is more than 20 years old. We aimed to improve the calibration of SAPS II using data from the Norwegian Intensive Care Registry (NIR). This is the first recalibration of SAPS II for Nordic data. ⋯ As expected, Model B is better calibrated than Model A, and both models have similar uniformity of fit and equal discrimination. Introducing Model B into Norwegian ICUs may improve precision in decision-making. Units will have a more realistic benchmark for the assessment of ICU performance. Mortality risk estimates from Model B are better than previous SAPS II estimates have been.
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Acta Anaesthesiol Scand · Jul 2014
Review Meta AnalysisDexmedetomidine for preventing sevoflurane-related emergence agitation in children: a meta-analysis of randomized controlled trials.
Emergence agitation (EA) is a common problem after sevoflurane anesthesia in children. Prophylactic dexmedetomidine has been directed at this issue; however, the efficacy remains controversial. We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effectiveness of dexmedetomidine on the incidence of sevoflurane-related EA. ⋯ Dexmedetomidine reduced the incidence of sevofurane-related EA (pooled RR = 0.351; 95% CI: 0.275-0.449; P = 0.965; heterogeneity test, I(2) = 0.0%), and it also resulted in a lower incidence of severe EA (pooled RR = 0.119; 95% CI: 0.033-0.422; P = 0.962; heterogeneity test, I(2) = 0.0%). All subgroup analyses for potential sources of heterogeneity showed a lower incidence of sevoflurane-related EA after dexmedetomidine administration. This meta-analysis demonstrated that dexemedetomidine was effective in reducing the incidence of sevoflurane-induced EA in children as compared with placebo.
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Acta Anaesthesiol Scand · Jul 2014
Randomized Controlled Trial Comparative StudyEffect of n-3 fatty acids on markers of brain injury and incidence of sepsis-associated delirium in septic patients.
Data regarding immunomodulatory effects of parenteral n-3 fatty acids in sepsis are conflicting. In this study, the effect of administration of parenteral n-3 fatty acids on markers of brain injury, incidence of sepsis-associated delirium, and inflammatory mediators in septic patients was investigated. ⋯ Administration of n-3 fatty acids did not affect markers of brain injury, incidence of sepsis-associated delirium, and inflammatory mediators in septic patients.