Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2014
Randomized Controlled Trial Comparative StudyThe influence of glucose load on metabolism during minor surgery using remifentanil-induced anesthesia.
During perioperative fasting, lipid metabolism gradually increases, resulting in free fatty acids (FFA) and/or ketone bodies. Suppression of surgical stress by remifentanil may allow the safe administration of glucose infusions, avoiding both hyperglycemia and ketogenesis. The effects of glucose infusion on glucose and lipid metabolism were therefore investigated in patients undergoing minor surgery with remifentanil anesthesia. ⋯ Infusion of low-dose glucose attenuated fat catabolism without causing hyperglycemia, indicating that infusion of low-dose glucose during remifentanil-induced anesthesia may be safe for patients.
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Acta Anaesthesiol Scand · Sep 2014
Controlled Clinical TrialAssessment of deep tissue hyperalgesia in the groin - a method comparison of electrical vs. pressure stimulation.
Deep pain complaints are more frequent than cutaneous in post-surgical patients, and a prevalent finding in quantitative sensory testing studies. However, the preferred assessment method - pressure algometry - is indirect and tissue unspecific, hindering advances in treatment and preventive strategies. Thus, there is a need for development of methods with direct stimulation of suspected hyperalgesic tissues to identify the peripheral origin of nociceptive input. ⋯ The presented tissue-specific direct deep tissue electrical stimulation technique has equal or superior reliability compared with the indirect tissue-unspecific stimulation by pressure algometry. This method may facilitate advances in mechanism based preventive and treatment strategies in acute and chronic post-surgical pain states.
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Acta Anaesthesiol Scand · Sep 2014
Observational StudyTidal ventilation distribution during pressure-controlled ventilation and pressure support ventilation in post-cardiac surgery patients.
Inhomogeneous ventilation is an important contributor to ventilator-induced lung injury. Therefore, this study examines homogeneity of lung ventilation by means of electrical impedance tomography (EIT) measurements during pressure-controlled ventilation (PCV) and pressure support ventilation (PSV) using the same ventilation pressures. ⋯ In post-cardiac surgery patients, PSV showed improved ventilation of the dependent lung region due to the contribution of the diaphragm activity, which is even more pronounced during lower assist levels.
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Acta Anaesthesiol Scand · Sep 2014
Case ReportsUse of neuromuscular monitoring to detect prolonged effect of succinylcholine or mivacurium: three case reports.
Mutations in the butyrylcholinesterase gene can lead to a prolonged effect of the neuromuscular blocking agents, succinylcholine and mivacurium. If the anaesthesiologist is not aware of this condition, it may result in insufficient respiration after tracheal extubation. However, this can be avoided with the use of objective neuromuscular monitoring if used adequately. ⋯ Both patients had insufficient respiration. They were therefore re-sedated, transferred to the intensive care unit and the tracheas were extubated after full recovery from neuromuscular blockade. We recommend the use of monitoring every time these agents are used, even with short-acting drugs like succinylcholine and mivacurium.
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Acta Anaesthesiol Scand · Sep 2014
Comparative StudyVentilation/perfusion ratios measured by multiple inert gas elimination during experimental cardiopulmonary resuscitation.
During cardiopulmonary resuscitation (CPR) the ventilation/perfusion distribution (VA /Q) within the lung is difficult to assess. This experimental study examines the capability of multiple inert gas elimination (MIGET) to determine VA /Q under CPR conditions in a pig model. ⋯ VA /Q assessment by MIGET is feasible during CPR and provides a novel tool for experimental purposes. Changes in VA /Q caused by different oxygen fractions are traceable during CPR. Beyond pulmonary perfusion deficits, these data imply an influence of the inspired oxygen level on VA /Q. Higher oxygen levels significantly increase shunt fractions and impair the normal VA /Q ratio.