Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2014
Emergency patients receiving anaesthesiologist-based pre-hospital treatment and subsequently released at the scene.
The Mobile Emergency Care Unit in Odense, Denmark consists of a rapid response car, manned with an anaesthesiologist and an emergency medical technician. Eleven per cent of the patients are released at the scene following treatment. The aim of the study was to investigate which diagnoses were assigned to patients released at the scene following treatment, to investigate the need for secondary contact with the hospital and to assess mortality in patients released at the scene. ⋯ Patients treated and released at the scene presented poorly defined conditions. Ninety-three per cent of all cases required no secondary contacts with the health care system. However, caution should be exercised when releasing patients at the scene following traffic accidents.
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Acta Anaesthesiol Scand · Sep 2014
Pulmonary function after hemorrhagic shock and resuscitation in a porcine model.
Hemorrhagic shock may trigger an inflammatory response and acute lung injury. The combination adenosine, lidocaine (AL) plus Mg(2+) (ALM) has organ-protective and anti-inflammatory properties with potential benefits in resuscitation.The aims of this study were to investigate: (1) pulmonary function and inflammation after hemorrhagic shock; (2) the effects of ALM/AL on pulmonary function and inflammation. ⋯ Hemorrhagic shock and resuscitation did not cause acute lung injury or pulmonary inflammation. The question whether ALM/AL has the potential to attenuate acute lung injury is unanswered.
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Elective knee and hip arthroplasty are common surgical procedures. Improved anaesthetic and nutritional care has the potential of increasing patient satisfaction and reducing length of hospital stay (LOS). The overall aim of this thesis was to evaluate the effect of perioperative nutrition and different anaesthetic techniques on per- and postoperative outcome after elective total hip arthroplasty (THA) or total knee arthroplasty (TKA). ⋯ Patients undergoing THA received an oral carbohydrate or placebo drink in a randomised controlled trial 90 min before and 120 min after surgery. The treatment resulted in less hunger and nausea and reduced pain compared with placebo. When intrathecal anaesthesia (ITA) and traditional intra- and postoperative care was compared with general anaesthesia (GA) combined with accelerated postoperative care for TKA, the LOS was reduced without adversely affecting pain or total satisfaction. TKA patients given identical perioperative treatment were randomised to either ITA or GA, and GA resulted in shorter LOS, less nausea, vomiting and dizziness. GA patients also required less postoperative analgesics and had lower pain scores. Patients receiving ITA indicated that they would like to change their method of anaesthesia in the event of a subsequent operation. THA patients receiving either ITA or GA resulted in similar findings as in the TKA study. In conclusion, this thesis shows that perioperative carbohydrate administration has a limited beneficial effect on THA patients. Accelerated postoperative care and GA has favourable recovery effects when compared with ITA and traditional postoperative care. When GA was compared with ITA in a Fast-Track set-up, GA resulted in a more favourable recovery profile for patients undergoing THA or TKA. Both TKA and THA patients preferred GA in case of a future operation.
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Acta Anaesthesiol Scand · Sep 2014
Calculation of volatile anaesthetics consumption from agent concentration and fresh gas flow.
The assessment of volatile agents' consumption can be performed by weighing vapourisers before and after use. This method is technically demanding and unavailable for retrospective analysis of anaesthesia records. Therefore, a method based on calculations from fresh gas flow and agent concentration is presented here. ⋯ By application of the presented specific volatile agent constants and equations, it becomes easy to calculate volatile agent consumption if the fresh gas flows and the resulting inhaled concentration of the volatile agent are known. By this method, it is possible to extract data about volatile agent consumption both ways: (1) retrospectively from sufficiently detailed and accurate anaesthesia recordings, as well as (2) by application of this method in a prospective setting. Therefore, this method is a valuable contribution to perform pharmacoeconomical surveys.