Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2015
Case ReportsSevere hypoglycemia during methadone escalation in an 8-year-old child.
This case report describes hypoglycemia during methadone escalation in an 8-year-old girl with acute lymphatic leukemia. After a significant increase in the methadone dosage, the blood glucose decreased from 12 mmol/l to 1 mmol/l. ⋯ There are few reports from the adult palliative setting which describe this serious side effect. This is to our knowledge, the first described pediatric case.
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Acta Anaesthesiol Scand · Nov 2015
Measuring resting energy expenditure during extracorporeal membrane oxygenation: preliminary clinical experience with a proposed theoretical model.
Extracorporeal membrane oxygenation (ECMO) is increasingly used in patients with severe respiratory failure. Indirect calorimetry (IC) is a safe and non-invasive method for measuring resting energy expenditure (REE). No data exist on the use of IC in ECMO-treated patients as oxygen uptake and carbon dioxide elimination are divided between mechanical ventilation and the artificial lung. We report our preliminary clinical experience with a theoretical model that derives REE from IC measurements obtained separately on the ventilator and on the artificial lung. ⋯ We present IC-acquired gas analysis in ECMO patients. We propose to insert individually obtained IC measurements at the native and the artificial lung in the Weir equation for retrieving a measured REEcomposite .
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Acta Anaesthesiol Scand · Nov 2015
ReviewEnhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations.
The present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery. ⋯ Evidence-based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.
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Acta Anaesthesiol Scand · Nov 2015
Case ReportsIntraosseous access in neonates and infants: risk of severe complications - a case report.
Gaining vascular access in a neonate during cardiopulmonary resuscitation is crucial and challenging. Intraosseous (IO) access can offer a fast and reliable method for achieving emergency access for fluids and drugs when venous access fails in a critically ill child. IO access can however result in rare, but serious adverse events including compartment syndrome and amputation. ⋯ Regular observation of the circulation and possible swelling of the leg should be performed. The IO administration of inotropic infusions should also be avoided after the initial resuscitation phase. When treating with therapeutic hypothermia, it may be wise to remove the IO needle much earlier than the currently recommended 24 h because of the problems in peripheral circulation and its monitoring.