Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2015
An in vitro evaluation of infusion methods using a syringe pump to improve noradrenaline administration.
International guidelines recommend noradrenaline (NA) as the vasopressor of choice to treat septic shock. The aim of this study was to determine the best way to infuse patients with NA. ⋯ A combination of a low dead-space volume extension set and a double pump method with a constant saline flow rate at 5 ml/h might be the solution to provide the most reliable NA infusion delivery.
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Acta Anaesthesiol Scand · Feb 2015
Effect of unfractionated heparin on endothelial glycocalyx in a septic shock model.
The constituents of vascular endothelial glycocalyx, such as syndecan-1 and heparan sulphate (HS), can be detected in the plasma of patients and animals with septic shock. However, the dynamics of glycocalyx degradation and its association with inflammation remains largely unknown. In this study, we investigated the association between the biomarkers of acute endothelial glycocalyx degradation and inflammatory factors. We also evaluated the effect of unfractionated heparin (UFH) on glycocalyx shedding in a canine septic shock model. ⋯ A therapeutic dose of UFH can protect glycocalyx from shedding by inhibiting inflammation. Additional studies with larger sample sizes are needed to confirm our conclusions.
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Acta Anaesthesiol Scand · Feb 2015
The spread of injectate during saphenous nerve block at the adductor canal: a cadaver study.
The spread of injectate during a saphenous nerve block at the adductor canal has not been clearly described. ⋯ Injection of 15 ml dye was sufficient to spread throughout the adductor canal and beyond both proximally and distally. Distinct ultrasonographic features could be identified separating a subsartorial injection from an injection within the adductor canal with consequent differences in the spread.
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Green urine from propofol infusion is a benign and rare side effect. The discolouration appears when clearance of propofol exceeds hepatic elimination, and extrahepatic elimination of propofol occurs. This case report presents a 24-year-old male with grass green discolouration of urine based on propofol infusion.
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Acta Anaesthesiol Scand · Feb 2015
Transpulmonary pressure and lung elastance can be estimated by a PEEP-step manoeuvre.
Transpulmonary pressure is a key factor for protective ventilation. This requires measurements of oesophageal pressure that is rarely used clinically. A simple method may be found, if it could be shown that tidal and positive end-expiratory pressure (PEEP) inflation of the lungs with the same volume increases transpulmonary pressure equally. The aim of the present study was to compare tidal and PEEP inflation of the respiratory system. ⋯ PEEP inflation of the respiratory system is extremely slow, and allows the chest wall complex, especially the abdomen, to yield and adapt to intrusion of the diaphragm. As a consequence a change in transpulmonary pressure is equal to the change in PEEP and transpulmonary pressure can be determined without oesophageal pressure measurements.