Acta anaesthesiologica Scandinavica
-
Acta Anaesthesiol Scand · May 2015
ReviewThe demise of early goal-directed therapy for severe sepsis and septic shock.
A protocol for the quantitative resuscitation of severe sepsis and septic shock known as early goal-directed therapy (EGDT) was published in 2001. Despite serious limitations, this study became widely adopted around the world and formed the basis of the Surviving Sepsis Campaign 6 h resuscitation bundle. Subsequently, a large number of observational before-and-after studies were published which demonstrated that EGDT reduced mortality. ⋯ Furthermore, accruing data suggest an association between the amount of fluid administered in the first 72 h and the mortality of patients with severe sepsis. Patients in all arms of the ProCESS and ARISE trials received substantial and nearly equivalent amounts of fluid. It is proposed that a more conservative fluid strategy and the earlier use of norepinephrine in patients with septic shock may be associated with further improvements in the outcome of patients with sepsis.
-
Acta Anaesthesiol Scand · May 2015
Implementation and preliminary validation of a new score that predicts post-operative complications.
An accurate pre-operative risk assessment could reduce morbidity and mortality for high-risk surgical patients. The aim of the study was to implement and preliminary validate a new score that could predict the occurrence of post-operative complications (PoCs): the Anesthesiological and Surgical Postoperative Risk Assessment (ASPRA) score. ⋯ The new ASPRA score has a high positive predictive value to predict the occurrence of PoCs. Further prospective studies are required to confirm these results.
-
Acta Anaesthesiol Scand · May 2015
Neurohistological abnormalities during early porcine endotoxemia.
Brain dysfunction is common in sepsis. We aimed to assess whether cerebral perfusion, oxygenation, and/or metabolism are abnormal during early endotoxemia, and how they may relate to potential neurohistological changes. ⋯ Early endotoxemia seems to be associated with histological signs of brain damage unrelated to systemic or cerebral hemodynamics or oxygenation.
-
Acta Anaesthesiol Scand · May 2015
Case ReportsThe ultrasound-assisted paraspinous approach to lumbar neuraxial blockade: a simplified technique in patients with difficult anatomy.
Pre-procedural ultrasound imaging of the spine to identify the interspinous and interlaminar space has been shown to facilitate subsequent performance of lumbar neuraxial blockade. However, adequate visualization of the vertebral canal can be challenging for less-experienced operators, and particularly in subjects with difficult anatomy. ⋯ Another key difference is the use of a paraspinous (or paramedian) needle approach rather than a midline approach that is advantageous where the interspinous spaces are narrowed by disease or suboptimal patient positioning. The anatomical basis and technical performance of this novel ultrasound-assisted paraspinous approach are presented in detail.