Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2017
Post-discharge nausea and vomiting after total intravenous anaesthesia and standardised PONV prophylaxis for ambulatory surgery.
The incidence of post-discharge nausea and vomiting (PDNV) after ambulatory anaesthesia using total intravenous anaesthesia with a risk-stratified anti-emetic approach is not well documented in the literature. In this study, we outline such an approach. The goal was to achieve an acceptably low rate of PDNV both immediately and the day after surgery. ⋯ Acceptably low rates of PDNV were achieved with the proposed standardised approach to PDNV prophylaxis. For almost 90% of patients, PDNV was not an issue the first day after surgery. Pain after discharge was a more common problem.
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Acta Anaesthesiol Scand · Aug 2017
Observational StudyAre severely injured trauma victims in Norway offered advanced pre-hospital care? National, retrospective, observational cohort.
Studies of severely injured patients suggest that advanced pre-hospital care and/or rapid transportation provides a survival benefit. This benefit depends on the disposition of resources to patients with the greatest need. Norway has 19 Emergency Helicopters (HEMS) staffed by anaesthesiologists on duty 24/7/365. National regulations describe indications for their use, and the use of the national emergency medical dispatch guideline is recommended. We assessed whether severely injured patients had been treated or transported by advanced resources on a national scale. ⋯ A highly developed and widely distributed HEMS system reached only half of severely injured trauma victims in Norway in 2013.
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Acta Anaesthesiol Scand · Aug 2017
Observational StudyUltrasound assessment of gastric content in the immediate postpartum period: a prospective observational descriptive study.
Pulmonary aspiration of gastric contents in pregnant women undergoing general anesthesia or sedation/analgesia in the peripartum period is a feared complication in obstetric anesthesia. We assessed the changes in antral cross-sectional area (CSA) with ultrasonography in laboring women and in the immediate postpartum period. ⋯ This study demonstrated that 48% of parturients in the immediate postpartum period presented an antral CSA ≥ 381 mm2 , cut-off being accepted for diagnosis of empty stomach and emphasizes the need for re-assessing before any general anesthetic procedure.
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Acta Anaesthesiol Scand · Aug 2017
Claims for compensation after injuries related to airway management: a nationwide study covering 15 years.
Securing the airway is one of the most important responsibilities in anaesthesia. Injuries related to airway management can occur. Analysis from closed claims can help to identify patterns of injury, risk factors and areas for improvement. ⋯ Anaesthesia procedures are not without risk, and injuries can occur when securing the airway. The most common injury was dental trauma. Clear patterns of airway management that resulted in injuries are not apparent from our data, but 37% of severe cases were related to emergency procedures which suggest the need for additional vigilance. Guidelines for difficult intubation situations are well established, but adherence to such guidelines varies. Good planning of every general anaesthesia should involve consideration of possible airway problems and assessment of pre-existing poor dentition.
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Acta Anaesthesiol Scand · Aug 2017
Observational StudyDelirium after fast-track hip and knee arthroplasty - a cohort study of 6331 elderly patients.
Postoperative delirium (PD) is a well-known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay (LOS). In elective orthopedic surgery, including hip and knee arthroplasty (THA/TKA), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast-track) aims to enhance recovery and reduce morbidity and LOS, but limited data are available on the effect on PD. Consequently, the study investigated signs of PD associated with LOS > 4 days. ⋯ Postoperative delirium symptoms contributing to LOS > 4 days in fast-track THA and TKA are rare in elderly patients.