Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2018
Anesthetic approach to postdural puncture headache in the peripartum period: An Israeli national survey.
Accidental dural puncture frequency among pregnant women is about 1.5%, while approximately 60% of these women will suffer from post-dural puncture headache (PDPH) that may be debilitating. ⋯ In this survey, different aspects of treatment and PDPH management were examined. EBP is considered the gold standard in treating PDPH, although prophylactic blood patch is ineffective. We observed a tendency of very low performance of both prophylactic EBP and epidural normal saline administration after delivery in most centers. Most hospitals perform EBP after 24-48 hours of conservative treatment, along with published recommendations that show increased EBP efficiency with this timeframe. In light of the survey information, we aim to reach a uniform literature-based management strategy across Israeli hospitals.
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Acta Anaesthesiol Scand · Nov 2018
Changes in nasotracheal tube depth in response to head and neck movement in children.
A tracheal tube is often inserted via the nasal cavity for dental surgery. The position of the tube tip is important, given that the head position sometimes changes during surgery. Head movement induces changes in the length of the trachea (t-length) and/or the distance between the nare and the vocal cords (n-v-distance). In this study, we investigated the changes in t-length and n-v-distance in children undergoing nasotracheal intubation. ⋯ A change in the position of the tracheal tube tip in the trachea depends mainly on changes in t-length during paediatric dental surgery.
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Acta Anaesthesiol Scand · Nov 2018
Trends in practice and safety measures of epidural analgesia: Report of a national survey.
The clinical use of epidural analgesia has changed over past decades. Minimally invasive surgery and emergence of alternative analgesic techniques have led to an overall decline in its use. In addition, there is increasing awareness of the patient-specific risks for complications such as spinal haematoma and abscess. Local guidelines for management of severe neurological complications during or after epidural analgesia, ie, "epidural alert systems", have been introduced in hospitals to coordinate and potentially streamline early diagnosis and treatment. How widely such protocols have been implemented in daily practice is unknown. ⋯ This national audit concerning use and safety of epidural analgesia demonstrates that a minority of Dutch hospitals have procedures to manage suspected neurological complications of epidural analgesia, whereas in the remaining hospitals responsibilities and timelines for management of epidural emergencies are determined on an ad hoc basis.
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Acta Anaesthesiol Scand · Nov 2018
Review Meta AnalysisPerioperative goal-directed therapy: A systematic review without meta-analysis.
Perioperative goal-directed therapy aims to optimise haemodynamics by titrating fluids, vasopressors and/or inotropes to predefined haemodynamic targets. Perioperative goal-directed therapy is a complex intervention composed of several independent component interventions. Trials on perioperative goal-directed therapy show conflicting results. We aimed to conduct a systematic review and meta-analysis to investigate the benefits and harms of perioperative goal-directed therapy. ⋯ Clinical heterogeneity in patients, interventions and outcomes in perioperative goal-directed therapy trials is too large to perform meta-analysis on all trials. Future trials and meta-analyses highly depend on universally agreed definitions on aspects beyond type of surgery of the complex intervention and its evaluation.
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Acta Anaesthesiol Scand · Nov 2018
Multicenter StudyIntensive care doctors' preferences for arterial oxygen tension levels in mechanically ventilated patients.
Oxygen is liberally administered in intensive care units (ICUs). Nevertheless, ICU doctors' preferences for supplementing oxygen are inadequately described. The aim was to identify ICU doctors' preferences for arterial oxygenation levels in mechanically ventilated adult ICU patients. ⋯ Intensive care unit doctors preferred PaO2 to SaO2 in monitoring oxygen treatment when peripheral oxygen saturation was not included in the question. The identification of PaO2 as the preferred target and the thorough clarification of preferences are important when ascertaining optimal oxygenation targets. In particular when designing future clinical trials of higher vs lower oxygenation targets in ICU patients.