Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2020
Review Meta AnalysisTopical application of ketamine to prevent postoperative sore throat in adults: a systematic review and meta-analysis.
Postoperative sore throat is a leading undesirable postoperative outcome. Ketamine is an N-methyl-d-aspartate receptor antagonist and its topical application is used for chronic pain and oral/throat indications. We conducted a systematic review to assess the efficacy of preoperative, topical ketamine application for preventing postoperative sore throat. ⋯ Preoperative, topical ketamine application may be more effective than non-analgesic methods in preventing postoperative sore throat. The number of studies did not suffice to determine the place of topical ketamine among agents to prevent postoperative sore throat.
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Acta Anaesthesiol Scand · May 2020
Randomized Controlled Trial Multicenter StudyEfficacy and safety of iloprost in patients with septic shock-induced endotheliopathy - protocol for the multicenter randomized, placebo-controlled, blinded, investigator-initiated COMBAT-SHINE trial.
In Europe 700.000 new cases of sepsis occur annually and more than 100.000 of these patients die due to multiorgan failure (MOF). We have identified shock-induced endotheliopathy (SHINE) to be associated with development of MOF and mortality. Furthermore, in patients with septic shock those with circulating levels of thrombomodulin (TM) above 10 ng/mL have twice the mortality (56% vs 28%) than those with levels below this level. Pilot studies indicate that infusion of iloprost (1 ng/kg/min) is associated with improved endothelial function in patients with septic shock. ⋯ This trial tests the safety and efficacy of iloprost vs placebo for 72 hours in patients with septic shock and SHINE. The outcome measures focus on the potential effect of the intervention to mitigate organ failure.
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The distribution and elimination kinetics of the water volume in infusion fluids can be studied by volume kinetics. The approach is a modification of drug pharmacokinetics and uses repeated measurements of blood hemoglobin and urinary excretion as input variables in (usually) a two-compartment model with expandable walls. Study results show that crystalloid fluid has a distribution phase that gives these fluids a plasma volume expansion amounting to 50%-60% of the infused volume as long as the infusion lasts, while the fraction is reduced to 15%-20% within 30 minutes after the infusion ends. ⋯ Concentrated urine before and during infusion slows down the elimination of crystalloid fluid. Colloid fluids have no distribution phase, an intravascular persistence half-life of 2-3 hours, and-at least for hydroxyethyl starch-the ability to reduce the effect of subsequently infused crystalloids. Accelerated distribution due to degradation of the endothelial glycocalyx layer has not yet been demonstrated.
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Acta Anaesthesiol Scand · May 2020
Observational StudyProspective observational investigation of body habitus measurements and relationship to epidural depth in term pregnant women.
High body mass index (BMI) can predict difficult neuraxial block; however, fat distribution may also be important. The primary study aim was to identify body habitus and fat distribution measurements that correlated with ultrasound measured epidural depth. We hypothesized that measurements such as midarm and subscapular fatpad thicknesses and length of cervical spine may correlate better with ultrasound measured epidural depth than a global measure of BMI. ⋯ Measurements of body habitus and fat distribution were no better than measured BMI to anticipate greater ultrasound measured depth to epidural space. Clinical trial number: Non-interventional observational study, not registered.
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Acta Anaesthesiol Scand · May 2020
Observational StudyThe potential for organ donation in Iceland: a nationwide study of deaths in intensive care units.
The deceased organ donation rate in Iceland has been low compared with other Western countries. The aim of this study was to explore the potential for organ donation after brain death in Iceland. ⋯ The donation rate increased markedly in the last 2 years of the study period after remaining low for more than a decade. This change can largely be explained by a high incidence of PDs and a low family refusal rate. Missed donation opportunities suggest a potential to maintain a high donation rate in the future.