Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 2021
Effect of immunoglobulin G on cytokine response in necrotising soft-tissue infection: a post-hoc analysis.
A marked inflammatory response in necrotising soft-tissue infection (NSTI) may contribute to the severe clinical course. Intravenous polyspecific immunoglobulin G (IVIG) is used by some as adjuvant treatment for NSTI, but in the randomised INSTINCT trial, no effect of IVIG in NSTI patients was seen on physical quality of life. In experimental studies, IVIG may induce immunosuppressive effects by reducing the pro-inflammatory response and neutralising circulating superantigens. However, data on the potential immunomodulatory effects are sparse and remain to be investigated in a clinical setting. In this post hoc analysis of the INSTINCT trial, we aimed to assess the effect of IVIG on various inflammatory cytokines up to day 3 after randomisation. ⋯ In ICU patients with NSTI, IVIG did not reduce the plasma concentration of cytokines in the first 3 days.
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Acta Anaesthesiol Scand · Oct 2021
Controlled Clinical TrialA new Situation Awareness model decrease clinical deterioration in the emergency departments - a controlled intervention study.
Studies have suggested that adding subjective parameters to early warning score (EWS) systems might prompt more proactive treatment and positively affect clinical outcomes. Hence, the study aimed to investigate effect of a situation awareness model consisting of objective and subjective parameters on clinical deterioration in adult emergency department (ED) patients. ⋯ The situation awareness model reduces odds of clinical deterioration, defined as a clinically relevant increase in EWS, in an unselected adult population of ED patients. However, there was no effect on secondary outcomes.
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Acta Anaesthesiol Scand · Oct 2021
Model-predicted capillary leakage in graded hypotension: Extended analysis of experimental spinal anesthesia.
Crystalloid fluid infused during the induction of spinal anesthesia is involved in a complex set of physiological responses, including vasodilatation, reactive vasoconstriction, and changes in mean arterial pressure (MAP). The present evaluation compares the modeled capillary leakage in anesthetized versus nonanesthetized body regions. ⋯ Graded hypotension during spinal anesthesia reduced the capillary filtration of fluid as determined by volume kinetic analysis. The effect was twice as great when venous blood was sampled from a nonanesthetized body region than from an anesthetized body region.
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Acta Anaesthesiol Scand · Oct 2021
Multicenter StudyASA classification and surgical severity grading used to identify a high-risk population, a multicenter prospective cohort study in Swedish tertiary hospitals.
Identification of surgical populations at high risk for negative outcomes is needed for clinical and research purposes. We hypothesized that combining two classification systems, ASA (American Society of Anesthesiology physical status) and surgical severity, we could identify a high-risk population before surgery. We aimed to describe postoperative outcomes in a population selected by these two classifications system. ⋯ Severity classification as major to Xmajor/complex and ASA ≥3 could be used to identify a high-risk surgical population concerning postoperative morbidity and mortality before surgery. Combining the two systems future electronic data extraction is possible of a high-risk population in tertiary hospitals.
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Acta Anaesthesiol Scand · Oct 2021
Randomized Controlled TrialQuality of recovery in patients under low- or standard-pressure pneumoperitoneum. A randomised controlled trial.
The use of low-pressure pneumoperitoneum seems to be capable of reducing complications such as post-operative pain. However, the quality of evidence supporting this conclusion is low. Both the lack of investigator blinding to both intra-abdominal pressure and to method of neuromuscular blockade represent key sources of bias. Hence, this prospective, randomised, and double-blind study aimed to compare the quality of recovery (Questionnaire QoR-40) of patients undergoing laparoscopic cholecystectomy under low-pressure and standard-pressure pneumoperitoneum. We tested the hypothesis that low pneumoperitoneum pressure enhances the quality of recovery following LC. ⋯ We thus conclude that the use of low-pressure pneumoperitoneum during elective laparoscopic cholecystectomy does not improve the quality of recovery.