Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2021
Randomized Controlled TrialEffects of different mean arterial pressure targets on plasma volume, ANP and glycocalyx - A randomised trial.
Arterial haematocrit (Hct) has been shown to decrease after anaesthesia induction, most probably because of an increased plasma volume (PV). The primary objective was to quantify change in PV if mean arterial pressure (MAP) was kept at baseline level or allowed to decrease to 60 mm Hg. Our secondary objective was to evaluate underlying mechanisms of this response. ⋯ Allowing mean arterial pressure to fall to 60 mm Hg during anaesthesia induction, increases the plasma volume due to reabsorption of interstitial water, with no ANP-induced degradation of the endothelial glycocalyx.
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Acta Anaesthesiol Scand · Feb 2021
Randomized Controlled Trial Multicenter StudyThe effect of remote ischaemic preconditioning on endothelial function after hip fracture surgery.
Endothelial dysfunction seems to play a role in the pathophysiology of myocardial injury after surgery. The aim of this randomised clinical trial was to examine whether remote ischaemic preconditioning in relation to hip fracture surgery ameliorates post-operative systemic endothelial dysfunction. ⋯ No beneficial effect of remote ischaemic preconditioning on the systemic endothelial dysfunction, assessed at a single time point on post-operative day one, was detected after hip fracture surgery.
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Acta Anaesthesiol Scand · Feb 2021
ReviewInterpreting the results of clinical trials, embracing uncertainty: A Bayesian approach.
Most clinical trials use null hypothesis significance testing with frequentist statistical inference to report P values and confidence intervals for effect estimates. This method leads to a dichotomisation of results as 'significant' or 'non-significant'. ⋯ The use of Bayesian statistics is introduced in this paper for a hypothetical sepsis trial with worked examples in the R language for Statistical Computing environment and the open-source statistical software JASP. It is hoped that this general introduction to Bayesian inference stimulates some interest and confidence among clinicians to consider applying these methods to the interpretation of new evidence for interventions relevant to anaesthesia and intensive care medicine.
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Acta Anaesthesiol Scand · Feb 2021
EditorialTime to consider supraglottic airway device oropharyngeal leak pressure measurement more objectively.
Oropharyngeal leak pressure (OLP) is considered a measure of successful placement, adequate performance and is a useful comparator between supraglottic airway devices (SADs). OLP measurement is based on the premise that the SAD is sited properly in the hypopharynx after blind placements, but the evidence suggests otherwise. Several limitations and controversies surround OLP. This editorial addresses the uses and pitfalls of OLP, the rationale for and methods of ascertaining OLP, the pros and cons of OLP measurement and newer modalities to improve its accuracy.
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Acta Anaesthesiol Scand · Feb 2021
Observational StudyEvaluation of the factors related to difficult ultrasound-guided radial artery catheterization in small children: A prospective observational study.
Although ultrasound guidance has significantly improved the success rate of radial artery catheterization, the failure rate in children is still high. For the further improvement of success rate, we prospectively evaluated the factors that make ultrasound-guided radial artery catheterization difficult in children under two years old. ⋯ A cross-sectional area of ≤ 1 mm2 and the presence of an anomalous branch of radial artery significantly increased the difficulty of ultrasound-guided radial artery catheterization in children under two years old. In patients of these ages, pre-procedural ultrasound scanning to find an optimal site for catheterization may increase the first-attempt success rate although further studies are needed to verify our results.