Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2022
Randomized Controlled TrialGeneral or regional anaesthesia for postpartum haemorrhage - a national population-based cohort study.
Anaesthesia is required to assist the treatment of postpartum haemorrhage (PPH) when manual removal of the placenta or emptying of the uterine cavity is required. The choice between general or regional anaesthesia may depend upon factors such as existing epidural, airway, hypovolaemia, and tradition. ⋯ Practice varies immensely between delivery centres with large centres preferring regional anaesthesia. Difference in practice might be explained by level of experience, here large centres might be more confident using regional anaesthesia. Knowledge is being extrapolated from literature on caesarean sections. Future studies should address the optimal choice of anaesthesia for PPH procedures.
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Acta Anaesthesiol Scand · Jan 2022
ReviewExisting fluid responsiveness studies using the mini-fluid challenge may be misleading: methodological considerations and simulations.
The mini-fluid challenge (MFC) is a clinical concept of predicting fluid responsiveness by rapidly infusing a small amount of intravenous fluids, typically 100 ml, and systematically assessing its haemodynamic effect. The MFC method is meant to predict if a patient will respond to a subsequent, larger fluid challenge, typically another 400 ml, with a significant increase in stroke volume. ⋯ Many existing MFC studies are likely overestimating the classification accuracy of the MFC. This should be considered before adopting the MFC into clinical practice. A better study design includes a second, independent measurement of stroke volume after the MFC. This measurement serves as reference for the response to the subsequent fluid challenge.
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Acta Anaesthesiol Scand · Jan 2022
Randomized Controlled TrialProgrammed, intermittent boluses vs. continuous infusion to the sciatic nerve - a non-inferiority randomized, controlled trial.
Trials comparing programmed, intermittent boluses (PIB) and continuous infusion in catheter-based nerve blocks found no analgesic differences. However, as these trials used equal doses of local anesthetic (LA), the time of action of each bolus was not accounted for. Therefore, the dose-sparing benefits of PIB may have been overlooked. We compared the analgesic effect of boluses administered in intervals resembling the time of action of each bolus with continuous infusion. We hypothesized that PIB provided non-inferior analgesia despite consuming less LA. ⋯ PIB provided non-inferior analgesia compared to continuous infusion for 72 postoperative hours despite using significantly less LA.
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Acta Anaesthesiol Scand · Jan 2022
Health-related quality of life, anxiety and depression and physical recovery after critical illness - a prospective cohort study.
Critical illness is often followed by mental and physical impairments. We aimed to assess the health-related quality of life (HRQoL), symptoms of anxiety and depression, and physical function in critically ill patients after discharge from the intensive care unit. ⋯ We found no change in HRQoL, anxiety, and depression, or physical function from 3 months to 1 year. Physical health-related quality of life was impaired at both time points. Subdomain scores for physical health-related quality of life were affected more than mental domains at both time points.
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Acta Anaesthesiol Scand · Jan 2022
Observational StudyFrequency, indications and success of out-of-hospital intubations in Finnish children.
Earlier studies have shown variable results regarding the success of paediatric emergency endotracheal intubation between different settings and operators. We aimed to describe the paediatric population intubated by physician-staffed helicopter emergency medical service (HEMS) and evaluate the factors associated with overall and first-pass success (FPS). ⋯ Emergency endotracheal intubation of children is successfully performed by a physician staffed HEMS unit even though these procedures are rare. To improve the care, emphasis should be on airway management of infants and patients in cardiac arrest.