Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2024
Review Meta AnalysisEffects of avoidance versus use of neuromuscular blocking agents for facilitation of tracheal intubation in children and infants.
The European Society of Anesthesiology and Intensive Care recommends the use of neuromuscular blocking agents (NMBA) in adults, to facilitate tracheal intubation and reduce its associated complications. Children who undergo tracheal intubation may suffer some of the same complications, however, no consensus exists regarding the use of NMBA for tracheal intubation in the pediatric population. We will explore the existing evidence assessing the effects of avoidance versus the use of NMBA for the facilitation of tracheal intubation in children and infants. ⋯ This protocol follows the preferred reporting items for systematic reviews and meta-analyses protocols recommendations. We will include all randomized controlled clinical trials assessing the effects of avoidance versus the use of NMBA for facilitation of tracheal intubation (oral or nasal) using direct laryngoscopy or video laryngoscopy in pediatric participants (<18 years). Our primary outcome is incidence of difficult tracheal intubation. Secondary outcomes include incidence of serious adverse events, failed intubation, events of upper airway discomfort or injury, and difficult laryngoscopy. We will conduct a thorough database search to identify relevant trials, including CENTRAL, MEDLINE, EMBASE, BIOSIS, Web of Science, CINAHL, and trial registries. Two review authors will independently handle the screening of literature and data extraction. Each trial will be evaluated for major sources of bias with the "classic risk of bias tool" used in the Cochrane Collaboration tool from 2011. We will use Review manager (RevMan) or R with the meta package to perform the meta-analysis. We will perform a trial sequential analysis on the meta-analysis of our primary outcome, providing an estimate of statistical reliability. Two review authors will independently assess the quality of the body of evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. We will use GRADEpro software to conduct the GRADE assessments and to create "Summary of the findings" tables.
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Acta Anaesthesiol Scand · Sep 2024
Randomized Controlled Trial Multicenter StudyPostoperative pain, recovery and discharge after robot-assisted laparoscopic prostatectomy: A multicentre, single blinded, randomised controlled trial.
General anaesthesia is standard of care for patients undergoing robot assisted laparoscopic prostatectomy (RALP). However, postoperative pain and bladder discomfort remains an issue, and optimising pain management could improve recovery and promote earlier home discharge. The main objective of this trial was to evaluate if patients receiving spinal anaesthesia are more frequently home ready at 8 pm on the same day compared with multimodal pain management following RALP under general anaesthesia. ⋯ We found no difference in time to home readiness between the groups. Approximately one-fourth of the patients achieved home readiness the same day after surgery without difference between the groups. Fewer patients had urge, and patient satisfaction was greater in group GS.
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Acta Anaesthesiol Scand · Sep 2024
Randomized Controlled Trial Comparative StudyEmpirical meropenem versus piperacillin/tazobactam for adult patients with sepsis (EMPRESS) trial: Protocol.
Piperacillin/tazobactam may be associated with less favourable outcomes than carbapenems in patients with severe bacterial infections, but the certainty of evidence is low. ⋯ EMPRESS will compare the effects of empirical meropenem against piperacillin/tazobactam in adult, critically ill patients with sepsis. Due to the pragmatic, adaptive design with high probability of conclusiveness, the trial results are expected to directly inform clinical practice.
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Acta Anaesthesiol Scand · Sep 2024
Multicenter StudyPlatelet transfusions in adult ICU patients with thrombocytopenia: A sub-study of the PLOT-ICU inception cohort study.
Platelet transfusions are frequently used in the intensive care unit (ICU), but current practices including used product types, volumes, doses and effects are unknown. ⋯ Among acutely admitted, adult ICU patients with thrombocytopenia, 20.8% received platelet transfusions in ICU of whom most received pooled products, but considerable variation was observed in product type, volumes and doses across countries. Prophylactic platelet transfusions were associated with limited increases in platelet counts.
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Acta Anaesthesiol Scand · Sep 2024
Multicenter StudyPatient recall of intensive care delirium: A qualitative investigation.
Many patients in the Intensive Care Unit (ICU) experience delirium. Understanding the patient perspective of delirium is important to improve care and reduce suffering. The aim of our study was to investigate the subjective patient experience of delirium, delirium-related distress, and delirium management in ICU. ⋯ The ICU survivors in our study recalled delirium as an unpleasant and frightening experience, often leading to delirium-related distress during and after their ICU stay, indicating the necessity for enhanced assessment and treatment.