Journals Acta Anaesthesiologica Scandin...

Acta Anaesthesiologica Scandinavica
Carla D Grundmann, Jan M Wischermann, Philipp Fassbender, Petra Bischoff, Ulrich H Frey
BACKGROUND: Intraoperative hypotension is associated with increased morbidity and mortality. The Hypotension Prediction Index (HPI) is an advancement of the arterial waveform analysis to predict intraoperative hypotension minutes before episodes occur enabling preventive treatments. We tested the hypothesis that the HPI combined with a personalized treatment protocol reduces intraoperative hypotension when compared to arterial waveform analysis alone. METHODS: We conducted a retrospective analysis of 100 adult consecutive patients undergoing moderate- or high-risk noncardiac surgery with invasive arterial pressure monitoring using either index guidance (HPI) or arterial waveform analysis (FloTrac) depending on availability (FloTrac, n=50; HPI, n=50)...
July 29, 2021: Acta Anaesthesiologica Scandinavica
Philipp Gude, Niclas Geldermann, Adrian I Georgevici, Jennifer Herzog-Niescery, Thomas Peter Weber, Heike Vogelsang, Stefan Dazert, Konstantin van Ackeren, Stefan Volkenstein
BACKGROUND: The optimal pain therapy for children undergoing tonsillotomy remains unknown. Our aim was to evaluate a standard pain therapy including the alternating application of ibuprofen and paracetamol. METHODS: Pain intensity of 81 in-patients after tonsillotomy aged 2 - 12 years was evaluated three times daily (mean observation 3.85 days) using the Children's and Infants' Postoperative Pain Scale (CHIPPS) in children < 5 years, or with the Faces Pain Scale-Revised (FPS-R) in older children...
July 26, 2021: Acta Anaesthesiologica Scandinavica
Frederik Mølgaard Nielsen, Thomas Lass Klitgaard, Elena Crescioli, Søren Rosborg Aagaard, Anne Sofie Andreasen, Lone Musaeus Poulsen, Martin Siegemund, Anne Craveiro Brøchner, Morten Heiberg Bestle, Susanne Andi Iversen, Björn Anders Brand, Jon Henrik Laake, Thorbjørn Grøfte, Thomas Hildebrandt, Theis Lange, Anders Perner, Olav Lilleholt Schjørring, Bodil Steen Rasmussen
BACKGROUND: Coronavirus disease (COVID-19) primarily affects the lungs and lower airways and may present as hypoxaemic respiratory failure requiring admission to an intensive care unit (ICU) for supportive treatment. Here, supplemental oxygen remains essential for COVID-19 patient management, but the optimal dosage is not defined. We hypothesise that targeting an arterial partial pressure of oxygen of 8 kPa throughout ICU admission is superior to targeting 12 kPa. METHODS: The Handling Oxygenation Targets in ICU patients with COVID-19 (HOT-COVID) trial, is an investigator-initiated, pragmatic, multicentre, randomised, parallel-group trial comparing a lower oxygenation target versus a higher oxygenation target in adult ICU patients with COVID-19...
July 26, 2021: Acta Anaesthesiologica Scandinavica
Núria M Zellweger, Morten Hylander Møller, Karen Louise Ellekjaer, Andreas Bender Jonsson, Kathrine Bruun Svan, Martin Siegemund, Anders Perner
INTRODUCTION: Intravenous (IV) fluids are widely used in everyday clinical practice. In the last two decades, several trials and clinical practice guidelines have been published on the use of different types and dosages of IV fluid. This may have led to a change in clinical practice. Thus, we aim to describe the use of IV crystalloids and colloids in Europe over a 10-year period. METHODS AND ANALYSIS: We will collect national or regional data on the use of IV crystalloids and colloids in European hospitals through companies and/or federal medical agencies that provide pharmaceutical data concerning the type and amount of fluids used from January 1st , 2010 to December 31st , 2019...
July 26, 2021: Acta Anaesthesiologica Scandinavica
Matias Vested, Anne Marie Sørensen, Cecilie Bjerring, Rasmus Ejlersgård Christensen, Felicia Dinesen, Malene Vang Koefoed Nielsen, Alexander Gilvanoff, Thea Ellehammer Hansen, Tatiana Nielsen, Lars S Rasmussen
BACKGROUND: To facilitate tracheal intubation, either a neuromuscular blocking agent or a bolus dose of remifentanil can be administered. We hypothesised that rocuronium 0.6 mg kg-1 provided a larger proportion of excellent intubating conditions compared to remifentanil 2 µg kg-1 in patients above 80 years. METHODS: A total of 78 patients were randomised to either rocuronium 0.6 mg kg-1 or remifentanil 2 µg kg-1 . General anaesthesia was initiated with fentanyl and propofol...
July 26, 2021: Acta Anaesthesiologica Scandinavica
Jemma Neuman, Luis F Schulz, Anders Aneman
We thank Prof. Xue and colleagues for their interest [letter ref] in our observational study on associations between mean systemic filling pressure and acute kidney injury (AKI) following elective cardiac surgery [2]. To be precise, we have not argued that calculating the mean systemic filling pressure analogue (Pmsa ) provides a surrogate for renal venous pressure. We have proposed that Pmsa represents a closer physiological approximation of the renal venous pressure compared to central venous pressure (CVP)...
July 26, 2021: Acta Anaesthesiologica Scandinavica
Jun Kobayashi
I read with interest an article in your journal by Lotz et al.1 They demonstrated that nitric oxide (NO) inhalation decreases pulmonary shunting and improves arterial oxygenation, leading to a therapeutic effect on coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome (ARDS). Inhaled NO (iNO) acts as a selective pulmonary artery vasodilator, alleviating lung ventilation/perfusion ratio. However, Lotz and colleagues assume that improved oxygenation is not the sole reason for survival benefits in patients treated with iNO, suggesting other modes of iNO action could have beneficial effects on systemic circulation...
July 26, 2021: Acta Anaesthesiologica Scandinavica
Marius Rehn, Michelle S Chew, Klaus T Olkkola, Martin Ingi Sigurðsson, Arvi Yli-Hankala, Morten Hylander Møller
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. The guideline can serve as a useful decision aid for clinicians managing children with suspected and confirmed septic shock and sepsis-associated organ dysfunction.
July 26, 2021: Acta Anaesthesiologica Scandinavica
Tian Tian, Bin Hu, Fu S Xue
With a great interest we read the recent article by Neuman et al1 assessing the association between mean systemic filling pressure analogue (Pmsa ) and acute kidney injury (AKI) following cardiac surgery. They showed that Pmsa as a surrogate for renal venous pressure was more closely associated with AKI than central venous pressure. As AKI has been significantly associated with morbidity and mortality in after cardiac surgery,2 their findings have potential implication. Other than the limitations described by authors in discussion, however, we noted several issues in their article on which we invited the authors to comment...
July 26, 2021: Acta Anaesthesiologica Scandinavica
Jacob Rosén, Peter Frykholm, Diddi Fors
BACKGROUND: Preoxygenation efficacy with high flow nasal cannula (HFNC) in obese patients is not clearly established. The primary aim of this study was to compare heated, humidified, high flow nasal cannula with face-mask for preoxygenation in this population. METHODS: We conducted a randomised, single centre, controlled trial. Forty subjects with BMI≥35 kg m-2 were randomly assigned to receive 5.0 min of preoxygenation with face-mask and 7 cmH2 O of PEEP (PEEP group) or HFNC at 70 L min-1 (HF group)...
July 26, 2021: Acta Anaesthesiologica Scandinavica
Jes R Johansen, Anders Perner, Julie H Brodtkorb, Morten H Møller
BACKGROUND: After being used for more than a decade the use of hydroxyethyl starch (HES) 130/0.38-0.45 in clinical practice was discouraged because of serious adverse events including bleeding, acute kidney injury and death. But could these adverse effects have been discovered sooner? By comparing the summary effect estimates of the adverse effects of HES 130/0.38-0.45 in different study designs we aimed to disclose any signal of this. METHODS: We systematically searched MEDLINE, EMBASE and Cochrane Library and hand-searched the reference lists of relevant studies to identify studies for inclusion...
July 26, 2021: Acta Anaesthesiologica Scandinavica
Emily Barot, Maj-Brit Nørregaard Kjaer, Marie Oxenbøll Collet, Elena Cresoli, Bodil Steen Rasmussen, Stine Estrup, Camilla Bekker Mortensen, Gitte Kingo Vesterlund, Praleene Sivapalan, Carl Thomas Anton, Camilla Rahbek Lysholm Bruun, Lone Musaeus Poulsen, Morten Hylander Møller, Anders Perner, Anders Granholm
BACKGROUND: Patient and public involvement (PPI) in randomised clinical trials (RCTs) has increased in recent years but remains the exception rather than the rule. We aim to assess the frequency and extent of PPI in large, contemporary RCTs conducted in an intensive care setting. METHODS AND DESIGN: We will conduct a meta-epidemiological study of RCTs conducted in intensive care settings published since 2019 and assess their use of PPI. We will extract trial characteristics and verify the use of PPI with trial authors unless specifically stated in the published paper...
July 17, 2021: Acta Anaesthesiologica Scandinavica
Chloe Heath, Aris Siafarikas, Aine Sommerfield, Britta S von Ungern-Sternberg
Patients with adrenal insufficiency are at risk of adrenal crisis, a potentially life-threatening emergency in the peri-operative period due to their attenuated ability to mount a cortisol response. There is lack of standardization regarding peri-operative stress-dose glucocorticoids in paediatric clinical practice with absence of agreed protocols. For the individual patient, the risk of adrenal crisis must be weighed against the potential adverse clinical outcomes associated with unnecessary or supra-physiologic glucocorticoid dosing in susceptible patients...
July 15, 2021: Acta Anaesthesiologica Scandinavica
Masahiro Yagihara, Aki Uemura, Yoshiki Nakajima
BACKGROUND: Infants and children require a larger dose of local anaesthetic to establish epidural analgesia than adults, but the reason for this remains unclear. We hypothesised that prominent ventro-dorsal expansion of the epidural space limits cranio-caudal spread of local anaesthetic in infants. Accordingly, we studied the dimensions of the epidural space with real-time ultrasound before and after epidural injection. METHODS: Ninety-six infants and children aged 0-12 years who underwent abdominal surgery under combined epidural and general anaesthesia were examined in this prospective observational study...
July 14, 2021: Acta Anaesthesiologica Scandinavica
Zeynab Gholamipoor, Mahsa Rahimzadeh, Hossein Montazerghaem, Nadereh Naderi
BACKGROUND: Acute kidney injury (AKI) is a common complication of cardiopulmonary bypass (CPB), associated with increased mortality in surgical patients. It is well proven that Th17 and its hallmark cytokine, IL-17, contribute to AKI development. Since the RAR-related orphan receptor C (RORC) gene is a master regulator of the Th17 differentiation, we aimed to evaluate the association between its polymorphisms, CPB-AKI and plasma IL-17 levels among Iranian patients undergoing cardiopulmonary bypass...
July 12, 2021: Acta Anaesthesiologica Scandinavica
Christina Cleveland Laursen, Christian Sylvest Meyhoff, Tonny Studsgaard Petersen, Espen Jimenez-Solem, Anne Mette Skov Sørensen, Troels Haxholdt Lunn
BACKGROUND: With increasing demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA), a higher percentage of patients are identified with comorbidities that might increase the risk of complications. We aimed to elucidate the preoperative characteristics of patients with a fatal outcome or admission to the Intensive Care Unit (ICU) within 90 days after THA or TKA. We arbitrarily hypothesized that more than 50% of those patients would be frail. METHODS: This is a register based, explorative study including patients undergoing elective, unilateral, primary THA or TKA in the Capital Region of Denmark from 2010 to 2017, and who subsequently died or were admitted to the ICU within 90 days...
July 12, 2021: Acta Anaesthesiologica Scandinavica
Jakob Zeuchner, Jonas Graf, Louise Elander, Jessica Frisk, Mats Fredrikson, Michelle S Chew
BACKGROUND: Current evidence for the conduct of Rapid Sequence Induction (RSI) is weak. This increases the risk of clinicians modifying the RSI procedure according to personal preferences. Checklists may help increase compliance to best-practice guidelines and reduce complication rates. Their value during RSI, a critical procedure in anaesthesia, is unknown. The aim of this study was to investigate compliance to local guidelines and frequency of RSI-related complications before and after introduction of an RSI checklist...
June 26, 2021: Acta Anaesthesiologica Scandinavica
Corinna Velik-Salchner, Helmuth Tauber, Verena Rastner, Werner Pajk, Markus Mittermayr, Dieter Wally, Juliane Kilo, David Vondrys, Dietmar Fries, Josef Fritz, Werner Streif
BACKGROUND: Bleeding is a common problem in children with congenital heart disease undergoing major cardiac surgery requiring cardiopulmonary bypass (CPB). Little is known about optimal management with blood products. OBJECTIVE: To investigate clinical outcome and hemostatic effects of fibrinogen concentrate (FC) in combination with prothrombin complex concentrate (PCC) versus standard treatment with fresh frozen plasma (FFP) in children undergoing cardiac surgery...
June 21, 2021: Acta Anaesthesiologica Scandinavica
Bjarni Árnason, Daniel Hertzberg, Daniel Kornhall, Mattias Günther, Mikael Gellerfors
BACKGROUND: Prehospital tracheal intubation in trauma patients has recently been questioned. However, not only the trauma and patient characteristics but also airway provider competence differ between systems making simplified statements difficult. METHOD: The study is a subgroup analysis of trauma patients included in the PHAST study. PHAST was a prospective, observational, multicentre study on pre-hospital advanced airway management by anaesthesiologist and nurse anaesthetist manned prehospital critical care teams in the Nordic countries May 2015 to November 2016...
June 21, 2021: Acta Anaesthesiologica Scandinavica
Marie Warrer Munch, Tine Sylvest Meyhoff, Marie Helleberg, Maj-Brit Nørregaard Kjaer, Anders Granholm, Carl Johan Steensen Hjortsø, Thomas Steen Jensen, Morten Hylander Møller, Peter Buhl Hjortrup, Mik Wetterslev, Gitte Kingo Vesterlund, Lene Russell, Vibeke Lind Jørgensen, Klaus Tjelle Kristiansen, Thomas Benfield, Charlotte Suppli Ulrik, Anne Sofie Andreasen, Morten Heiberg Bestle, Lone Musaeus Poulsen, Thomas Hildebrandt, Lene Surland Knudsen, Anders Møller, Christoffer Grant Sølling, Anne Craveiro Brøchner, Bodil Steen Rasmussen, Henrik Nielsen, Steffen Christensen, Thomas Strøm, Maria Cronhjort, Rebecka Rubenson Wahlin, Stephan M Jakob, Luca Cioccari, Balasubramanian Venkatesh, Naomi Hammond, Vivekanand Jha, Sheila Nainan Myatra, Marie Qvist Jensen, Jens Wolfgang Leistner, Vibe Sommer Mikkelsen, Jens S Svenningsen, Signe Bjørn Laursen, Emma Victoria Hatley, Camilla Meno Kristensen, Ali Al-Alak, Esben Clapp, Trine Bak Jonassen, Caroline Løkke Bjerregaard, Niels Christian Haubjerg Østerby, Mette Mindedahl Jespersen, Dalia Abou-Kassem, Mathilde Languille Lassen, Reem Zaabalawi, Mohammed Mahmoud Daoud, Suhayb Abdi, Nick Meier, Kirstine la Cour, Cecilie Bauer Derby, Birka Ravnholt Damlund, Jens Laigaard, Lene Lund Andersen, Johan Mikkelsen, Jeppe Lundholm Stadarfeld Jensen, Anders Hørby Rasmussen, Emil Arnerlöv, Mathilde Lykke, Mikkel Zacharias Bystrup Holst-Hansen, Boris Wied Tøstesen, Janne Schwab, Emilie Kabel Madsen, Christian Gluud, Theis Lange, Anders Perner
BACKGROUND: In the early phase of the pandemic, some guidelines recommended the use of corticosteroids for critically ill patients with COVID-19, whereas others recommended against the use despite lack of firm evidence of either benefit or harm. In the COVID STEROID trial, we aimed to assess the effects of low-dose hydrocortisone on patient-centred outcomes in adults with COVID-19 and severe hypoxia. METHODS: In this multicentre, parallel-group, placebo-controlled, blinded, centrally randomised, stratified clinical trial, we randomly assigned adults with confirmed COVID-19 and severe hypoxia (use of mechanical ventilation or supplementary oxygen with a flow of at least 10 L/min) to either hydrocortisone (200 mg/day) versus a matching placebo for 7 days or until hospital discharge...
June 17, 2021: Acta Anaesthesiologica Scandinavica
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