Acta Anaesthesiologica Scandinavica

Olav Magnus Fredheim, Ingeborg Marie Skulberg, Morten Magelssen, Siri Steine
BACKGROUND: The anaesthetic propofol is often mentioned as a drug that can be used in palliative sedation. The existing literature of how to use propofol in palliative sedation is scarce, with lack of information about how propofol could be initiated for palliative sedation, doses and treatment outcomes. AIM: To describe the patient population, previous and concomitant medication and clinical outcome when propofol was used for palliative sedation. METHODS: A retrospective study with quantitative and qualitative data...
July 6, 2020: Acta Anaesthesiologica Scandinavica
Marianne Ylikoski, Janne J Jokinen, Jorma Lahtela, Markku J Kauppi, Heini Huhtala, Heidi Immonen, Raine Tiihonen
BACKGROUND: Perioperative dysglycaemia is associated with deleterious outcomes but guidelines to improve glucose management are poorly or inconsistently adhered to. We evaluated glucose management among diabetic and nondiabetic patients undergoing elective hip or knee arthroplasty. METHODS: Capillary plasma glucose (CPG) was measured prospectively four times daily of 209 patients undergoing elective hip or knee surgery. Actions of the attending teams to CPG values and detection of patients at risk were analysed...
July 2, 2020: Acta Anaesthesiologica Scandinavica
Minna Kallioinen, Jussi P Posti, Melissa Rahi, Deepak Sharma, Ari Katila, Juha Grönlund, Tero Vahlberg, Janek Frantzén, Klaus T Olkkola, Teijo I Saari, Riikka Takala
BACKGROUND: Cerebral autoregulation is often impaired after aneurysmal subarachnoid haemorrhage (aSAH). Dexmedetomidine is being increasingly used, but its effects on cerebral autoregulation in patients with aSAH have not been studied before. Dexmedetomidine could be a useful sedative in patients with aSAH as it enables neurological assessment during the infusion. The aim of this preliminary study was to compare the effects of dexmedetomidine on dynamic and static cerebral autoregulation with propofol and/or midazolam in patients with aSAH...
July 1, 2020: Acta Anaesthesiologica Scandinavica
S R Rasmussen, K Kandler, R V Nielsen, P C Jakobsen, M Ranucci, H B Ravn
BACKGROUND: Acute kidney injury (AKI) is a serious complication following cardiac surgery associated with increased mortality. Red blood cell transfusion enhances the risk of developing AKI. However, the impact of other blood products on AKI is virtually unexplored. The aim of this study was to explore if transfusion of red blood cells, fresh frozen plasma and platelets alone or in combination was associated with postoperative AKI. METHODS: Patients undergoing elective on-pump cardiac surgery were included (n=1960) between 2012 to 2014...
July 1, 2020: Acta Anaesthesiologica Scandinavica
Nina Andersen-Ranberg, Lone M Poulsen, Anders Perner, Jørn Wetterslev, Ole Mathiesen, Camilla B Mortensen, Stine Estrup, Bjørn H Ebdrup, Johanna Hästbacka, Giuseppe Citerio, Jesus Caballero, Matthew P G Morgan, Marie Oxenbøll-Collet, Sven-Olaf Weber, Anne Sofie Andreasen, Morten H Bestle, Helle B S Pedersen, Louise G Nielsen, Bülent Uslu, Troels B Jensen, Carsten Thee, Nilanjan Dey, Theis Lange
BACKGROUND: The AID-ICU trial aims to assess the benefits and harms of haloperidol for the treatment of delirium in acutely admitted, adult intensive care unit (ICU) patients. This paper describes the detailed statistical analysis plan for the primary publication of results from the AID-ICU trial. METHODS: The AID-ICU trial is a investigator-initiated, pragmatic, international, multicentre, randomised, blinded, parallel-group trial allocating 1000 adult ICU patients with manifest delirium 1:1 to haloperidol or placebo...
June 27, 2020: Acta Anaesthesiologica Scandinavica
Nicola G Clausen, Maja Filipovic, Gerrit H de Pater, Caroline Zickerman, Mogens Ydemann
BACKGROUND: In Denmark, thousands of infants and children require general anaesthesia annually. Hypotension during general anaesthesia might reduce cerebral blood flow and oxygen delivery to the brain. Safe lower limits of blood pressure are ill defined. The Hypotension in Paediatric Populations Observational study objective was to assess blood pressure in Danish children during general anaesthesia. METHODS: This study is a prospective observational multicentre study...
June 26, 2020: Acta Anaesthesiologica Scandinavica
Elin Helset, Ingvild Nordøy, Hilde Sporsem, Victoria D Bakke, Jan F Bugge, Karianne W Gammelsrud, Manuela Zucknick, Elisabeth von der Lippe
BACKGROUND: Vancomycin trough levels are frequently subtherapeutic in intensive care unit (ICU) patients. The aim of this study was to identify patients at risk of therapeutic failure defined as vancomycin area-under-the-curve0-24 /minimum inhibitory concentration (AUC0-24 /MIC) <400, and to examine possible effects of different MICs, the variability in renal clearance and continuous renal replacement therapy (CRRT), and the relevance of vancomycin therapy. METHODS: A prospective observational study of ICU patients ≥ 18 years at initiation of vancomycin therapy was conducted from May 2013 to October 2015...
June 23, 2020: Acta Anaesthesiologica Scandinavica
P Uusalo, M J Järvisalo
INTRODUCTION: Use of metformin increases plasma lactate concentration and may lead to metformin-associated lactic acidosis (MALA). Previous studies have suggested severe MALA to have a mortality of 17-21%, but have included patients with other coincident conditions such as sepsis. The treatment of choice is continuous renal replacement therapy (CRRT), which has been performed using heparin analogues or no anticoagulation in former studies. MATERIALS AND METHODS: Patients admitted to the Intensive Care Unit of Turku University Hospital Finland with lactic acidosis without any other recognizable etiology than concomitant metformin treatment who required CRRT between years 2010-2019 were included...
June 21, 2020: Acta Anaesthesiologica Scandinavica
Eric B Rosero, Girish P Joshi
BACKGROUND: The suitability of ambulatory surgery in obese patients remains controversial. This study aimed to investigate the "cutoff" value of body mass index (BMI) associated with increased likelihood of hospital readmissions within the first 24 hours of surgery in patients undergoing ambulatory hernia repair. MATERIALS AND METHODS: The study used data from the 2012-2016 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP)...
June 19, 2020: Acta Anaesthesiologica Scandinavica
Charlotte Slagelse, Henrik Gammelager, Lene Hjerrild Iversen, Kathleen Dori Liu, Henrik Toft Sørensen, Christian Fynbo Christiansen
BACKGROUND: Angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin-receptor blocker (ARB) users may be associated with increased mortality in patients with postoperative acute kidney injury (AKI), but data are limited. We studied whether users of ACE-I/ARBs with AKI after colorectal cancer surgery (CRC) were associated with increased one-year mortality after AKI. METHODS: This population-based cohort study in Northern Denmark included patients with AKI within 7 days after CRC surgery during 2005-2014...
June 17, 2020: Acta Anaesthesiologica Scandinavica
Niklas I Nielsen, Henrik Kehlet, Kirill Gromov, Anders Troelsen, Henrik Husted, Claus Varnum, Per Kjaersgaard-Andersen, Lasse E Rasmussen, Hans Mandøe, Nicolai B Foss
BACKGROUND: Patients undergoing total knee arthroplasty (TKA) / total hip arthroplasty (THA) still experience moderate-severe postoperative pain despite optimized pain management regimes. Patients already on opioid-treatment, and pain catastrophizers (PCs) have a higher risk of postoperative pain. The use of preoperative intravenous high-dose glucocorticoids decreases postoperative pain after TKA and THA, but optimal dose is yet to be found, and the effect on subpopulations at high pain risk is unknown...
June 13, 2020: Acta Anaesthesiologica Scandinavica
Linda Block, Ali El Merhi, Jaquette Liljencrantz, Silvana Naredi, Miroslaw Staron, Helena Odenstedt Hergès
BACKGROUND: The onset of cerebral ischemia is difficult to predict in patients with altered consciousness using the methods available. We hypothesise that changes in Heart Rate Variability (HRV), Near-Infrared Spectroscopy (NIRS) and Electroencephalography (EEG) correlated to clinical data and processed by artificial intelligence (AI) can indicate the development of imminent cerebral ischemia and reperfusion respectively. This study aims to develop a method that enables detection of imminent cerebral ischemia in unconscious patients, noninvasively and with the support of AI...
June 13, 2020: Acta Anaesthesiologica Scandinavica
Jin Ha Park, Ki-Young Lee, Young Deuk Choi, Jongsoo Lee, Hye Jung Shin, Dong Woo Han, Jiwon Baek, So Yeon Kim
BACKGROUND: Ventricular repolarisation is affected differently by the types of anaesthetics used. This study aimed to compare the effect of different types of anaesthetics on ventricular repolarisation during robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: Sixty-nine patients were randomly assigned in a 1:1:1 ratio to the Sevoflurane (sevoflurane/remifentanil), Desflurane (desflurane/remifentanil), or total intravenous anaesthesia (TIVA [propofol/remifentanil]) groups; however, only 67 patients completed the study...
June 12, 2020: Acta Anaesthesiologica Scandinavica
Sine Wichmann, Marija Barbateskovic, Jane Lindschou, Christian Gluud, Anders Perner, Morten H Bestle
BACKGROUND: In the intensive care unit, fluid overload is frequent and a risk factor for organ dysfunction and increased mortality. Primarily, lung and kidney functions may be impaired by fluid overload resulting in acute respiratory failure and acute kidney injury. No clinical guidelines exist for treatment of fluid overload in intensive care patients. Loop diuretics, most often furosemide, appear to be the most frequently used pharmacological intervention. The aim of this protocol is to describe the methods of a systematic review assessing the evidence of treatment with loop diuretics in adult intensive care patients with fluid overload...
June 12, 2020: Acta Anaesthesiologica Scandinavica
Josefine S Baekgaard, Trine G Eskesen, Jae Moo Lee, Camilla Ikast Ottosen, Katrine Bennett Gyldenkaerne, Jasmin Garoussian, Rasmus Ejlersgaard Christensen, Martin Sillesen, David R King, George C Velmahos, Lars S Rasmussen, Jacob Steinmetz
BACKGROUND: In the trauma population, ketamine is commonly used during rapid sequence induction. However, as ketamine has been associated with important side effects this study sought to compare in-hospital mortality in trauma patients after induction with ketamine versus other induction agents. METHODS: We retrospectively identified adult trauma patients intubated in the pre-hospital phase or initially in the trauma bay at two urban level-1 trauma centers during a two-year period using local trauma registries and medical records...
June 12, 2020: Acta Anaesthesiologica Scandinavica
R Rentola, M B Skrifvars, E Heinonen, T Häggblom, J Hästbackax
BACKGROUND: Controlling arterial carbon dioxide is paramount in mechanically ventilated patients, and an accurate and continuous noninvasive monitoring method would optimize management in dynamic situations. In this study, we validated and further refined formulas for estimating partial pressure of carbon dioxide with respiratory gas and pulse oximetry data in mechanically ventilated cardiac arrest patients. METHODS: A total of 4,741 data sets were collected retrospectively from 233 resuscitated patients undergoing therapeutic hypothermia...
June 10, 2020: Acta Anaesthesiologica Scandinavica
Heike Vogelsang, Alexander Lang, Bilal Cevik, Nikolaj M Botteck, Thomas P Weber, Jennifer Herzog-Niescery
BACKGROUND: Thoracic epidural analgesia is beneficial after major abdominal surgery, though side-effects and complications are rare but potentially devastating. The incidence of catheter-related infection is approximately 5.5%. Several guidelines have been recommended to prevent complications during thoracic epidural catheterisation. Tunnelling is often recommended to reduce the incidence of infections and dislocations. METHODS: A retrospective, monocentric analysis of our acute pain service database was performed between 2010 and 2018...
June 10, 2020: Acta Anaesthesiologica Scandinavica
Heidi Kangasniemi, Piritta Setälä, Anna Olkinuora, Heini Huhtala, Joonas Tirkkonen, Antti Kämäräinen, Ilkka Virkkunen, Arvi Yli-Hankala, Esa Jämsen, Sanna Hoppu
BACKGROUND: Data are scarce on the withdrawal of life-sustaining therapies and limitation of care orders (LCOs) during physician-staffed Helicopter Emergency Medical Service (HEMS) missions. We investigated LCOs and the quality of information available when physicians made treatment decisions in prehospital care. METHODS: A prospective, nationwide, multicentre study including all Finnish physician-staffed HEMS bases during a six-month study period. All HEMS missions where a patient had pre-existing LCOs and/or a new LCO were included...
June 10, 2020: Acta Anaesthesiologica Scandinavica
Hyongmin Oh, Hyung-Been Yhim, Hyun-Kyu Yoon, Hyung-Chul Lee, Jung Hee Kim, Yong Hwy Kim, Hee-Pyoung Park
BACKGROUND: Anesthetic techniques can affect perioperative neuroendocrine function. The objective of this study was to compare 3-month postoperative neuroendocrine functional outcomes between sevoflurane and propofol anesthesia in patients undergoing endoscopic transsphenoidal surgery (ETS) for removal of non-functional pituitary adenomas (NFPAs) retrospectively. METHODS: Among 356 patients who underwent ETS for removal of NFPAs under sevoflurane-remifentanil anesthesia (sevoflurane group, n = 103) or propofol-remifentanil anesthesia (propofol group, n = 253), 92 patients in each group were selected and their 3-month postoperative neuroendocrine functional outcomes (primary outcome measure) were compared after propensity score matching...
May 29, 2020: Acta Anaesthesiologica Scandinavica
Helene K Nedergaard, Hanne I Jensen, Mette Stylsvig, Hanne T Olsen, Thomas Strøm, Palle Toft
BACKGROUND: Critical illness can cause posttraumatic stress and impaired mental health. The NONSEDA-trial was a Scandinavian multicenter RCT, assessing non-sedation versus sedation with a daily wake-up call during mechanical ventilation in critically ill adults. The aim of this sub-study was to assess the effect of non-sedation on posttraumatic stress and mental health. METHODS: This sub-study is based on all participating patients from a single NONSEDA trial-site (Kolding, Denmark)...
May 29, 2020: Acta Anaesthesiologica Scandinavica
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