Acta Anaesthesiologica Scandinavica
1399-6576
0001-5172
Đan mạch
Cơ quản chủ quản: Blackwell Munksgaard , WILEY
Lĩnh vực:
Anesthesiology and Pain MedicineMedicine (miscellaneous)
Phân tích ảnh hưởng
Thông tin về tạp chí
Acta Anaesthesiologica Scandinavica publishes papers on original work in the fields of anaesthesiology, intensive care, pain, emergency medicine, and subjects related to their basic sciences, on condition that they are contributed exclusively to this Journal. Case reports and short communications may be considered for publication if of particular interest; also letters to the Editor, especially if related to already published material. The editorial board is free to discuss the publication of reviews on current topics, the choice of which, however, is the prerogative of the board. Every effort will be made by the Editors and selected experts to expedite a critical review of manuscripts in order to ensure rapid publication of papers of a high scientific standard.
Các bài báo tiêu biểu
Neurologic and histologic outcome after intraneural injections of lidocaine in canine sciatic nerves Background: Inadvertent intraneural injection of local anesthetics may result in neurologic injury. We hypothesized that an intraneural injection may be associated with higher injection pressures and an increase in the risk of neurologic injury.Methods: The study was conducted in accordance with the principles of laboratory animal care, and was approved by the Laboratory Animal Care and Use Committee. Fifteen dogs of mixed breed (16–21 kg) were studied. After general endotracheal anesthesia, the sciatic nerves (n = 30) were exposed bilaterally. Under direct vision, a 25‐gauge, long‐beveled needle (30°) was placed either epineurally (n = 10) or intraneurally (n = 20), and 4 ml of preservative‐free lidocaine 20 mg/ml was injected using an automated infusion pump (4 ml/min). Injection pressure data were acquired using an in‐line manometer coupled to a computer via an analog‐to‐digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations. One week later, the dogs were killed, the sciatic nerves excised and histologic examination was performed by pathologists blind to the purpose of the study.Results: All perineural injections resulted in low pressures (≤ 5 psi). In contrast, eight of 20 intraneural injections resulted in high pressures (20–38 psi) at the beginning of the injection. Twelve intraneural injections, however, resulted in pressures of less than 12 psi. Neurologic function returned to baseline within 3 h after perineural injections and within 24 h after intraneural injections, when the measured injection pressures were less than 12 psi. Neurologic deficits persisted throughout the study period after all eight intraneural injections that resulted in high injection pressures. Histologic examination of the affected nerves revealed fascicular axonolysis and cellular infiltration.Conclusions: The data in our canine model of intraneural injection suggest that intraneural injections do not always lead to nerve injury. High injection pressures during intraneural injection may be indicative of intrafascicular injection and may predict the development of neurologic injury.
Tập 51 Số 1 - Trang 101-107 - 2007
Pain management after total hip arthroplasty at five different Danish hospitals: A prospective, observational cohort study of 501 patients Background The available literature does not present a “gold standard” for post‐operative pain treatment after total hip arthroplasty (THA). The aim of this prospective observational study was to explore and document post‐operative pain treatment, including outcomes, in a large cohort of patients undergoing THA at five different Danish hospitals. Methods This prospective, multicentre, observational cohort study of 501 THA patients was performed at five different hospitals in the Capital Region and at the Region Zealand in Denmark, from April 2014 to April 2016. The study had two co‐primary outcomes: Pain during mobilisation at 6 hours post‐operatively (numeric rating scale [NRS] [0‐10]) and morphine consumption 0‐24 hours post‐operatively. Results A large variety of analgesic treatments were used at the included hospitals and none of the hospitals used the same non‐opioid basic analgesic regimen. For all patients at all hospitals, the NRS–pain level during mobilisation at 6 hours was 5 (3‐6), (median [interquartile range]) and the 24‐hour intravenous morphine (eqv) consumption was 25 mg (18‐35). Although some statistically significant differences between hospitals were found for morphine use, no non‐opioid analgesic regimen demonstrated consistent clinically relevant superior efficacy. In general, pain levels at rest were low to moderate and pain during mobilisation was moderate. Conclusions Analgesic treatment routines differed between hospitals. Pain levels, however, did not differ substantially and were in general low at rest and moderate during mobilisation. No non‐opioid analgesic treatment demonstrated consistent analgesic superiority.
Tập 63 Số 7 - Trang 923-930 - 2019
Methylmethacrylate monomer produces direct relaxation of vascular smooth muscle <i>in vitro</i> Methylmethacrylate bone cement is associated with severe hypotensive reactions during surgery and anesthesia. The purpose of this in vitro study was to determine if methylmethacrylate monomer could produce hypotension by acting directly on vascular smooth muscle. Segments of human saphenous vein or rabbit thoracic aorta were cut into rings. The rings were mounted in isolated tissue chambers in order to measure isometric tension development. Methylmethacrylate monomer (methylmethacrylic acid ester) produced direct relaxation of venous or aortic rings preconstricted with either potassium ion or noradrenaline. The relaxation was concentration‐dependent, occurring at concentrations from 10‐1 to 10‐1 M. The relaxation of rabbit aortic rings {preconstricted with noradrenaline) was unaffected by pre‐treatment with atropine, propranolol, cimetidine, indomethacin, or methylene blue. Endothelial stripping with Triton X‐100, sufficient to completely abolish acetylcholine‐induced relaxation, also had little effect on methylmethacrylate‐induced relaxation. Methylmethacrylate produced direct relaxation of rabbit aortic rings constricted with either potassium or noradrenaline in calcium‐deficient media, and inhibited subsequent calcium‐induced constriction. These results suggest that methylmethacrylate monomer may interfere with intracellular and extracellular calcium mobilization and excitation/contraction coupling in vascular smooth muscle. The direct relaxation of venous and arterial smooth muscle produced by methylmethacrylate monomer may contribute in part to the hypotension that can occur when acrylic bone cement is employed during orthopedic procedures.
Tập 39 Số 5 - Trang 685-689 - 1995
The effects of intraoperative infusion of dexmedetomidine on early renal function after percutaneous nephrolithotomy
Tập 55 Số 5 - Trang 539-544 - 2011
Evaluation of myocardial contractility in the chronically instrumented dog with intact autonomic nervous system function: effects of desflurane and isoflurane Characterization of changes in myocardial contractility using indices derived from ventricular pressure‐segment length loops in animals with intact autonomic nervous system (ANS) function is complicated by alterations in systemic hemodynamics mediated by baroreceptor reflexes and by spontaneous respiration and its effects on ventricular pressure and filling. This investigation examined and compared the effects of desflurane and isoflurane on myocardial contractility in dogs with intact ANS reflexes using techniques designed to overcome these potential difficulties. Two groups comprising 18 experiments were performed using nine dogs chronically instrumented for measurement of aortic and left ventricular pressure, the maximum rate of increase of left ventricular pressure (dP/dt), subendocardial segment length, cardiac output and intrathoracic pressure. A brief occlusion of the inferior vena cava was used to alter preload to generate pressure‐length loops prior to onset of baroreceptor reflex‐mediated increases in heart rate. Respiratory variation in ventricular pressure was negated by calculation of “transmural pressure” via instantaneous subtraction of intrathoracic pressure from corresponding left ventricular pressure. Contractility was then evaluated in the conscious and anesthetized states using transmural pressure‐length loops and calculation of the preload recruitable stroke work (PRSW) relationship. Dogs were anesthetized with 1.25, 1.5, or 1.75 MAC desflurane or isoflurane and measurements were repeated after 30 min of equilibration at each anesthetic concentration. Desflurane and isoflurane produced similar declines in PRSW slope [Mw ; 41±6 (5.5 ±0.8) during 1.75 MAC desflurane compared to 43 ± 5 mmHg (5.7 ± 0.7 kPa) during 1.75 MAC isoflurane], indicating that these agents cause similar depression of contractile state at equivalent MAC. The PRSW relationship derived from transmural pressure‐length loops using brief inferior vena caval occlusion may facilitate the examination of the impact of other volatile and intravenous anesthetics on myocardial contractility using a load‐independent index of contractile state in the presence of intact ANS reflexes.
Tập 37 Số 2 - Trang 203-210 - 1993
Modifications of the National Early Warning Score for patients with chronic respiratory disease Background The National Early Warning Score (NEWS) uses physiological variables to detect deterioration in hospitalized patients. However, patients with chronic respiratory disease may have abnormal variables not requiring interventions. We studied how the Capital Region of Denmark NEWS Override System (CROS), the Chronic Respiratory Early Warning Score (CREWS) and the Salford NEWS (S‐NEWS) affected NEWS total scores and NEWS performance. Methods In an observational study, we included patients with chronic respiratory disease. The frequency of use of CROS and the NEWS total score changes caused by CROS, CREWS and S‐NEWS were described. NEWS, CROS, CREWS and S‐NEWS were compared using 48‐h mortality and intensive care unit (ICU) admission within 48 h as outcomes. Results We studied 11,266 patients during 25,978 admissions; the use of CROS lowered NEWS total scores in 40% of included patients. CROS, CREWS and S‐NEWS had lower sensitivities than NEWS for 48‐h mortality and ICU admission. Specificities and PPV were higher. CROS, CREWS and S‐NEWS downgraded, respectively, 51.5%, 44.9% and 32.8% of the NEWS total scores from the ‘mandatory doctor presence’ and ‘immediate doctor presence and specialist consultation’ total score intervals to lower intervals. Conclusion Capital Region of Denmark NEWS Override System was frequently used in patients with chronic respiratory disease. CROS, CREWS and S‐NEWS reduced sensitivity for 48‐h mortality and ICU admission. Using the methodology prevalent in the NEWS literature, we cannot conclude on the safety of these systems. Future prospective studies should investigate the balance between detection rate and alarm fatigue of different systems, or use controlled designs and patient‐centred outcomes.
Tập 62 Số 2 - Trang 242-252 - 2018
Cerebral cortical effects of desflurane in sheep: comparison with isoflurane, sevoflurane and enflurane Background: Different volatile anesthetic agents have differing propensities for inducing seizures. A measure of the predilection to develop seizures is the presence of interictal spike discharges (spikes) on the electrocorticogram (ECoG). In this study, we investigated the propensity of desflurane to induce cortical spikes and made a direct objective comparison with enflurane, isoflurane, and sevoflurane. The ECoG effects of desflurane have not been previously reported.Methods: After establishment of invasive monitoring and a parasagittal array of eight electrodes to record the ECoG; eight adult merino sheep were given a series of short inhalational anesthetics (using desflurane, enflurane, sevoflurane and isoflurane); each titrated to ECoG burst suppression. Anesthetic effect was estimated by the effects on the approximate entropy of the ECoG. The effect of anesthetic on the spike‐rate in the ECoG was analyzed using a non‐linear mixed‐effect method with a sigmoid Emax model.Results: A similar ‘depth of anesthesia’ was achieved for each agent, as estimated by the approximate entropy. The mean (SD) values of Emax for the spike‐rate vs. approximate entropy relationship were desflurane 0.5 (0.9), enflurane 17.2 (4.0), isoflurane 0.7 (1.2), and sevoflurane 5.3 (1.2) spikes/min. The spike rate caused by desflurane was similar to isoflurane and significantly lower than that of enflurane (P < 0.001), and sevoflurane (P = 0.009).Conclusion: Desflurane induces minimal cerebral cortical spike activity when administered to burst suppression, consistent with its low propensity for inducing seizures in non‐epileptic brains. The agents can be ranked by their relative ability to cause spike activity: enflurane >> sevoflurane > isoflurane = desflurane.
Tập 50 Số 3 - Trang 313-319 - 2006
Regional anaesthesia and cancer metastases: the implication of local anaesthetics
Tập 57 Số 10 - Trang 1211-1229 - 2013
Cognitive dysfunction after minor surgery in the elderly Background: Major surgery is frequently associated with postoperative cognitive dysfunction (POCD) in elderly patients. Type of surgery and hospitalization may be important prognostic factors. The aims of the study were to find the incidence and risk factors for POCD in elderly patients undergoing minor surgery.Methods: We enrolled 372 patients aged greater than 60 years scheduled for minor surgery under general anesthesia. According to local practice, patients were allocated to either in‐ (199) or out‐patient (173) care. Cognitive function was assessed using neuropsychological testing preoperatively and 7 days and 3 months postoperatively. Postoperative cognitive dysfunction was defined using Z‐score analysis.Results: At 7 days, the incidence (confidence interval) of POCD in patients undergoing minor surgery was 6.8% (4.3–10.1). At 3 months the incidence of POCD was 6.6% (4.1–10.0). Logistic regression analysis identified the following significant risk factors: age greater than 70 years (odds ratio [OR]: 3.8 [1.7–8.7], P = 0.01) and in‐ vs. out‐patient surgery (OR: 2.8 [1.2–6.3], P = 0.04).Conclusions: Our finding of less cognitive dysfunction in the first postoperative week in elderly patients undergoing minor surgery on an out‐patient basis supports a strategy of avoiding hospitalization of older patients when possible.
Tập 47 Số 10 - Trang 1204-1210 - 2003
Desflurane versus propofol maintenance for outpatient laparoscopic cholecystectomy Background : The aims of the study were to evaluate costs and clinical characteristics of desflurane‐based anaesthetic maintenance versus propofol for outpatient cholecystectomy.Methods : All 60 patients received ketamine 0.2 mg kg‐1 , fentanyl 2 μg kg‐1 and propofol 2 mg kg‐1 for induction. Ketorolac 0.4 mg kg‐1 and ondansetron 0.05 mg kg‐1 +droperidol 20 μg Kg‐1 was given as prophylaxis for postoperative pain and emesis, respectively. The patients were randomly assigned into Group P with propofol maintenance and opioid supplements, or Group D with desflurane in a low‐flow circuit system.Results : All the patients were successfully discharged within 8 h without any serious complications. Emergence from anaesthesia was more rapid after desflurane; they opened their eyes and stated date of birth at mean 6.4 and 8.4 min respectively, compared with 9.6 and 12 min in the propofol group (P<0.05). Nausea and pain were more frequent in Group D, 40% and 80% respectively; versus 17% and 50% in Group P (P<0.05). By telephone interview at 24 h and 7 d after the procedure, there was no major difference between the groups. With desflurane, drug costs per case were 10 $ lower than with propofol.Conclusion : We conclude that desflurane is cheaper and has a more rapid emergence than propofol for outpatient cholecystectomy. However, propofol results in less pain and nausea in the recovery unit. Despite ondansetron and droperidol prophylaxis, there was still a substantial amount of nausea and vomiting after desflurane.
Tập 42 Số 1 - Trang 106-110 - 1998