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| 2. |
- Enekvist, Bruno, et al.
(författare)
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The effect of increased apparatus dead space and tidal volumes on carbon dioxide elimination and oxygen saturations in a low-flow anesthesia system.
- 2008
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Ingår i: Journal of Clinical Anesthesia. - : Elsevier BV. - 1873-4529 .- 0952-8180. ; 20:3, s. 170-174
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE: To determine if a large tidal volume (V(T)), with an unchanged end-tidal carbon dioxide partial pressure (P(ET)co(2)), could improve arterial carbon dioxide elimination, oxygen saturation (Spo(2)), and arterial blood oxygenation. DESIGN: Prospective, randomized, clinical study. SETTING: Single university hospital. PATIENTS: 60 ASA physical status I and II patients scheduled for elective urologic or general surgery. INTERVENTIONS: Patients were randomly assigned to one of two treatments: patients in group 1, nondead space (NDS), received a fresh gas flow of 1 L/min without added apparatus dead space volume. Patients in group 2, dead space (DS), received ventilation using an added dead space volume between the Y-piece and tracheal tube. In both groups, patients' lungs were ventilated to a fixed P(ET)co(2) value of 33.8 mmHg. Patients in the DS group were ventilated with V(T)s to maintain an airway plateau pressure (P(plateau)) of 0.04 cm H(2)O/kg over initial plateau pressure. The corrugated tube was then adjusted to maintain a fixed P(ET)co(2). MEASUREMENTS: Dead space volumes, P(ET)co(2), arterial CO(2) tension (Paco(2)), SpO(2), arterial O(2) tension (Pao(2)), V(T)s, and airway pressures were measured. MAIN RESULTS: Arterial CO(2) tension was significantly lower in the DS group, 36 +/- 2.3 mmHg, compared with the NDS group, 37.5 +/- 2.3 mmHg (P < 0.05), and the difference between P(ET)co(2) and Paco(2) was lower in the DS group than in the NDS group (P < 0.001). Oxygen saturation was 99% +/- 1.0% in the DS group compared with 98.5% +/- 1.5% in the NDS group (P < 0.05). Arterial O(2) tension was 13.2 +/- 25.5 mmHg in the DS group and 119.1 +/- 30.2 mmHg in NDS group (not significant). CONCLUSION: Larger V(T)s, with an unchanged P(ET)CO(2) concentration created by an added apparatus dead space volume, improved arterial carbon dioxide elimination.
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- Flisberg, Per, et al.
(författare)
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Apnea and bradypnea in patients receiving epidural bupivacaine-morphine for postoperative pain relief as assessed by a new monitoring method.
- 2002
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Ingår i: Journal of Clinical Anesthesia. - 1873-4529. ; 14:2, s. 129-134
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE: To evaluate postoperative breathing patterns with a new monitoring device in patients given bupivacaine-morphine epidural analgesia. DESIGN: Open explorative study. SETTING: Inpatient anesthesia in a university hospital setting. PATIENTS: 15 ASA physical status I and II patients aged 28 to 87 years and scheduled for major abdominal surgery. INTERVENTIONS: All patients underwent abdominal surgery with epidural anesthesia combined with general anesthesia. Postoperatively, they continued with epidural analgesia consisting of bupivacaine and morphine. On the first postoperative night, the breathing pattern was studied with a new noninvasive monitoring device measuring respiratory frequency and apnea. Arterial blood gas analysis was performed in case of apnea or low respiratory frequency. MEASUREMENTS AND MAIN RESULTS: A total of 84 alarm events were registered in 11 patients. Twenty-one percent (18/84) of the alarms were associated with arterial carbon dioxide tension (PaCO2) levels greater than 48.8 mmHg. Three of the four patients with PaCO2 levels greater than 48.8 mmHg were older than 80 years of age. CONCLUSION: The tested noninvasive monitoring device may detect abnormal respiratory breathing patterns in patients at risk for respiratory depression during epidural analgesia with bupivacaine-morphine.
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- Frković, Vedran, et al.
(författare)
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Finger width as a measure of femoral block puncture site : an ultrasonographic anatomical-anthropometric study
- 2015
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Ingår i: Journal of clinical anesthesia. - : Elsevier BV. - 0952-8180 .- 1873-4529. ; 27:7, s. 553-557
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Tidskriftsartikel (refereegranskat)abstract
- Study objective: Femoral nerve blockade is a regional anesthetic procedure that may be used in prehospital and emergency settings in cases of femoral trauma. Its speed and performance depend on how well the puncture site can be accurately located, something that usually is achieved via visible landmarks and/or by combining various universal preestablished measurements. Most of these methods have been derived from cadaver studies, which often suffer limitations in clinical settings. To facilitate a quick and easy determination of the puncture site, we here attempt to find an in vivo anthropometric measure that closely corresponds to the distance between the femoral artery and femoral nerve.Design: This is a prospective observational study.Patients: The study includes 67 patients presenting for elective surgery.Measurements: The distance from the femoral nerve to the femoral artery, projected to the skin, was measured by a 13-MHz ultrasonographic linear probe. Anthropometric measurements of the width of the hand fingers were carried out at the distal interphalangeal joints.Results: The distance from the femoral artery to the femoral nerve projected to the skin was found to closely correspond to the width of the fifth finger of the dominant hand measured at the distal interphalangeal joint.Conclusion: Because it relies on individual anthropometric information, this finding offers an individualized approach to determining the puncture site in a given patient. We believe that such an approach can improve and simplify femoral nerve blockade procedures in prehospital and emergency settings.
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| 5. |
- Johansson, Anders, et al.
(författare)
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The quotient end-tidal/inspired concentration of sevoflurane in a low-flow system.
- 2002
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Ingår i: Journal of Clinical Anesthesia. - 1873-4529. ; 14:4, s. 267-270
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE: To investigate the effect of two different fresh gas flows on inspired and end-tidal sevoflurane concentration for a given vaporizer setting in a low-flow anesthesia system.DESIGN: Prospective clinical study.SETTING: Department of Anesthesiology of a university teaching hospital.PATIENTS: 56 ASA physical status I and II patients without systemic diseases, having elective surgery with an expected anesthesia time of at least 120 minutes.INTERVENTIONS: Patients were randomly assigned to receive either 1.0 or 2.0 L/min fresh gas flow with the vaporizer setting fixed at 2% sevoflurane. The inspired (In), end-tidal (Et), and Et/In ratio sevoflurane concentrations were estimated.MEASUREMENTS AND MAIN RESULTS: After 120 minutes of sevoflurane anesthesia the inspired and end-tidal sevoflurane concentration were 1.45 +/- 0.10% versus 1.28 +/- 0.12% (p < 0.001) in the 1.0 L/min group and 1.64 +/- 0.08% versus 1.46 +/- 0.11% (p < 0.001) in the 2.0 L/min group. The ratio end-tidal and inspired concentrations/vaporizer setting was 0.64 +/- 0.06 and 0.73 +/- 0.05 in the 1.0 L/min group versus 0.73 +/- 0.05 and 0.82 +/- 0.04 in the 2.0 L/min group. For the ratio inspired and end-tidal/vaporizer setting there were significant difference between the groups (p < 0.001). The estimated ratio end-tidal/inspired was 0.88 +/- 0.04 in the 1.0 L/min group versus 0.89 +/- 0.04 in the 2.0 L/min group (ns).CONCLUSION: After 120 minutes of sevoflurane anesthesia at a vaporizer setting of 2% there is a significant difference between fresh gas flow of 1.0 and 2.0 L/min for inspired and end-tidal concentrations, but not for the ratio end-tidal/inspired.
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| 6. |
- Johansson, Anders, et al.
(författare)
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Wound infiltration with ropivacaine and fentanyl: Effects on postoperative pain and PONV after breast surgery
- 2003
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Ingår i: Journal of Clinical Anesthesia. - 1873-4529. ; 15:2, s. 113-118
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Tidskriftsartikel (refereegranskat)abstract
- Study Objective: To determine whether Postoperative wound infiltration with local anesthetics combined with fentanyl improves analgesia following breast surgery; and to investigate awakening and Postoperative nausea/vomiting. Design: Prospectively randomized clinical study. Setting: University hospital. Patients: 45 ASA physical status I and II patients scheduled for breast surgery. Interventions: Patients were prospectively randomized and assigned to one of three treatments during general anesthesia: postsurgical wound infiltration with ropivacaine 0.375%; wound infiltration with ropivacaine 0.375% combined with fentanyl 0.5 mug/kg; and intravenous (IV) fentanyl 0.5 mug/kg before skin incision and no wound infiltration. Time to first verbal response, Pain at rest, Postoperative nausea and vomiting, and ketobemidone and dixyrazine utilization were compared. Measurements and Main Results: Time to first verbal response was significantly shorter in the IV fentanyl group compared to both infiltration groups (8.1 +/- 4.5 min vs. 15.3 +/- 4.3, and 12.0 +/- 5.0 min; p < 0.05, respectively). Postoperative Pain at rest, and nausea and vomiting occurred with similar frequencies in the groups. Ketobemidone utilization in both infiltration groups, (2.4 +/- 1.8 mg and 3.1 +/- 1.8 mg, respectively) was not different compared to the IV fentanyl group (2.9 +/- 2.0 mg; NS). There were no differences in Postoperative antiemetic requirements during the first, second and third two-hour periods postoperatively. The dixyrazine consumption was similar in the three groups, (0.9 +/- 1.5 mg, 0.8 +/- 1.3 mg, and 1.4 +/- 1.8 mg, respectively; NS). Conclusion: Postsurgical ropivacaine wound infiltration, with or without adding fentanyl, demonstrates no differences in postoperative Pain relief and nausea/vomiting compared to a balanced general anesthetic including IV fentanyl. (C) 2003 by Elsevier Science Inc.
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| 8. |
- Khanna, Ashish K, et al.
(författare)
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Role of continuous pulse oximetry and capnography monitoring in the prevention of postoperative respiratory failure, postoperative opioid-induced respiratory depression and adverse outcomes on hospital wards: A systematic review and meta-analysis.
- 2024
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Ingår i: Journal of clinical anesthesia. - 1873-4529. ; 94
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Forskningsöversikt (refereegranskat)abstract
- The current standards of postoperative respiratory monitoring on medical-surgical floors involve spot-pulse oximetry checks every 4-8h, which can miss the opportunity to detect prolonged hypoxia and acute hypercapnia. Continuous respiratory monitoring can recognize acute respiratory depression episodes; however, the existing evidence is limited. We sought to review the current evidence on the effectiveness of continuous pulse oximetry (CPOX) with and without capnography versus routine monitoring and their effectiveness for detecting postoperative respiratory failure, opioid-induced respiratory depression, and preventing downstream adverse events.We performed a systematic literature search on Ovid Medline, Embase, and Cochrane Library databases for articles published between 1990 and April 2023. The study protocol was registered in Prospero (ID: 439467), and PRISMA guidelines were followed. The NIH quality assessment tool was used to assess the quality of the studies. Pooled analysis was conducted using the software R version 4.1.1 and the package meta. The stability of the results was assessed using sensitivity analysis.Systematic Review and Meta-Analysis.Postoperative recovery area.56,538 patients, ASA class II to IV, non-invasive respiratory monitoring, and post-operative respiratory depression.Continuous pulse oximetry with or without capnography versus routine monitoring.Respiratory rate, oxygen saturation, adverse events, and rescue events.23 studies (17 examined CPOX without capnography and 5 examined CPOX with capnography) were included in this systematic review. CPOX was better at recognizing desaturation (SpO2<90%) OR: 11.94 (95% CI: 6.85, 20.82; p<0.01) compared to standard monitoring. No significant differences were reported for ICU transfer, reintubation, and non-invasive ventilation between the two groups.Oxygen desaturation was the only outcome better detected with CPOX in postoperative patients in hospital wards. These comparisons were limited by the small number of studies that could be pooled for each outcome and the heterogeneity between the studies.
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| 10. |
- Schmidt, Annette, 1956, et al.
(författare)
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Is cell salvage safe in liver resection? A pilot study.
- 2009
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Ingår i: Journal of clinical anesthesia. - : Elsevier BV. - 1873-4529 .- 0952-8180. ; 21:8, s. 579-84
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the quality of cell salvaged (CS) blood in patients undergoing hemihepatectomy (study group) and compare it with CS-blood from aortic surgery (control group).
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