Acta Anaesthesiologica Scandinavica最新文献

Background: The objective of this study was to evaluate anaesthesia care professionals' perceptions and attitudes regarding the implementation and advancement of digital solutions in perioperative care.

Methods: Anaesthesia personnel working in public Swedish institutions where anaesthesia is administered were invited to respond to an online survey regarding their attitudes towards digitalization in the workplace and their perceptions of information provision and future digitalization within anaesthesia and surgical healthcare. Data were analyzed using descriptive statistics, independent-samples Kruskal-Wallis tests, and post-hoc pairwise comparisons.

Results: The survey response rate was 64.0% (n = 627). Most respondents agreed/strongly agreed that digital solutions facilitate their work, the preoperative preparation, patient participation, and being involved in the patients' journeys throughout the perioperative care process. The majority also agreed/strongly agreed that digital solutions could make more patients adequately prepared before anaesthesia/surgery, reduce the number of non-optimized patients, and adapt the perioperative process to the patients' individual needs, as well as lead to reduced costs for the healthcare provider and reduced cancelled anaesthesia/surgeries. However, there were statistically significant differences between responses in relation to age groups, where the largest differences were observed between respondents in the age groups 20-30 and 61-70 years and in relation to what part of Sweden respondents worked in, with the largest differences between respondents working in Southern Sweden and the middle part of Sweden.

Conclusion: Swedish anaesthesia personnel are confident that digital solutions may enhance the efficiency of care within the anaesthesia setting. However, varying perceptions on the benefits and necessity of digital solutions are indicated.

Background: Acute heart failure is a clinical syndrome characterized by cardiac dysfunction and neurohumoral activation, encompassing complex underlying pathophysiology which may vary across phenotypes. Nitroglycerine is a nitrate donor with vasodilatory effects on both venous capacitance vessels and arterial resistance vessels in higher doses, typically used with the aim of reducing congestion, preload, and afterload. A limited number of studies have proposed that nitroglycerin could promote diuresis and natriuresis. However, the exact hemodynamic effects of nitroglycerin remain uncertain in the clinical setting of acute decompensated heart failure. We hypothesize that intravenous nitroglycerin induces a significant increase in stroke volume and urinary output while lowering cardiac filling pressures.

Methods: This will be a prospective single-center interventional clinical study of 21 patients hospitalized with a diagnosis of AHF. Patients are examined before and after administration of intravenous nitroglycerin. To characterize hemodynamic phenotypes of AHF, continuous estimates of stroke volume will be obtained, and total blood volume estimated. Vital signs and estimates of peripheral perfusion will be recorded continuously. Measures of cardiac function, renal function, volume status, and autonomic function will be assessed sequentially.

Conclusion: This study will assess the acute effects of vasodilation on stroke volume and urinary output in hospitalized patients with AHF. Furthermore, characterizing the hemodynamic profile of the patient prior to vasodilation may help explore which patients will benefit from vasodilation.

Background: Total hip arthroplasty is a common surgical procedure, but dislocation remains a significant complication often requiring closed reduction. Current anesthetic practices for closed reduction of total hip arthroplasty vary widely, and evidence on the efficacy, safety, and cost-effectiveness of different anesthetic and analgetic regimens is limited.

Methods: This scoping review follows the Joanna Briggs Institute (JBI) guidelines and PRISMA-ScR framework. A systematic search will be conducted in major databases to identify studies on anesthetic approaches for closed reduction of dislocated total hip arthroplasty. Eligible studies will include adult patients and focus on outcomes such as success rate, complications, patient satisfaction, and procedural efficiency. Data will be extracted and synthesized narratively and descriptively.

Results: The review will map the existing evidence on anesthetic and analgetic regimens, including their success rates, associated complications, and cost-effectiveness. It will also highlight gaps in the literature and variations in practice across different settings.

Conclusion: By summarizing current evidence and identifying research gaps, this scoping review aims to inform clinical practice and guide future studies, ultimately improving the safety, effectiveness, and efficiency of anesthetic strategies for closed reduction of dislocated total hip arthroplasties.

Introduction: A decrease in renal perfusion during acute kidney injury (AKI) due to critical COVID-19 has previously been demonstrated. The objective of this study was to compare the effects of plasma expansion with a standardized fluid bolus on renal perfusion in critically ill patients with AKI compared to similar patients without AKI.

Methods: A case control study design was used to investigate group differences before and after a standardized intervention. ICU-treated COVID-19 patients without underlying kidney disease were assigned to two groups based on KDIGO Creatinine criteria for AKI. Renal perfusion was assessed by magnetic resonance imaging using phase contrast and arterial spin labeling before and directly after plasma expansion with 7.5 mL/kg Ringer's Acetate (Baxter). Arithmetic means of mean arterial pressures (MAP) recorded before and after plasma infusion were compared. Data was analyzed with a mixed model repeated measures ANOVA for all kidneys using a random effect to account for research subjects.

Results: Nine patients with AKI and eight without were included in the study. The hemodynamic response to plasma expansion was similar in both groups, with increases in MAP by 9 mmHg (95% CI 0.5-18) and 15 mmHg (95% CI 5-24) in patients with and without AKI, respectively. Total renal perfusion and cortical perfusion were not significantly changed by plasma expansion in either group. There was a reduction of medullary perfusion in patients without AKI from 55 (95% CI 39-79) to 34 (95% CI 24-48) mL/min/100 g (p = .0027).

Conclusion: Plasma expansion with a standardized fluid bolus did not increase renal perfusion in critically ill patients with COVID-19, with or without AKI.

Background: Both the European Society of Anaesthesiology and Intensive Care and the Difficult Airway Society recommend the use of neuromuscular blocking agents (NMBAs) to facilitate tracheal intubation and to reduce the risk of complications. Even though it is recommended to use video laryngoscopy for intubation, especially in circumstances where difficult tracheal intubation is expected, the evidence for the combination of video laryngoscopy and NMBAs is sparse. This protocol outlines a systematic review of the effect of avoidance versus use of NMBAs for tracheal intubation during video laryngoscopy in adults.

Methods: This protocol is made in accordance with reporting items for systematic reviews and meta-analyses protocols recommendations. We intent to include randomised controlled trials assessing the effect of avoidance versus use of NMBAs during video laryngoscopy to facilitate tracheal intubation (either nasal or oral) in the adult population. The primary outcome is failed first-pass intubation. Our secondary outcomes include adverse and serious adverse events. A thorough search will be done to identify relevant trials, including CENTRAL, MEDLINE, EMBASE, BIOSIS, Web of Science and CIHNAL. Furthermore, trial registries will be searched for unpublished trials. Each trial will be evaluated for bias. We will use appropriate packages in R to perform the meta-analysis. Additionally, we will perform trial sequential analysis on the meta-analysis of our primary outcome. Lastly, we will employ the GRADE approach and create "Summary of Findings" tables.

Background: Patients with chronic heart failure (CHF) experience congestion-related symptoms such as dyspnoea and oedema, both of which are associated with poor outcomes. Loop diuretics are the cornerstone to treat congestion and to maintain euvolemia. While furosemide is the most used loop diuretic, other loop diuretics may exhibit theoretical advantages. We aim to compare all types of loop diuretics for patients with CHF.

Methods: This protocol for a systematic review is conducted with guidance from the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will include randomised clinical trials (RCTs) of loop diuretics with other loop diuretics, placebo, or standard of care in CHF patients. The search will be conducted across the major medical databases (including Medline, Embase, and Cochrane Central Register of Controlled Trials). The searches will begin in February 2025. The primary outcome will be all-cause mortality. Secondary outcomes will be all-cause hospitalization, serious adverse events (SAEs), and changes in body weight (kg). Data will be analysed by traditional meta-analyses, Trial Sequential Analyses (TSA), and network meta analysis. The risk of bias will be assessed using the Cochrane Risk of Bias tool-version 2. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Confidence in Network Meta-Analysis (CINEMA) approach.

Background and methods: Few guidelines address how to handle unanticipated ventilatory problems and hypoxemia in a successfully intubated patient. We will refer to this situation as "can intubate-cannot ventilate." The situation may occur immediately after intubation or later during general anaesthesia. The aim of this paper is to describe an algorithm for handling this situation. In an intubated patient, the airway can be considered a continuum from the ventilator to the alveoli, and the problem is somewhere along this route: Ventilator → Hoses → Filter → Tracheal tube (TT) → Tracheae → Bronchi → Bronchioles → Alveoli. The proposed algorithm is based on clinical experience and has not been externally validated.

Results: The first critical decision to be made is whether the TT has been placed correctly in the trachea or not. Positive wave-formed capnography is the primary marker for correct intubation. Video and/or direct laryngoscopy can be used for further verification. The patient should be disconnected from the ventilator and manually ventilated with bag-valve and 100% oxygen. An open tube should then be verified by applying a suction catheter through the tube. If these measures do not improve the situation, a fibreoptic scope should be inserted to further assess possible causes of difficult ventilation. If no obvious treatable cause is detected at this point, bronchospasm, anaphylaxis, or pneumothorax should be ruled out or treated. Further handling should focus on optimizing gas exchange in the lungs and considering more advanced treatment options to improve oxygenation and circulation.

Conclusions: We have proposed an algorithm to handle unanticipated problems with ventilation and oxygenation in a patient who has been successfully intubated. Equipment failure and a blocked TT should be ruled out before diagnosing and treating medical or surgical causes of ventilatory problems.

Editorial comment: This article presents a logical approach to the time-sensitive and critical situation where, for some reason, after intubation, ventilation of the lungs is not succeeding. The authors propose steps for a systematic approach, and recognition of different possible explanations for ventilation not working is informative.

Background: Haemorrhage is a leading cause of morbidity and mortality in trauma, and prehospital transfusion of blood products is often necessary. Whole blood has been proposed to be the best alternative, but it is unclear whether, and how, storage and transport of the blood in a helicopter affects the blood units. We investigated the coagulation capacity and platelet function in whole blood at different time points during helicopter missions.

Methods: Twenty units of low-titre group O RhD negative whole blood were collected from healthy volunteers and analysed before, during and after transport in a helicopter. Coagulation and platelet function, as measured by thromboelastography, and blood samples for pH, electrolytes, glucose and lactate were assessed at baseline and 24, 72 and 168 h after storage in the helicopter. Plasma concentrations of coagulation factors and haemoglobin and blood counts were measured at baseline and after 168 h.

Results: Plasma concentrations of coagulation factors and haemoglobin did not change during storage and transport. Platelet counts decreased from a baseline mean of 172 ± 29 × 10⁹/L to a mean of 120 ± 28 × 10⁹/L after 168 h, and platelet function worsened slightly but significantly by 8%-9% during storage and transport. pH and glucose decreased while potassium and lactate levels increased after 168 h compared with baseline.

Conclusion: Storage and transport of whole-blood units in a rescue helicopter, for up to 168 h, had a slight impact on the blood quality. Storage of whole blood on board of the helicopter holds up to European standard, measured as temperature and haemolysis.

Background: The use of local anesthetics (LA) in individuals with Brugada syndrome (BrS) remains a subject of debate due to the lack of large-scale studies confirming their potential risks. This study primarily aimed to evaluate the incidence of new malignant arrhythmias or defibrillation events in patients diagnosed with BrS during the perioperative period, following the administration of local anesthetics, and within 30 days postoperatively. The secondary objective was to analyze the occurrence of adverse effects during hospitalization, as well as 30-day readmission and mortality rates.

Methods: A retrospective cohort study was performed on patients with BrS who underwent locoregional anesthesia between January 1, 1996, and September 30, 2020. Anesthetic records and electronic medical records were thoroughly reviewed for up to 30 days following each administration of local anesthetics.

Results: A total of 47 procedures involving patients with BrS who underwent locoregional anesthesia were analyzed. The patients were categorized into three groups: 27 in the peripheral nerve block (PNB) group, 13 in the epidural anesthesia group, and 9 in the spinal anesthesia group. One patient in the PNB group experienced intraoperative ventricular fibrillation following the administration of ajmaline. No other adverse events were observed.

Conclusion: In this retrospective study, our findings do not indicate an increased arrhythmogenic risk or a higher incidence of adverse events associated with the administration of local anesthetics in patients with BrS. However, the available data are insufficient to confirm the safety of local anesthetic use in this population. Enhanced vigilance is recommended when administering local anesthetics to individuals with BrS. Prospective studies are necessary to further evaluate and establish the safety profile of local anesthetics in this patient group.

Background: Estimating equations for the assessment of glomerular filtration rate (GFR) have been poorly investigated in the critical care setting. We evaluated the agreement between the GFR measured with ⁵¹CrEDTA/iohexol (mGFR) and four estimating equations based on serum concentrations of creatine and/or cystatin C (eGFR) in two cohorts: critically ill patients and outpatients with normal-to-moderately reduced GFR.

Methods: Forty-three patients in the critical care group and 48 patients in the outpatient group were included. GFR was measured (mGFR) by plasma infusion clearance of ⁵¹Cr-EDTA/iohexol (critical care group) and the single injection, one-sample plasma ⁵¹Cr-EDTA clearance technique (outpatients). The following estimating equations (eGFR) were used: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for creatinine (CKD-EPI_Cr), cystatin C (CKD-EPI_{Cys C}), creatinine+cystatin C (CKD-EPI_{Cr + Cys C}) and the Lund-Malmö creatinine+cystatin C equation (LM_{Cr + Cys C}). Agreement between mGFR and eGFR was assessed by the Bland-Altman method and accuracy by calculating P30 and P10.

Results: In the critically ill group, the bias between the estimating equations and mGFR was -3.6 to 2.8 mL/min/1.73 m², while the error was 121%-127% and the accuracy (P30) 33%-40%. In the outpatients, the bias between the estimating equations and mGFR was -13.0 to 7.6 mL/min/1.73 m², while the error was 31%-41% and the accuracy (P30), 67%-96%.

Conclusions: All four equations performed poorly in assessing GFR in the critically ill cohort with an unacceptably high error and low accuracy in contrast to the outpatient group. To accurately assess GFR in critically ill patients, GFR must be measured not estimated.

Editorial comment: For the assessment of glomerular filtration rate (GFR), it can be measured directly, but is frequently estimated using a point measure of serum creatinine concentration. In this study, ICU case GFR estimations, by different adjusted equations, done also for a cohort of outpatients, showed that these serum creatinine-based estimations for ICU cases are not highly precise or reliable.