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Retningslinjer for oppfølging av tvillingsvangerskap og fødsler
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The objective of this study is to find out how guidelines for management of twin pregnancy and delivery have changed over the past century. It was also in our concern to look into the scientific basis of these recommendations.
The paper is based on a study of literature. The material consisted of a total of 129 articles. This was achieved by a manual search through the Old Medical Library at UiO, in combination with computer search through medical databases. Keywords for the search were “twin”, “multiple” and “pregnancy”. Other criteria were English or Scandinavian language and a systematic index.
The articles were assessed from a chronological point of view. The themes discussed and the guidelines given were compared decade by decade.
There are three main findings concerning antenatal management of twin pregnancy. Obstetricians worldwide have agreed that bed rest should no longer be recommended for women carrying twins. Secondly, the methods for diagnosing twin pregnancies have changed since the 1970-ies from strictly clinical to ultrasound-based. Thirdly, the development of the ultrasound technology has opened for new diagnostic and interventional methods.
On the issues regarding twin delivery, the guidelines have changed. The first half of the 20th century was characterized by lack of antenatal diagnosis of twins, which meant that few twin births were prepared beforehand. Today there are wide diagnostic possibilities and an opportunity to plan twin delivery.
To conclude, the literature shows that obstetrical guidelines change over time. The changes reflect the available medical scientific knowledge and technological development of each given period of time
Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study
No full textBackground Results from retrospective studies suggest that use of neuromuscular blocking agents during general
anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use
of neuromuscular blocking agents is associated with postoperative pulmonary complications.
Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in
28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital
procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge
were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination
within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative
pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were
adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and
adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513.
Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular
blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who
had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI
–5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised
without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49;
ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7)
were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex
instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at
a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes.
Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an
increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of
neuromuscular blockade against the increased risk of postoperative pulmonary complications
