Voiko anestesian syvyyttä mitata aivosähkökäyrällä?

Vaikka anestesiologinen monitorointi on viime vuosina kehittynyt nopeasti, tahaton hereillä olo yleisanestesian aikana on edelleen merkittävä kliininen ongelma. Sitä esiintyy noin yhdellä tuhannesta leikkauspotilaasta, mikä tarkoittaa kolminumeroista tapausten määrää Suomessa vuosittain. Anestesian riittävyyttä voidaan tavanomaisten kliinisten merkkien lisäksi arvioida muun muassa aivosähkökäyrässä (EEG:ssä) tapahtuvia muutoksia seuraamalla. Eri anestesiaaineiden EEG-vaikutukset ovat kuitenkin varsin moninaiset, eikä ihmisen tietoisuudelle tai tajuttomuudelle ole ainakaan toistaiseksi onnistuttu kehittämään yksiselitteistä neurofysiologista mittaria tai suuretta. Nykymenetelmien rajoituksista huolimatta kirjoittajat suosittelevat EEG:n ja siitä johdettujen indeksien rutiinimaista seurantaa osana modernin balansoidun anestesian monitorointia ja laadunvarmistust

Thromboelastometry-guided treatment algorithm in postpartum haemorrhage : a randomised, controlled pilot trial

Background: Postpartum haemorrhage causes significant mortality among parturients. Early transfusion of blood products based on clinical judgement and conventional coagulation testing has been adapted to the treatment of postpartum haemorrhage, but rotational thromboelastometry (ROTEM) may provide clinicians means for a goal-directed therapy to control coagulation. We conducted a parallel design, randomised, controlled trial comparing these two approaches. We hypothesised that a ROTEM-guided protocol would decrease the need for red blood cell transfusion. Methods: We randomised 60 parturients with postpartum haemorrhage of more than 1500 ml to receive either ROTEM-guided or conventional treatment, with 54 patients included in the final analysis. The primary outcome was consumption of blood products, and secondarily we assessed for possible side-effects of managing blood loss such as thromboembolic complications, infections, and transfusion reactions. Results: The median (25th–75th percentile) number of RBC units transfused was 2 (1–4) in the ROTEM group and 3 (2–4) in the control group (P=0.399). The median number of OctaplasLG® units given was 0 in both groups (0–0 and 0–2) (P=0.030). The median total estimated blood loss was 2500 ml (2100–3000) in the ROTEM group and 3000 ml (2200–3100) in the control group (P=0.033). No differences were observed in secondary outcomes. Conclusions: ROTEM-guided treatment of postpartum haemorrhage could have a plasma-sparing effect but possibly only a small reduction in total blood loss. Clinical trial registration: NCT02461251.publishedVersionPeer reviewe

S-ketamine for the treatment of depression

Abstract Ketamine infusion has been reported to rapidly relieve depressive symptoms and suicidal ideation in patients with treatment-resistant depression (TRD). It has also been tested in electroconvulsive therapy (ECT) anaesthesia and has been suggested to enhance the response to ECT. S-ketamine is less studied than a racemic mixture or R-enantiomer in these patients. S-ketamine is more potent as an anaesthetic and might thus also have a better antidepressive effect. In this article we present recent data concerning the antidepressive and adverse effects of S-ketamine compared with racemic and R-ketamine in major depressive disorder (MDD), especially in TRD. Based on recent literature, it is obvious that S-ketamine also possesses antidepressive properties. In ECT anaesthesia, S-ketamine might enhance the antidepressive effect of this treatment. S-ketamine may also be preferable when compared with other anaesthetics regarding adverse cognitive effects. Its adverse psychotomimetic effects may be avoidable when used in anaesthetic doses. Although the data on S-ketamine at the moment is only based on case reports and expert opinions rather than adequate prospective randomized studies, it still may offer an important option when treating severe and resistant depression

Thermal suit connected to a forced-air warming unit for preventing intraoperative hypothermia : A randomised controlled trial

Background Inadvertent intraoperative hypothermia is a common occurrence in surgical patients. A thermal suit is an option for passive insulation. However, active warming is known to be more effective. Therefore, we hypothesised that a forced-air warming (FAW) unit connected to the thermal suit is superior to a commercial FAW blanket and a warming mattress in breast cancer surgery. Methods Forty patients were randomised to this prospective, clinical trial to wear either the thermal suit or conventional hospital clothes under general anaesthesia. The Thermal suit group had a FAW unit set to 38 degrees C and connected to the legs of the suit. The Hospital clothes group had a lower body blanket set to 38 degrees C and a warming mattress set to 37 degrees C. Core temperature was measured with zero-heat-flux sensor. The primary outcome was core temperature on admission to the recovery room. Results There was no difference in mean core temperatures at anaesthetic induction (P = .4) or on admission to the recovery room (P = .07). One patient in the Thermal suit group (5%) vs six patients in the Hospital clothes group (32%) suffered from intraoperative hypothermia (P = .04, 95% CI 1.9%-49%). Mean skin temperatures (MSTs) were higher in the Thermal suit group during anaesthesia. No burns or skin irritations were reported. Two patients in the Thermal suit group sweated. Conclusions A thermal suit connected to a FAW unit was not superior to a commercial FAW blanket, although the incidence of intraoperative hypothermia was lower in patients treated with a thermal suit.Peer reviewe

Clinical practice guideline on spinal stabilisation of adult trauma patients : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline New clinical guidelines on the spinal stabilisation of adult trauma patients-consensus and evidence based. The guideline can serve as a useful decision aid for clinicians caring for patients with traumatic spinal cord injury. However, it is important to acknowledge that the overall certainty of evidence supporting the guideline recommendations was low, implying that further research is likely to have an important impact on the confidence in the estimate of effect.Peer reviewe

Pulseless electrical activity and successful out-of-hospital resuscitation - long-term survival and quality of life: an observational cohort study

Peer reviewe

Endorsement of clinical practice guidelines by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Clinical practice guidelines from other organizations or societies with assumed clinical and contextualized relevance for Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) members, may trigger a formal evaluation by The Clinical Practice Committee (CPC) for possible SSAI endorsement. This avoids unnecessary duplicate processes and minimizes resource-waste. Identified guidelines are assessed for endorsement using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument. The SSAI CPC utilizes the AGREE II online coordinated group appraisal platform to assess the methodological rigor and transparency in which the guideline was developed. The results of the assessment, including the decision to endorse or not, are presented to the SSAI Board for sanctioning. This document briefly outlines the process for evaluation of non-SSAI guidelines by the CPC for possible SSAI endorsement.Peer reviewe

Transfusion strategies in bleeding critically ill adults : A clinical practice guideline from the European Society of Intensive Care Medicine: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. This trustworthy clinical practice guideline serves as a useful decision aid for Nordic anaesthesiologists caring for critically ill patients with bleeding.Non peer reviewe

Clinical practice guideline on prevention of rhabdomyolysis induced acute kidney injury : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical Practice Committee endorses the recent DASAIM/DSIT guideline for prevention of rhabdomyolysis-induced acute kidney injury. However, we emphasize the low quality of evidence with only weak recommendations for all interventions, highlighting that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimates.Peer reviewe