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dc.contributor.authorJensen, A G
dc.contributor.authorCallesen, T
dc.contributor.authorHagemo, J S
dc.contributor.authorHreinsson, K
dc.contributor.authorLund, V
dc.contributor.authorNordmark, J
dc.date.accessioned2011-01-07T11:24:28Z
dc.date.available2011-01-07T11:24:28Z
dc.date.issued2010-09-01
dc.date.submitted2011-01-07
dc.identifier.citationActa Anaesthesiol Scand. 2010, 54(8):922-50en
dc.identifier.issn1399-6576
dc.identifier.pmid20701596
dc.identifier.doi10.1111/j.1399-6576.2010.02277.x
dc.identifier.urihttp://hdl.handle.net/2336/118925
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractEmergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1-1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.
dc.language.isoenen
dc.relation.urlhttp://dx.doi.org/10.1111/j.1399-6576.2010.02277.xen
dc.subject.meshAnaphylaxisen
dc.subject.meshAnesthesia, Generalen
dc.subject.meshAnestheticsen
dc.subject.meshAntacidsen
dc.subject.meshAntiemeticsen
dc.subject.meshCholinergic Antagonistsen
dc.subject.meshCricoid Cartilageen
dc.subject.meshEmergency Medical Servicesen
dc.subject.meshFastingen
dc.subject.meshGastric Acidity Determinationen
dc.subject.meshGastric Emptyingen
dc.subject.meshHumansen
dc.subject.meshHypnotics and Sedativesen
dc.subject.meshIntubation, Intratrachealen
dc.subject.meshMuscle Relaxants, Centralen
dc.subject.meshNarcoticsen
dc.subject.meshPositive-Pressure Respirationen
dc.subject.meshPostureen
dc.subject.meshPreoperative Careen
dc.subject.meshRespiratory Aspirationen
dc.subject.meshScandinaviaen
dc.subject.meshTidal Volumeen
dc.titleScandinavian clinical practice guidelines on general anaesthesia for emergency situationsen
dc.typeArticleen
dc.contributor.departmentDepartment of anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark. anders.gadegaard.jensen@ouh.regionsyddanmark.dken
dc.identifier.journalActa anaesthesiologica Scandinavicaen
html.description.abstractEmergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1-1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.


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