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  • 1.
    Al Dabbagh, Zewar
    et al.
    Dept Mol Med & Surg, Sect Orthopaed & Sports Med, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden.
    Jansson, Karl-Åke
    Dept Mol Med & Surg, Sect Orthopaed & Sports Med, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden.
    Stiller, Carl-Olav
    Dept Med, Clin Pharmacol Unit, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Med, Clin Epidemiol Unit, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden; Dept Epidemiol & Publ Hlth, University College London (UCL), London, England .
    Weiss, Rudiger J.
    Dept Mol Med & Surg, Sect Orthopaed & Sports Med, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden.
    No signs of dose escalations of potent opioids prescribed after tibial shaft fractures: a study of Swedish National Registries2014In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, p. 4-Article in journal (Refereed)
    Abstract [en]

    Background: The pattern of opioid use after skeletal trauma is a neglected topic in pain medicine. The purpose of this study was to analyse the long-term prescriptions of potent opioids among patients with tibial shaft fractures.

    Methods: Data were extracted from the Swedish National Hospital Discharge Register, the National Pharmacy Register, and the Total Population Register, and analysed accordingly. The study period was 2005-2008.

    Results: We identified 2,571 patients with isolated tibial shaft fractures. Of these, 639 (25%) collected a prescription for opioids after the fracture. The median follow-up time was 17 (interquartile range [IQR] 7-27) months. Most patients with opioid prescriptions after fracture were male (61%) and the median age was 45 (16-97) years. The leading mechanism of injury was fall on the same level (41%). At 6 and 12 months after fracture, 21% (95% CI 17-24) and 14% (11-17) were still being treated with opioids. Multiple Cox regression-analysis (adjusted for age, sex, type of treatment, and mechanism of injury) revealed that older patients (age >50 years) were more likely to end opioid prescriptions (Hazard ratio 1.5 [95% CI 1.3-1.9]). During follow-up, the frequency of patients on moderate and high doses declined. Comparison of the daily morphine equivalent dose among individuals who both had prescriptions during the first 3 months and the 6th month indicated that the majority of these patients (11/14) did not have dose escalations.

    Conclusions: We did not see any signs in registry-data of major dose escalations over time in patients on potent opioids after tibial shaft fractures.

  • 2.
    Bahlmann, Hans
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Södertälje Hosp, Sweden.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Pleth variability index or stroke volume optimization during open abdominal surgery: a randomized controlled trial2018In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 18, article id 115Article in journal (Refereed)
    Abstract [en]

    Background: The impact of Goal Directed Fluid Therapy (GDFT) based on the non-invasive Pleth Variability Index (PVI) on clinical outcome after abdominal surgery has only sparingly been explored. The purpose of this study was to compare the effect of intraoperative GDFT guided by PVI to a control group using esophageal Doppler on the incidence of complications and length of hospital stay after major abdominal surgery. We hypothesized that there would be no difference between the groups. Methods: This was a randomized controlled trial in a Swedish university hospital between November 2011 and January 2015; 150 patients scheduled for open abdominal surgery lasting 2 h or more were included. Exclusion criteria included hepatic resection or severe cardiac arrhythmia. The patients were randomized 1: 1 to either the intervention group or the control group. The intervention group received intraoperative GDFT by administering fluid boluses of 3 ml/kg tetrastarch aiming at a PVI value below 10%, while GDFT in the control group aimed for optimization of stroke volume as assessed with esophageal Doppler. Blinded observers assessed complications until postoperative day 30 using pre-defined definitions, as well as length of hospital stay. Results: One hundred and-fifty patients were randomized and 146 patients were available for the final data analysis. Median duration of surgery was 3 h. A total of 64 complications occurred in the PVI group (N = 74) and 70 in the Doppler group (N = 72) (p = 0.93). Median (IQR) length of stay was 8.0 (8.0) days in the PVI group and 8.0 (9.5) in the Doppler group (P = 0.57). Conclusions: No difference in clinical outcome, as defined by number of postoperative complications, and length of hospital stay, was found when goal directed fluid therapy was applied using PVI as an alternative to esophageal Doppler. PVI appears to be an acceptable alternative to esophageal Doppler for goal directed fluid therapy during major open abdominal surgery.

  • 3. Bergenzaun, Lill
    et al.
    Öhlin, Hans
    Gudmundsson, Petri
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Düring, Joachim
    Willenheimer, Ronnie
    Chew, Michelle S.
    High-sensitive cardiac Troponin T is superior to echocardiography in predicting 1-year mortality in patients with SIRS and shock in intensive care.2012In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 12, no 25Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Left ventricular (LV) dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock. METHODS: A prospective, observational, cohort study of 49 patients. B-natriuretic peptide (BNP), highsensitive troponin T (hsTNT) and transthoracic echocardiography (TTE) were assessed within 12 h of study inclusion. LV systolic function was measured by ejection fraction (LVEF), mean atrioventricular plane displacement (AVPDm), peak systolic tissue Doppler velocity imaging (TDIs) and velocity time integral in the LV outflow tract (LVOT VTI). LV diastolic function was evaluated by transmitral pulsed Doppler (E, A, E/A, E-deceleration time), tissue Doppler indices (e, a, E/e) and left atrial volume (La volume). APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores were calculated. RESULTS: hsTNT was significantly higher in non-survivors than in survivors (60 [17.0-99.5] vs 168 [89.8-358] ng/l, p = 0.003). Other univariate predictors of mortality were APACHE II (p = 0.009), E/e (p = 0.023), SOFA (p = 0.024) and age (p = 0.031). Survivors and nonsurvivors did not differ regarding BNP (p = 0.26) or any LV systolic function parameter (LVEF p = 0.87, AVPDm p = 0.087, TDIs p = 0.93, LVOT VTI p = 0.18). Multivariable logistic regression analysis identified hsTNT (p = 0.010) as the only independent predictor of 1-year mortality; adjusted odds ratio 2.0 (95% CI 1.2- 3.5). CONCLUSIONS: hsTNT was the only independent predictor of 1-year mortality in patients with shock. Neither BNP nor echocardiographic parameters had an independent prognostic value. Further studies are needed to establish the clinical significance of elevated hsTNT in patients in shock.

  • 4.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Danderyd Hospital.
    Johansson, Dorota
    Bactiguard AB, Stockholm; Tullinge, SE-146 21, Sweden .
    Bergström, Linda
    Bactiguard AB, Stockholm; Tullinge, SE-146 21, Sweden .
    Jalal, Shah
    Karolinska Institutet, Division of Clinical Microbiology, Department of Laboratory Medicine.
    Kohn, Ivar
    Department Anesthesia and Intensive Care, Karolinska University Hospital Huddinge.
    Frostell, Claes
    Karolinska Institutet, Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Danderyd Hospital.
    Kalman, Sigridur
    Department Anesthesia and Intensive Care, Karolinska University Hospital Huddinge, CLINTEC, Karolinska Institutet.
    Tolerability and performance of BIP endotracheal tubes with noble metal alloy coating: a randomized clinical evaluation study2015In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 15, p. 1-10, article id 174Article in journal (Refereed)
    Abstract [en]

    Background

    Hospital acquired infections worsen the outcome of patients treated in intensive care units and are costly. Coatings with silver or metal alloys may reduce or alter the formation of biofilm on invasive medical devices. An endotracheal tube (ETT) is used to connect the patient to a ventilator and coated tubes have been tested in relation to bacterial colonization and respiratory infection. In the present study, we aimed to evaluate and compare a coated and uncoated ETT for patient symptoms and local tracheal tolerability during short term clinical use. Degree of bacterial colonization was also described.

    Methods

    A silver-palladium-gold alloy coating (‘Bactiguard®’Infection Protection, BIP) has been extensively used on urinary tract catheters and lately also on central venous catheters. We performed a randomised, single-blinded, controlled, first in man, post Conformité Européenne (EC) certification and CE marking study, focused on Bactiguard® coated ETTs (BIP ETT). Thirty patients at a tertiary university hospital scheduled for upper abdominal elective surgery with an expected duration of anaesthesia of at least 3 h were randomised; BIP ETT (n = 20) or standard ETT (n = 10). The tolerability was assessed with a modified version of Quality of Life Head and Neck Module, QLQ-H&N35 and by inspection of the tracheal mucosa with a fibre-optic bronchoscope before intubation and at extubation. Adverse Events (AE) and bacterial adherence were also studied. Statistical evaluations were carried out with the Fisher’s Exact Test, the Clopper-Pearson method, as well as a Proportional Odds Model.

    Results

    Differences between groups were identified in 2 of 8 patient related symptoms with regard to tolerability by QLQ-H&N35 (cough, p = 0.022 and dry mouth, p = 0.014 in the treatment group.). No mucosal damage was identified with bronchoscopy. A low level of bacterial colonization with normal flora, equal between groups, was seen after short-term of intubation (median 5 h). No serious Adverse Events related to the use of an ETT were observed. The results should be treated with caution due to statistical confounders, a small study size and large inter-individual variability in bacterial adhesion.

    Conclusions

    The new device BIP ETT is well tolerated and has good clinical performance during short-term intubation. Studies with larger sample sizes and longer intubation periods (>24 h) in the ICU-setting are needed and can now be planned in order to identify possible differences in clinical outcomes.

  • 5.
    Chew, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    High-sensitive cardiac Troponin T is superior to echocardiography in predicting 1-year mortality in patients with SIRS and shock in intensive care2012In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 12, no 25Article in journal (Refereed)
    Abstract [en]

    Background

    Left ventricular (LV) dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock.

    Methods

    A prospective, observational, cohort study of 49 patients. B-natriuretic peptide (BNP), high-sensitive troponin T (hsTNT) and transthoracic echocardiography (TTE) were assessed within 12 h of study inclusion. LV systolic function was measured by ejection fraction (LVEF), mean atrioventricular plane displacement (AVPDm), peak systolic tissue Doppler velocity imaging (TDIs) and velocity time integral in the LV outflow tract (LVOT VTI). LV diastolic function was evaluated by transmitral pulsed Doppler (E, A, E/A, E-deceleration time), tissue Doppler indices (é, á, E/é) and left atrial volume (La volume). APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores were calculated.

    Results

    hsTNT was significantly higher in non-survivors than in survivors (60 [17.0-99.5] vs 168 [89.8-358] ng/l, p = 0.003). Other univariate predictors of mortality were APACHE II (p = 0.009), E/é (p = 0.023), SOFA (p = 0.024) and age (p = 0.031). Survivors and non-survivors did not differ regarding BNP (p = 0.26) or any LV systolic function parameter (LVEF p = 0.87, AVPDm p = 0.087, TDIs p = 0.93, LVOT VTI p = 0.18). Multivariable logistic regression analysis identified hsTNT (p = 0.010) as the only independent predictor of 1-year mortality; adjusted odds ratio 2.0 (95% CI 1.2- 3.5).

    Conclusions

    hsTNT was the only independent predictor of 1-year mortality in patients with shock. Neither BNP nor echocardiographic parameters had an independent prognostic value. Further studies are needed to establish the clinical significance of elevated hsTNT in patients in shock.

  • 6.
    Dahl, Michael
    et al.
    Aalborg Univ Hosp, Dept Anesthesiol & Intens Care Med, Hobrovej 18-21, DK-9000 Aalborg, Denmark..
    Hayes, Chris
    Aalborg Univ Hosp, Dept Anesthesiol & Intens Care Med, Hobrovej 18-21, DK-9000 Aalborg, Denmark..
    Rasmussen, Bodil Steen
    Aalborg Univ Hosp, Dept Anesthesiol & Intens Care Med, Hobrovej 18-21, DK-9000 Aalborg, Denmark..
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
    Secher, Niels H.
    Univ Copenhagen, Dept Anesthesiol, Copenhagen Muscle Res Ctr, Rigshosp 2043, Blegdamsvej 9, DK-2100 Copenhagen, Denmark..
    Can a central blood volume deficit be detected by systolic pressure variation during spontaneous breathing?2016In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, article id 58Article in journal (Refereed)
    Abstract [en]

    Background: Whether during spontaneous breathing arterial pressure variations (APV) can detect a volume deficit is not established. We hypothesized that amplification of intra-thoracic pressure oscillations by breathing through resistors would enhance APV to allow identification of a reduced cardiac output (CO). This study tested that hypothesis in healthy volunteers exposed to central hypovolemia by head-up tilt. Methods: Thirteen healthy volunteers were exposed to central hypovolemia by 45 degrees head-up tilt while breathing through a facemask with 7.5 cmH(2)O inspiratory and/or expiratory resistors. A brachial arterial catheter was used to measure blood pressure and thus systolic pressure variation (SPV), pulse pressure variation and stroke volume variation. Pulse contour analysis determined stroke volume (SV) and CO and we evaluated whether APV could detect a 10 % decrease in CO. Results: During head-up tilt SV decreased form 91 (+/- 46) to 55 (+/- 24) mL (mean +/- SD) and CO from 5.8 (+/- 2.9) to 4.0 (+/- 1.8) L/min (p < 0.05), while heart rate increased (65 (+/- 11) to 75 (+/- 13) bpm; P < 0.05). Systolic pressure decreased from 127 (+/- 14) to 121 (+/- 13) mmHg during head-up tilt, while SPV tended to increase (from 21 (+/- 15)% to 30 (+/- 13) %). Yet during head-up tilt, a SPV >= 37 % predicted a decrease in CO >= 10 % with a sensitivity and specificity of 78 % and 100 %, respectively. Conclusion: In spontaneously breathing healthy volunteers combined inspiratory and expiratory resistors enhance SPV during head-up tilted induced central hypovolemia and allow identifying a 10 % reduction in CO. Applying inspiratory and expiratory resistors might detect a fluid deficit in spontaneously breathing patients.

  • 7.
    Hahn, Robert G
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Research Unit, Södertälje Hospital, Södertälje, Sweden.
    Ljunggren, Stefan
    Research Unit, Södertälje Hospital, Södertälje, Sweden.
    Preoperative insulin resistance reduces complications after hip replacement surgery in non-diabetic patients.2013In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 13, no 1, p. 39-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Insulin resistance negatively affects the outcome of surgery in patients with type 2 diabetes. This association is often believed to be present in other patient populations as well, but studies are lacking on the influence of preoperative insulin resistance on the clinical course of surgery in non-diabetic patients.

    METHODS: Sixty non-diabetic patients with a mean age of 68 years underwent a 75-min intravenous glucose tolerance test (IVGTT) one day before and after elective hip replacement surgery. Patients were regarded to be either insulin resistant (< median insulin sensitivity) or not (> median insulin sensitivity). Hypotensive events occurring in the postoperative care unit and complications in the orthopedic ward were recorded. Fatigue and well-being were assessed via questionnaires.

    RESULTS: A total of 52 patients were included in the final analysis. Insulin resistance before surgery was associated with a lower risk of arterial hypotension in the postoperative care unit (systolic pressure < 80 mmHg; P < 0.05) and with fewer complications in the orthopedic ward (mean 1.9 versus 1.2 per operation, P < 0.01), particularly with respect to nausea/vomiting (P < 0.04) and arterial hypotension (P < 0.05). Fewer of these patients had more than one complication (23% versus 58%, P < 0.001), while no statistical link between preoperative insulin resistance and fatigue or well-being was evident. Insulin resistance, when measured one day postoperatively, did not correlate with the number of complications.

    CONCLUSIONS: Preoperative insulin resistance offers some benefit in the postoperative period and early convalescence in non-diabetic patients who undergo hip replacement surgery.

  • 8.
    Hellström, Per M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
    Samuelsson, Bodil
    Danderyd Hosp, Div Orthoped, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Sophiahemmet Univ Coll, Stockholm, Sweden..
    Al-Ani, Amer N.
    Karolinska Univ Hosp, Dept Clin Sci & Technol Clintec, Div Orthoped, Karolinska Inst, Huddinge, Sweden..
    Hedström, Margareta
    Karolinska Univ Hosp, Dept Clin Sci & Technol Clintec, Div Orthoped, Karolinska Inst, Huddinge, Sweden..
    Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: a pilot study2017In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 17, article id 23Article in journal (Refereed)
    Abstract [en]

    Background: Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture. Methods: In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55. Results: The mean gastric half-emptying time in the elderly study group was 53 +/- 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 +/- 4 (41-106) and 59 +/- 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture. Conclusion: This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.

  • 9. Hellström, Per M
    et al.
    Samuelsson, Bodil
    Sophiahemmet University.
    Al-Ani, Amer N
    Hedström, Margareta
    Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: a pilot study2017In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 17, no 1, p. 23-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture.

    METHODS: In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55.

    RESULTS: The mean gastric half-emptying time in the elderly study group was 53 ± 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 ± 4 (41-106) and 59 ± 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture.

    CONCLUSION: This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT02753010 . Registered 17 April 2016, retrospectively.

  • 10.
    Hindocha, Nishma
    et al.
    Zealand Univ Hosp, Denmark.
    Manhem, Filip
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care.
    Bäckryd, Emmanuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bågesund, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ice versus lidocaine 5% gel for topical anaesthesia of oral mucosa: a randomized cross-over study2019In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 19, no 1, article id 227Article in journal (Refereed)
    Abstract [en]

    Background

    Topical anaesthesia is important to optimize pain control during dental injection. Our aim was to describe a new simple method for topical anaesthesia of oral mucosa and to compare the effectiveness of ice and lidocaine 5% gel for topical anaesthesia of oral mucosa.

    Methods

    A total of 40 patients aged 10.7–19.5 years were included. The side and method of application were both randomized. Heart rate was recorded, and discomfort and pain were evaluated with a visual analogue scale (VAS). A paired t-test was used to compare mean values, a chi2 test was used to compare proportions, and a Pearson correlation test was used to examine correlations between variables.

    Results

    When ice was used, buccal injection VAS pain was rated lower (p = 0.044), and VAS discomfort was rated higher (p = 0.001), in comparison to when lidocaine 5% gel was used. There was no significant difference in relative heart rate change between ice and lidocaine 5% gel at either needle stick or injection. Lidocaine 5% gel produced a relative heart rate reduction after palatal injection (0.99 ± 0.06) while buccal injection produced an increased relative heart rate (1.02 ± 0.08) (p = 0.010). Unpleasant taste was more frequently reported when lidocaine 5% gel was used (p = 0.025). An application time of 1 min was sufficient for both ice and lidocaine 5% gel to achieve pain reduction from needle stick in buccal mucosa.

    Conclusion

    The cheap and readily available described method using ice for topical anaesthesia of oral mucosa before dental injection is an effective alternative to lidocaine 5% gel.

    Trial registration

    The European Union Drug Regulating Authorities Clinical Trials Database EudraCT201300530531. Date of registration: February 10th, 2014.

  • 11.
    Jaensson, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Division of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gender differences in sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study2014In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, no 56Article in journal (Refereed)
    Abstract [en]

    Background and objective. Postoperative sore throat and hoarseness are common minor complications following airway manipulation. This study was primarily done to determine gender differences in the incidence of these symptoms and the location of POST after laryngeal mask airway (LMA) and endotracheal tube (ETT).

    Methods. A total of 112 men and 185 women were included during a four month period. All patients were evaluated postoperatively and after 24 hours about the occurrence of sore throat, its location and hoarseness. If the patients had any symptom, they were followed-up at 48, 72 and 96 hours until the symptoms resolved.

    Results. There was no significant gender difference in postoperative sore throat (POST) and postoperative hoarseness (PH) when analyzing both airway devices together. The incidence of sore throat and hoarseness were higher postoperatively after an ETT than an LMA (32% vs. 19%, p= 0.012) and 57% vs. 33% (p< 0.001) respectively. Significantly more women than men had POST after an LMA (26% vs. 6%, p=0.004). No significant gender difference was found in either POST or PH after an ETT or in the incidence of PH after an LMA. More patients located their pain below the larynx after an ETT vs. an LMA (24% vs. 4%). Pain above the larynx was more common after an LMA than an ETT (52 % vs. 37 %).

    Conclusions.  In a clinical setting where women are intubated with a smaller size ETT than men, there were no significant differences in POST or PH between genders. Additionally, more women than men have POST when an LMA is used. Awareness of POST and PH may help streamline patients in whom the best airway device could be used during anesthesia and surgery.

  • 12.
    Kallioinen, Minna
    et al.
    Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Finland.
    Scheinin, Annalotta
    Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Finland / Turku PET Centre, University of Turku and Turku University Hospital, Finland.
    Maksimow, Mikael
    Medicity Research Laboratory, University of Turku, Finland.
    Långsjö, Jaakko
    Turku PET Centre, University of Turku and Turku University Hospital, Finland / Department of Intensive Care, Tampere University Hospital, Finland.
    Kaisti, Kaike
    Turku PET Centre, University of Turku and Turku University Hospital, Finland / Department of Anesthesiology and Intensive Care, Oulu University Hospital, Finland.
    Takala, Riikka
    Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Finland.
    Vahlberg, Tero
    Department of Clinical Medicine, Biostatistics, University of Turku and Turku University Hospital, Finland.
    Valli, Katja
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Centre, University of Turku, Finland.
    Salmi, Marko
    Medicity Research Laboratory, University of Turku, Finland / Institute of Biomedicine, University of Turku, Finland.
    Scheinin, Harry
    Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Finland / Turku PET Centre, University of Turku and Turku University Hospital, Finland / Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Finland.
    Maksimow, Anu
    Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Finland.
    The influence of dexmedetomidine and propofol on circulating cytokine levels in healthy subjects2019In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 19, no 1, p. 1-8, article id 222Article in journal (Refereed)
    Abstract [en]

    Background: Surgery and diseases modify inflammatory responses and the immune system. Anesthetic agents also have effects on the human immune system but the responses they induce may be altered or masked by the surgical procedures or underlying illnesses. The aim of this study was to assess how single-drug dexmedetomidine and propofol anesthesia without any surgical intervention alter acute immunological biomarkers in healthy subjects. Methods: Thirty-five healthy, young male subjects were anesthetized using increasing concentrations of dexmedetomidine (n = 18) or propofol (n = 17) until loss of responsiveness (LOR) was detected. The treatment allocation was randomized. Multi-parametric immunoassays for the detection of 48 cytokines, chemokines and growth factors were used. Concentrations were determined at baseline and at the highest drug concentration for each subject. Results: The changes in the concentration of eotaxin (decrease after dexmedetomidine) and platelet-derived growth factor (PDGF, increase after propofol) were statistically significantly different between the groups. Significant changes were detected within both groups; the concentrations of monocyte chemotactic protein 1, chemokine ligand 27 and macrophage migration inhibitory factor were lower in both groups after the drug administration. Dexmedetomidine decreased the concentration of eotaxin, interleukin-18, interleukin-2Ra, stem cell factor, stem cell growth factor and vascular endothelial growth factor, and propofol decreased significantly the levels of hepatocyte growth factor, IFN-.-induced protein 10 and monokine induced by IFN-gamma, and increased the levels of interleukin-17, interleukin-5, interleukin-7 and PDGF. Conclusions: Dexmedetomidine seemed to have an immunosuppressive effect on the immune system whereas propofol seemed to induce mixed pro- and anti-inflammatory effects on the immune system. The choice of anesthetic agent could be relevant when treating patients with compromised immunological defense mechanisms. Trial registration: Before subject enrollment, the study was registered in the European Clinical Trials database (EudraCT number 2013-001496-21, The Neural Mechanisms of Anesthesia and Human Consciousness) and in ClinicalTrials.gov (Principal Investigator: Harry Scheinin, number NCT01889004, The Neural Mechanisms of Anesthesia and Human Consciousness, Part 2, on the 23rd of June 2013).

  • 13.
    Knudsen, Kati
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Department of Health and Caring Sciences, University of Gävle.
    Nilsson, Ulrica
    Faculty of Medicine and Health, School of Health Sciences, Örebro University.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study2016In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, article id 71Article in journal (Refereed)
    Abstract [en]

    Background Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure. Methods A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories. Results From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff’s competence, professional caring and support, and no hesitation about new awake intubation. The patients felt they lacked information about what to expect and relied on the professionals’ expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself. Conclusions Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.

  • 14.
    Knudsen, Kati
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Nilsson, Ulrica
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Högman, Marieann
    Centre for Research & Development, Uppsala University/Region Gävleborg, 801 88 Gävle, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Pöder, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study2016In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, no 1, article id 71Article in journal (Refereed)
    Abstract [en]

    Background

    Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure.

    Methods

    A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories.

    Results

    From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff’s competence, professional caring and support, and no hesitation about new awake intubation. The patients felt they lacked information about what to expect and relied on the professionals’ expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself.

    Conclusions

    Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.

  • 15.
    Knudsen, Kati
    et al.
    Department of Public Health and Caring Sciences, Caring Sciences, Uppsala, Sweden; Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; Centre for Research & Development, Region Gävleborg, Gävle, Sweden; Centre for Research & Development, Uppsala University, Uppsala, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Högman, Marieann
    Centre for Research & Development, Region Gävleborg, Gävle, Sweden; Centre for Research & Development, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Pöder, Ulrika
    Department of Public Health and Caring Sciences, Caring Sciences, Uppsala, Sweden.
    Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study2016In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, no 1, article id 71Article in journal (Refereed)
    Abstract [en]

    Background: Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure.

    Methods: A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories.

    Results: From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff’s competence, professional caring and support, and no hesitation about new awake intubation. The patients felt they lacked information about what to expect and relied on the professionals’ expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself.

    Conclusions: Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.

  • 16.
    Knudsen, Kati
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Högskolan i Gävle, University of Gävle.
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Nilsson, Ulrica
    Örebro universitet, Örebro University.
    A nationwide postal questionnaire survey: the presence of airway guidelines in anaesthesia department in Sweden2014In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, p. 25-Article in journal (Refereed)
    Abstract [en]

    Background

    In Sweden, airway guidelines aimed toward improving patient safety have been recommended by the Swedish Society of Anaesthesia and Intensive Care Medicine. Adherence to evidence-based airway guidelines is known to be generally poor in Sweden. The aim of this study was to determine whether airway guidelines are present in Swedish anaesthesia departments.

    Methods

    A nationwide postal questionnaire inquiring about the presence of airway guidelines was sent out to directors of Swedish anaesthesia departments (n = 74). The structured questionnaire was based on a review of the Swedish Society of Anaesthesia and Intensive Care voluntary recommendations of guidelines for airway management. Mean, standard deviation, minimum/maximum, percentage (%) and number of general anaesthesia performed per year as frequency (n), were used to describe, each hospital type (university, county, private). For comparison between hospitals type and available written airway guidelines were cross tabulation used and analysed using Pearson’s Chi-Square tests. A p- value of less than 0 .05 was judged significant.

    Results

    In total 68 directors who were responsible for the anaesthesia departments returned the questionnaire, which give a response rate of 92% (n 68 of 74). The presence of guidelines showing an airway algorithm was reported by 68% of the departments; 52% reported having a written patient information card in case of a difficult airway and guidelines for difficult airways, respectively; 43% reported the presence of guidelines for preoperative assessment; 31% had guidelines for Rapid Sequence Intubation; 26% reported criteria for performing an awake intubation; and 21% reported guidelines for awake fibre-optic intubation. A prescription for the registered nurse anaesthetist for performing tracheal intubation was reported by 24%. The most frequently pre-printed preoperative elements in the anaesthesia record form were dental status and head and neck mobility.

    Conclusions

    Despite recommendations from the national anaesthesia society, the presence of airway guidelines in Swedish anaesthesia departments is low. From the perspective of safety for both patients and the anaesthesia staff, airway management guidelines should be considered a higher priority.

  • 17.
    Knudsen, Kati
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
    Pöder, Ulrika
    Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högman, Marieann
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden, and Centre for Research & Development Uppsala University/ County Council of Gävleborg, Gavle, Sweden.
    Larsson, Anders
    Department of surgical sciences, Uppsala University, Anaesthesiology & ICM, Uppsala, Sweden.
    Nilsson, Ulrica
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    A nationwide postal questionnaire survey: The presence of airway guidelines in anaesthesia department in Sweden2014In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, no 25, p. 25-Article in journal (Refereed)
    Abstract [en]

    Background

    In Sweden, airway guidelines aimed toward improving patient safety have been recommended by the Swedish Society of Anaesthesia and Intensive Care Medicine. Adherence to evidence-based airway guidelines is known to be generally poor in Sweden. The aim of this study was to determine whether airway guidelines are present in Swedish anaesthesia departments.

    Methods

    A nationwide postal questionnaire inquiring about the presence of airway guidelines was sent out to directors of Swedish anaesthesia departments (n = 74). The structured questionnaire was based on a review of the Swedish Society of Anaesthesia and Intensive Care voluntary recommendations of guidelines for airway management. Mean, standard deviation, minimum/maximum, percentage (%) and number of general anaesthesia performed per year as frequency (n), were used to describe, each hospital type (university, county, private). For comparison between hospitals type and available written airway guidelines were cross tabulation used and analysed using Pearson’s Chi-Square tests. A p- value of less than 0 .05 was judged significant.

    Results

    In total 68 directors who were responsible for the anaesthesia departments returned the questionnaire, which give a response rate of 92% (n 68 of 74). The presence of guidelines showing an airway algorithm was reported by 68% of the departments; 52% reported having a written patient information card in case of a difficult airway and guidelines for difficult airways, respectively; 43% reported the presence of guidelines for preoperative assessment; 31% had guidelines for Rapid Sequence Intubation; 26% reported criteria for performing an awake intubation; and 21% reported guidelines for awake fibre-optic intubation. A prescription for the registered nurse anaesthetist for performing tracheal intubation was reported by 24%. The most frequently pre-printed preoperative elements in the anaesthesia record form were dental status and head and neck mobility.

    Conclusions

    Despite recommendations from the national anaesthesia society, the presence of airway guidelines in Swedish anaesthesia departments is low. From the perspective of safety for both patients and the anaesthesia staff, airway management guidelines should be considered a higher priority.

  • 18.
    Knudsen, Kati
    et al.
    Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden; Dept Hlth & Caring Sci, University of Gävle, Gävle, Sweden.
    Pöder, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högman, Marieann
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden; Centre for Research & Development, County Council of Gävleborg, Gävle, Sweden; Centre for Research & Development, Uppsala University, Uppsala, Sweden.
    Larsson, Anders
    Department of surgical sciences, Anaesthesiology & ICM, Uppsala University, Uppsala, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    A nationwide postal questionnaire survey: the presence of airway guidelines in anaesthesia department in Sweden2014In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, no 25Article in journal (Refereed)
    Abstract [en]

    Background: In Sweden, airway guidelines aimed toward improving patient safety have been recommended by the Swedish Society of Anaesthesia and Intensive Care Medicine. Adherence to evidence-based airway guidelines is known to be generally poor in Sweden. The aim of this study was to determine whether airway guidelines are present in Swedish anaesthesia departments.

    Methods: A nationwide postal questionnaire inquiring about the presence of airway guidelines was sent out to directors of Swedish anaesthesia departments (n = 74). The structured questionnaire was based on a review of the Swedish Society of Anaesthesia and Intensive Care voluntary recommendations of guidelines for airway management. Mean, standard deviation, minimum/maximum, percentage (%) and number of general anaesthesia performed per year as frequency (n), were used to describe, each hospital type (university, county, private). For comparison between hospitals type and available written airway guidelines were cross tabulation used and analysed using Pearson’s Chi-Square tests. A p- value of less than 0 .05 was judged significant.

    Results: In total 68 directors who were responsible for the anaesthesia departments returned the questionnaire, which give a response rate of 92% (n 68 of 74). The presence of guidelines showing an airway algorithm was reported by 68% of the departments; 52% reported having a written patient information card in case of a difficult airway and guidelines for difficult airways, respectively; 43% reported the presence of guidelines for preoperative assessment; 31% had guidelines for Rapid Sequence Intubation; 26% reported criteria for performing an awake intubation; and 21% reported guidelines for awake fibre-optic intubation. A prescription for the registered nurse anaesthetist for performing tracheal intubation was reported by 24%. The most frequently pre-printed preoperative elements in the anaesthesiarecord form were dental status and head and neck mobility.

    Conclusions: Despite recommendations from the national anaesthesia society, the presence of airway guidelines in Swedish anaesthesia departments is low. From the perspective of safety for both patients and the anaesthesia staff, airway management guidelines should be considered a higher priority

  • 19.
    Kuchalik, Jan
    et al.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Magnuson, Anders F.K.
    Tina, Elisabet
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Research Laboratory, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro University Hospital. Perioperative Medicine and Intensive Care, Institution for Physiology and Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Anesthesiology and Intensive Care Solna, Karolinska University Hospital, Stockholm, Sweden.
    Does local infiltration analgesia reduce peri-operative inflammation following total hip arthroplasty?: A randomized, double-blind study2017In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 17, article id 63Article in journal (Refereed)
    Abstract [en]

    Background: Postoperative inflammation following total hip arthroplasty (THA) can lead to delayed mobilization and return of hip function. Our primary aim was to assess whether local infiltration analgesia (LIA) during surgery can prevent postoperative inflammation.

    Methods: This is a sub-analysis of data from a broader double-blind study where 56 patients received spinal anaesthesia for THA. Additionally, Group FNB (Femoral Nerve Block) received an ultrasound-guided femoral nerve block using 30 mL of ropivacaine 7.5 mg/mL (225 mg), and 151.5 mL of saline peri-articularly intra-operatively. Group LIA received 30 mL saline in the femoral nerve block and ropivacaine 2 mg/mL, 300 mg (150 mL) + ketorolac 30 mg (1 mL) + adrenaline 0.5 mg (0.5 mL) peri-articularly. After 23 h, the LIA mixture (22 mL) was injected via a catheter placed peri-articularly in Group LIA and 22 mL saline in Group FNB. A battery of pro-and anti-inflammatory cytokines was assessed using a commercially available kit preoperatively and after 4 h and 3 days postoperatively. Additionally, CRP, platelet count and white blood count was determined pre- and postoperatively.

    Results: There was a general trend towards an increase in pro-inflammatory cytokines postoperatively, which returned to normal levels after 3 days. IL-6 concentration was significantly lower 4 h postoperatively in Group LIA compared to Group FNB (p = 0.015). No other significant differences were found between the groups in other cytokines. CRP levels were significantly higher in Group FNB compared to Group LIA 3 days postoperatively (p < 0.001). No other significant differences were seen between the groups.

    Conclusion: Local infiltration analgesia has a modest but short-lasting effect on postoperative inflammation in patients undergoing total hip arthroplasty. This is likely to be due to local infiltration of ketorolac and/or local anaesthetics in the LIA mixture. Future studies should be directed towards assessing whether the use of LIA translates into better patient outcomes.

  • 20.
    Li, Yuhong
    et al.
    Zhejiang University, Peoples R China; Shaoxing Peoples Hospital, Sweden.
    He, Rui
    Zhejiang University, Peoples R China.
    Ying, Xiaojiang
    Shaoxing Peoples Hospital, Sweden.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Ringer's lactate, but not hydroxyethyl starch, prolongs the food intolerance time after major abdominal surgery; an open-labelled clinical trial2015In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 15Article in journal (Refereed)
    Abstract [en]

    Background: The infusion of large amounts of Ringers lactate prolongs the functional gastrointestinal recovery time and increases the number of complications after open abdominal surgery. We performed an open-labelled clinical trial to determine whether hydroxyethyl starch or Ringers lactate exerts these adverse effects when the surgery is performed by laparoscopy. Methods: Eighty-eight patients scheduled for major abdominal cancer surgery (83% by laparoscopy) received a first-line fluid treatment with 9 ml/kg of either 6% hydroxyethyl starch 130/0.4 (Voluven) or Ringers lactate, just after induction of anaesthesia; this was followed by a second-line infusion with 12 ml/kg of either starch or Ringers lactate over 1 hour. Further therapy was managed at the discretion of the attending anaesthetist. Outcome data consisted of postoperative gastrointestinal recovery time, complications and length of hospital stay. Results: The order of the infusions had no impact on the outcome. Both the administration of greater than= 2 L of Ringers lactate and the development of a surgical complication were associated with a longer time period of paralytic ileus and food intolerance (two-way ANOVA, P less than 0.02), but only surgical complications prolonged the length of hospital stay (P less than 0.001). The independent effect of Ringers lactate and complications of food intolerance time amounted to 2 days each. The infusion of greater than= 1 L of hydroxyethyl starch did not adversely affect gastrointestinal recovery. Conclusions: Ringers lactate, but not hydroxyethyl starch, prolonged the gastrointestinal recovery time in patients undergoing laparoscopic cancer surgery. Surgical complications prolonged the hospital stay.

  • 21.
    Pieris, Lalitha
    et al.
    Sri Lanka.
    Sigera, Ponsuge Chathurani
    Sri Lanka.
    De Silva, Ambepitiyawaduge Pubudu
    Sri Lanka.
    Munasinghe, Sithum
    Sri Lanka.
    Rashan, Aasiyah
    Sri Lanka.
    Athapattu, Priyantha Lakmini
    Sri Lanka.
    Jayasinghe, Kosala Saroj Amarasiri
    Sri Lanka.
    Samarasinghe, Kerstin
    Kristianstad University, Faculty of Health Science.
    Beane, Abi
    Sri Lanka.
    Dondorp, Arjen M
    Thailand.
    Haniffa, Rashan
    Sri Lanka.
    Experiences of ICU survivors in a low middle income country- a multicenter study.2018In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 18, no 1, article id 30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Stressful patient experiences during the intensive care unit (ICU) stay is associated with reduced satisfaction in High Income Countries (HICs) but has not been explored in Lower and Middle Income Countries (LMICs). This study describes the recalled experiences, stress and satisfaction as perceived by survivors of ICUs in a LMIC.

    METHODS: This follow-up study was carried out in 32 state ICUs in Sri Lanka between July and December 2015.ICU survivors' experiences, stress factors encountered and level of satisfaction were collected 30 days after ICU discharge by a telephone questionnaire adapted from Granja and Wright.

    RESULTS: Of 1665 eligible ICU survivors, 23.3% died after ICU discharge, 49.1% were uncontactable and 438 (26.3%) patients were included in the study. Whilst 78.1% (n = 349) of patients remembered their admission to the hospital, only 42.3% (n = 189) could recall their admission to the ICU. The most frequently reported stressful experiences were: being bedridden (34.2%), pain (34.0%), general discomfort (31.7%), daily needle punctures (32.9%), family worries (33.6%), fear of dying and uncertainty in the future (25.8%). The majority of patients (376, 84.12%) found the atmosphere of the ICU to be friendly and calm. Overall, the patients found the level of health care received in the ICU to be "very satisfactory" (93.8%, n = 411) with none of the survivors stating they were either "dissatisfied" or "very dissatisfied".

    CONCLUSION: In common with HIC, survivors were very satisfied with their ICU care. In contrast to HIC settings, specific ICU experiences were frequently not recalled, but those remembered were reported as relatively stress-free. Stressful experiences, in common with HIC, were most frequently related to uncertainty about the future, dependency, family, and economic concerns.

  • 22.
    Thomas, Owain
    et al.
    Lund University, Sweden; SUS Lund University Hospital, Sweden.
    Larsson, Anna
    Lund University, Sweden.
    Tynngård, Nahreen
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Schott, Ulf
    Lund University, Sweden; SUS Lund University Hospital, Sweden.
    Thromboelastometry versus free-oscillation rheometry and enoxaparin versus tinzaparin: an in-vitro study comparing two viscoelastic haemostatic tests dose-responses to two low molecular weight heparins at the time of withdrawing epidural catheters from ten patients after major surgery2015In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 15Article in journal (Refereed)
    Abstract [en]

    Background: Monitoring low molecular weight heparins (LMWHs) in the perioperative period is prudent in patients at high risk of coagulative complications, especially when the patient has an epidural catheter requiring withdrawal, which is associated with the risk of spinal haematoma. The aim of this study was to evaluate the in vitro dose-responses of two different LMWHs on two different viscoelastic haemostatic tests, using blood sampled from patients with normal routine coagulation parameters, on the day after major surgery when their epidural catheters were due to be withdrawn. Methods: Enoxaparin or tinzaparin were added in vitro to blood from ten patients who had undergone oesophageal resection, to obtain plasma concentrations of approximately 0, 0.5, 1.0 and 1.5 IU/mL. Coagulation was monitored using thromboelastometry (ROTEM (R)) using the InTEM (R) activating reagent; and free oscillation rheometry (FOR: ReoRox (R)), activated using thromboplastin. Clot initiation was measured using ROTEM-CT, ReoRox-COT1 and ReoRox-COT2. Clot propagation was measured using ROTEM-CFT, ROTEM-Alpha Angle and ReoRox-Slope. Clot stability was measured using ROTEM-MCF and ReoRox-Gmax, and clot lysis was measured using ROTEM-ML and ReoRox-ClotSR. Results: Clot initiation time assessed by thromboelastometry and FOR was prolonged by increasing concentrations of both LMWHs (P &lt; 0.01). Equivalent doses of tinzaparin in international units (anti FXa units) per millilitre prolonged clot initiation more than enoxaparin (P &lt; 0.05). There was significant inter-individual variation - the ranges of CT and COT1 at LMWH-concentrations of 0 and 1.5 IU/mL overlapped. None of the tests reflecting clot formation rate or stability showed a dose-response to either LMWH but clot lysis showed a tentative negative dose-response to the LMWHs. Conclusions: Clot initiation times dose-dependent prolongation by LMWHs in this study agrees with previous research, as does tinzaparins stronger anti-coagulative effect than enoxaparin at equivalent levels of anti-FXa activity. This casts doubt on the validity of using anti-FXa assays alone to guide dosage of LMWHs. The significant inter-individual variation in dose-response suggests that the relationship between dose and effect in the postoperative period is complicated. While both ROTEM and FOR may have some role in postoperative monitoring, more research is needed before any conclusion can be made about their clinical usefulness.

  • 23.
    Vidlund, Mårten
    et al.
    Örebro University, School of Health Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Tajik, Bashir
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Håkanson, Erik
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Holm, Jonas
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Vanky, Farkas
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Svedjeholm, Rolf
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Post hoc analysis of the glutamics-trial: intravenous glutamate infusion and use of inotropic drugs after cabg2016In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, no 1, article id 54Article in journal (Refereed)
    Abstract [en]

    Background: Intravenous glutamate reduced the risk of developing severe circulatory failure after isolated coronary artery bypass graft surgery (CABG) for acute coronary syndrome (ACS) in a double-blind randomised clinical trial (GLUTAMICS-ClinicalTrials.gov Identifier: NCT00489827 ). Here our aim was to study if glutamate was associated with reduced the use of inotropes.

    Methods: Post-hoc analysis of 824 patients undergoing isolated CABG for ACS in the GLUTAMICS-trial. ICU-records were retrospectively scrutinised including hourly registration of inotropic drug infusion, dosage and total duration during the operation and postoperatively.

    Results: ICU-records were found for 171 out of 177 patients who received inotropes perioperatively. Only one fourth of the patients treated with inotropes fulfilled study criteria for postoperative heart failure at weaning from cardiopulmonary bypass (CPB) or later in the ICU. Inotropes were mainly given preemptively to facilitate weaning from CPB or to treat postoperative circulatory instability (bleeding, hypovolaemia). Except for a significantly lower use of epinephrine there were only trends towards lower need of other inotropes overall in the glutamate group. In patients treated with inotropes (glutamate n = 17; placebo n = 13) who fulfilled study criteria for left ventricular failure at weaning from CPB the average duration of inotropic treatment (34 ± 20 v 80 ± 77 h; p = 0.014) and the number of inotropes used (1.35 ± 0.6 v 1.85 ± 0.7; p = 0.047) were lower in the glutamate group.

    Conclusions: Intravenous glutamate was associated with a minor influence on inotrope use overall in patients undergoing CABG for ACS whereas a considerable and significant reduction was observed in patients with heart failure at weaning from CPB.

  • 24.
    Vidlund, Mårten
    et al.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Tajik, Bashir
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Holm, Jonas
    Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Vánky, Farkas
    Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Post hoc analysis of the glutamics-trial: intravenous glutamate infusion and use of inotropic drugs after cabg2016In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, p. 1-9, article id 16:54Article in journal (Refereed)
    Abstract [en]

    Background: Intravenous glutamate reduced the risk of developing severe circulatory failure after isolated coronary artery bypass graft surgery (CABG) for acute coronary syndrome (ACS) in a double-blind randomised clinical trial (GLUTAMICS-ClinicalTrials. gov Identifier:NCT00489827). Here our aim was to study if glutamate was associated with reduced the use of inotropes.

    Methods: Post-hoc analysis of 824 patients undergoing isolated CABG for ACS in the GLUTAMICS-trial. ICU-records were retrospectively scrutinised including hourly registration of inotropic drug infusion, dosage and total duration during the operation and postoperatively.

    Results: ICU-records were found for 171 out of 177 patients who received inotropes perioperatively. Only one fourth of the patients treated with inotropes fulfilled study criteria for postoperative heart failure at weaning from cardiopulmonary bypass (CPB) or later in the ICU. Inotropes were mainly given preemptively to facilitate weaning from CPB or to treat postoperative circulatory instability (bleeding, hypovolaemia). Except for a significantly lower use of epinephrine there were only trends towards lower need of other inotropes overall in the glutamate group. In patients treated with inotropes (glutamate n = 17; placebo n = 13) who fulfilled study criteria for left ventricular failure at weaning from CPB the average duration of inotropic treatment (34 +/- 20 v 80 +/- 77 h; p = 0.014) and the number of inotropes used (1.35 +/- 0.6 v 1.85 +/- 0.7; p = 0.047) were lower in the glutamate group.

    Conclusions: Intravenous glutamate was associated with a minor influence on inotrope use overall in patients undergoing CABG for ACS whereas a considerable and significant reduction was observed in patients with heart failure at weaning from CPB.

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