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  • 1.
    Abbott, T. E. F.
    et al.
    Queen Mary Univ London, England.
    Ahmad, T.
    Queen Mary Univ London, England.
    Phull, M. K.
    Barts Hlth NHS Trust, England.
    Fowler, A. J.
    Guys and St Thomass NHS Fdn Trust, England.
    Hewson, R.
    Barts Hlth NHS Trust, England.
    Biccard, B. M.
    Univ Cape Town, South Africa.
    Chew, Michelle
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Gillies, M.
    Univ Edinburgh, Scotland.
    Pearse, R. M.
    Queen Mary Univ London, England.
    The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis2018Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 120, nr 1, s. 146-155Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained amp;gt;= 1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); Pamp;lt;0.01], but no difference in complication rates [OR 1.02 (0.88-1.19); P = 0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62-0.92); Pamp;lt;0.01; I-2 = 87%] and reduced complication rates [OR 0.73 (0.61-0.88); Pamp;lt;0.01; I-2 = 89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

  • 2.
    Abrahams, M
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi.
    Eriksson, H
    Björnström, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Eintrei, Christina
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Effects of propofol on extracellular acidification rates in primary cortical cell cultures: application of silicon microphysiometry to anaesthesia.1999Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 83, s. 567-569Artikel i tidskrift (Refereegranskat)
  • 3.
    Alstrom, U
    et al.
    University of Uppsala Hospital.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Stahle, E
    University of Uppsala Hospital.
    Svedjeholm, Rolf
    Linköpings universitet, Institutionen för medicin och hälsa, Thoraxkirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Friberg, O
    Örebro University Hospital.
    Cost analysis of re-exploration for bleeding after coronary artery bypass graft surgery2012Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 108, nr 2, s. 216-222Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Re-exploration for bleeding after cardiac surgery is an indicator of substantial haemorrhage and is associated with increased hospital resource utilization. This study aimed to analyse the costs of re-exploration and estimate the costs of haemostatic prophylaxis. less thanbrgreater than less thanbrgreater thanMethods. A total of 4232 patients underwent isolated, first-time, coronary artery bypass graft (CABG) surgery during 2005-8. Each patient re-explored for bleeding (n = 127) was matched with two controls not requiring re-exploration (n = 254). Cost analysis was based on resource utilization from completion of CABG until discharge. A mean cost per patient for re-exploration was calculated. Based on this, the net cost of prophylactic treatment with haemostatic drugs for preventing re-exploration was calculated. less thanbrgreater than less thanbrgreater thanResults. Patients undergoing re-exploration had higher exposure to clopidogrel before operation, prolonged stays in the intensive care unit, and more blood transfusions than controls. The mean incremental cost for re-exploration was (sic)6290 [95% confidence interval (CI) (sic)3408-(sic)9173] per patient, of which 48% [(sic)3001 (95% CI (sic)249-(sic)2147)] was due to prolonged stay, 31% [(sic)1928 (95% CI (sic)1710-(sic)2147)] to the cost of surgery/anaesthesia, 20% [(sic)1261 (95% CI (sic)1145-(sic)1378)] to the increased number of blood transfusions, and andlt;2% [(sic)100 (95% CI (sic)39-(sic)161)] to the cost of haemostatic drugs. A cost model, at an estimated 50% efficacy for recombinant activated clotting factor VIIa and a 50% expected risk for re-exploration without prophylaxis, demonstrated that to be cost neutral, prophylaxis of four patients needed to result in one avoided re-exploration. less thanbrgreater than less thanbrgreater thanConclusions. The resource utilization costs were substantially higher in patients requiring re-exploration for bleeding. From a strict cost-effectiveness perspective, clinical interventions to prevent haemorrhage might be underutilized.

  • 4.
    Alström, Ulrica
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Levin, L-Å
    Ståhle, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Thoraxkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Svedjeholm, R
    Friberg, Ö
    Cost analysis of re-exploration for bleeding after coronary artery bypass graft surgery2012Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 108, nr 2, s. 216-222Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Re-exploration for bleeding after cardiac surgery is an indicator of substantial haemorrhage and is associated with increased hospital resource utilization. This study aimed to analyse the costs of re-exploration and estimate the costs of haemostatic prophylaxis.

    METHODS:

    A total of 4232 patients underwent isolated, first-time, coronary artery bypass graft (CABG) surgery during 2005-8. Each patient re-explored for bleeding (n=127) was matched with two controls not requiring re-exploration (n=254). Cost analysis was based on resource utilization from completion of CABG until discharge. A mean cost per patient for re-exploration was calculated. Based on this, the net cost of prophylactic treatment with haemostatic drugs for preventing re-exploration was calculated.

    RESULTS:

    Patients undergoing re-exploration had higher exposure to clopidogrel before operation, prolonged stays in the intensive care unit, and more blood transfusions than controls. The mean incremental cost for re-exploration was (sic)6290 [95% confidence interval (CI) (sic)3408-(sic)9173] per patient, of which 48% [(sic)3001 (95% CI (sic)249-(sic)2147)] was due to prolonged stay, 31% [(sic)1928 (95% CI (sic)1710-(sic)2147)] to the cost of surgery/anaesthesia, 20% [(sic)1261 (95% CI (sic)1145-(sic)1378)] to the increased number of blood transfusions, and <2% [(sic)100 (95% CI (sic)39-(sic)161)] to the cost of haemostatic drugs. A cost model, at an estimated 50% efficacy for recombinant activated clotting factor VIIa and a 50% expected risk for re-exploration without prophylaxis, demonstrated that to be cost neutral, prophylaxis of four patients needed to result in one avoided re-exploration.

    CONCLUSIONS:

    The resource utilization costs were substantially higher in patients requiring re-exploration for bleeding. From a strict cost-effectiveness perspective, clinical interventions to prevent haemorrhage might be underutilized.

  • 5.
    Bartha, Erzsébet
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi.
    Carlsson, Per
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Kalman, Sigga
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery2006Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 96, nr 1, s. 111-117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. The outcome of different treatment strategies for postoperative pain has been an issue of controversy. Apart from efficacy and effectiveness a policy decision should also consider cost-effectiveness. Since economic analyses on postoperative pain treatment are rare we developed a decision model in a pilot cost-effectiveness analysis (CEA) comparing epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) after major abdominal surgery in routine care. Methods. Using a decision-tree model, treatment with EDA (ropivacaine and morphine) was compared with PCIA (morphine). Effects and costs of treatment were established. The number of pain-free days at rest (pain intensity <30 using visual analogue scale 1-100 mm) was the primary measure of effect. An incremental cost-effectiveness ratio (ICER) was calculated as the difference in direct costs divided by the difference in effect. A database on 644 patients collected for the purpose of quality control during the period of 1997 to 1999 was the main data source. Sensitivity analysis was used to test uncertain data. Results. EDA was more effective in terms of pain-free days but more expensive. The additional cost for each pain-free day was 5652 Euros. Conclusion. It is a judgement of value if the additional cost is reasonable. When the cost of around 55 000 Euros per gained life-year with full health for other interventions is debated, our result indicates poor cost-effectiveness for EDA. Before any conclusion can be drawn concerning policy recommendations the difference in costs has to be related to other outcome measures as length of hospital stay, morbidity and mortality are required. © The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved.

  • 6.
    Bergek, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Zdolsek, Joachim H.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Hahn, Robert
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US. Linköpings universitet, Medicinska fakulteten. Research Unit, Södertälje Hospital, Södertälje, Sweden.
    Non-invasive blood haemoglobin and plethysmographic variability index during brachial plexus block2015Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 114, nr 5, s. 812-817Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Plethysmographic measurement of haemoglobin concentration (SpHb  ), pleth variability index (PVI), and perfusion index (PI) with the Radical-7 apparatus is growing in popularity. Previous studies have indicated that SpHb  has poor precision, particularly when PI is low. We wanted to study the effects of a sympathetic block on these measurements.

    Methods Twenty patients underwent hand surgery under brachial plexus block with one Radical-7 applied to each arm. Measurements were taken up to 20 min after the block had been initiated. Venous blood samples were also drawn from the non-blocked arm.

    Results During the last 10 min of the study, SpHb  had increased by 8.6%. The PVI decreased by 54%, and PI increased by 188% in the blocked arm (median values). All these changes were statistically significant. In the non-blocked arm, these parameters did not change significantly.

    Conclusions Brachial plexus block significantly altered SpHb  , PVI, and PI, which indicates that regional nervous control of the arm greatly affects plethysmographic measurements obtained by the Radical-7. After the brachial plexus block, SpHb  increased and PVI decreased.

  • 7.
    Buratovic, Sonja
    et al.
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Biologiska sektionen, Institutionen för organismbiologi, Miljötoxikologi.
    Stenerlöw, Bo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Medicinsk strålningsvetenskap.
    Sundell-Bergman, S.
    Swedish Univ Agr Sci, Dept Soil & Environm, Umea, Sweden.
    Fredriksson, Anders
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Biologiska sektionen, Institutionen för organismbiologi, Miljötoxikologi.
    Viberg, Henrik
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Biologiska sektionen, Institutionen för organismbiologi, Miljötoxikologi.
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Eriksson, Per
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Biologiska sektionen, Institutionen för organismbiologi, Miljötoxikologi.
    Effects on adult cognitive function after neonatal exposure to clinically relevant doses of ionising radiation and ketamine in mice2018Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 120, nr 3, s. 546-554Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Radiological methods for screening, diagnostics and therapy are frequently used in healthcare. In infants and children, anaesthesia/sedation is often used in these situations to relieve the patients' perception of stress or pain. Both ionising radiation (IR) and ketamine have been shown to induce developmental neurotoxic effects and this study aimed to identify the combined effects of these in a murine model. Methods: Male mice were exposed to a single dose of ketamine (7.5 mg kg(-1) body weight) s.c. on postnatal day 10. One hour after ketamine exposure, mice were whole body irradiated with 50-200 mGy gamma radiation (Cs-137). Behavioural observations were performed at 2, 4 and 5 months of age. At 6 months of age, cerebral cortex and hippocampus tissue were analysed for neuroprotein levels. Results: Animals co-exposed to IR and ketamine displayed significant (P <= 0.01) lack of habituation in the spontaneous behaviour test, when compared with controls and single agent exposed mice. In the Morris Water Maze test, co-exposed animals showed significant (P <= 0.05) impaired learning and memory capacity in both the spatial acquisition task and the relearning test compared with controls and single agent exposed mice. Furthermore, in co-exposed mice a significantly (P <= 0.05) elevated level of tau protein in cerebral cortex was observed. Single agent exposure did not cause any significant effects on the investigated endpoints. Conclusion: Co-exposure to IR and ketamine can aggravate developmental neurotoxic effects at doses where the single agent exposure does not impact on the measured variables. These findings show that estimation of risk after paediatric low-dose IR exposure, based upon radiation dose alone, may underestimate the consequences for this vulnerable population.

  • 8.
    Cecconi, M
    et al.
    1Anaesthesia and Intensive Care, St George’s Hospital and St George’s University of London, London, UK,.
    Hochrieser, H
    Center for Medical Statistics, Informatics, and Intelligent Systems .
    Chew, Michelle
    Department of Anaesthesia and Intensive Care and Institute of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Grocott, M
    Anaesthesia and Critical Care Medicine, University of Southampton, Southampton, UK, .
    Hoeft, A
    Department of Anaesthesiology, University of Bonn,Bonn, Germany, .
    Hoste, A
    Intensive Care Unit, Ghent University Hospital, Ghent, Belgium.
    Jammer, I
    Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen 5021, Norway .
    Posch, M
    Center for Medical Statistics, Informatics, and Intelligent Systems, .
    Metnitz, P
    Clinical Department of General Anaesthesiology, Emergency- and Intensive Care Medicine, Department of Anaesthesiology and Intensive Care Medicine, LKH - University Hospital of Graz, Medical University of Graz, Austria.
    Pelosi, P
    9Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy .
    Moreno, R
    Hospital de São José, Centro Hospitalar de Lisboa Central, EPE, UCINC, Lisbon, Portugal .
    Pearse, R M
    Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK, .
    Vincent, J L
    Department of Intensive Care, Erasme Hospital Université Libre de Bruxelles, Brussels, Belgium .
    Rhodes, A
    Anaesthesia and Intensive Care, St George’s Hospital and St George’s University of London, London, UK.
    Preoperative abnormalities in serum sodium concentrations are associated with higher in-hospital mortality in patients undergoing major surgery.2016Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 116, nr 1, s. 63-69Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Abnormal serum sodium concentrations are common in patients presenting for surgery. It remains unclear whether these abnormalities are independent risk factors for postoperative mortality.

    METHODS: This is a secondary analysis of the European Surgical Outcome Study (EuSOS) that provided data describing 46 539 patients undergoing inpatient non-cardiac surgery. Patients were included in this study if they had a recorded value of preoperative serum sodium within the 28 days immediately before surgery. Data describing preoperative risk factors and serum sodium concentrations were analysed to investigate the relationship with in-hospital mortality using univariate and multivariate logistic regression techniques.

    RESULTS: Of 35 816 (77.0%) patients from the EuSOS database, 21 943 (61.3%) had normal values of serum sodium (138-142 mmol litre(-1)) before surgery, 8538 (23.8%) had hyponatraemia (serum sodium ≤137 mmol litre(-1)) and 5335 (14.9%) had hypernatraemia (serum sodium ≥143 mmol litre(-1)). After adjustment for potential confounding factors, moderate to severe hypernatraemia (serum sodium concentration ≥150 mmol litre(-1)) was independently associated with mortality [odds ratio 3.4 (95% confidence interval 2.0-6.0), P<0.0001]. Hyponatraemia was not associated with mortality.

    CONCLUSIONS: Preoperative abnormalities in serum sodium concentrations are common, and hypernatraemia is associated with increased mortality after surgery. Abnormalities of serum sodium concentration may be an important biomarker of perioperative risk resulting from co-morbid disease.

  • 9.
    Chew, Michelle
    Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries2016Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 117, nr 5, s. 601-609Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care.

    Methods

    We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries.

    Results

    A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2–7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries.

    Conclusions

    Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.

  • 10.
    Crockett, D. C.
    et al.
    Univ Oxford, Nuffield Div Anaesthet, Oxford, England.
    Cronin, J. N.
    Kings Coll London, Ctr Human & Appl Physiol Sci, London, England.
    Bommakanti, N.
    Univ Oxford, Nuffield Div Anaesthet, Oxford, England;Columbia Univ, Vagelos Coll Phys & Surg, New York, NY USA.
    Chen, R.
    Univ Oxford, Nuffield Div Anaesthet, Oxford, England.
    Hahn, C. E. W.
    Univ Oxford, Nuffield Div Anaesthet, Oxford, England.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Farmery, A. D.
    Univ Oxford, Nuffield Div Anaesthet, Oxford, England.
    Formenti, F.
    Univ Oxford, Nuffield Div Anaesthet, Oxford, England;Kings Coll London, Ctr Human & Appl Physiol Sci, London, England;Univ Nebraska, Dept Biomech, Omaha, NE 68182 USA.
    Tidal changes in PaO2 and their relationship to cyclical lung recruitment/derecruitment in a porcine lung injury model2019Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 122, nr 2, s. 277-285Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Tidal recruitment/derecruitment (R/D) of collapsed regions in lung injury has been presumed to cause respiratory oscillations in the partial pressure of arterial oxygen (PaO2). These phenomena have not yet been studied simultaneously. We examined the relationship between R/D and PaO2 oscillations by contemporaneous measurement of lung-density changes and PaO2. Methods: Five anaesthetised pigs were studied after surfactant depletion via a saline-lavage model of R/D. The animals were ventilated with a mean fraction of inspired O-2 (FiO(2)) of 0.7 and a tidal volume of 10 ml kg(-1) Protocolised changes in pressure-and volume-controlled modes, inspiratory: expiratory ratio (I:E), and three types of breath-hold manoeuvres were undertaken. Lung collapse and PaO2 were recorded using dynamic computed tomography (dCT) and a rapid PaO2 sensor. Results: During tidal ventilation, the expiratory lung collapse increased when I: E <1 [mean (standard deviation) lung collapse = .7 (8.7)%; P<0.05], but the amplitude of respiratory PaO2 oscillations [ 2.2 (0.8) kPa] did not change during the respiratory cycle. The expected relationship between respiratory PaO2 oscillation amplitude and R/D was therefore not clear. Lung collapse increased during breath-hold manoeuvres at end-expiration and end-inspiration (14% vs 0.9-2.1%; P<0.0001). The mean change in PaO2 from beginning to end of breath-hold manoeuvres was significantly different with each type of breath-hold manoeuvre (P<0.0001). Conclusions: This study in a porcine model of collapse-prone lungs did not demonstrate the expected association between PaO2 oscillation amplitude and the degree of recruitment/derecruitment. The results suggest that changes in pulmonary ventilation are not the sole determinant of changes in PaO2 during mechanical ventilation in lung injury.

  • 11.
    Dahlberg, Karuna
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Philipsson, Anna
    Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Hagberg, Lars
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Jaensson, Maria
    Örebro universitet, Institutionen för hälsovetenskaper.
    Hälleberg Nyman, Maria
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial2017Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, nr 5, s. 1039-1046Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.

    Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.

    Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.

    Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.

    Clinical trial registration:NCT02492191

  • 12.
    Edsberg, Lennart
    KTH, Tidigare Institutioner, Numerisk analys och datalogi, NADA.
    Volume kinetics of glucose solutions given by intravenous infusion2001Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 87, nr 6, s. 834-843Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Glucose solutions given by intravenous (i.v.) infusion exert volume effects that are governed by the amount of fluid administered and also by the metabolism of the glucose. To understand better how the body handles glucose solutions, two volume kinetic models were developed in which consideration was given to the osmotic fluid shifts that accompany the metabolism of glucose. These models were fitted to data obtained when 21 volunteers who were given approximately 1 litre of glucose 2.5 or 5% or Ringer's solution (control) over 45 min. The maximum haemodilution was similar for all three fluids, but it decreased more rapidly when glucose had been infused. The volume of distribution for the infused glucose molecules was larger (similar to 12 litres) than for the infused fluid, which amounted to (mean (SEM)) 3.7 (0.3) (glucose 2.5%). 2.8 (0.2) (glucose 5%), and 2.5 (0.2) litres (Ringer). Fluid accumulated in a remote (cellular) body fluid space when glucose had been administered (similar to0.2 and 0.4 litres, respectively), while expansion of an intermediate fluid space (7.1 (13) litres) could be demonstrated in 33% of the Ringer experiments. In conclusion, kinetic models were developed which consider the relationship between the glucose metabolism and the disposition of intravenous fluid. One of them, in which infused fluid expands two instead of three body fluid spaces, was successfully fitted to data on blood glucose and blood haemoglobin obtained during infusions of 2.5 and 5% glucose.

  • 13.
    Eintrei, Christina
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Sokoloff, L
    Smith, C B
    Effects of diazepam and ketamine administred individually or in combination on regional rates of glucose utilization in rat brain.1999Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 82, s. 596-602Artikel i tidskrift (Refereegranskat)
  • 14.
    Fant, F
    et al.
    Örebro University.
    Axelsson, K
    Örebro University.
    Sandblom, D
    Örebro University.
    Magnuson, A
    Örebro University.
    Andersson, S-O
    Örebro University.
    Gupta, Anil
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och operationkliniken US.
    Thoracic epidural analgesia or patient-controlled local analgesia for radical retropubic prostatectomy: a randomized, double-blind study2011Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 107, nr 5, s. 782-789Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Postoperative pain after radical retropubic prostatectomy is moderate to severe. The primary aim of this study was to assess whether intra-abdominal local anaesthetics provide similar analgesia compared with thoracic epidural analgesia (TEA). less thanbrgreater than less thanbrgreater thanMethods. Fifty patients, ASA I-II, participated in this prospective, double-blinded study. All patients had TEA. After operation, they were randomized into two groups of 25 patients: Group PCLA (patient-controlled local analgesia): self-administration of 10 ml of ropivacaine 2 mg ml(-1) via the intra-abdominal catheter for 48 h. Group TEA: infusion of 10 ml h(-1) of ropivacaine 1 mg ml(-1), fentanyl 2 mg ml(-1), and epinephrine 2 mg ml 21 epidurally for 48 h. The primary endpoint was pain on coughing at 4 h after operation. Rescue medication was morphine i.v. as required. less thanbrgreater than less thanbrgreater thanResults. Pain on coughing at 4, 24, and 48 h was significantly lower in Group TEA [0 (0-10)] compared with Group PCLA [4 (0-10)] (Pandlt;0.05). Significantly lower pain intensity was also found in Group TEA compared with Group PCLA at the incision site, deep pain, and pain on coughing at 4 and 24 h (Pandlt;0.05). Morphine consumption was significantly greater in Group PCLA [12 (0-46)] compared with Group TEA [0 (0-20)] at 0-48 h after operation [median (range)] (P=0.015). Maximum expiratory pressure was higher in Group TEA compared with Group PCLA at 24 h (Pandlt;0.01). less thanbrgreater than less thanbrgreater thanConclusions. TEA provides superior postoperative pain relief with better preservation of expiratory muscle strength compared with PCLA.

  • 15.
    Fant, F.
    et al.
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Tina, Elisabet
    Region Örebro län. Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Research Centre.
    Sandblom, D.
    Department of Urology and the Health Academy, Örebro University Hospital, Örebro, Sweden.
    Andersson, Swen-Olof
    Department of Urology and the Health Academy, Örebro University Hospital, Örebro, Sweden.
    Magnuson, A.
    Clinical Epidemiology and Biostatistical Unit, Örebro University Hospital, Örebro, Sweden.
    Hultgren-Hörnquist, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Axelsson, Kjell
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy2013Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 110, nr 5, s. 747-757Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Epidural anaesthesia and analgesia has been shown to suppress the neurohormonal stress response, but its role in the inflammatory response is unclear. The primary aim was to assess whether the choice of analgesic technique influences these processes in patients undergoing radical retropubic prostatectomy.

    Methods: Twenty-six patients were randomized to Group P (systemic opioid-based analgesia) or Group E (thoracic epidural-based analgesia) perioperatively. Induction and maintenance of anaesthesia followed a standardized protocol. The following measurements were made perioperatively: plasma cortisol, glucose, insulin, C-reactive proteins, leucocyte count, plasma cytokines [interleukin (IL)-6, tumour necrosis factor (TNF)-alpha], and pokeweed mitogen-stimulated cytokines [interferon (IFN)-gamma, IL-2, IL-12p70, IL-10, IL-4, and IL-17]. Other parameters recorded were pain, morphine consumption, and perioperative complications.

    Results: Plasma concentration of cortisol and glucose were significantly higher in Group P compared with Group E at the end of surgery, the mean difference was 232 nmol litre(-1) [95% confidence interval (CI) 84-381] (P=0.004) and 1.6 mmol litre(-1) (95% CI 0.6-2.5) (P=0.003), respectively. No significant differences were seen in IL-6 and TNF-alpha at 24 h (P=0.953 and 0.368, respectively) and at 72 h (P=0.931 and 0.691, respectively). IL-17 was higher in Group P compared with Group E, both at 24 h (P=0.001) and 72 h (P=0.018) after operation. Pain intensity was significantly greater in Group P compared with Group E (P<0.05) up to 24 h.

    Conclusions: In this small prospective randomized study, thoracic epidural analgesia reduced the early postoperative stress response but not the acute inflammatory response after radical retrobupic prostatectomy, suggesting that other pathways are involved during the acute phase reaction.

  • 16.
    Fant, Federica
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Axelsson, Kjell
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Sandblom, Dag
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistical Unit, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Andersson, Swen-Olof
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Gupta, Anil
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Thoracic epidural analgesia or patient-controlled local analgesia for radical retropubic prostatectomy: a randomized, double-blind study2011Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 107, nr 5, s. 782-789Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background.Postoperative pain after radical retropubic prostatectomy is moderate to severe. The primary aim of this study was to assess whether intra-abdominal local anaesthetics provide similar analgesia compared with thoracic epidural analgesia (TEA).

    Methods.Fifty patients, ASA I–II, participated in this prospective, doubleblinded study. All patients had TEA. After operation, they were randomized into two groups of 25 patients: Group PCLA (patient- ontrolled local analgesia): self-administration of 10 ml of ropivacaine 2 mg ml21 via the intra-abdominal catheter for 48 h. Group TEA: infusion of 10 ml h–1 of ropivacaine 1 mg ml–1, fentanyl 2mg ml21, and epinephrine 2mg ml21 epidurally for 48 h. The primary endpoint was pain on coughing at 4 h after operation. Rescue medication was morphine i.v. as required.

    Results.Pain on coughing at 4, 24, and 48 h was significantly lower in Group TEA [0 (0–10)] compared with Group PCLA [4 (0–10)] (P,0.05). Significantly lower pain intensity was also found in Group TEA compared with Group PCLA at the incision site, deep pain, and pain on coughing at 4 and 24 h (P,0.05). Morphine consumption was significantly greater in Group PCLA [12 (0–46)] compared with Group TEA [0 (0–20)] at 0–48 h after operation [median (range)] (P¼0.015). Maximum expiratory pressure was higher in Group TEA compared with Group PCLA at 24 h (P,0.01).Conclusions.TEA provides superior postoperative pain relief with better preservation of expiratory muscle strength compared with PCLA.

  • 17.
    Fors, Diddi
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Eiriksson, K.
    Arvidsson, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Gas embolism during laparoscopic liver resection in a pig model: frequency and severity2010Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 105, nr 3, s. 282-288Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Laparoscopic liver surgery is evolving rapidly. Carbon dioxide embolism is a potential complication. The aim of this work was to study the frequency and severity of gas embolism (GE) during laparoscopic liver lobe resection in a pig model and the resulting cardiovascular and respiratory changes. Methods. Fifteen anaesthetized piglets underwent laparoscopic left liver lobe resection. Haemodynamic and respiratory variables were monitored, including systemic and pulmonary arterial pressures, end-tidal CO2, and pulmonary dead space. Online blood gas monitoring and a transoesophageal echocardiography (TOE) were used. GE was graded semi-quantitatively as grade 0 (none), grade 1 (minor), or grade 2 (major), depending on the TOE results. Results. In 10 of 15 piglets, GE occurred. In total, 33 separate episodes of GE were recorded. All 13 episodes of grade 2 and three of grade 1 were serious enough to cause mainly respiratory, but also haemodynamic effects. Mostly, grade 1 GE caused only minor respiratory or haemodynamic changes. Most variables were affected during grade 2 GE; the most important were Pa-O2, Pa-CO2, end-tidal CO2, Vd/Vt, and mean pulmonary arterial pressure. Conclusions. GE occurred frequently during laparoscopic liver resection in this experimental study. Approximately half of the embolisms were serious enough to cause respiratory or haemodynamic disturbances or both. Pending further human studies, a combination of several monitoring techniques, with narrow limits for the alarm settings, will ensure correct interpretation of the complex physiological response to GE and reveal it early enough to alert the anaesthetist and the surgeon to the ongoing problem.

  • 18.
    Fors, Diddi
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Eiriksson, K.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Waage, A.
    Arvidsson, D.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    High-frequency jet ventilation shortened the duration of gas embolization during laparoscopic liver resection in a porcine model2014Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, nr 3, s. 484-490Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Positive pressure mechanical ventilation causes rhythmic changes in thoracic pressure and central blood flow. If entrainment occurs, it could be easier for carbon dioxide to enter through a wounded vein during laparoscopic liver lobe resection (LLR). High-frequency jet ventilation (HFJV) is a ventilating method that does not cause pronounced pressure or blood flow changes. This study aimed to investigate whether HFJV could influence the frequency, severity, or duration of gas embolism (GE) during LLR. Methods. Twenty-four anaesthetized piglets underwent lobe resection and were randomly assigned to either normal frequency ventilation (NFV) or HFJV (n=12 per group). During resection, a standardized injury to the left hepatic vein was created to increase the risk of GE. Haemodynamic and respiratory variables were monitored. Online blood gas monitoring and transoesophageal echocardiography were used. GE occurrence and severity were graded as 0 (none), 1 (minor), or 2 (major), depending on the echocardiography results. Results. GE duration was shorter in the HFJV group (P=0.008). However, no differences were found between the two groups in the frequency or severity of embolism. Incidence of Grade 2 embolism was less than that found in previous studies and physiological responses to embolism were variable. Conclusion. HFJV shortened the mean duration of GE during LLR and was a feasible ventilation method during the procedure. Individual physiological responses to GE were unpredictable.

  • 19.
    Fors, Diddi
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Eiriksson, Kristinn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Arvidsson, Dag
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Elevated PEEP without effect upon gas embolism frequency or severity in experimental laparoscopic liver resection2012Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 109, nr 2, s. 272-278Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Carbon dioxide (CO2) embolism is a potential complication in laparoscopic liver surgery. Gas embolism (GE) is thought to occur when central venous pressure (CVP) is lower than the intra-abdominal pressure (IAP). This study aimed to investigate whether an increased CVP due to induction of PEEP could influence the frequency and severity of GE during laparoscopic liver resection. Twenty anaesthetized piglets underwent laparoscopic left liver lobe resection and were randomly assigned to either 5 or 15 cm H2O PEEP (n10 per group). During resection, a standardized injury to the left hepatic vein [venous cut (VC)] was created to increase the risk of GE. Haemodynamic and respiratory variables were monitored, and online arterial blood gas monitoring and transoesophageal echocardiography (TOE) were used. The occurrence and severity of embolism was graded as 0 (none), 1 (minor), or 2 (major), depending on the TOE results. No differences were found between the two groups regarding the frequency or severity of GE, during either the VC (P0.65) or the rest of the surgery (P0.24). GE occurred irrespective of the CVPIAP gradient. Mechanisms other than the CVPIAP gradient seemed during laparoscopic liver surgery to contribute to the formation of CO2 embolism. This is of clinical importance to the anaesthetists.

  • 20.
    Fredén, Filip
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Berglund, Jan Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Reber, Adrian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Högman, Marie-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Inhalation of a nitric oxide synthase inhibitor to a hypoxic or collapsed lung lobe in anaesthetized pigs: effects on pulmonary blood flow distribution1996Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 77, nr 3, s. 413-418Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    I.v. administration of the nitric oxide synthase inhibitor, nitro-L-arginine methyl ester (L-NAME), not only reduces blood flow in a hypoxic lung region but also causes systemic vasoconstriction and a decrease in cardiac output. In this study, we delivered nebulized L-NAME 0.2-1 mg kg-1 to the left lower lobe of 10 anaesthetized pigs. The left lower lobe was made hypoxic by selective inhalation of 5% oxygen or collapsed by interrupted ventilation, or both. Inhalation of L-NAME reduced fractional blood flow to the left lower lobe from 5.3 (SD 3.1)% to 1.7 (1.4)% (P < 0.05) in lobar hypoxia and from 6.0 (3.3) to 2.7 (2.7)% (P < 0.05) in lobar collapse. These reductions were accompanied by a significant increase in PaO2. There were no significant changes in arterial pressure, cardiac output or heart rate. We have shown that selective inhalation of L-NAME reduced blood flow to a hypoxic or collapsed lung region without systemic effects. The possible role for nitric oxide synthase inhibition in reducing shunt during one-lung ventilation, however, requires further study.

  • 21.
    Frykholm, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Schindler, E.
    Asklepios Klin Sankt Augustin, Dept Paediat Anaesthesia, St Augustin, NRW, Germany.
    Suempelmann, R.
    Hannover Med Sch, Clin Anaesthesiol & Intens Care Med, Hannover, Germany.
    Walker, R.
    Royal Manchester Childrens Hosp, Manchester, Lancs, England.
    Weiss, M.
    Univ Childrens Hosp, Dept Anaesthesia, Zurich, Switzerland.
    Preoperative fasting in children: review of existing guidelines and recent developments2018Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 120, nr 3, s. 469-474Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The current guidelines for preoperative fasting recommend intervals of 6, 4, and 2 h (6-4-2) of fasting for solids, breast milk, and clear fluids, respectively. The objective is to minimize the risk of pulmonary aspiration of gastric contents, but also to prevent unnecessarily long fasting intervals. Pulmonary aspiration is rare and associated with nearly no mortality in paediatric anaesthesia. The incidence may have decreased during the last decades, judging from several audits published recently. However, several reports of very long fasting intervals have also been published, in spite of the implementation of the 6-4-2 fasting regimens. In this review, we examine the physiological basis for various fasting recommendations, the temporal relationship between fluid intake and residual gastric content, and the pathophysiological effects of preoperative fasting, and review recent publications of various attempts to reduce the incidence of prolonged fasting in children. The pros and cons of the current guidelines will be addressed, and possible strategies for a future revision will be suggested.

  • 22.
    Giesecke, Kajsa
    et al.
    Department of Anaesthesiology, Huddingc Hospital, Huddinge, Sweden.
    Klingstedt, Christer
    Department of Anaesthesiology, South Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Hagenfeldt, Lars
    Department of Clinical Chemistry, Huddinge Hospital, Huddinge, Sweden.
    The modifying influence of anaesthesia on postoperative protein catabolism1994Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 72, nr 6, s. 697-699Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We studied two groups of six patients scheduled for gastrointestinal surgery; they were allocated randomly to receive high- or low-dose fentanyl anaesthesia. The confounding effect of protein balance, before the trauma of surgery, on postoperative nitrogen excretion was controlled by standardized protein intake before operation, supplemented by adequate calories. The high-dose group had significantly lower stress levels during surgery, assessed by arterial blood concentrations of cortisone, adrenaline and glucose. After operation, protein catabolism was measured for 7 days. The high-dose group had significantly lower postoperative excretion of ammonia and slightly lower excretion of urea and 3-methylhistidine. Low-stress anaesthesia may thus diminish postoperative catabolism, which could be important in frail patients by reducing mortality, ICU resources, or both. 

  • 23.
    Good, Lars
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Ortopedi och Idrottsmedicin. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Peterson, E
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Lisander, Björn
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement2003Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 90, nr 5, s. 596-599Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Total knee arthroplasty (TKA) is often carried out using a tourniquet and shed blood is collected in drains. Tranexamic acid decreases the external blood loss. Some blood loss may be concealed, and the overall effect of tranexamic acid on the haemoglobin (Hb) balance is not known. Methods. Patients with osteoarthrosis had unilateral cemented TKA using spinal anaesthesia. In a double-blind fashion, they received either placebo (n=24) or tranexamic acid 10 mg kg-1 (n=27) i.v. just before tourniquet release and 3 h later. The decrease in circulating Hb on the fifth day after surgery, after correction for Hb transfused, was used to calculate the loss of Hb in grams. This value was then expressed as ml of blood loss. Results. The groups had similar characteristics. The median volume of drainage fluid after placebo was 845 (interquartile range 523-990) ml and after tranexamic acid was 385 (331-586) ml (P<0.001). Placebo patients received 2 (0-2) units and tranexamic acid patients 0 (0-0) units of packed red cells (P<0.001). The estimated blood loss was 1426 (1135-1977) ml and 1045 (792-1292) ml, respectively (P<0.001). The hidden loss of blood (calculated as loss minus drainage volume) was 618 (330-1347) ml and 524 (330-9620) ml, respectively (P=0.41). Two patients in each group developed deep vein thrombosis. Conclusions. Tranexamic acid decreased total blood loss by nearly 30%, drainage volume by ~50% and drastically reduced transfusion. However, concealed loss was only marginally influenced by tranexamic acid and was at least as large as the drainage volume.

  • 24.
    Gornall, B. F.
    et al.
    Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Clayton VIC, Australia; Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC, Australia.
    Myles, Paul S.
    Academic Board of Anaesthesia and Perioperative Medicine, Department of Epidemiology and Preventive Medicine, Monash University,Clayton VIC, Australia; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne Vic, Australia.
    Smith, C. L.
    Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC, Australia.
    Burke, J. A.
    Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne Vic, Australia.
    Leslie, K.
    Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne Vic, Australia.
    Pereira, M. J.
    Department of Anaesthesia, Central Lisbon Hospital Center, Lisbon, Portugal.
    Bost, J. E.
    Biostatistics and Clinical and Translational Science, University of Pittsburgh, Pittsburgh PA, USA; Center for Research on Health Care (CRHC) Data Cente, University of Pittsburgh, Pittsburgh PA, USA.
    Kluivers, K. B.
    Department of Obstetrics and Gynecology, Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Anaesthesia and Intensive Care, Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Centre for Health Care, Örebro University Hospital, Örebro, Sweden.
    Tanaka, V.
    Department of Anesthesiology, Nara Medical University, Kashihara, Japan.
    Forbes, A.
    Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC, Australia.
    Measurement of quality of recovery using the QoR-40:a quantitative systematic review2013Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 111, nr 2, s. 161-169Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background.Several rating scales have been developed to measure quality of recovery aftersurgery and anaesthesia, but the most extensively used is the QoR-40, a 40-itemquestionnaire that provides a global score and subscores across five dimensions: patientsupport, comfort, emotions, physical independence, and pain. It has been evaluated in avariety of settings, but its overall psychometric properties (validity, reliability, ease of use,and interpretation) and clinical utility are uncertain.

    Methods.We undertook a quantitative systematic review of studies evaluatingpsychometric properties of the QoR-40. Data were combined in meta-analyses usingrandom effects models. This resulted in a total sample of 3459 patients from 17 studiesoriginating in nine countries.

    Results.We confirmed content, construct, and convergent [pooled r¼0.58, 95% confidenceinterval (CI): 0.51–0.65] validity. Reliability was confirmed by excellent intraclass correlation(pooleda¼0.91, 95% CI: 0.88–0.93), test–retest reliability (pooled r¼0.90, 95% CI: 0.86–0.92), and inter-rater reliability (intraclass correlation¼0.86). The clinical utility of theQoR-40 instrument was supported by high patient recruitment into evaluation studies(97%), and an excellent completion and return rate (97%). The mean time to completethe QoR-40 was 5.1 (95% CI: 4.4–5.7) min.

    Conclusions.The QoR-40 is a widely used and extensively validated measure of quality ofrecovery. The QoR-40 is a suitable measure of postoperative quality of recovery in arange of clinical and research situations.Keywords:health status; meta-analysis; outcomes

  • 25.
    Gupta, Anil
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och operationkliniken US.
    Bjornsson, A.
    Department Anaesthesiol and Intens Care, Orebro.
    Fredriksson, M.
    Hallböök, Olof
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken i Östergötland.
    Eintrei, Christina
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Intensivvårdskliniken US.
    Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery: a retrospective analysis of data from 655 patients in Central Sweden2011Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 107, nr 2, s. 164-170Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. There is some evidence that epidural analgesia (EDA) reduces tumour recurrence after breast and prostatic cancer surgery. We assessed whether EDA reduces long-term mortality after colorectal cancer surgery. Methods. All patients having colorectal cancer surgery between January 2004 and January 2008 at Linkoping and Orebro were included. Exclusion criteria were: emergency operations, laparoscopic-assisted colorectal resection, and stage 4 cancer. Statistical information was obtained from the Swedish National Register for Deaths. Patients were analysed in two groups: EDA group or patient-controlled analgesia (PCA group) as the primary method of analgesia. Results. A total of 655 patients could be included. All-cause mortality for colorectal cancer (stages 1-3) was 22.7% (colon: 20%, rectal: 26%) after 1-5 yr of surgery. Multivariate regression analysis identified the following statistically significant factors for death after colon cancer (Pless than0.05): age (greater than72 yr) and cancer stage 3 (compared with stage 1). A similar model for rectal cancer found that age (greater than72 yr) and the use of PCA rather than EDA and cancer stages 2 and 3 (compared with stage 1) were associated with a higher risk for death. No significant risk of death was found for colon cancer when comparing EDA with PCA (P=0.23), but a significantly increased risk of death was seen after rectal cancer when PCA was used compared with EDA (P=0.049) [hazards ratio: 0.52 (0.27-1.00)]. Conclusions. We found a reduction in all-cause mortality after rectal but not colon cancer in patients having EDA compared with PCA technique.

  • 26.
    Hahn, R G.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Letter: Haemodilution made difficult2013Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 111, nr 4, s. 679-680Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 27.
    Hahn, Robert G
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US. Research Unit, Södertälje Hospital, Sweden.
    Should anaesthetists stop infusing isotonic saline?2014Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 112, nr 1, s. 4-6Artikel i tidskrift (Refereegranskat)
  • 28.
    Hedenstierna, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Edmark, L
    Perchiazzi, G
    Postoperative lung complications: have multicentre studies been of any help?2015Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 114, nr 4, s. 541-543Artikel i tidskrift (Refereegranskat)
  • 29.
    Holm, J.
    et al.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    Vidlund, Mårten
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital, Örebro, Sweden.
    Vanky, F.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    Friberg, Örjan
    Region Örebro län. Department of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital, Örebro, Sweden.
    Håkanson, E.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    Walther, S.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    Svedjeholm, R.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery2014Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, nr 1, s. 75-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Postoperative heart failure remains the major cause of death after cardiac surgery. As N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.

    Methods: A total of 365 patients with acute coronary syndrome (ACS) undergoing isolated coronary artery bypass graft (CABG) surgery were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure after operation according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on receiver operating characteristics analysis, these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng litre(-1). The follow-up time averaged 4.4 (0.7) yr.

    Results: Preoperative NT-proBNP >= 1028 ng litre(-1) [odds ratio (OR) 9.9,95% confidence interval (CI) 1.01-98.9; P=0.049] and EuroSCORE II (OR 1.24, 95% CI 1.06-1.46; P=0.008) independently predicted severe circulatory failure after operation. In intermediate-risk patients (EuroSCORE II 2.0-10.0), NT-proBNP >= 1028 ng litre(-1) was associated with a higher incidence of severe circulatory failure (6.6% vs 0%; P=0.007), renal failure (14.8% vs 5.4%; P=0.03), stroke (6.6% vs 0.7%; P=0.03), longer intensive care unit stay [37 (35) vs 27 (38) h; P=0.002], and worse long-term survival.

    Conclusions: Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NT-proBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.

  • 30.
    Holm, Jonas
    et al.
    Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Institutionen för medicin och hälsa, Thoraxkirurgi. Linköpings universitet, Hälsouniversitetet.
    Håkanson, Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Thoraxanestesi med intensivvård. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och operationkliniken US.
    Vánky, Farkas
    Linköpings universitet, Institutionen för medicin och hälsa, Thoraxkirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Svedjeholm, Rolf
    Linköpings universitet, Institutionen för medicin och hälsa, Thoraxkirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Mixed venous oxygen saturation predicts short- and long-term outcome after coronary artery bypass grafting surgery: a retrospective cohort analysis2011Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 107, nr 3, s. 344-350Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Complications of an inadequate haemodynamic state are a leading cause of morbidity and mortality after cardiac surgery. Unfortunately, commonly used methods to assess haemodynamic status are not well documented with respect to outcome. The aim of this study was to investigate SV(O2) as a prognostic marker for short-and long-term outcome in a large unselected coronary artery bypass grafting (CABG) cohort and in subgroups with or without treatment for intraoperative heart failure. less thanbrgreater than less thanbrgreater thanMethods. Two thousand seven hundred and fifty-five consecutive CABG patients and subgroups comprising 344 patients with and 2411 patients without intraoperative heart failure, respectively, were investigated. SV(O2) was routinely measured on admission to the intensive care unit (ICU). The mean (SD) follow-up was 10.2 (1.5) yr. less thanbrgreater than less thanbrgreater thanResults. The best cut-off for 30 day mortality related to heart failure based on receiver-operating characteristic analysis was SV(O2) 60.1%. Patients with SV(O2) andlt;60% had higher 30 day mortality (5.4% vs 1.0%; P andlt; 0.0001) and lower 5 yr survival (81.4% vs 90.5%; P andlt; 0.0001). The incidences of perioperative myocardial infarction, renal failure, and stroke were also significantly higher, leading to a longer ICU stay. Similar prognostic information was obtained in the subgroups that were admitted to ICU with or without treatment for intraoperative heart failure. In patients admitted to ICU without treatment for intraoperative heart failure and SV(O2) andgt;= 60%, 30 day mortality was 0.5% and 5 yr survival 92.1%. less thanbrgreater than less thanbrgreater thanConclusions. SV(O2) andlt;60% on admission to ICU was related to worse short- and long-term outcome after CABG, regardless of whether the patients were admitted to ICU with or without treatment for intraoperative heart failure.

  • 31.
    Holm, Jonas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Vidlund, M.
    Örebro University Hospital, Sweden .
    Vánky, Farkas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Friberg, O.
    Örebro University Hospital, Sweden .
    Håkanson, E.
    Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Walther, Sten
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Svedjeholm, Rolf
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery2014Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, nr 1, s. 75-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Postoperative heart failure remains the major cause of death after cardiac surgery. As N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.

    METHODS:

    A total of 365 patients with acute coronary syndrome (ACS) undergoing isolated coronary artery bypass graft (CABG) surgery were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure after operation according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on receiver operating characteristics analysis, these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng litre(-1). The follow-up time averaged 4.4 (0.7) yr.

    RESULTS:

    Preoperative NT-proBNP≥1028 ng litre(-1) [odds ratio (OR) 9.9, 95% confidence interval (CI) 1.01-98.9; P=0.049] and EuroSCORE II (OR 1.24, 95% CI 1.06-1.46; P=0.008) independently predicted severe circulatory failure after operation. In intermediate-risk patients (EuroSCORE II 2.0-10.0), NT-proBNP≥1028 ng litre(-1) was associated with a higher incidence of severe circulatory failure (6.6% vs 0%; P=0.007), renal failure (14.8% vs 5.4%; P=0.03), stroke (6.6% vs 0.7%; P=0.03), longer intensive care unit stay [37 (35) vs 27 (38) h; P=0.002], and worse long-term survival.

    CONCLUSIONS:

    Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NT-proBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.

  • 32.
    Håkansson, E
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Håkansson, E
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Konstantinov, I
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Thoraxkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Fransson, Sven Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Radiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Svedjeholm, Rolf
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Thoraxkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Management of life-threatening haemoptysis2002Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 88, s. 291-295Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Massive haemoptysis represents a major medical emergency that is associated with a high mortality. Here we present two cases of life-threatening haemoptysis, the first caused by rupture of an aortic aneurysm into the lung in a 37-yr-old woman with polyarteritis nodosa and the second caused by massive bleeding from an angiectatic vascular malformation in the right main bronchus in a 21-yr-old woman. Fibreoptic bronchoscopy played an essential role in the diagnostic process and management of the respiratory tract. Diagnosis in the first case was obtained by CT scan and the aneurysm was treated surgically. In the second case, bronchial arteriography contributed to both definitive diagnosis and treatment. Initial cardiorespiratory management, diagnostic procedures and definitive therapy are described and reviewed. Adequate early management of the cardiorespiratory system is essential to the outcome. Aggressive measures to elucidate the cause of haemoptysis and prompt therapy are warranted because of the high risk of recurrence.

  • 33.
    Håkansson, Erik
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Konstatinov, I
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Thoraxkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Fransson, Sven Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Radiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Svedjeholm, Rolf
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Thoraxkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Invited reply to dr Savage on management of life-thretening haemotysis2002Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 89, s. 185-186Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 34.
    Jaensson, Maria
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Dahlberg, Karuna
    Örebro universitet, Institutionen för hälsovetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Evaluation of postoperative recovery in day surgery patients using a mobile phone application: a multicentre randomized trial2017Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, nr 5, s. 1030-1038Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores.

    Methods: The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14.

    Results: On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound.

    Conclusions: Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care.

  • 35.
    Kallionpää, R. E.
    et al.
    Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, Turku, Finland / Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
    Scheinin, A.
    Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland / Turku PET Centre, University of Turku and Turku University Hospital,Turku, Finland.
    Kallionpää, R. A.
    Institute of Biomedicine, University of Turku, Turku, Finland.
    Sandman, N.
    Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, Universityof Turku, Turku, Finland.
    Kallioinen, M.
    Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
    Laitio, R.
    Turku PET Centre, University of Turku and Turku University Hospital,Turku, Finland.
    Laitio, T.
    Turku PET Centre, University of Turku and Turku University Hospital,Turku, Finland.
    Kaskinoro, K.
    Turku PET Centre, University of Turku and Turku University Hospital,Turku, Finland.
    Kuusela, T.
    Department of Physics and Astronomy, University of Turku, Turku, Finland.
    Revonsuo, Antti
    Högskolan i Skövde, Institutionen för biovetenskap. Högskolan i Skövde, Forskningscentrum för Systembiologi. Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, Turku, Finland.
    Scheinin, H.
    Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland / Turku PET Centre, University of Turku and Turku University Hospital,Turku, Finland / Integrative Physiology and Pharmacology,Institute of Biomedicine, University of Turku, Turku, Finland.
    Valli, Katja
    Högskolan i Skövde, Institutionen för biovetenskap. Högskolan i Skövde, Forskningscentrum för Systembiologi. Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, Turku, Finland / Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
    Spoken words are processed during dexmedetomidine-induced unresponsiveness2018Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 121, nr 1, s. 270-280Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studying the effects of anaesthetic drugs on the processing of semantic stimuli could yield insights into how brain functions change in the transition from wakefulness to unresponsiveness. Here, we explored the N400 event-related potential during dexmedetomidine- and propofol-induced unresponsiveness. Methods: Forty-seven healthy subjects were randomised to receive either dexmedetomidine (n = 23) or propofol (n = 24) in this open-label parallel-group study. Loss of responsiveness was achieved by stepwise increments of pseudo-steady-state plasma concentrations, and presumed loss of consciousness was induced using 1.5 times the concentration required for loss of responsiveness. Pre-recorded spoken sentences ending either with an expected (congruous) or an unexpected (incongruous) word were presented during unresponsiveness. The resulting electroencephalogram data were analysed for the presence of the N400 component, and for the N400 effect defined as the difference between the N400 components elicited by congruous and incongruous stimuli, in the time window 300-600 ms post-stimulus. Recognition of the presented stimuli was tested after recovery of responsiveness. Results: The N400 effect was not observed during dexmedetomidine- or propofol-induced unresponsiveness. The N400 component, however, persisted during dexmedetomidine administration. The N400 component elicited by congruous stimuli during unresponsiveness in the dexmedetomidine group resembled the large component evoked by incongruous stimuli at the awake baseline. After recovery, no recognition of the stimuli heard during unresponsiveness occurred. Conclusions: Dexmedetomidine and propofol disrupt the discrimination of congruous and incongruous spoken sentences, and recognition memory at loss of responsiveness. However, the processing of words is partially preserved during dexmedetomidine-induced unresponsiveness.

  • 36.
    Kimme, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Fridriksson, Steen
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurokirurgi. Linköpings universitet, Hälsouniversitetet.
    Engdahl, O.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Hillman, Jan
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurokirurgi. Linköpings universitet, Hälsouniversitetet.
    Vegfors, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Moderate hypothermia for 359 operations to clip cerebral aneurysms2004Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 93, nr 3, s. 343-347Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Experimental data have suggested that hypothermia (32–34°C) may improve outcome after cerebral ischaemia, but its efficacy has not yet been established conclusively in humans. In this study we examined the feasibility and safety of deliberate moderate perioperative hypothermia during operations for subarachnoid aneurysms.

    Methods. A total of 359 operations for intracranial cerebral aneurysms were included in this prospective study. By using cold intravenous infusions (4°C) and convective cooling our aim was to reduce the patient's core temperature to more than 34°C within 1 h before operation. The protocol assessed postoperative complications such as infections, prolonged mechanical ventilation, pulmonary complications and coagulopathies.

    Results. During surgery, the body temperature was reduced to a mean of 32.5 (sd 0.4) °C. Cooling was accomplished at a rate of 4.0 (sd 0.4) °C h−1. All patients were normothermic at 5 (sd 2) h postoperatively. Peri/postoperative complications included circulatory instability (n=36, 10%), arrhythmias (n=17, 5%) coagulation abnormalities and blood transfusion (n=169, 47%), infections (n=29, 8%) and pulmonary complications (infiltrate or oedema while on ventilatory support) (n=97, 27%). Eighteen patients died within 30 days (5%). There was no significant correlation between the extent of hypothermia and any of the complications. However, there was a strong correlation between the occurrence of complications and the severity of the underlying neurological disease as assessed by the Hunt and Hess score.

    Conclusion. Moderate hypothermia accomplished within 1 h of induction of anaesthesia and maintained during surgery for subarachnoid aneurysms appears to be a safe method as far as the risks of peri/postoperative complications such as circulatory instability, coagulation abnormalities and infections are concerned.

  • 37.
    Kozian, Alf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Schilling, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Fredén, Filip
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Maripuu, Enn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Avdelningen för sjukhusfysik.
    Röcken, Christoph
    Institute of Pathology, Charite University Hospital, Berlin, Germany.
    Strang, Christof
    Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
    Hachenberg, Thomas
    Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study2008Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 100, nr 4, s. 549-559Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: One-lung ventilation (OLV) increases mechanical stress in the lung and affects ventilation and perfusion (V, Q). There are no data on the effects of OLV on postoperative V/Q matching. Thus, this controlled study evaluates the influence of OLV on V/Q distribution in a pig model using a gamma camera technique [single-photon emission computed tomography (SPECT)] and relates these findings to lung histopathology after OLV. METHODS: Eleven anaesthetized and ventilated pigs (V(T)=10 ml kg(-1), Fio2=0.40, PEEP=5 cm H2O) were studied. After lung separation, OLV and thoracotomy were performed in seven pigs (OLV group). During OLV and in a two-lung ventilation (TLV), control group (n=4) ventilation settings remained unchanged. SPECT with (81m)Kr (ventilation) and (99m)Tc-labelled macro-aggregated albumin (perfusion) was performed before, during, and 90 min after OLV/TLV. Finally, lung tissue samples were harvested and examined for alveolar damage. RESULTS: OLV affected ventilation and haemodynamic variables, but there were no differences between the OLV group and the control group before and after OLV/TLV. SPECT revealed an increase of perfusion in the dependent lung compared with baseline (49-56%), and a corresponding reduction of perfusion (51-44%) in non-dependent lungs after OLV. No perfusion changes were observed in the control group. This resulted in increased low V/Q regions and a shift of V/Q areas to 0.3-0.5 (10(-0.5)-10(-0.3)) in dependent lungs of OLV pigs and was associated with an increased diffuse alveolar damage score. CONCLUSIONS: OLV in pigs results in a substantial V/Q mismatch, hyperperfusion, and alveolar damage in the dependent lung and may thus contribute to gas exchange impairment after thoracic surgery.

  • 38.
    Kozian, Alf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Schilling, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Schütze, Hartmut
    Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
    Heres, Franziska
    Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
    Hachenberg, Thomas
    Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Lung computed tomography density distribution in a porcine model of one-lung ventilation2009Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 102, nr 4, s. 551-560Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: One-lung ventilation (OLV) exposes the dependent lung to increased mechanical stress which may affect the postoperative course. This study evaluates regional pulmonary gas/tissue distribution in a porcine model of OLV. METHODS: Nine anaesthetized and mechanically ventilated (V(T)=10 ml kg(-1), FI(O(2))=0.40, PEEP=5 cm H(2)O) pigs were studied. After lung separation by an endobronchial blocker, lateral thoracotomy and OLV were performed in six pigs. Three animals served as controls. Static end-expiratory and end-inspiratory spiral computed tomography (CT) scans were done before, during, and after OLV and at corresponding times in controls. CT images were analysed by defined regions of interest and summarized voxels were classified by defined lung X-ray density intervals (atelectasis, poorly aerated, normally aerated, and overaerated). RESULTS: Dependent lungs contained poorly aerated regions and atelectasis with a significant tidal recruitment during conventional two-lung ventilation (TLV) before OLV (expiration vs inspiration: atelectasis 29% vs 14%; poorly aerated 66% vs 44%; normally aerated 4% vs 41% of the dependent lung volume, P<0.05). During OLV (V(T)=10 ml kg(-1)), cyclic recruitment was increased. The density spectrum of the ventilated lung changed from consolidation to aeration (expiration vs inspiration: atelectasis 10% vs 2%; poorly aerated 71% vs 18%; normally aerated 19% vs 79%, P<0.05). After OLV, increased aeration remained with less atelectasis and poorly aerated regions. Lung density distribution in the non-dependent lung of OLV pigs was unaltered after the period of complete lung collapse. CONCLUSIONS: Cyclic tidal recruitment during OLV in pigs was associated with a persistent increase of aeration in the dependent lung.

  • 39.
    Kuchalik, Jan
    et al.
    Dept Anaesthesiol & Intens Care, Örebro University Hospital, Örebro, Sweden; Inst Med & Hlth, Örebro University Hospital, Örebro, Sweden.
    Granath, B.
    Dept Orthopaed Surg, Örebro University Hospital, Örebro, Sweden; Inst Med & Hlth, Örebro University Hospital, Örebro, Sweden.
    Ljunggren, A.
    Dept Anaesthesiol & Intens Care, Örebro University Hospital, Örebro, Sweden.
    Magnuson, A.
    Clin Epidemiol & Biostat Unit, Örebro University Hospital, Örebro, Sweden.
    Lundin, Anders
    Dept Orthopaed Surg, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Dept Anaesthesiol & Intens Care, Örebro University Hospital, Örebro, Sweden.
    Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia2013Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 111, nr 5, s. 793-799Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Postoperative pain after total hip arthroplasty (THA) can delay mobilization. This was assessed after intrathecal morphine (ITM) compared with local infiltration analgesia (LIA) using a non-inferiority design. Eighty patients were recruited in this randomized, double-blind study. ITM 0.1 mg (Group ITM) or periarticular local anaesthetic (ropivacaine 300 mg)ketorolac 30 mg epinephrine 0.5 mg (total volume 151.5 ml) (Group LIA) were compared. After 24 h, 22 ml of saline (Group ITM) or ropivacaine (150 mg)ketorolac (30 mg)epinephrine (0.1 mg) (Group LIA) were injected via a catheter. After operation, rescue analgesic consumption, pain intensity, and home-readiness were measured. Morphine consumption was equivalent, median difference 0 mg (95 confidence interval 4 to 4.5) between the groups at 024 h. During 2448 h, it was lower in Group LIA (3 mg, 060 mg, median, range) compared with Group ITM (10 mg, 081 mg) (P0.01). Lower pain scores were recorded at rest at 8 h in Group ITM (P0.01), but in Group LIA on standing and mobilization, at 2448 h (P0.01). Paracetamol and tramadol consumption was lower in Group LIA (P0.05 and 0.05, respectively) as was pruritus, nausea, and vomiting (P0.05). Lower pain intensity was recorded early after surgery in ITM group but later, analgesic consumption, pain intensity on mobilization, and side-effects were lower in patients receiving LIA. LIA is a good alternative to ITM in patients undergoing THA.

  • 40.
    Laaksonen, L.
    et al.
    University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Kallioinen, M.
    Turku University Hospital, Turku, Finland.
    Långsjö, J.
    Tampere University Hospital, Tampere, Finland.
    Laitio, T.
    Turku University Hospital, Turku, Finland.
    Scheinin, A.
    University of Turku. Turku, Finland / Turku University Hospital, Turku, Finland.
    Scheinin, J.
    Kuopio University Hospital, Kuopio, Finland.
    Kaisti, K.
    Oulu University Hospital, Oulu, Finland.
    Maksimow, A.
    Turku University Hospital, Turku, Finland.
    Kallionpää, R. E.
    Turku University Hospital, Turku, Finland / University of Turku, Turku, Finland.
    Rajala, V.
    Turku University Hospital, Turku, Finland.
    Johansson, J.
    University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland / Umeå University, Umeå, Sweden.
    Kantonen, O.
    University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland / University of California, Irvine, CA, USA.
    Nyman, M.
    Turku University Hospital, Turku, Finland.
    Sirén, S.
    Turku University Hospital, Turku, Finland.
    Valli, Katja
    Högskolan i Skövde, Institutionen för biovetenskap. Högskolan i Skövde, Forskningscentrum för Systembiologi. Turku University Hospital, Turku, Finland / University of Turku, Turku, Finland.
    Revonsuo, Antti
    Högskolan i Skövde, Institutionen för biovetenskap. Högskolan i Skövde, Forskningscentrum för Systembiologi. University of Turku, Turku, Finland.
    Solin, O.
    University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Vahlberg, T.
    University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Alkire, M.
    University of California, Irvine, CA, USA.
    Scheinin, Harry
    University of Turku, Turku, Finland / Turku University Hospital, Turku, Finland.
    Comparative effects of dexmedetomidine, propofol, sevoflurane, and S-ketamine on regional cerebral glucose metabolism in humans: a positron emission tomography study2018Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 121, nr 1, s. 281-290Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IntroductionThe highly selective α2-agonist dexmedetomidine has become a popular sedative for neurointensive care patients. However, earlier studies have raised concern that dexmedetomidine might reduce cerebral blood flow without a concomitant decrease in metabolism. Here, we compared the effects of dexmedetomidine on the regional cerebral metabolic rate of glucose (CMRglu) with three commonly used anaesthetic drugs at equi-sedative doses.

    MethodsOne hundred and sixty healthy male subjects were randomised to EC50 for verbal command of dexmedetomidine (1.5 ng ml−1n=40), propofol (1.7 μg ml−1n=40), sevoflurane (0.9% end-tidal; n=40) or S-ketamine (0.75 μg ml−1n=20) or placebo (n=20). Anaesthetics were administered using target-controlled infusion or vapouriser with end-tidal monitoring. 18F-labelled fluorodeoxyglucose was administered 20 min after commencement of anaesthetic administration, and high-resolution positron emission tomography with arterial blood activity samples was used to quantify absolute CMRglu for whole brain and 15 brain regions.

    ResultsAt the time of [F18]fluorodeoxyglucose injection, 55% of dexmedetomidine, 45% of propofol, 85% of sevoflurane, 45% of S-ketamine, and 0% of placebo subjects were unresponsive. Whole brain CMRglu was 63%, 71%, 71%, and 96% of placebo in the dexmedetomidine, propofol, sevoflurane, and S-ketamine groups, respectively (P<0.001 between the groups). The lowest CMRglu was observed in nearly all brain regions with dexmedetomidine (P<0.05 compared with all other groups). With S-ketamine, CMRgludid not differ from placebo.

    ConclusionsAt equi-sedative doses in humans, potency in reducing CMRglu was dexmedetomidine>propofol>ketamine=placebo. These findings alleviate concerns for dexmedetomidine-induced vasoconstriction and cerebral ischaemia.

  • 41. Laaksonen, L.
    et al.
    Kallioinen, M.
    Löngsjö, J.
    Laitio, T.
    Scheinin, A.
    Scheinin, J.
    Kaisti, K.
    Maksimow, A.
    Kallionpää, R. E.
    Rajala, V.
    Johansson, Jarkko
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
    Kantonen, O.
    Nyman, M.
    Sirén, S.
    Valli, K.
    Revonsuo, A.
    Solin, O.
    Vahlberg, T.
    Alkire, M.
    Scheinin, H.
    Comparative effects of dexmedetomidine, propofol, sevoflurane, and S-ketamine on regional cerebral glucose metabolism in humans: a positron emission tomography study2018Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 121, nr 1, s. 281-290Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The highly selective α2-agonist dexmedetomidine has become a popular sedative for neurointensive care patients. However, earlier studies have raised concern that dexmedetomidine might reduce cerebral blood flow without a concomitant decrease in metabolism. Here, we compared the effects of dexmedetomidine on the regional cerebral metabolic rate of glucose (CMRglu) with three commonly used anaesthetic drugs at equi-sedative doses.

    Methods: One hundred and sixty healthy male subjects were randomised to EC50 for verbal command of dexmedetomidine (1.5 ng ml-1; n=40), propofol (1.7 μg ml-1; n=40), sevoflurane (0.9% end-tidal; n=40) or S-ketamine (0.75 μg ml−1; n=20) or placebo (n=20). Anaesthetics were administered using target-controlled infusion or vapouriser with end-tidal monitoring. 18F-labelled fluorodeoxyglucose was administered 20 min after commencement of anaesthetic administration, and high-resolution positron emission tomography with arterial blood activity samples was used to quantify absolute CMRglu for whole brain and 15 brain regions.

    Results: At the time of [F18]fluorodeoxyglucose injection, 55% of dexmedetomidine, 45% of propofol, 85% of sevoflurane, 45% of S-ketamine, and 0% of placebo subjects were unresponsive. Whole brain CMRglu was 63%, 71%, 71%, and 96% of placebo in the dexmedetomidine, propofol, sevoflurane, and S-ketamine groups, respectively (P<0.001 between the groups). The lowest CMRglu was observed in nearly all brain regions with dexmedetomidine (P<0.05 compared with all other groups). With S-ketamine, CMRglu did not differ from placebo.

    Conclusions: At equi-sedative doses in humans, potency in reducing CMRglu was dexmedetomidine>propofol>ketamine=placebo. These findings alleviate concerns for dexmedetomidine-induced vasoconstriction and cerebral ischaemia.

  • 42.
    Larsson, J.
    et al.
    Uppsala University.
    Holmström, Inger
    Uppsala University; Örebro universitet.
    How excellent anaesthetists perform in the operating theatre: a qualitative study on non-technical skills2013Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 110, nr 1, s. 115-121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Teaching trainees to become competent professionals who can keep the complex system of anaesthesia safe is important. From a safety point of view, non-technical skills such as smooth cooperation and good communication deserve as much attention as theoretical knowledge and practical skills, which by tradition have dominated training programmes in anaesthesiology. This study aimed to describe the way excellent anaesthetists act in the operating theatre, as seen by experienced anaesthesia nurses.                                                                                                     

    Methods The study had a descriptive and qualitative design. Five focus group interviews with three or four experienced Swedish anaesthesia nurses in each group were conducted. Interviews were analysed by using a qualitative method, looking for common themes.                                                                                                                  

    Results Six themes were found: (A) structured, responsible, and focused way of approaching work tasks; (B) clear and informative, briefing the team about the action plan before induction; (C) humble to the complexity of anaesthesia, admitting own fallibility; (D) patient-centred, having a personal contact with the patient before induction; (D) fluent in practical work without losing overview; and (F) calm and clear in critical situations, being able to change to a strong leading style.                                                                                                                  

    Conclusions Experienced anaesthesia nurses gave nuanced descriptions of how excellent anaesthetists behave and perform. These aspects of the anaesthetist's work often attract too little attention in specialist training, notwithstanding their importance for safety and fluency at work. Creating role models based on studies like the present one could be one way of increasing safety in anaesthesia.   

  • 43. Larsson, J.
    et al.
    Holmström, Inger
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    How excellent anaesthetists perform in the operating theatre: a qualitative study on non-technical skills2013Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 110, nr 1, s. 115-121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Teaching trainees to become competent professionals who can keep the complex system of anaesthesia safe is important. From a safety point of view, non-technical skills such as smooth cooperation and good communication deserve as much attention as theoretical knowledge and practical skills, which by tradition have dominated training programmes in anaesthesiology. This study aimed to describe the way excellent anaesthetists act in the operating theatre, as seen by experienced anaesthesia nurses.                                                                                                     

    Methods The study had a descriptive and qualitative design. Five focus group interviews with three or four experienced Swedish anaesthesia nurses in each group were conducted. Interviews were analysed by using a qualitative method, looking for common themes.                                                                                                                  

    Results Six themes were found: (A) structured, responsible, and focused way of approaching work tasks; (B) clear and informative, briefing the team about the action plan before induction; (C) humble to the complexity of anaesthesia, admitting own fallibility; (D) patient-centred, having a personal contact with the patient before induction; (D) fluent in practical work without losing overview; and (F) calm and clear in critical situations, being able to change to a strong leading style.                                                                                                                  

    Conclusions Experienced anaesthesia nurses gave nuanced descriptions of how excellent anaesthetists behave and perform. These aspects of the anaesthetist's work often attract too little attention in specialist training, notwithstanding their importance for safety and fluency at work. Creating role models based on studies like the present one could be one way of increasing safety in anaesthesia.   

  • 44.
    Larsson, Jan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Holmström, Inger Knutsson
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    How excellent anaesthetists perform in the operating theatre: a qualitative study on non-technical skills2013Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 110, nr 1, s. 115-121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Teaching trainees to become competent professionals who can keep the complex system of anaesthesia safe is important. From a safety point of view, non-technical skills such as smooth cooperation and good communication deserve as much attention as theoretical knowledge and practical skills, which by tradition have dominated training programmes in anaesthesiology. This study aimed to describe the way excellent anaesthetists act in the operating theatre, as seen by experienced anaesthesia nurses.

    Methods The study had a descriptive and qualitative design. Five focus group interviews with three or four experienced Swedish anaesthesia nurses in each group were conducted. Interviews were analysed by using a qualitative method, looking for common themes.

    Results Six themes were found: (A) structured, responsible, and focused way of approaching work tasks; (B) clear and informative, briefing the team about the action plan before induction; (C) humble to the complexity of anaesthesia, admitting own fallibility; (D) patient-centred, having a personal contact with the patient before induction; (D) fluent in practical work without losing overview; and (F) calm and clear in critical situations, being able to change to a strong leading style.

    Conclusions Experienced anaesthesia nurses gave nuanced descriptions of how excellent anaesthetists behave and perform. These aspects of the anaesthetist's work often attract too little attention in specialist training, notwithstanding their importance for safety and fluency at work. Creating role models based on studies like the present one could be one way of increasing safety in anaesthesia.

  • 45.
    Larsson, Jan
    et al.
    Uppsala universitet, Sweden.
    Holmström, Inger
    Uppsala universitet, Sweden.
    Lindberg, Eva
    Uppsala universitet, Sweden.
    Rosenqvisr, urban
    Uppsala universitet, Sweden.
    Anaesthetists understand their work in different ways – Reply2004Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 93, nr 2, s. 303-304Artikel i tidskrift (Övrigt vetenskapligt)
  • 46.
    Larsson, Jan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Holmström, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Lindberg, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Rosenqvist, Urban
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Anaesthetists understand their work in different ways - Reply2004Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 93, nr 2, s. 303-304Artikel i tidskrift (Refereegranskat)
  • 47.
    Larsson, Jan
    et al.
    Uppsala Academic Hospital, Uppsala, Sweden.
    Holmström, Inger
    University of Uppsala, Sweden.
    Lindberg, Eva
    University of Uppsala, Sweden.
    Rosenqvist, Urban
    University of Uppsala, Sweden.
    Trainee anaesthetists understand their work in different ways: implications for specialist education2004Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 92, nr 3, s. 381-387Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Traditionally, programmes for specialist educationin anaesthesia and intensive care have been based on lists ofattributes such as skills and knowledge. However, modern researchin the science of teaching has shown that competence developmentis linked to changes in the way professionals understand theirwork. The aim of this study was to define the different waysin which trainee anaesthetists understand their work.

    Methods. Nineteen Swedish trainee anaesthetists were interviewed.The interviews sought the answers to three open-ended questions.(i) When do you feel you have been successful in your work?(ii) What is difficult or what hinders you in your work? (iii)What is the core of your anaesthesia work? Transcripts of theinterviews were analysed by a phenomenographic approach, a researchmethod aiming to determine the various ways a group of peopleunderstand a phenomenon.

    Results. Six ways of understanding their work were defined:giving anaesthesia according to a standard plan; taking responsibilityfor the patient’s vital functions; minimizing the patient’ssuffering and making them feel safe; giving service to specialistdoctors to facilitate their care of patients; organizing andleading the operating theatre and team; and developing one’sown competence, using the experience gained from every new patientfor learning.

    Conclusions. Trainee anaesthetists understand their work indifferent ways. The trainee’s understanding affects bothhis/her way of performing work tasks and how he/she developsnew competences. A major task for teachers of anaesthesia isto create learning situations whereby trainees can focus onnew aspects of their professional work and thus develop newways of understanding it.

  • 48.
    Larsson, Jan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Holmström, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Lindberg, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Rosenqvist, Urban
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Trainee anaesthetists understand their work in different ways: implications for specialist education2004Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 92, nr 3, s. 381-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Traditionally, programmes for specialist education in anaesthesia and intensive care have been based on lists of attributes such as skills and knowledge. However, modern research in the science of teaching has shown that competence development is linked to changes in the way professionals understand their work. The aim of this study was to define the different ways in which trainee anaesthetists understand their work.

    Methods. Nineteen Swedish trainee anaesthetists were interviewed. The interviews sought the answers to three open-ended questions. (i) When do you feel you have been successful in your work? (ii) What is difficult or what hinders you in your work? (iii) What is the core of your anaesthesia work? Transcripts of the interviews were analysed by a phenomenographic approach, a research method aiming to determine the various ways a group of people understand a phenomenon.

    Results. Six ways of understanding their work were defined: giving anaesthesia according to a standard plan; taking responsibility for the patient’s vital functions; minimizing the patient’s suffering and making them feel safe; giving service to specialist doctors to facilitate their care of patients; organizing and leading the operating theatre and team; and developing one’s own competence, using the experience gained from every new patient for learning.

    Conclusions. Trainee anaesthetists understand their work in different ways. The trainee’s understanding affects both his/her way of performing work tasks and how he/she develops new competences. A major task for teachers of anaesthesia is to create learning situations whereby trainees can focus on new aspects of their professional work and thus develop new ways of understanding it.

  • 49.
    Larsson, Jan
    et al.
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Rosenqvist, Urban
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Burdened by training not by anaesthesia2008Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 100, nr 4, s. 560-561Artikel i tidskrift (Övrigt vetenskapligt)
  • 50.
    Larsson, Jan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Holmström, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Rosenqvist, Urban
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Burdened by training not by anaesthesia2008Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 100, nr 4, s. 560-561Artikel i tidskrift (Refereegranskat)
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