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  • 1.
    Abildgaard, Lars
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Aaro, Stig
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine.
    Lisander, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Limited effectiveness of intraoperative autotransfusion in major back surgery2001In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 18, no 12, p. 823-828Article in journal (Refereed)
    Abstract [en]

    Background and objective: The efficiency of intraoperative autotransfusion in scoliosis surgery is poorly known but needs to be evaluated, not least because of the large blood losses in these patients. This is a retrospective analysis of transfusion requirements of 43 such patients. Methods: Records from 43 patients were studied. During surgery, the shed blood was salvaged and washed in an autotransfusion device (AT1000 Auto-transfusion Unit«) and a suspension of red cells was reinfused. Results: Fifty-eight per cent of the intraoperative blood loss was salvaged. The total blood loss during the patients' hospital stay was calculated from the haemoglobin balance, 24% of this loss was salvaged by the device. Moreover, 36 of the patients needed allogeneic blood transfusion. Conclusion: The efficiency of the autotransfusion device was relatively low in relation to the total extravasation, mainly because the postoperative blood loss is substantial.

  • 2. Ahlström, Katarina
    et al.
    Biber, Björn
    Åberg, Anna-Maja
    Abrahamsson, Pernilla
    Johansson, Göran
    Ronquist, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Medicinal Chemistry.
    Waldenström, Anders
    Haney, Michael F.
    Exogenous carbon monoxide does not affect cell membrane energy availability assessed by sarcolemmal calcium fluxes during myocardial ischaemia-reperfusion in the pig2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 5, p. 356-362Article in journal (Refereed)
    Abstract [en]

    Carbon monoxide is thought to be cytoprotective and may hold therapeutic promise for mitigating ischaemic injury. The purpose of this study was to test low-dose carbon monoxide for protective effects in a porcine model of acute myocardial ischaemia and reperfusion. In acute open-thorax experiments in anaesthetised pigs, pretreatment with low-dose carbon monoxide (5% increase in carboxyhaemoglobin) was conducted for 120 min before localised ischaemia (45 min) and reperfusion (60 min) was performed using a coronary snare. Metabolic and injury markers were collected by microdialysis sampling in the ventricular wall. Recovery of radio-marked calcium delivered locally by microperfusate was measured to assess carbon monoxide treatment effects during ischaemia/reperfusion on the intracellular calcium pool. Coronary occlusion and ischaemia/reperfusion were analysed for 16 animals (eight in each group). Changes in glucose, lactate and pyruvate from the ischaemic area were observed during ischaemia and reperfusion interventions, though there was no difference between carbon monoxide-treated and control groups during ischaemia or reperfusion. Similar results were observed for glycerol and microdialysate Ca-45(2+) recovery. These findings show that a relatively low and clinically relevant dose of carbon monoxide did not seem to provide acute protection as indicated by metabolic, energy-related and injury markers in a porcine myocardial ischaemia/reperfusion experimental model. We conclude that protective effects of carbon monoxide related to ischaemia/reperfusion either require higher doses of carbon monoxide or occur later after reperfusion than the immediate time frame studied here. More study is needed to characterise the mechanism and time frame of carbon monoxide-related cytoprotection.

  • 3.
    Ahlström, Katarina
    et al.
    Anesthesia and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Biber, Björn
    Anesthesia and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Åberg, Anna-Maja
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Abrahamsson, Pernilla
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Johansson, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Ronquist, Gunnar
    Department of Medical Chemistry, Uppsala University, Uppsala, Sweden.
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Haney, Michael F.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Exogenous carbon monoxide does not affect cell membrane energy availability assessed by sarcolemmal calcium fluxes during myocardial ischaemia-reperfusion in the pig2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 5, p. 356-362Article in journal (Refereed)
    Abstract [en]

    Carbon monoxide is thought to be cytoprotective and may hold therapeutic promise for mitigating ischaemic injury. The purpose of this study was to test low-dose carbon monoxide for protective effects in a porcine model of acute myocardial ischaemia and reperfusion.In acute open-thorax experiments in anaesthetised pigs, pretreatment with low-dose carbon monoxide (5% increase in carboxyhaemoglobin) was conducted for 120 min before localised ischaemia (45 min) and reperfusion (60 min) was performed using a coronary snare. Metabolic and injury markers were collected by microdialysis sampling in the ventricular wall. Recovery of radio-marked calcium delivered locally by microperfusate was measured to assess carbon monoxide treatment effects during ischaemia/reperfusion on the intracellular calcium pool.Coronary occlusion and ischaemia/reperfusion were analysed for 16 animals (eight in each group). Changes in glucose, lactate and pyruvate from the ischaemic area were observed during ischaemia and reperfusion interventions, though there was no difference between carbon monoxide-treated and control groups during ischaemia or reperfusion. Similar results were observed for glycerol and microdialysate Ca recovery.These findings show that a relatively low and clinically relevant dose of carbon monoxide did not seem to provide acute protection as indicated by metabolic, energy-related and injury markers in a porcine myocardial ischaemia/reperfusion experimental model. We conclude that protective effects of carbon monoxide related to ischaemia/reperfusion either require higher doses of carbon monoxide or occur later after reperfusion than the immediate time frame studied here. More study is needed to characterise the mechanism and time frame of carbon monoxide-related cytoprotection.

  • 4.
    Ander, Fredrik
    et al.
    Örebro University, School of Medical Sciences. Department of Anaesthesia and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Magnuson, Anders
    de Leon, Alex
    Department of Anaesthesia and Intensive Care, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Does the β-receptor antagonist esmolol have analgesic effects?: A randomised placebo-controlled cross-over study on healthy volunteers undergoing the cold pressor test2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 3, p. 165-172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Esmolol may attenuate the sympathetic response to pain and reduce postoperative opioid consumption. It is not clear whether esmolol has an analgesic effect per se.

    OBJECTIVES: The aim of this study was to evaluate the analgesic effect of esmolol in the absence of anaesthetics and opioids. We tested the hypothesis that esmolol would reduce the maximum pain intensity perceived during the cold pressor test (CPT) by 2 points on a 0 to 10 numeric pain rating scale (NRS) compared to placebo.

    DESIGN: Randomised, placebo-controlled cross-over study.

    SETTING: Postoperative recovery area, Örebro University Hospital. Study period, November 2013 to February 2014.

    PARTICIPANTS: Fourteen healthy volunteers. Exclusion criteria included ongoing medication, pregnancy and breastfeeding and participation in other medical trials.

    INTERVENTIONS: At separate study sessions, participants received interventions: esmolol (0.7 mg kg bolus over 1 min followed by infusion at 10 μg kg min); 0.9% normal saline bolus then remifentanil infusion at 0.2 μg kg min and 0.9% normal saline bolus and infusion according to a random sequence. All infusions were administered over 30 min.

    MAIN OUTCOME MEASURES: Perceived maximum pain intensity score, pain tolerance and haemodynamic changes during CPT, and occurrence of side-effects to interventions compared to placebo, respectively.

    RESULTS: Esmolol did not reduce perceived pain intensity or pain tolerance during the CPT. The NRS-max score was similar for esmolol, 8.5 (±1.4) and placebo, 8.4 (±1.3). The mean difference was 0.1 [95% confidence interval (-1.2 to 1.4)], P value equal to 0.83. Remifentanil significantly reduced NRS-max scores, 5.4 (±2.1) compared to placebo, [mean difference -3.1 (95% confidence interval (-4.4 to -1.8)), P < 0.001]. Side-effects were seen with remifentanil but not with esmolol.

    CONCLUSION: No direct analgesic effect of esmolol could be demonstrated in the present study. The postoperative opioid-sparing effect demonstrated in previous studies, could therefore be secondary to other factors such as avoidance of opioid-induced hyperalgesia, synergy with coadministered opioids or altered pharmacokinetics of those drugs.

    TRIAL REGISTRATION: European clinical trials database, https://eudract.ema.europa.eu/, EudraCT no. 2011-005780-24.

  • 5.
    Bahlmann, Hans
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Halldestam, Ingvar
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial2019In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 36, no 2, p. 153-161Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Goal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications.

    OBJECTIVES: The aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care.

    DESIGN: A randomised controlled study.

    SETTING: Two Swedish university hospitals, between October 2011 and October 2015.

    PATIENTS: Sixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency.

    INTERVENTION: A three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min m and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg.

    MAIN OUTCOME MEASURE: The incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list.

    RESULTS: Fifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P < 0.01) and dobutamine more frequently (27/30 vs. 9/29, P < 0.01). The median [interquartile range, IQR] incidence of complications per patient 5 days after surgery was 2 [0 to 3] in the intervention group and 1 [0 to 2] in the control group (P = 0.10), and after 30 days 4 [2 to 6] in the intervention group and 2 [1 to 4] in the control group (P = 0.10).

    CONCLUSION: Goal-directed therapy during oesophageal resection did not result in a reduction of the incidence of postoperative complications.

    TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01416077.

  • 6.
    Bergek, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
    Zdolsek, Joachim
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Hahn, Robert G
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Accuracy of noninvasive haemoglobin measurement by pulse oximetry depends on the type of infusion fluid2012In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 29, no 12, p. 586-592Article in journal (Refereed)
    Abstract [en]

    Context: Measurement of blood haemoglobin concentration by pulse oximetry could be of value in determining when erythrocytes should be transfused during surgery, but the effect of infusion fluids on the results is unclear.

    Objective: To study the effect of crystalloid and colloid fluid on the accuracy (bias) and precision of pulse oximetry haemoglobin estimation to indicate the venous haemoglobin concentration in volunteers.

    Design: Open interventional crossover study.

    Setting: Single university hospital.

    Participants: Ten male volunteers aged 18–28 (mean 22) years.

    Interventions: Each volunteer underwent three infusion experiments on separate days and in random order. The infusions were Ringer's acetate (20 ml kg−1), hydroxyethyl starch 130/0.4 (10 ml kg−1) and a combination of both.

    Results: At the end of the infusions of Ringer's acetate, pulse oximetry haemoglobin concentration had decreased more than the true haemoglobin concentration (15 vs. 8%; P < 0.005; n  = 10) whereas starch solution decreased pulse oximetry haemoglobin concentration less than true haemoglobin concentration (7 vs. 11%; P < 0.02; n  = 20). The same differences were seen when the fluids were infused separately and when they were combined. The overall difference between all 956 pairs of pulse oximetry haemoglobin concentration and true haemoglobin concentrations (the bias) averaged only −0.7 g l−1 whereas the 95% prediction interval was wide, ranging from −24.9 to 23.7 g l−1. In addition to the choice of infusion fluid, the bias was strongly dependent on the volunteer (each factor, P < 0.001).

    Conclusion: The bias of measuring haemoglobin concentration by pulse oximetry is dependent on whether a crystalloid or a colloid fluid is infused.

  • 7.
    Cajander, Per
    et al.
    Örebro University, School of Medical Sciences. Department of Anaesthesia and Intensive Care, Örebro, Sweden.
    Edmark, Lennart
    Department of Anaesthesia and Intensive Care, Västerås, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    de Leon, Alex
    Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg, sWeden; School of Medical Sciences, Örebro University, Örebro, Sweden.
    Effect of positive end-expiratory pressure on gastric insufflation during induction of anaesthesia when using pressure-controlled ventilation via a face mask: A randomised controlled trial2019In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 36, no 9, p. 625-632Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Face mask ventilation (FMV) during induction of anaesthesia is associated with risk of gastric insufflation that may lead to gastric regurgitation and pulmonary aspiration. A continuous positive airway pressure (CPAP) has been shown to reduce gastric regurgitation. We therefore hypothesised that CPAP followed by FMV with positive end-expiratory pressure (PEEP) during induction of anaesthesia would reduce the risk of gastric insufflation.

    OBJECTIVE: The primary aim was to compare the incidence of gastric insufflation during FMV with a fixed PEEP level or zero PEEP (ZEEP) after anaesthesia induction. A secondary aim was to investigate the effects of FMV with or without PEEP on upper oesophageal sphincter (UES), oesophageal body and lower oesophageal sphincter (LES) pressures.

    DESIGN: A randomised controlled trial.

    SETTING: Single centre, Department of Anaesthesia and Intensive Care, Örebro University Hospital, Sweden.

    PARTICIPANTS: Thirty healthy volunteers.

    INTERVENTIONS: Pre-oxygenation without or with CPAP 10 cmH2O, followed by pressure-controlled FMV with either ZEEP or PEEP 10 cmH2O after anaesthesia induction.

    MAIN OUTCOME MEASURES: A combined impedance/manometry catheter was used to detect the presence of gas and to measure oesophageal pressures. The primary outcome measure was the cumulative incidence of gastric insufflation, defined as a sudden anterograde increase in impedance of more than 1 kΩ over the LES. Secondary outcome measures were UES, oesophageal body and LES pressures.

    RESULTS: The cumulative incidence of gastric insufflation related to peak inspiratory pressure (PIP), was significantly higher in the PEEP group compared with the ZEEP group (log-rank test P < 0.01). When PIP reached 30 cmH2O, 13 out of 15 in the PEEP group compared with five out of 15 had shown gastric insufflation. There was a significant reduction of oesophageal sphincter pressures within groups comparing pre-oxygenation to after anaesthesia induction, but there were no significant differences in oesophageal sphincter pressures related to the level of PEEP.

    CONCLUSION: Contrary to the primary hypothesis, with increasing PIP the tested PEEP level did not protect against but facilitated gastric insufflation during FMV. This result suggests that PEEP should be used with caution after anaesthesia induction during FMV, whereas CPAP during pre-oxygenation seems to be safe.

    TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02238691.

  • 8.
    CHEW, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions A statement from the ESA-ESICM joint taskforce on perioperative outcome measures2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 3, p. 88-105Article in journal (Refereed)
    Abstract [en]

    There is a need for large trials that test the clinical effectiveness of interventions in the field of perioperative medicine. Clinical outcome measures used in such trials must be robust, clearly defined and patient-relevant. Our objective was to develop standards for the use of clinical outcome measures to strengthen the methodological quality of perioperative medicine research. A literature search was conducted using PubMed and opinion leaders worldwide were invited to nominate papers that they believed the group should consider. The full texts of relevant articles were reviewed by the taskforce members and then discussed to reach a consensus on the required standards. The report was then circulated to opinion leaders for comment and review. This report describes definitions for 22 individual adverse events with a system of severity grading for each. In addition, four composite outcome measures were identified, which were designed to evaluate postoperative outcomes. The group also agreed on standards for four outcome measures for the evaluation of healthcare resource use and quality of life. Guidance for use of these outcome measures is provided, with particular emphasis on appropriate duration of follow-up. This report provides clearly defined and patient-relevant outcome measures for large clinical trials in perioperative medicine. These outcome measures may also be of use in clinical audit. This report is intended to complement and not replace other related work to improve assessment of clinical outcomes following specific surgical procedures.

  • 9.
    Chew, Michelle
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Dalesjö, Lina
    Hallands Hosp Halmstad, Sweden.
    Life-threatening ketoacidosis in a lactating woman2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 12, p. 984-986Article in journal (Other academic)
    Abstract [en]

    n/a

  • 10.
    Chew, Michelle S.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Mangelus, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Enlund, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Spetz, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lyckner, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Surgery was successful - but how did it go for the patient?: Experiences from and hopes for the Swedish Perioperative Register2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 7, p. 453-454Article in journal (Other academic)
  • 11.
    Chew, Michelle S
    et al.
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Mangelus, Claes
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Enlund, Gunnar
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Spetz, Peter
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Lyckner, Sara
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Surgery was successful – but how did it go for the patient? Experiences from and hopes for the Swedish Perioperative Register2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 7, p. 453-454Article in journal (Refereed)
  • 12.
    Chew, Michelle S
    et al.
    Department of Anaesthesia and Intensive Care, Hallands sjukhus Halmstad.
    Mangelus, Claes
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Enlund, Gunnar
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Spetz, Peter
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Lyckner, Sara
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Surgery was successful--but how did it go for the patient? Experiences from and hopes for the Swedish Perioperative Register.2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 7, p. 453-454Article in journal (Other academic)
  • 13.
    Chew, Michelle S
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Walder, Bernhard
    University Hospital Geneva, Switzerland.
    Improving perioperative outcome: time to update protocols2017In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 4, p. 185-188Article in journal (Other academic)
    Abstract [en]

    n/a

  • 14.
    De Geer, Lina
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Oscarsson Tibblin, Anna
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Amino-terminal pro-brain natriuretic peptide as a predictor of outcome in patients admitted to intensive care. A prospective observational study2012In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 29, no 6, p. 275-279Article in journal (Refereed)
    Abstract [en]

    Context: Amino-terminal pro-brain-type natriuretic peptide is known to predict outcome in patients with heart failure, but its role in an intensive care setting is not yet fully established. Objective: To assess the incidence of elevated amino-terminal pro-brain natriuretic peptide (NT-pro-BNP) on admission to intensive care and its relation to death in the ICU and within 30 days. Design: Prospective, observational cohort study. Setting: A mixed noncardiothoracic tertiary ICU in Sweden. Patients and main outcome measures NT-pro-BNP was collected from 481 consecutive patients on admission to intensive care, in addition to data on patient characteristics and outcome. A receiver-operating characteristic curve was used to identify a discriminatory level of significance, a stepwise logistic regression analysis to correct for other clinical factors and a Kaplan-Meier analysis to assess survival. The correlation between Simplified Acute Physiology Score (SAPS) 3, Sequential Organ Failure Assessment score (SOFA) and NT-pro-BNP was analysed using Spearmans correlation test. Quartiles of NT-pro-BNP elevation were compared for baseline data and outcome using a logistic regression model. Results: An NT-pro-BNP more than 1380 ng l(-1) on admission was an independent predictor of death in the ICU and within 30 days [odds ratio (OR) 2.6; 95% confidence interval (CI), 1.5 to 4.4] and was present in 44% of patients. Thirty-three percent of patients with NT-pro-BNP more than 1380 ng l(-1), and 14.6% of patients below that threshold died within 30 days (log rank P 0.005). NT-pro-BNP correlated moderately with SAPS 3 and with SOFA on admission (Spearmans rho 0.5552 and 0.5129, respectively). In quartiles of NT-pro-BNP elevation on admission, severity of illness and mortality increased significantly (30-day mortality 36.1%; OR 3.9; 95% CI, 2.0 to 7.3 in the quartile with the highest values, vs. 12.8% in the lowest quartile). Conclusion: We conclude that NT-pro-BNP is commonly elevated on admission to intensive care, that it increases with severity of illness and that it is an independent predictor of mortality.

  • 15.
    De Hert, Stefan
    et al.
    Univ Ghent, Belgium.
    Staender, Sven
    Reg Hosp Mannedorf Zurich, Switzerland; Paracelsus Med Univ Salzburg, Austria.
    Fritsch, Gerhard
    Paracelsus Med Univ Salzburg, Austria; AUVA Traumactr Vienna, Austria.
    Hinkelbein, Jochen
    Univ Hosp Cologne, Germany.
    Afshari, Arash
    Univ Copenhagen, Denmark.
    Bettelli, Gabriella
    Univ San Marino, San Marino.
    Bock, Matthias
    Paracelsus Med Univ Salzburg, Austria; Merano Hosp Franz Tappeiner, Italy.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Coburn, Mark
    Rhein Westfal TH Aachen, Germany.
    De Robertis, Edoardo
    Univ Naples Federico II, Italy.
    Drinhaus, Hendrik
    Univ Hosp Cologne, Germany.
    Feldheiser, Aarne
    Charite Univ Med Berlin, Germany.
    Geldner, Gotz
    RKH Klinikum Ludwigsburg, Germany.
    Lahner, Daniel
    AUVA Traumactr Vienna, Austria; Ludwig Boltzmann Inst Expt and Clin Traumatol, Austria.
    Macas, Andrius
    Lithuanian Univ Hlth Sci, Lithuania.
    Neuhaus, Christopher
    Univ Hosp Heidelberg, Germany.
    Rauch, Simon
    Merano Hosp Franz Tappeiner, Italy; EURAC Res, Italy.
    Santos-Ampuero, Maria Angeles
    Hosp Schwyz, Switzerland.
    Solca, Maurizio
    Danube Univ Krems, Austria.
    Tanha, Nima
    Not Found:Linkoping Univ, Linkoping Univ Hosp, Dept Anaesthesia and Intens Care, Linkoping, Sweden; Linkoping Univ, Linkoping Univ Hosp, Dept Med and Hlth Sci, Linkoping, Sweden.
    Traskaite, Vilma
    Lithuanian Univ Hlth Sci, Lithuania.
    Wagner, Gernot
    Danube Univ Krems, Austria.
    Wappler, Frank
    Univ Witten Herdecke, Germany.
    Pre-operative evaluation of adults undergoing elective noncardiac surgery Updated guideline from the European Society of Anaesthesiology2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 6, p. 407-465Article in journal (Refereed)
    Abstract [en]

    The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

  • 16.
    de Leon, Alex
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ahlstrand, Rebecca
    Örebro University, School of Health and Medical Sciences.
    Thörn, Sven-Egron
    Örebro University, School of Health and Medical Sciences.
    Wattwil, Magnus
    Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 4, p. 273-278Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE:

    The oesophageal sphincters play an important role in protecting the airway. During manometric studies, administration of an anxiolytic agent is often required to make insertion of the catheter acceptable for the patient. The anxiolytic should not affect the results of the measurements. This study evaluates the effects of two different doses of propofol on the pressures in the oesophageal sphincters. The effect of increased abdominal pressure was also studied.

    METHODS:

    Twenty healthy volunteers, 10 young (mean age 25 years) and 10 elderly (mean age 71 years), were recruited. The effects of a low dose of propofol [0.3 mg kg(-1) intravenously (i.v.)] and a high dose of propofol (young group 0.9 mg kg(-1) i.v. and elderly group 0.6 mg kg(-1) i.v.) were studied with and without external abdominal pressure.

    RESULTS:

    There were no statistically significant changes in lower oesophageal sphincter (LOS) pressure after the low dose of propofol. After the high dose, there was an increase in LOS pressure, which was statistically significant in the young group (P < 0.05). The upper oesophageal sphincter (UOS) pressure decreased after both doses of propofol (P < 0.01 for the higher dose and P < 0.05 for the lower dose).

    CONCLUSION:

    A low dose of propofol (0.3 mg kg(-1) i.v.) leaves the LOS unaffected in young and elderly volunteers and can be used safely as an anxiolytic agent during studies of the LOS without influencing the results. However, the UOS is more sensitive to the effects of propofol and we do not recommend the use of propofol as an anxiolytic agent during manometric studies of the UOS.

  • 17.
    Fant, Federica
    et al.
    Dept. anasthesiology and intensive care, Örebro University Hospital, Örebro, Sweden; Dept. anasthesiology and intensive care, Danderyds Hospital, Danderyd, Sweden.
    Tina, Elisabet
    Örebro University, School of Medical Sciences.
    Andersson, Sven Olof
    Dept. urology and The Health Academy, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Clinical epidemiology and biostatics, Faculty of medicine and health, Örebro University Hospital, Örebro, Sweden.
    Hultgren-Hörnquist, Elisabeth
    Örebro University, School of Medical Sciences.
    Gupta, Anil
    Dept. Anasthesiology and intensive care, Örebro University Hospital, Örebro, Sweden; Dept. of anasthesiology, surgical services and intensive care medicine, Karolinska University Hospital, Stockholm, Sweden.
    Early perioperative immunological effects of anaesthesia and analgesia in patients undergoing prostate cancer surgery: A randomised pilot study.2017In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 4, p. 241-243Article in journal (Refereed)
  • 18. Garcia-Fernandez, Javier
    et al.
    Canfran, Susana
    Gomez de Segura, Ignacio A.
    Suarez-Sipmann, Fernando
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Aguado, Delia
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Pressure safety range of barotrauma with lung recruitment manoeuvres: A randomised experimental study in a healthy animal model2013In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 30, no 9, p. 567-574Article in journal (Refereed)
    Abstract [en]

    CONTEXT

    Recruitment manoeuvres aim at reversing atelectasis during general anaesthesia but are associated with potential risks such as barotrauma.

    OBJECTIVE

    To explore the range of pressures that can be used safely to fully recruit the lung without causing barotrauma in an ex-vivo healthy lung rabbit model.

    DESIGN

    Prospective, randomised, experimental study.

    SETTING

    Experimental Unit, La Paz University Hospital, Madrid, Spain.ANIMALSFourteen healthy young New Zealand rabbits of 12 weeks of age.

    INTERVENTIONS

    Animals were euthanised, the thorax and both pleural spaces were opened and the animals were allocated randomly into one of two groups submitted to two distinct recruitment manoeuvre strategies: PEEP-20 group, in which positive end-expiratory pressure (PEEP) was increased in 5-cmH(2)O steps from 0 to 20cmH(2)O and PEEP-50 group, in which PEEP was increased in 5-cmH(2)O steps from 0 to 50cmH(2)O. In both groups, a driving pressure of 15cmH(2)O was maintained until maximal PEEP and its corresponding maximal inspiratory pressures (MIPs) were reached. From there on, driving pressure was progressively increased in 5-cmH(2)O steps until detectable barotrauma occurred. Two macroscopic conditions were defined: anatomically open lung and barotrauma.

    MAIN OUTCOME MEASURES

    We measured open lung and barotrauma MIP, PEEP and driving pressure obtained using each strategy. A pressure safety range, defined as the difference between barotrauma MIP and anatomically open lung MIP, was also determined in both groups.RESULTSOpen lung MIP was similar in both groups: 23.63.8 and 23.3 +/- 4.1cmH(2)O in the PEEP-50 and PEEP-20 groups, respectively (P=0.91). However, barotrauma MIP in the PEEP-50 group was higher (65.7 +/- 3.4cmH(2)O) than in the PEEP-20 group (56.7 +/- 5 0.2cmH(2)O) (P=0.003) resulting in a safety range of pressures of respectively 33.3 +/- 8.7 and 42.1 +/- 3.9cmH(2)O (P=0.035).

    CONCLUSION

    In this ex-vivo model, we found a substantial difference between recruitment and barotrauma pressures using both recruitment strategies. However, a higher margin of safety was obtained when a higher PEEP and lower driving pressure strategy was used for recruiting the lung.

  • 19.
    Gillies, Michael A.
    et al.
    Royal Infirm Edinburgh NHS Trust, Scotland.
    Pearse, Rupert
    Royal London Hosp, England.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Peri-operative goal-directed therapy A definitive answer remains elusive2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 7, p. 467-468Article in journal (Other academic)
    Abstract [en]

    n/a

  • 20.
    Golster, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Seven years of patient-controlled epidural analgesia in a Swedish hospital A prospective survey2014In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 31, no 11, p. 589-596Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Epidural analgesia for postoperative pain relief needs to be monitored regularly in order to evaluate benefits and avoid potential hazards. OBJECTIVES To evaluate efficacy and safety profile of a ward- based regimen for postoperative epidural analgesia combining patient-controlled epidural analgesia (PCEA) and continuous epidural infusion (CEI). DESIGN We conducted a prospective survey in all patients who received postoperative epidural analgesia between March 2004 and February 2011. PATIENTS We analysed 4663 patients undergoing elective and acute surgery. SETTING University hospital in Sweden. RESULTS The median level of catheter insertion ranged from T8 in high abdominal surgery to T11 in gynaecological surgery. Mean infusion rate was 5.4 +/- 1.6ml h (-1) and was adjusted for age. Mean duration was 3.3 +/- 2.1 days. Eighty-seven percent of the patients rated satisfaction 8 to 10 out of 10 on a post-treatment scale. Reasons for termination were elective in 77.1%, due to inadequate pain relief in 11.4%, due to suspected infection in 0.7% and due to other causes in 10.9%. Of the latter, dislodgement of the catheter (4.0%) and leakage from the puncture site (1.4%) dominated. Catheter reinsertion was performed in 5.3% of the patients, and in 5.0%, the treatment was converted into an intravenous (i. v.) morphine patientcontrolled analgesia regimen. The incidence of motor blockade was 1.7%, sedation 2.1%, nausea 12.8% and pruritus 18.8%. Bolus doses accounted for 16% of the total infusion volume. No epidural haematoma was seen. One epidural abscess requiring antibiotic treatment occurred. CONCLUSION Our prospective survey indicates that PCEA in combination with CEI is effective and relatively well tolerated. The incidence of side effects is generally low and severe adverse events very rare.

  • 21.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Editorial Material: Why are crystalloid and colloid fluid requirements similar during surgery and intensive care?2013In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 30, no 9, p. 515-518Article in journal (Other academic)
    Abstract [en]

    n/a

  • 22.
    Hahn, Robert
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lyons, Gordon
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    The half-life of infusion fluids An educational review2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 7, p. 475-482Article, review/survey (Refereed)
    Abstract [en]

    An understanding of the half-life (T-1/2) of infused fluids can help prevent iatrogenic problems such as volume overload and postoperative interstitial oedema. Simulations show that a prolongation of the T-1/2 for crystalloid fluid increases the plasma volume and promotes accumulation of fluid in the interstitial fluid space. The T-1/2 for crystalloids is usually 20 to 40 min in conscious humans but might extend to 80 min or longer in the presence of preoperative stress, dehydration, blood loss of amp;lt;1 l or pregnancy. The longest T-1/2 measured amounts to between 3 and 8 h and occurs during surgery and general anaesthesia with mechanical ventilation. This situation lasts as long as the anaesthesia. The mechanisms for the long T-1/2 are only partly understood, but involve adrenergic receptors and increased renin and aldosterone release. In contrast, the T-1/2 during the postoperative period is usually short, about 15 to 20 min, at least in response to new fluid. The commonly used colloid fluids have an intravascular persistence T-1/2 of 2 to 3 h, which is shortened by inflammation. The fact that the elimination T-1/2 of the infused macromolecules is 2 to 6 times longer shows that they also reside outside the bloodstream. With a colloid, fluid volume is eliminated in line with its intravascular persistence, but there is insufficient data to know if this is the same in the clinical setting.

  • 23.
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Effects of anaesthesia on ventilation/perfusion matching2014In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 31, no 9, p. 447-449Article in journal (Other academic)
  • 24.
    Hemmes, Sabrine N. T.
    et al.
    Acad Med Ctr, Amsterdam, Netherlands..
    Neto, Ary Serpa
    Hosp Israelita Albert Einstein, Sao Paulo, Brazil.;Fac Med ABC, Sao Paulo, Brazil..
    Binnekade, Jan M.
    Acad Med Ctr, Amsterdam, Netherlands..
    Canet, Jaume
    Hosp Badalona Germans Trias & Pujol, Barcelona, Spain..
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Univ Hosp Uppsala, Uppsala, Sweden..
    Jaber, Samir
    St Eloi Univ Hosp, Montpellier, France..
    Hiesmayr, Michael
    Med Univ Vienna, Vienna, Austria..
    Hollmann, Markus W.
    Acad Med Ctr, Amsterdam, Netherlands..
    Mills, Gary H.
    Sheffield Teaching Hosp, Sheffield, S Yorkshire, England..
    Melo, Marcos F. Vidal
    Massachusetts Gen Hosp, Boston, MA 02114 USA..
    Pearse, Rupert
    Queen Mary Univ London, London, England..
    Putensen, Christian
    Univ Hosp Bonn, Bonn, Germany..
    Schmid, Werner
    Med Univ Vienna, Vienna, Austria..
    Severgnini, Paolo
    Univ Insubria, Varese, Italy..
    Wrigge, Hermann
    Univ Leipzig, Leipzig, Germany..
    de Abreu, Marcelo Gama
    Univ Hosp Dresden, Dresden, Germany..
    Pelosi, Paolo
    Univ Genoa, IRCCS AOU San Martino IST Hosp, Genoa, Italy..
    Schultz, Marcus J.
    Acad Med Ctr, Amsterdam, Netherlands..
    Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries2017In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 8, p. 492-507Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome. TRIAL REGISTRATION The study was registered at Clinicaltrials.gov, number NCT01601223.

  • 25. Hinz, J
    et al.
    Gehoff, A
    Moerer, O
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Frerichs, I
    Hahn, G
    Hellige, G
    Quintel, M
    Regional filling characteristics of the lungs in mechanically ventilated patients with acute lung injury.2007In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 24, no 5, p. 414-424Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objective of the study was to determine regional pulmonary filling characteristics in 20 mechanically ventilated patients with acute lung injury. METHODS: Regional filling characteristics were calculated from tracings of regional tidal volumes vs. global tidal volumes measured by electrical impedance tomography (EIT). These plots were fitted to a polynomial function of the second degree. Regional polynomial coefficients of the second degree characterized the curve linearity of the plots. Near-zero values of the polynomial coefficient indicated a homogeneous increase in regional tidal volumes during the whole inspiration. Positive values hinted at initial low regional tidal volume change suggesting lung volume recruitment. Negative values indicated late low regional tidal volume change implying hyperinflation of this lung region. RESULTS: We found a broad heterogeneity of regional lung filling characteristics. The minimal regional polynomial coefficients varied from -2.80 to -0.56 (median -1.16), while the maximal regional polynomial coefficients varied from 0.58 to 3.65 (median 1.41). CONCLUSIONS: Measurements of regional filling characteristics by EIT may be a helpful tool to adjust the respiratory settings during mechanical ventilation to optimize lung recruitment and to avoid overdistension. It applies a non-pressure-related assessment to the mechanics of lung inflation and gives a view of the real problems underlying ventilatory strategies dependent on global characteristics.

  • 26.
    Holzgraefe, Bernhard
    et al.
    Karolinska Univ Hosp, ECMO Dept Karolinska, Huddinge, Sweden; Karolinska Univ Hosp, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care Med, Huddinge, Sweden.
    Andersson, Christin
    Karolinska Univ Hosp, Dept Psychol, Huddinge, Sweden; Karolinska Univ Hosp, Dept Clin Neurosci, Stockholm, Sweden.
    Kalzén, Håkan
    Karolinska Univ Hosp, ECMO Dept Karolinska, Q9 00, S-17176 Stockholm, Sweden.
    von Bahr, Viktor
    Karolinska Univ Hosp, ECMO Dept Karolinska, Huddinge, Sweden; Karolinska Univ Hosp, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care Med, Huddinge, Sweden.
    Mosskin, Mikael
    Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Palmér, Kenneth
    Karolinska Univ Hosp, ECMO Dept Karolinska, Q9 00, S-17176 Stockholm, Sweden.
    Frenckner, Björn
    Karolinska Univ Hosp, ECMO Dept Karolinska, Q9 00, S-17176 Stockholm, Sweden.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
    Does permissive hypoxaemia during extracorporeal membrane oxygenation cause long-term neurological impairment?: A study in patients with H1N1-induced severe respiratory failure2017In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 2, p. 98-103Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Extracorporeal Life Support Organisation accepts permissive hypoxaemia in adult patients during extracorporeal membrane oxygenation (ECMO). The neurological long-term outcome of this approach has not yet been studied.

    OBJECTIVES: We investigated the prevalence of brain lesions and cognitive dysfunction in survivors from the Influenza A/H1N1 2009 pandemic treated with permissive hypoxaemia during ECMO for severe acute respiratory distress syndrome (ARDS). Our hypothesis was that this method is reasonable if tissue hypoxia is avoided.

    DESIGN: Long-term follow-up study after ECMO.

    SETTING: Karolinska University Hospital, Sweden, from October 2012 to July 2013.

    PATIENTS: Seven patients treated with ECMO for severe influenza A/H1N1-induced ARDS were studied 3.2 years after treatment. Blood lactate concentrations were used as a surrogate for tissue oxygenation.

    INTERVENTIONS: Neurocognitive outcome was studied with standardised cognitive tests and MRI of the brain.

    MAIN OUTCOME MEASURES: Cognitive functioning and hypoxic brain lesions after permissive hypoxaemia during ECMO. The observation period was the first 10 days of ECMO or the entire treatment period if shorter than 10 days.

    RESULTS: Eleven of 13 patients were still alive 3 years after ECMO. We were able to contact seven of these patients (mean age 31 years), who all agreed to participate in this study. Mean +/- SD peripherally measured arterial saturation during the observation period was 79 +/- 10%. Full-scale Intelligence Quotient was within one standard deviation or above from the mean of a healthy population in five patients, and was 1.5 SD below the mean in one patient. In one other patient, it could not be determined because of a lack of formal education. Memory functioning was normal in all patients. MRI showed no changes related to cerebral hypoxia.

    CONCLUSIONS: Permissive hypoxaemia during ECMO might not negatively affect long-term cognitive outcome if adequate organ perfusion is maintained.

  • 27.
    Jammer, Ib
    et al.
    Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Anaesthesia and Intensive Care, Haukeland University Hospital,.
    Wickboldt, Nadine
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Geneva, Geneva, Switzerland.
    Sander, Michael
    Department of Anaesthesia and Intensive Care, Charite, Berlin, Germany.
    Smith, Andrew
    Royal Lancaster Infirmary, Lancaster University, Lancaster, UK.
    Schultz, Marcus J
    Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
    Pelosi, Paolo
    Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Hospital,University of Genoa, Genoa, Italy.
    Leva, Brigitte
    European Society of Anaesthesiology, Brussels, Belgium.
    Rhodes, Andrew
    Critical Care, St George’s Hospital, London, UK.
    Hoeft, Andreas
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany .
    Walder, Bernhard
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Geneva, Geneva, Switzerland.
    Chew, Michelle S
    Department of Anaesthesia and Intensive Care Medicine, Hallands Sjukhus, Halmstad, Sweden Institute of Clinical Sciences, Lund University, Sweden.
    Pearse, Rupert M
    Queen Mary University of London, London, UK.
    Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 2, p. 88-105Article in journal (Refereed)
    Abstract [en]

    There is a need for large trials that test the clinical effectiveness of interventions in the field of perioperative medicine. Clinical outcome measures used in such trials must be robust, clearly defined and patient-relevant. Our objective was to develop standards for the use of clinical outcome measures to strengthen the methodological quality of perioperative medicine research. A literature search was conducted using PubMed and opinion leaders worldwide were invited to nominate papers that they believed the group should consider. The full texts of relevant articles were reviewed by the taskforce members and then discussed to reach a consensus on the required standards. The report was then circulated to opinion leaders for comment and review. This report describes definitions for 22 individual adverse events with a system of severity grading for each. In addition, four composite outcome measures were identified, which were designed to evaluate postoperative outcomes. The group also agreed on standards for four outcome measures for the evaluation of healthcare resource use and quality of life. Guidance for use of these outcome measures is provided, with particular emphasis on appropriate duration of follow-up. This report provides clearly defined and patient-relevant outcome measures for large clinical trials in perioperative medicine. These outcome measures may also be of use in clinical audit. This report is intended to complement and not replace other related work to improve assessment of clinical outcomes following specific surgical procedures.

  • 28.
    Jawad, Monir
    et al.
    Department of Anaesthesiology and Intensive Care, Central Hospital in Kristianstad, Kristianstad, Sweden.
    Baigi, Amir
    Department of Primary Healthcare, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Oldner, Anders
    Department of Anaesthesiology, Karolinska University Hospital and Institute, Surgical Services and Intensive Care, Stockholm, Sweden.
    Pearse, Rupert M
    Queen Mary University of London and Adult Critical Care Unit, Royal London Hospital, London, UK.
    Rhodes, Andrew
    Department of Intensive Care Medicine, St George's Healthcare NHS Trust, London, UK.
    Seeman-Lodding, Helen
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Chew, Michelle S
    Institute of Clinical Sciences Malmö, Lund University, Lund and the Department of Anaesthesiology and Intensive Care, Halland Hospital, Halmstad, Sweden.
    Swedish surgical outcomes study (SweSOS): An observational study on 30-day and 1-year mortality after surgery.2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 5, p. 317-325Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The European Surgical Outcomes Study (EuSOS) revealed large variations in outcomes among countries. In-hospital mortality and ICU admission rates in Sweden were low, going against the assumption that access to ICU improves outcome. Long-term mortality was not reported in EuSOS and is generally poorly described in the current literature.

    OBJECTIVE: To describe the characteristics of the Swedish subset of EuSOS and identify predictors of short and long-term mortality after surgery.

    DESIGN: An observational cohort study.

    SETTING: Six universities and two regional hospitals in Sweden.

    PATIENTS: A cohort of 1314 adult patients scheduled for surgery between 4 April and 11 April 2011.

    MAIN OUTCOME MEASURES: 30-day and 1-year mortality.

    RESULTS: A total of 303 patients were lost to follow-up, leaving 1011 for analysis; 69% of patients were classified as American Society of Anesthesiologists' physical status 1 or 2, and 68% of surgical procedures were elective. The median length of stay in postanaesthesia care units (PACUs) was 175 min (interquartile range 110-270); 6.6% of patients had PACU length of stay of more than 12 h and 3.6% of patients were admitted to the ICU postoperatively. Thirty-day mortality rate was 1.8% [95% confidence interval (CI) 1.0-2.6] and 8.5% (CI 6.8-10.2) at 1 year (n = 18 and 86). The risk of death was higher than in an age and sex-matched population after 30 days (standardised mortality ratio 10.0, CI 5.9-15.8), and remained high after 1 year (standardised mortality ratio 3.9, CI 3.1-4.8). Factors predictive of 30-day mortality were age, American Society of Anesthesiologists' physical status, number of comorbidities, urgency of surgery and ICU admission. For 1-year mortality, age, number of comorbidities and urgency of surgery were independently predictive. ICU admission and long stay in PACU were not significant predictors of long-term mortality.

    CONCLUSION: Mortality rate increased almost five-fold at 1 year compared with 30-day mortality after surgery, demonstrating a significantly sustained long-term risk of death in this surgical population. In Sweden, factors associated with long-term postoperative mortality were age, number of comorbidities and surgical urgency.

  • 29.
    Jildenstål,, Pether K.
    et al.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Hallén, Jan L.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Rawal, Narinder
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Department of Anaesthesiology, Linköping University, Linköping, Sweden.
    Berggren, Lars
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden: Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden.
    Effect of auditory evoked potential-guided anaesthesia on consumption of anaesthetics and early postoperative cognitive dysfunction: a randomised controlled trial2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 3, p. 213-219Article in journal (Refereed)
    Abstract [en]

    Background: Post-operative cognitive dysfunction (POCD) after non-cardiac surgery is a well known problem in some categories of patients. This study aims to evaluate the influence of auditory evoked potential (AEP)-guided anaesthesia on the requirement for anaesthetic drugs and their influence on POCD.

    Methods: Four hundred and fifty patients aged between 18 and 92 years scheduled for ophthalmic surgery under general anaesthesia were assigned randomly to one of two groups. In group A (AEP group), the depth of anaesthesia (DoA) was aimed at an AEP index (AAI) between 15 and 25. In group C (control group), DoA was guided by clinical signs. Hypotension was treated with fluids and vasopressors using a standardised algorithm. A mini-mental test and the Cognitive Failure Questionnaire were used to evaluate cognitive function.

    Results: Anaesthetic drug requirements were significantly lower in group A than in group C: propofol 92.526.5 vs. 103.839.5mg (P¼<0.001) and desflurane end-tidal concentration 2.50.58 vs. 3.30.79% (P<0.001). In group A, 36 patients (16%) received additional fluids and vasopressors compared to 65 patients (29%) in group C (P<0.01). AAI values differed significantly between the groups: 18 (11–21) in group A vs. 12 (10–19) in group C (P<0.001). The number of patients with POCD was 16 in group C compared to two in group A (P<0.001) at day 1 post-operation.

    Conclusion: AEP monitoring allows dose reduction of anaesthetic agents, leading to better cardiovascular stability and decreased requirements for intra-operative fluids and vasopressors. Cognitive decline seen following minor ophthalmic surgery, even when anaesthesia is assessed clinically, is short-lived with no long-term sequelae.

  • 30. Levein, N-G
    et al.
    Thörn, S-E
    Wattwil, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology.
    Effects of clonidine and dopamine on gastric tone2002In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 19, p. 99-104Article in journal (Refereed)
  • 31.
    Lisander, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Johansson, T
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Do we know all about hypothermia and are studies on the subject unethical?2003In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 20, no 10, p. 851-Article in journal (Refereed)
  • 32.
    Ljunggren, Stefan
    et al.
    Södertälje Hospital, Sweden.
    Nyström, Thomas
    Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Hahn, Robert G
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Södertälje Hospital, Sweden.
    Accuracy and precision of commonly used methods for quantifying surgery-induced insulin resistance: Prospective observational study2014In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 31, no 2, p. 110-116Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Insulin resistance develops in the perioperative setting and has an adverse influence on postoperative recovery and well-being.

    OBJECTIVES: To evaluate the effectiveness of commonly used methods for quantifying surgery-induced insulin resistance.

    DESIGN: Prospective observational study.

    SETTING: Surgery department and orthopaedic ward at two regional hospitals.

    PATIENTS: Twenty-two patients (mean age 68 years) scheduled for elective hip replacement.

    INTERVENTIONS: A short seven-sample intravenous glucose tolerance test (IVGTT) followed by a euglycaemic hyperinsulinaemic glucose clamp 1 day before and 2 days after the surgery.

    MAIN OUTCOME MEASURES: Insulin resistance shown by dynamic tests (the IVGTT and the glucose clamp) were compared to static tests [the quantitative insulin sensitivity check index (QUICKI) and the homeostatic model assessment-insulin resistance (HOMA-IR)], which use only the plasma glucose and insulin concentrations at baseline.

    RESULTS: The linear correlation coefficients for the relationship between insulin resistance as obtained with the glucose clamp and the other methods before or after surgery were 0.76 (IVGTT), 0.58 (QUICKI) and -0.65 (HOMA). The prediction errors (precision) averaged 18, 29 and 31%, respectively. Surgery-induced insulin resistance amounted to 45% (glucose clamp), 26% (IVGTT), 4% (QUICKI) and 3% (HOMA).

    CONCLUSION: Despite reasonably good linear correlations, the static tests grossly underestimated the degree of insulin resistance that developed in response to surgery.

  • 33.
    Longo, Silvina
    et al.
    Hosp Privado Univ Cordoba, Dept Anesthesia, Cordoba, Argentina..
    Siri, Juan
    Acosta, Cecilia
    Hosp Privado Comunidad Mar Del Plata, Dept Anesthesia, Mar Del Plata, Buenos Aires, Argentina..
    Palencia, Alberto
    Hosp Privado Univ Cordoba, Dept Cardiovasc Surg, Cordoba, Argentina..
    Echegaray, Arturo
    Chiotti, Ivan
    Hosp Privado Univ Cordoba, Dept Intens Care, Cordoba, Argentina..
    Parisi, Andres
    Ricci, Lila
    Univ Nacl Mar del Plata, Fac Ciencias Exactas, Dept Math, Mar Del Plata, Buenos Aires, Argentina..
    Natal, Marcela
    Univ Nacl Mar del Plata, Fac Ciencias Exactas, Dept Math, Mar Del Plata, Buenos Aires, Argentina..
    Suarez-Sipmann, Fernando
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. CIBERES, Madrid, Spain..
    Tusman, Gerardo
    Hosp Privado Comunidad Mar Del Plata, Dept Anesthesia, Mar Del Plata, Buenos Aires, Argentina..
    Lung recruitment improves right ventricular performance after cardiopulmonary bypass A randomised controlled trial2017In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 2, p. 66-74Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Atelectasis after cardiopulmonary bypass (CPB) can affect right ventricular (RV) performance by increasing its outflow impedance. OBJECTIVE The aim of this study was to determine whether a lung recruitment manoeuvre improves RV function by re-aerating the lung after CPB. DESIGN Randomised controlled study. SETTING Single-institution study, community hospital, Cordoba, Argentina. PATIENTS Forty anaesthetised patients with New York Heart Association class I or II, preoperative left ventricular ejection fraction at least 50% and Euroscore 6 or less scheduled for cardiac surgery with CPB. INTERVENTIONS Patients were assigned to receive either standard ventilation with 6 cmH(2)O of positive end-expiratory pressure (PEEP; group C, n = 20) or standard ventilation with a recruitment manoeuvre and 10 cmH(2)O of PEEP after surgery (group RM, n = 20). RV function, left ventricular cardiac index (CI) and lung aeration were assessed by transoesophageal echocardiography (TOE) before, at the end of surgery and 30 min after surgery. MAIN OUTCOME MEASURES RV function parameters and atelectasis assessed by TOE. RESULTS Haemodynamic data and atelectasis were similar between groups before surgery. At the end of surgery, CI had decreased from 2.9 +/- 1.1 to 2.6 +/- 0.9 l min(-1) m(-2) in group C (P = 0.24) and from 2.8 +/- 1.0 to 2.6 +/- 0.8 l min(-1) m +/- 2 in group RM (P = 0.32). TOE-derived RV function parameters confirmed a mild decrease in RV performance in 95% of patients, without significant differences between groups (multivariate Hotelling t-test P = 0.16). Atelectasis was present in 18 patients in group C and 19 patients in group RM (P = 0.88). After surgery, CI decreased further from 2.6 to 2.4 l min(-)1 m(-2) in group C (P = 0.17) but increased from 2.6 to 3.7 l min(-1) m(-2) in group RM (P<0.001). TOE-derived RV function parameters improved only in group RM (Hotelling t-test P<0.001). Atelectasis was present in 100% of patients in group C but only in 10% of those in group RM (P<0.001). CONCLUSION Atelectasis after CPB impairs RV function but this can be resolved by lung recruitment using 10 cm H2O of PEEP.

  • 34.
    Lund, M.
    et al.
    Karolinska Inst, Dept Anaesthesiol & Intens Care, CLINTEC, Div Anaesthesia, Huddinge, Sweden..
    von Dobeln, Alexandersson G.
    Karolinska Inst, Karolinska Univ Hosp, Dept Oncol Pathol, Oncol, Stockholm, Sweden..
    Lundell, L.
    Karolinska Inst, Karolinska Univ Hosp Huddinge, Dept Surg, Div Surg,CLINTEC, Stockholm, Sweden..
    Winter, R
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems. Royal Inst Technol, Sch Technol & Hlth, Cardiol Sect, Med, Stockholm, Sweden..
    Tsai, J. A.
    Karolinska Inst, Karolinska Univ Hosp Huddinge, Dept Surg, Div Surg,CLINTEC, Stockholm, Sweden..
    Kalman, S.
    Karolinska Inst, Dept Anaesthesiol & Intens Care, CLINTEC, Div Anaesthesia, Huddinge, Sweden..
    Neoadjuvant chemoradiotherapy but not chemotherapy impairs cardiac function in patients with cancer in the esophagus or gastroesophageal junction - a prospective randomized study2014In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 31, p. 55-55Article in journal (Other academic)
  • 35. Lund, Mikael
    et al.
    Tsai, Jon A.
    Nilsson, Magnus
    Winter, Reidar
    KTH, School of Technology and Health (STH). Karolinska Inst, Sweden.
    Lundell, Lars
    Kalman, Sigridur
    Effects of neoadjuvant chemo or chemoradiotherapy for oesophageal cancer on perioperative haemodynamics A prospective cohort study within a randomised clinical trial2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 9, p. 653-661Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Neoadjuvant chemoradiotherapy might improve oncological outcome compared with chemotherapy after surgery for oesophagus or gastrooesophageal junction cancer. However, radiotherapy may induce cardiovascular side-effects that could increase the risk of perioperative adverse effects and postoperative morbidity. OBJECTIVES The aim of this study was to compare the perioperative haemodynamics in patients undergoing oesophagectomy following neoadjuvant chemotherapy or chemoradiotherapy for cancer. DESIGN A prospective single-centre cohort study within a randomised multi-centre trial. SETTING A Swedish University Hospital from January 2009 to March 2013. PATIENTS A total of 31 patients (chemotherapy 17, chemoradiotherapy 14) included in a multi-centre trial randomising chemotherapy vs. chemoradiotherapy and operated at Karolinska University Hospital, Huddinge. INTERVENTIONS Cisplatin and 5-fluorouracil, either with or without concurrent radiotherapy (40 Gy), were given prior to surgery. Cardiac function was assessed with LiDCOplus (LiDCO Ltd, London, United Kingdom), echocardiography, troponin T and N-terminal pro-B-type natriuretic peptide, before, during and after surgery. MAIN OUTCOME MEASURES The primary outcome was the interaction effect of the neoadjuvant treatment on stroke volume index during the perioperative period. Secondary outcomes were the interaction effects of oxygen delivery index, cardiac index, echocardiography and biochemical markers. RESULTS The groups were matched regarding comorbidities, but patients in the chemoradiotherapy group were older (66 vs. 60 years P = 0.03). Haemodynamic values changed in a similar way in both groups during the study period. The chemoradiotherapy group had a lower cardiac index before surgery (2.9 vs. 3.4 l min(-1) m(-2), P = 0.03). On the third postoperative day, both groups displayed a hyperdynamic state compared with baseline, with no increase in troponin T, and a similar increase in N-terminal pro-B-type natriuretic peptide. CONCLUSION Neoadjuvant chemoradiotherapy for oesophageal or gastrooesophageal junction cancer seems to induce only a marginal negative effect on cardiac function compared with neoadjuvant chemotherapy. This difference did not remain when patients' haemodynamics were challenged by surgery.

  • 36.
    Navarro, Lais H.
    et al.
    Botucatu Medical School, UNESP, Botucatu, Sao Paulo, Brazil (LHN.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Postoperative acute kidney injury A never-ending challenge2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 9, p. 639-640Article in journal (Other academic)
  • 37. Neto, Ary Serpa
    et al.
    da Costa, Luiz Guilherme V
    Hemmes, Sabrine N T
    Canet, Jaume
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
    Jaber, Samir
    Hiesmayr, Michael
    Hollmann, Markus W
    Mills, Gary H
    Vidal Melo, Marcos F
    Pearse, Rupert
    Putensen, Christian
    Schmid, Werner
    Severgnini, Paolo
    Wrigge, Hermann
    Gama de Abreu, Marcelo
    Pelosi, Paolo
    Schultz, Marcus J
    The LAS VEGAS risk score for prediction of postoperative pulmonary complications: An observational study2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 9, p. 691-701Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Currently used pre-operative prediction scores for postoperative pulmonary complications (PPCs) use patient data and expected surgery characteristics exclusively. However, intra-operative events are also associated with the development of PPCs.

    OBJECTIVE: We aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data.

    DESIGN: This is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study.

    SETTINGS: A total of 146 hospitals across 29 countries.

    PATIENTS: Adult patients requiring intra-operative ventilation during general anaesthesia for surgery.

    INTERVENTIONS: The cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation.

    MAIN OUTCOME MEASURES: Prediction performance of developed models for PPCs.

    RESULTS: Of the 6063 patients analysed, 10.9% developed at least one PPC. Regression modelling identified 13 independent risk factors for PPCs: six patient characteristics [higher age, higher American Society of Anesthesiology (ASA) physical score, pre-operative anaemia, pre-operative lower SpO2 and a history of active cancer or obstructive sleep apnoea], two procedure-related features (urgent or emergency surgery and surgery lasting ≥ 1 h), and five intra-operative events [use of an airway other than a supraglottic device, the use of intravenous anaesthetic agents along with volatile agents (balanced anaesthesia), intra-operative desaturation, higher levels of positive end-expiratory pressures > 3 cmH2O and use of vasopressors]. The area under the receiver operating characteristic curve of the LAS VEGAS risk score for prediction of PPCs was 0.78 [95% confidence interval (95% CI), 0.76 to 0.80] for the development subsample and 0.72 (95% CI, 0.69 to 0.76) for the validation subsample.

    CONCLUSION: The LAS VEGAS risk score including 13 peri-operative characteristics has a moderate discriminative ability for prediction of PPCs. External validation is needed before use in clinical practice.

    TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, number NCT01601223.

  • 38.
    Nilsson, Lena
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Johansson, Anders
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Kalman, Sigga
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    The phase of the respiratory variation in the photoplethysmographic signal is not affected by sympathetic tone2004In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 21, p. 76-77Article in journal (Refereed)
  • 39.
    Nilsson, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lindenberger, Marcus
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    The effect of positive end-expiratory pressure and tripled tidal volume on pleth variability index during hypovolaemia in conscious subjects A volunteer study2013In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 30, no 11, p. 671-677Article in journal (Refereed)
    Abstract [en]

    BACKGROUNDThe pulse oximeter measurement pleth variability index (PVI) can detect hypovolaemia during positive pressure ventilation.OBJECTIVESWe studied whether PVI can detect a hypovolaemic state in spontaneously breathing humans and whether better discrimination is obtained by modifying the breathing patterns.DESIGNExperimental study.SETTINGClinical physiology department in a university hospital.PARTICIPANTSFourteen healthy volunteers aged between 18 and 27 (mean 21) years.INTERVENTIONSA hypovolaemic state was induced by lower body negative pressure (LBNP) of 40mmHg (LBNP40) and 15mmHg (LBNP15). Data were collected in four separate series with normal breathing and application of positive end-expiratory pressure (PEEP) 5cmH(2)O, with and without tripling of the tidal volume.MAIN OUTCOME MEASURESPVI (meanstandard deviation), heart rate, arterial blood pressure and cardiac index (CI).RESULTSCardiac index decreased from 2.4 to 1.7 and 2.1 lmin(-1)m(-2) at LBNP40 and LBNP15, respectively (Pandlt;0.001). The mean PVI for the four breathing modes increased with the degree of LBNP, from 23.55.9% at baseline to 27.9 +/- 9.3% at LBNP40, and to 25.2 +/- 6.9% at LBNP15 (Pandlt;0.01). The greatest increase in PVI, to 31.7 +/- 12.3%, was recorded for the PEEP and tripled tidal volume breathing mode when hypovolaemia was induced by LBNP40. However, there was considerable overlap between the LBNP levels.CONCLUSIONThe PVI increased significantly for higher LBNP, but overlap was common regardless of breathing mode. The PVI can be used to indicate a hypovolaemic state during spontaneous breathing in groups but not in individuals.TRIAL REGISTRATIONClinicaltrials.gov identifier NCT01456559

  • 40.
    Nilsson, Ulrica
    et al.
    Department of Anaesthesia and Intensive Care and Centre for Healthcare Sciences, Orebro University Hospital, Orebro, Sweden.
    Berg, Katarina
    Department of Medical and Health Sciences,, Sweden.
    Unosson, Mitra
    Department of Medical and Health Sciences,, Sweden; Department of Social and Welfare Studies, Linkoping University, Linkoping, Sweden.
    Brudin, Lars
    Kalmar County Council, Kalmar, Sweden.
    Idvall, Ewa
    Department of Medical and Health Sciences,, Sweden; Kalmar County Council, Kalmar, Sweden.
    Relation between personality and quality of postoperative recovery in day surgery patients2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 8, p. 671-675Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Personality factors have been found to influence long-term postoperative depressive symptoms, health and distress in inpatients. To our knowledge, no studies have analysed whether the personality traits of day surgery patients relate to postoperative recovery. Hence, this study aims to explore possible relationships between personality traits and the quality of postoperative recovery in patients undergoing day surgery.

    METHODS: Our study used a consecutive sample of 260 day surgery patients to explore possible relationships between personal traits, measured by a short Big Five scale, and postoperative recovery, measured by modified Quality of Recovery-40, on postoperative days 1, 7 and 14.

    RESULTS: We found a positive correlation in changes of 'physical independence' and 'extroversion' (r = 0.20; P = 0.010) and 'intellect' (r = 0.18; P = 0.021) on postoperative days 1 and 7. These correlations were not observed on postoperative day 14. With regard to the change between days 7 and 14, correlations were found between 'physical interdependence' and 'agreeableness' and between 'physical interdependence' and 'conscientiousness' (r = -0.17; P = 0.028-0.030 for both).

    CONCLUSION: Day surgery patients appear to be a homogenous group with stable personalities, demonstrating some minor correlations between personality traits and the quality of postoperative recovery on days 1, 7 and 14. However, further studies are needed.

  • 41.
    Nilsson, Ulrica
    et al.
    Örebro University Hospital, Sweden.
    Berg, Katarina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Kalmar County Council.
    Idvall, Ewa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Relation between personality and quality of postoperative recovery in day surgery patients2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 8, p. 671-675Article in journal (Refereed)
    Abstract [en]

    Background and objective Personality factors have been found to influence long-term postoperative depressive symptoms, health and distress in inpatients. To our knowledge, no studies have analysed whether the personality traits of day surgery patients relate to postoperative recovery. Hence, this study aims to explore possible relationships between personality traits and the quality of postoperative recovery in patients undergoing day surgery. Methods Our study used a consecutive sample of 260 day surgery patients to explore possible relationships between personal traits, measured by a short Big Five scale, and postoperative recovery, measured by modified Quality of Recovery-40, on postoperative days 1, 7 and 14. Results We found a positive correlation in changes of physical independence and extroversion (r = 0.20; P = 0.010) and intellect (r = 0.18; P = 0.021) on postoperative days 1 and 7. These correlations were not observed on postoperative day 14. With regard to the change between days 7 and 14, correlations were found between physical interdependence and agreeableness and between physical interdependence and conscientiousness (r = -0.17; P = 0.028-0.030 for both). Conclusion Day surgery patients appear to be a homogenous group with stable personalities, demonstrating some minor correlations between personality traits and the quality of postoperative recovery on days 1, 7 and 14. However, further studies are needed.

  • 42.
    Nilsson, Ulrica
    et al.
    Department of Anaesthesia and Intensive Care and Centre for Healthcare Sciences, Örebro University Hospital, Örebro, Sweden.
    Berg, Katarina
    Department of Medical and Health Sciences, Sweden.
    Unosson, Mitra
    Department of Medical and Health Sciences, Sweden.
    Brudin, Lars
    Kalmar County Council, Kalmar, Sweden.
    Idvall, Ewa
    Department of Medical and Health Sciences, Sweden.
    The relationship between personality and quality of postoperative recovery in day surgery patients2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 8, p. 671-675Article in journal (Refereed)
    Abstract [en]

    Background and objective: Personality factors have been found to influence long-term postoperative depressive symptoms, health and distress in inpatients. To our knowledge, no studies have analysed whether the personality traits of day surgery patients relate to postoperative recovery. Hence, this study aims to explore possible relationships between personality traits and the quality of postoperative recovery in patients undergoing day surgery.

    Methods: Our study used a consecutive sample of 260 day surgery patients to explore possible relationships between personal traits, measured by a short Big Five scale, and postoperative recovery, measured by modified Quality of Recovery-40, on postoperative days 1, 7 and 14.

    Results: We found a positive correlation in changes of ‘physical independence’ and ‘extroversion’ (r = 0.20; P = 0.010) and ‘intellect’ (r = 0.18; P = 0.021) on postoperative days 1 and 7. These correlations were not observed on postoperative day 14. With regard to the change between days 7 and 14, correlations were found between ‘physical interdependence’ and ‘agreeableness’ and between ‘physical interdependence’ and ‘conscientiousness’ (r = -0.17; P = 0.028–0.030 for both).

    Conclusion: Day surgery patients appear to be a homogenous group with stable personalities, demonstrating some minor correlations between personality traits and the quality of postoperative recovery on days 1, 7 and 14. However, further studies are needed.

  • 43.
    Nilsson, Ulrica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Unosson, Mitra
    Inst för Omvårdnad, Hälsouniversitetet Linköping.
    Rawal, Narinder
    Dep of Anesthesiology and Intensive Care, Örebro University Hospital.
    Stress reduction and analgesia in patients exposed to calm music postoperatively: a randomized controlled trial2005In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, ISSN 0265-0215, Vol. 22, p. 96-102Article in journal (Refereed)
  • 44.
    Nilsson, Ulrica
    et al.
    Örebro University Hospital, Department of Anaesthesiology and Intensive Care, Örebro, Sweden.
    Unosson, Mitra
    Faculty of Health Science, Department of Medicine and Care, Division of Nursing Science, Linköping, Sweden.
    Rawal, Narinder
    Örebro University Hospital, Department of Clinical Medicine, Division of Anaesthesiology, Örebro, Sweden.
    Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial2005In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 22, no 2, p. 96-102Article in journal (Refereed)
    Abstract [en]

    Background and objectives: This randomized controlled trial was designed to evaluate, first, whether intra- or postoperative music therapy could influence stress and immune response during and after general anaesthesia and second, if there was a different response between patients exposed to music intra- or postoperatively.

    Method: Seventy-five patients undergoing open hernia repair as day care surgery were randomly allocated to three groups: intraoperative music, postoperative music and silence (control group). Anaesthesia and postoperative analgesia were standardized and the same surgeon performed all the operations. Stress response was assessed during and after surgery by determining the plasma cortisol and blood glucose levels. Immune function was evaluated by studying immunoglobulin A (IgA) levels. Patients’ postoperative pain, anxiety, blood pressure (BP), heart rate (HR) and oxygen saturation were also studied as stress markers.

    Results: There was a significantly greater decrease in the level of cortisol in the postoperative music group vs. the control group (206 and 72 mmol L 1 decreases, respectively) after 2 h in the post anaesthesia care unit. The postoperative music group had less anxiety and pain and required less morphine after 1 h compared with the control group. In the postoperative music group the total requirement of morphine was significantly lower than in the control group. The intraoperative music group reported less pain after 1 h in the post anaesthesia care unit. There was no difference in IgA, blood glucose, BP, HR and oxygen saturation between the groups.

    Conclusion: This study suggests that intraoperative music may decrease postoperative pain, and that postoperative music therapy may reduce anxiety, pain and morphine consumption.

  • 45.
    Nilsson, Urban
    et al.
    Örebro universitet Örebro.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Rawal, Narinder
    Örebro universitet Örebro.
    Stress reduction and analgesia in patients exposed to calming music postoperatively: A randomized controlled trial2005In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 22, no 2, p. 96-102Article in journal (Refereed)
    Abstract [en]

    Background and objectives: This randomized controlled trial was designed to evaluate, first, whether intra- or postoperative music therapy could influence stress and immune response during and after general anaesthesia and second, if there was a different response between patients exposed to music intra- or postoperatively. Method: Seventy-five patients undergoing open hernia repair as day care surgery were randomly allocated to three groups: intraoperative music, postoperative music and silence (control group). Anaesthesia and postoperative analgesia were standardized and the same surgeon performed all the operations. Stress response was assessed during and after surgery by determining the plasma cortisol and blood glucose levels. Immune function was evaluated by studying immunoglobulin A (IgA) levels. Patients' postoperative pain, anxiety, blood pressure (BP), heart rate (HR) and oxygen saturation were also studied as stress markers. Results: There was a significantly greater decrease in the level of cortisol in the postoperative music group vs. the control group (206 and 72 mmol L-1 decreases, respectively) after 2 h in the post anaesthesia care unit. The postoperative music group had less anxiety and pain and required less morphine after 1 h compared with the control group. In the postoperative music group the total requirement of morphine was significantly lower than in the control group. The intraoperative music group reported less pain after 1 h in the post anaesthesia care unit. There was no difference in IgA, blood glucose, BP, HR and oxygen saturation between the groups. Conclusion: This study suggests that intraoperative music may decrease postoperative pain, and that postoperative music therapy may reduce anxiety, pain and morphine consumption. © 2005 European Society of Anaesthesiology.

  • 46.
    Perniola, Andrea
    et al.
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro; Linköping University, Linköping, Sweden.
    Crafoord, Kristina
    Department of Obstetrics and Gynecology, University Hospital, Örebro.
    Darvish, Bijan
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro.
    Magnuson, Anders
    Statistical and Epidemiology Unit, University Hospital, Örebro and.
    Axelsson, Kjell
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro.
    A double-blind dose-finding study of local anesthetics infused intraperitoneally for postoperative pain relief following abdominal hysterectomy.2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, p. 421-429Article in journal (Refereed)
    Abstract [en]

    Background and objective Local anaesthetics administered intraabdominally have been found to reduce analgesic requirements postoperatively after hysterectomy. This study was designed to assess the optimal dose of local anaesthetics for best pain relief.

    Methods Sixty patients undergoing abdominal hysterectomy were randomly divided into three groups to receive 10 ml hS1 infusion of levobupivacaine intraabdominally postoperatively for 48 h in a double-blind manner: group L, 7.5mghS1; group M, 12.5mghS1 and group H, 17.5mghS1. Pain intensity was measured using the numeric rating scale, ketobemidone consumption over 48 h was measured with a patient controlled analgesia pump, recovery parameters, expiratory muscle strength, time to home readiness, plasma concentration of levobupivacaine and health-related quality of life were all measured at defined time points postoperatively.

    Results No differences were found between the active groups in pain intensity, recovery parameters or healthrelated quality of life. Pain intensity was maximal during 0– 4 h and during coughing. Expiratory muscle strength decreased significantly during 0–4 h in all active groups, with no differences between the groups. Plasma concentration of levobupivacaine was below known toxic concentrations in humans, and no patient had symptoms of local anaesthetic toxicity. Health-related quality of life showed improved scores at 3 months after the operation compared with preoperative values, but no differences between the groups were found in any of the parameters. Conclusion Satisfactory analgesia can be achieved with low doses of levobupivacaine administered intraabdominally, except during the early postoperative period. No advantages were seen in this study when higher doses of levobupivacaine were administered as a continuous infusion for postoperative pain relief. Eur J Anaesthesiol 26:421–429 Q 2009 European Society of Anaesthesiology

  • 47.
    Perniola, Andrea
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gupta, Anil
    Crafoord, Kristina
    Darvish, Bijan
    Magnuson, Anders
    Axelsson, Kjell
    Intraabdominal local anaesthetics for postoperative pain relief following abdominal hysterectomy: a randomized, double-blind, dose-finding study2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 5, p. 421-429Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Local anaesthetics administered intraabdominally have been found to reduce analgesic requirements postoperatively after hysterectomy. This study was designed to assess the optimal dose of local anaesthetics for best pain relief.

    METHODS: Sixty patients undergoing abdominal hysterectomy were randomly divided into three groups to receive 10 ml h infusion of levobupivacaine intraabdominally postoperatively for 48 h in a double-blind manner: group L, 7.5 mg h; group M, 12.5 mg h and group H, 17.5 mg h. Pain intensity was measured using the numeric rating scale, ketobemidone consumption over 48 h was measured with a patient-controlled analgesia pump, recovery parameters, expiratory muscle strength, time to home readiness, plasma concentration of levobupivacaine and health-related quality of life were all measured at defined time points postoperatively.

    RESULTS: No differences were found between the active groups in pain intensity, recovery parameters or health-related quality of life. Pain intensity was maximal during 0-4 h and during coughing. Expiratory muscle strength decreased significantly during 0-4 h in all active groups, with no differences between the groups. Plasma concentration of levobupivacaine was below known toxic concentrations in humans, and no patient had symptoms of local anaesthetic toxicity. Health-related quality of life showed improved scores at 3 months after the operation compared with preoperative values, but no differences between the groups were found in any of the parameters.

    CONCLUSION: Satisfactory analgesia can be achieved with low doses of levobupivacaine administered intraabdominally, except during the early postoperative period. No advantages were seen in this study when higher doses of levobupivacaine were administered as a continuous infusion for postoperative pain relief.

  • 48.
    Petrino, Roberta
    et al.
    European Society for Emergency Medicine (EUSEM).
    Dryver, Eric
    EUSEM Education Committee.
    Brown, Ruth
    Emergency Medicine Examination Reference Group for Europe (EMERGE).
    Kurland, Lisa
    UEMS (Union Européenne des Médecins Spécialistes) Section & Board of Emergency Medicine.
    Collaboration in emergency medical care in Europe: the patient is the winner2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 3, p. 237-238Article in journal (Refereed)
  • 49.
    Poso, Tomi
    et al.
    Sunderby Hospital, Department of Anaesthesiolofy & Intensive Care.
    Kesek, Doris
    Umea University, Department of Surgery & Perioperative Science, Department fo Cardiothorac Anaesthesia.
    Winso, Ola
    Umea University, Department of Surgery & Perioperative Science, Department fo Cardiothorac Anaesthesia.
    Andersson, Staffan
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Volatile rapid sequence induction in morbidly obese patients2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 11, p. 781-787Article in journal (Refereed)
    Abstract [en]

    Background and objective The interest in bariatric surgery is growing. Morbidly obese patients have an increased risk of hypoxia and decreased blood pressure during rapid sequence induction (RSI). Alternate RSI methods that provide cardiovascular and respiratory stability are required. With this in mind, we evaluated a method for volatile RSI in morbidly obese patients. Design Observational study. Methods Thirty-four patients with mean BMI 42.4 kg m(-2) undergoing bariatric surgery (morbidly obese group) and 22 patients with mean BMI 25.6 kg m(-2) as a control group were included in the study. Anaesthesia was induced with sevoflurane, propofol, suxamethonium and alfentanil, designed to avoid respiratory and haemodynamic adverse events and to minimise depressing effect on the brain respiratory centre under ongoing RSI. Peripheral oxygen saturation (SpO(2)) and mean arterial blood pressure were registered before and after endotracheal intubation. In addition, two time periods were measured during RSI: spontaneous breathing time (SBT) and apnoea time. Results We found no significant differences between the groups. No periods of desaturation were detected. SpO(2) was 100% before and after endotracheal intubation in all patients. Mean arterial pressure was maintained at a stable level in both groups. Mean SBT and apnoea time were 65.6 and 45.8 s in the morbidly obese group, and 70.7 and 47.7 s in the control group, respectively.

  • 50.
    Pösö, Tomi
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Kesek, Doris
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Winsö, Ola
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Andersson, Staffan
    Volatile rapid sequence induction in morbidly obese patients2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 11, p. 781-787Article in journal (Refereed)
    Abstract [en]

    Background and objective: The interest in bariatric surgery is growing. Morbidly obese patients have an increased risk of hypoxia and decreased blood pressure during rapid sequence induction (RSI). Alternate RSI methods that provide cardiovascular and respiratory stability are required. With this in mind, we evaluated a method for volatile RSI in morbidly obese patients.

    Design: Observational study.

    Methods: Thirty-four patients with mean BMI 42.4 kg m(-2) undergoing bariatric surgery (morbidly obese group) and 22 patients with mean BMI 25.6 kg m(-2) as a control group were included in the study. Anaesthesia was induced with sevoflurane, propofol, suxamethonium and alfentanil, designed to avoid respiratory and haemodynamic adverse events and to minimise depressing effect on the brain respiratory centre under ongoing RSI. Peripheral oxygen saturation (SpO(2)) and mean arterial blood pressure were registered before and after endotracheal intubation. In addition, two time periods were measured during RSI: spontaneous breathing time (SBT) and apnoea time.

    Results: We found no significant differences between the groups. No periods of desaturation were detected. SpO(2) was 100% before and after endotracheal intubation in all patients. Mean arterial pressure was maintained at a stable level in both groups. Mean SBT and apnoea time were 65.6 and 45.8 s in the morbidly obese group, and 70.7 and 47.7 s in the control group, respectively.

    Conclusion: A combination of sevoflurane, propofol, suxamethonium and alfentanil is a suitable method for RSI which maintains cardiovascular and respiratory stability in both morbidly obese and lean patients.

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