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  • 301. Sander, C. Hallsjo
    et al.
    Hallbaeck, M.
    Sipmann, Fernando Suarez
    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.
    Wallin, M.
    Oldner, A.
    Bjorne, H.
    A novel continuous capnodynamic method for cardiac output assessment in a porcine model of lung lavage2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 8, p. 1022-1031Article in journal (Refereed)
    Abstract [en]

    BackgroundWe have evaluated a new method for continuous monitoring of effective pulmonary blood flow (COEPBF), i.e. cardiac output (CO) minus intra-pulmonary shunt, during mechanical ventilation. The method has shown good trending ability during severe hemodynamic challenges in a porcine model with intact lungs. In this study, we further evaluate the COEPBF method in a model of lung lavage. MethodsCO(EPBF) was compared to a reference method for CO during hemodynamic and PEEP alterations, 5 and 12cmH(2)O, before and after repeated lung lavages in 10 anaesthetised pigs. Bland-Altman, four-quadrant and polar plot methodologies were used to determine agreement and trending ability. ResultsAfter lung lavage at PEEP 5cmH(2)O, the ratio of arterial oxygen partial pressure related to inspired fraction of oxygen significantly decreased. The mean difference (limits of agreement) between methods changed from 0.2 (-1.1 to 1.5) to -0.9 (-3.6 to 1.9)l/min and percentage error increased from 34% to 70%. Trending ability remained good according to the four-quadrant plot (concordance rate 94%), whereas mean angular bias increased from 4 degrees to -16 degrees when using the polar plot methodology. ConclusionBoth agreement and precision of COEPBF were impaired in relation to CO when the shunt fraction was increased after lavage at PEEP 5cmH(2)O. However, trending ability remained good as assessed by the four-quadrant plot, whereas the mean polar angle, calculated by the polar plot, was wide.

  • 302. Sandin, M.
    et al.
    Thörn, Sven-Egron
    Örebro University, School of Health and Medical Sciences.
    Dahlqvist, A.
    Wattwil, L.
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences.
    Wattwil, Magnus
    Örebro University, School of Health and Medical Sciences.
    Effects of pain stimulation on bispectral index, heart rate and blood pressure at different minimal alveolar concentration values of sevoflurane2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 3, p. 420-426Article in journal (Other academic)
    Abstract [en]

    Background: The aim of the present study was to examine the level of unconsciousness measured with bispectral index (BIS) at different minimal alveolar concentration (MAC) levels of sevoflurane, and to study the hemodynamic and BIS reactions during noxious stimulation with transcutaneous electrical nerve stimulation (TENS) and an ice water pain test (IWP).

    Methods: This study was approved by the Ethics Committee and was performed on 10 healthy, young volunteers (six males and four females), ASA physical status I. Anesthesia was induced and maintained with sevoflurane in an oxygen/air mixture. The volunteers were spontaneously breathing, but if necessary, ventilation was mechanically supported. TENS and IWP were performed at 1.0, 1.5 and 2.0 MAC of sevoflurane.

    Results: At 1.0 MAC, there was a significant increase in BIS during pain stimulation both with IWP (P<0.03) and with TENS (P<0.005), but at 1.5 MAC there were no changes. A marked variation in BIS was seen at 2.0 MAC, with periods of burst suppression and periods of high BIS values despite clinical signs of deep anesthesia. These marked variations in BIS were seen before, during and after pain stimulation. One volunteer (# 8) had a short episode of convulsions at 2.0 MAC.

    Conclusion: BIS, heart rate and blood pressure increased during pain stimulation at 1.0 MAC but not at 1.5 MAC of sevoflurane. There was a remarkable variation in BIS at 2.0 MAC of sevoflurane, with BIS values indicating wakefulness despite clinical signs of deep anesthesia. This BIS variation is probably caused by epileptogenic activity due to sevoflurane.

  • 303.
    Savilampi, Johanna
    et al.
    Örebro university, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Magnuson, Anders
    Örebro university, Örebro, Sweden.
    Effects of remifentanil on pharyngeal swallowing: a double blind, randomized, cross-over study in healthy volunteers2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, p. 46-46Article in journal (Other academic)
  • 304.
    Savilampi, Johanna
    et al.
    Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden .
    Wattwil, Magnus
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden .
    Effects of remifentanil on the esophagogastric junction and swallowing2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 8, p. 1002-1009Article in journal (Refereed)
    Abstract [en]

    Background: A recent study demonstrated that reflux is associated with impaired pressure augmentation in the esophagogastric junction (EGJ), caused by diaphragmal contractions during inspiration. It is unknown whether this augmentation is influenced by opioids. Swallowing difficulties can be a poorly recognised side effect of remifentanil. Here, we investigated whether remifentanil influences inspiratory EGJ augmentation and evaluated subjective swallowing difficulties induced by remifentanil. We also used the peripheral opioid receptor antagonist methylnaltrexone to evaluate whether these effects are centrally or peripherally mediated.

    Methods: Ten healthy volunteers participated in a double-blind, randomised, cross-over trial at the University Hospital in orebro, Sweden. They were studied on two different occasions, during which they were randomly assigned to receive either methylnaltrexone 0.15mg/kg or saline subcutaneously 30min before the target-controlled infusion of remifentanil of 3ng/mL. EGJ pressures were measured by high-resolution manometry. Swallowing difficulties were assessed when volunteers performed dry swallows. The outcomes were the differences in EGJ pressures at baseline and during remifentanil infusion and with methylnaltrexone vs. placebo. Differences in swallowing difficulties before and during remifentanil, and with methylnaltrexone vs. placebo were also recorded.

    Results: Remifentanil decreased the inspiratory EGJ augmentation and induced swallowing difficulties. No statistically significant differences between methylnaltrexone and placebo occasions were found.

    Conclusions: Remifentanil may increase risk for gastroesophageal reflux by decreasing the inspiratory EGJ augmentation. The clinical significance of remifentanil-induced swallowing difficulties is to be studied further. Given the limited sample size, it cannot be concluded whether these effects are centrally or peripherally mediated.

  • 305.
    Savilampi, Johanna
    et al.
    Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Magnusson, Anders
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University Hospital. Department of Anesthesiology and Intensive CareDepartment of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Effects of remifentanil on esophageal motility: A double blind, randomized, cross-over study in healthy volunteers2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 9, p. 1126-1136Article in journal (Refereed)
    Abstract [en]

    Background: Recent studies have shown that remifentanil increases the risk of aspiration and induces subjective swallowing difficulties. The mechanisms are not completely understood. Here, we investigated whether remifentanil impairs esophageal motility and hypothesized that this is one possible underlying mechanism. Naloxone was used to evaluate whether the effects of remifentanil are mediated through opioid receptors. We also examined subjective swallowing difficulties and the influence of metoclopramide on remifentanil-induced effects.

    Methods: Fourteen healthy volunteers participated in a double-blind, randomized, cross-over trial at the University Hospital in orebro, Sweden. They were studied on two different occasions, during which they were randomly assigned to receive either naloxone given as a bolus of 6g/kg followed by an infusion of 0.1g/kg/min, or saline 5min before target-controlled infusions of remifentanil at three target-site concentrations: 1, 2, and 3 ng/ml. On both occasions, 0.2mg/kg metoclopramide was given before the final measurement. Five swallows were performed during each measuring condition, and the metrics defining esophageal motility were measured by high-resolution manometry. Outcomes were differences in the metrics at baseline vs. during remifentanil infusion, with naloxone vs. placebo, and with remifentanil before and after metoclopramide administration. Differences in swallowing difficulties were also recorded.

    Results: Remifentanil decreased swallow-evoked esophagogastric junction relaxation and the latency time of esophageal peristalsis. There were no significant effects of naloxone or metoclopramide on remifentanil-induced effects, and we detected no differences in swallowing difficulties.

    Conclusions: Remifentanil induces dysfunction of esophageal motility; this may contribute to the elevated risk of regurgitation and aspiration.

  • 306. Schumann, S
    et al.
    Messmer, F
    Lichtwarck-Aschoff, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Haberthuer, C
    Guttmann, J
    Cardiogenic oscillations in spontaneous breathing airway signal reflect respiratory system mechanics2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 8, p. 980-986Article in journal (Refereed)
    Abstract [en]

    Background: Heartbeat-related pressure oscillations appear at the airway opening. We investigated whether these cardiogenic oscillations (COS) - extracted from spontaneous breathing signals - reflect the compliance of the respiratory system. Methods: Fifteen volunteers breathed spontaneously at normal or reduced chest wall compliance, i.e. with and without thorax strapping, and at normal or reduced lung compliance, induced by positive end-expiratory pressure (PEEP). COS-related signals were extracted by averaging the flow and pressure curve sections, temporally aligned to the electrocardiogram signal. Results: COS-related airway pressure and flow curves correlated closely for each subject (r(2) =0.97±0.02, P<0.0001). At the unstrapped thorax, the oscillation's amplitudes were 0.07±0.03 cmH(2) O (pressure) and 22±10 ml/s (flow). COS-related pressure amplitudes correlated closely with the ratio of tidal volume divided by pressure amplitude (r(2) =0.88, P<0.001) and furthermore increased with either thorax strapping (P<0.001) or with increasing PEEP (P=0.049). Conclusion: We conclude that COS extracted from the pressure and flow signal reflect the compliance of the respiratory system and could potentially allow estimating respiratory system mechanics during spontaneous breathing.

  • 307.
    Scott, M. J.
    et al.
    Royal Surrey County Hospital, NHS Foundation Trust, University of Surrey, Guildford, United Kingdom.
    Baldini, G.
    Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal QC, Canada.
    Fearon, K. C. H.
    Royal Infirmary Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom.
    Feldheiser, A.
    Department of Anesthesiology, Intensive Care Medicine Campus Charite, Mitte and Campus Virchow-Klinikum Charite, University Medicine, Berlin, Germany.
    Feldman, L. S.
    Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montreal QC, Canada.
    Gan, T. J.
    Department of Anesthesiology, Duke University Medical Center, Durham NY, United States; Department of Anesthesiology, Stony Brook University, Stony Brook NY, United States.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden.
    Lobo, D. N.
    Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research, Biomedical Research Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom.
    Rockall, T. A.
    Royal Surrey County Hospital, NHS Foundation Trust, University of Surrey, Guildford, United Kingdom.
    Schricker, T.
    Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital, Montreal QC, Canada.
    Carli, F.
    Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal QC, Canada.
    Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 10, p. 1212-1231Article, review/survey (Refereed)
    Abstract [en]

    Background: The present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.

    Methods: The physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.

    Results: The pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.

    Conclusions: Evidence-based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

  • 308. Seeman‐Lodding, Helen
    et al.
    Häggmark, Sören
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Jern, Christina
    Jern, Sverker
    Johansson, Göran
    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.
    Biber, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Systemic levels and preportal organ release of tissue‐type plasminogen activator are enhanced by PEEP in the pig1999In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 43, no 6, p. 623-633Article in journal (Refereed)
  • 309.
    Segerdahl, M.
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, CLINTEC Unit for Anesthesia, Karolinska Universitetssjukhuset Huddinge, Stockholm, Sweden.
    Warren-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Rawal, N.
    Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Brattwall, M.
    Sahlgrenska University Hospital/Mölndal, Unit of Day Care Surgery, Göteborg, Sweden.
    Jakobsson, J.
    Department of Physiology and Pharmacology, Unit for Anesthesia, Karolinska Institute, Stockholm, Sweden / Department of Anaesthesia at the Foot & Ankle Surgery Clinic, Stockholm, Sweden.
    Children in day surgery: clinical practice and routines. The results from a nation-wide survey2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 6, p. 821-828Article in journal (Refereed)
    Abstract [en]

    Background: Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking. Methods: We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail. Results: The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1-6-year-olds, and in 7-16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1-6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1-3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy. Conclusions: In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.

  • 310.
    Segerdahl, M.
    et al.
    Karolinska Inst, Unit Anesthesia, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Rawal, N.
    Örebro Univ Hosp, Dept Anesthesia & Intens Care, Örebro, Sweden .
    Brattwall, M.
    Sahlgrenska Univ Hosp Molndal, Unit Day Care Surg, Gothenburg, Sweden.
    Jakobsson, J.
    Karolinska Inst, Unit Anesthesia, Dept Physiol & Pharmacol, Stockholm, Sweden.
    Clinical practice and routines for day surgery in Sweden2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 1, p. 117-124Article in journal (Refereed)
    Abstract [en]

    Background: Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking.

    Methods: We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail.

    Results: The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1–6-year-olds, and in 7–16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1–6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1–3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy.

    Conclusions: In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.

  • 311.
    Seilitz, Jenny
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Westerling-Andersson, Kristian
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Assessment of acute gastrointestinal injury score in postoperative cardiac surgical patients2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1044-1044Article in journal (Other academic)
    Abstract [en]

    Background: Gastrointestinal (GI) complications following cardiac surgery are infrequent but feared due to high morbidity and mortality. In 2012 new guidelines for grading acute GI injury (AGI score) in the intensive care setting were presented (1). We aimed to apply the AGI score in postoperative cardiac surgical patients.

    Methods: A total number of 352 adult patients undergoing elective heart surgery with extra-corporeal circulation completed the study. Prospectively, AGI score was assessed daily during the first three post-operative days according to normal GI function (AGI 0), risk of developing GI dysfunction (AGI 1), GI dysfunction (AGI 2), GI failure (AGI 3) and GI failure with severe impact on distant organ function (AGI 4).

    Results: Ninety-eight percent of the patients were assessed to have a daily peak score of ≤1, but only 36% were completely free from GI symptoms. Seven patients received a peak score of 2–3. The two patients with the highest peak and accumulated AGI scores died later due to GI complications.

    Conclusions: Postoperative assessment of AGI score in cardiac surgical patients is feasible. A majority presented with a risk of developing GI dysfunction but did not progress further. Early postoperative GI dys-function might predispose for later GI complications, but a larger study population is needed to further investigate this association.

    Reference:1. Reintam BA et al. Intens Care Med 2012; 38: 384–94.

  • 312.
    Semenas, Egidijus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Nozari, A.
    Sharma, Hari Shanker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sex differences in cerebral injury after severe haemorrhage and ventricular fibrillation in pigs2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 3, p. 343-353Article in journal (Refereed)
    Abstract [en]

    Background: Experimental studies of haemorrhagic shock have documented a superior haemodynamic response and a better outcome in female animals as compared with male controls. Such sexual dimorphism has, nevertheless, not been reported after circulatory arrest that follows exsanguination and shock. We aimed to study differences in cerebral injury markers after exsanguination cardiac arrest in pre-pubertal piglets. The hypothesis was that cerebral injury is less extensive in female animals, and that this difference is independent of sexual hormones or choice of resuscitative fluid. Methods: Thirty-two sexually immature piglets (14 males and 18 females) were subjected to 5 min of haemorrhagic shock followed by 2 min of ventricular fibrillation and 8 min of cardiopulmonary resuscitation, using three resuscitation fluid regimens (whole blood, hypertonic saline and dextran, or acetated Ringers' solution plus whole blood and methylene blue). Haemodynamic values, cellular markers of brain injury and brain histology were studied. Results: After successful resuscitation, female piglets had significantly greater cerebral cortical blood flow, tended to have lower S-100beta values and a lower cerebral oxygen extraction ratio. Besides, in female animals, systemic and cerebral venous acidosis were mitigated. Female piglets exhibited a significantly smaller increase in neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) expression in their cerebral cortex, smaller blood-brain-barrier (BBB) disruption and significantly smaller neuronal injury. Conclusion: After resuscitation from haemorrhagic circulatory arrest, cerebral reperfusion is greater, and BBB permeability and neuronal injury is smaller in female piglets. An increased cerebral cortical iNOS and nNOS expression in males implies a mechanistic relationship with post-resuscitation neuronal injury and warrants further investigation.

  • 313.
    Semenas, Egidijus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sharma, Hari Shanker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Adrenaline increases blood-brain-barrier permeability after haemorrhagic cardiac arrest in immature pigs2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 5, p. 620-629Article in journal (Refereed)
    Abstract [en]

    BackgroundAdrenaline (ADR) and vasopressin (VAS) are used as vasopressors during cardiopulmonary resuscitation. Data regarding their effects on blood-brain barrier (BBB) integrity and neuronal damage are lacking. We hypothesised that VAS given during cardiopulmonary resuscitation (CPR) after haemorrhagic circulatory arrest will preserve BBB integrity better than ADR. MethodsTwenty-one anaesthetised sexually immature male piglets (with a weight of 24.31.3kg) were bled 35% via femoral artery to a mean arterial blood pressure of 25mmHg in the period of 15min. Afterwards, the piglets were subjected to 8min of untreated ventricular fibrillation followed by 15min of open-chest CPR. At 9min of circulatory arrest, piglets received amiodarone 1.0mg/kg and hypertonic-hyperoncotic solution 4ml/kg infusions for 20min. At the same time, VAS 0.4U/kg was given intravenously to the VAS group (n=9) while the ADR group received ADR 20g/kg (n=12). Internal defibrillation was attempted from 11min of cardiac arrest to achieve restoration of spontaneous circulation. The experiment was terminated 3h after resuscitation. ResultsThe intracranial pressure (ICP) in the post-resuscitation phase was significantly greater in ADR group than in VAS group. VAS group piglets exhibited a significantly smaller BBB disruption compared with ADR group. Cerebral pressure reactivity index showed that cerebral blood flow autoregulation was also better preserved in VAS group. ConclusionsResuscitation with ADR as compared with VAS after haemorrhagic circulatory arrest increased the ICP and impaired cerebrovascular autoregulation more profoundly, as well as exerted an increased BBB disruption though no significant difference in neuronal injury was observed.

  • 314. Servin, F S
    et al.
    Raeder, J C
    Merle, J C
    Wattwil, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology.
    Hanson, A L
    Lauwers, M H
    Aitkenhead, A L
    Marty, J C
    Reite, K
    Martinsson, S
    Remifentanil sedation compared with propofol during regional anaesthesia2002In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 46, p. 309-315Article in journal (Refereed)
  • 315.
    Sicardi Salomón, Z.
    et al.
    South Hospital, Stockholm, Sweden.
    Rodhe, Peter
    South Hospital, Stockholm, Sweden.
    Hahn, Robert G
    South Hospital, Stockholm, Sweden.
    Progressive decrease in glucose clearance during surgery2006In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 7, p. 848-854Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Anaesthesia and surgery reduce the clearance of glucose. We studied how surgical procedures of different magnitude affect the clearance of a glucose load.

    METHODS: An intravenous infusion of 10 ml/kg/h of 2.5% buffered glucose was given over 80 min to 26 patients with a mean age of 50 years. The infusion started with the skin incision during minor surgery (inguinal hernia repair), medium-range surgery (laparoscopic cholecystectomy) and major surgery (aortic surgery, gastrectomy or colorectal surgery). General anaesthesia was induced in all patients and was supplemented by thoracic epidural analgesia for those undergoing major surgery. Plasma glucose was measured repeatedly for comparison of the clearance and endogenous glucose production during and after the infusion.

    RESULTS: Metabolic changes affected the shape of the plasma glucose curves more than the peak values. In those undergoing minor surgery, the clearance after the infusion was 65% of that recorded during the actual administration of glucose. The corresponding values for medium-range and major surgery were 37% and 60%, respectively (P < 0.001). The limited decrease in clearance in major surgery can probably be attributed to the epidural analgesia. In all three groups, the estimated endogenous glucose production decreased by the same magnitude as the clearance. The volume of distribution for glucose averaged 10.3 l.

    CONCLUSION: The hyperglycaemic effect of anaesthesia and surgery was not fully expressed within 80 min, regardless of the extent of surgery, and therefore appears to develop slowly. Even minor surgical trauma affected the metabolism of glucose.

  • 316.
    Siekmann, Wiebke
    et al.
    Örebro University, School of Medical Sciences. Anaesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Tina, Elisabet
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Research Laboratory, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Clinical Research Laboratory, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Physiology and Pharma cology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Concentration-dependent cell viability and proliferation in vitro of colon cancer cell lines SW480 and SW620 on exposure to lidocaine or ropivacaine2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1017-1018Article in journal (Other academic)
    Abstract [en]

    Background: Cancer cells change phenotypes and properties when evolving from primary tumor cells to metastatic cells. These changes might affect the response to local anesthetics (LA). The aim of this study was to investigate if lidocaine or ropivacaine have a dose- dependent effect on cell viability and proliferation of a primary and a secondary colon carcinoma cell line in vitro.

    Methods: The colon cancer cell lines SW 480, derived from primary tumor and SW620 from metastatic tumor in the same patient, were exposed to increasing log-concentrations of lidocaine and ropivacaine. Cell viability was measured using CellTiter Blue, and cell proliferation by PKH67, after exposure for up to 72 h.

    Results: Cell viability was not affected after 24 h of exposure. However, the metastatic cell line SW620 showed a significant increase in cell viability at low concentrati ons after 48 and 72 h. Exposure to the higher, but clinically relevant, concentrations of both LA resulted in decreased cell viability in both cell lines. These higher concentrations also showed an inhibitory effect on cell proliferation after 72 h, which was more pronounced for ropivacaine.

    Conclusions: Low concentrations of lidocaine and ropivacaine, as achieved in plasma by epidural infusion of LA, do not have direct antiproliferative effects on these colon cancer cell lines in vitro. Higher concentrations of LA, as during continuous local infiltration into tissues over 72 h, inhibit proliferation of both cancer cell lines. The increase in cell viability seen in SW620 should be investigated and underlying mechanisms further elucidated in future studies.

  • 317.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Burn Unit . Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Combined neuraxial and general anaesthesia - A dangerous combination? [6]2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no 2, p. 265Other (Other academic)
    Abstract [en]

    [No abstract available]

  • 318.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre.
    Combined neuraxial and general anaesthesia - Do not ignore complications2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 1, p. 161-162Article in journal (Other academic)
  • 319.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Burn Unit . Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    The 'Parkland protocol' for early fluid resuscitation of burns: Too little, too much, or...even...too late...?2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 6, p. 725-726Other (Other academic)
    Abstract [en]

    [No abstract available]

  • 320.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    The "Parkland protocol" for early fluid resuscitation of burns: too little, too much, or . . . even . . . too late . . .?2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 6, p. 725-726Article in journal (Other academic)
  • 321.
    Sjöberg, Folke
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Nilsson, Gert
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Dual mode antimony electrode for simultaneous measurements of PO2 and pH2000In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 44, no 1, p. 32-36Article in journal (Refereed)
    Abstract [en]

    Background: In biomedical research and clinical medicine there is a demand for potent sensors to measure the components that make up blood gas analyses. Today, as when the electrochemical PO2, PCO2 and pH electrodes were first introduced, these measurements are usually made with the same type of sensor technology. The aims of the present study were, firstly, to find out whether the platinum cathode in the Clark electrode can be replaced by antimony for oxygen measurements (amperometry (A)), secondly, whether, during oxygen measurements, the inherent corrosion potential of the antimony metal can be used for measurement of pH in the same measurement area (potentiometry (P)). Methods: An electrode of purified, crystallographically orientated monocrystalline antimony (COMA) connected to a reference electrode (silver- silver chloride) was used for the P measurements. Measurements of A (at -900 mV) and P were made in an aqueous environment regulated for oxygen, pH, and temperature. Results: Reproducible oxygen sensitivities of 0.925 nA/% oxygen (2% CV (coefficient of variation)) (A), 10.7 mV/% (P), and 0.7mV/% (P) were found in the oxygen range: 0-21%, <5%, and above 5%, respectively. The pH sensitivity was 57 mV/pH unit (P). Oxygen and pH measurements were less accurate at oxygen concentrations close to 0%. Conclusions: Both the oxygen and pH part of the composite electrode signal can be identified by this dual mode technique (A and P). The sensor seems to be promising as it provides measurements of two separate variables (oxygen and pH) and also has the desirable characteristics of a solid state sensor.

  • 322.
    Sjöberg, Folke
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Intensive care registries and the evolution of the concept of quality of care - reflections from the 10-year anniversary symposium of the Swedish Intensive Care Registry2012In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 9, p. 1073-1077Article in journal (Other academic)
  • 323. Sjöström, B.
    et al.
    Haljamäe, H.
    Dahlgren, Lars-Ove
    Linköping University, Faculty of Educational Sciences. Linköping University, Department of Behavioural Sciences, Studies in Adult, Popular and Higher Education.
    Lindström, B.
    Assessment of postoperative pain: Impact of clinical experience and professional role.1997In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 41, p. 339-344Article in journal (Refereed)
  • 324.
    Soe, Jesper Langager
    et al.
    Univ Copenhagen, Hvidovre Hosp, Dept Anaesthesiol & Intens Care, Copenhagen, Denmark..
    Hansen, Magna
    Univ Hosp North Norway, Dept Anaesthesiol, Tromso, Norway..
    Tjessem, Marius
    Ullevaal Univ Hosp, Dept Anaesthesiol, Oslo, Norway..
    Ohlen, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Suominen, Pertti
    Univ Helsinki, Cent Hosp, Childrens Hosp, Dept Anesthesiol, Helsinki, Finland..
    Interhospital transport of critically ill children and neonates in the Nordic countries. How and by whom?2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 996-996Article in journal (Other academic)
  • 325.
    Solheim, N.
    et al.
    Lovisenberg Diakonal Hosp, Oslo, Norway;Univ Oslo, Inst Clin Med, Fac Med, Oslo, Norway.
    Gregersen, I.
    Univ Oslo, Inst Clin Med, Fac Med, Oslo, Norway;Oslo Univ Hosp, Res Inst Internal Med, Oslo, Norway.
    Halvorsen, B.
    Univ Oslo, Inst Clin Med, Fac Med, Oslo, Norway;Oslo Univ Hosp, Res Inst Internal Med, Oslo, Norway.
    Bjerkeli, V.
    Univ Oslo, Inst Clin Med, Fac Med, Oslo, Norway;Oslo Univ Hosp, Res Inst Internal Med, Oslo, Norway.
    Stubhaug, A.
    Univ Oslo, Inst Clin Med, Fac Med, Oslo, Norway;Oslo Univ Hosp, Div Emergencies & Crit Care, Dept Pain Med & Res, Oslo, Norway.
    Gordh, T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Rosseland, L. A.
    Univ Oslo, Inst Clin Med, Fac Med, Oslo, Norway;Oslo Univ Hosp, Div Emergencies & Crit Care, Dept Res & Dev, Oslo, Norway.
    Randomized controlled trial of intra-articular ketorolac on pain and inflammation after minor arthroscopic knee surgery2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 6, p. 829-838Article in journal (Refereed)
    Abstract [en]

    Background: Ketorolac is an effective non-steroidal anti-inflammatory drug, commonly used with local anaesthetics as part of local infiltration analgesia protocols following orthopaedic surgery. However, systemic uptake and drug action may be the major mechanism after local infiltration. The aims of this project were to study the effects of a small, systemically ineffective dose of ketorolac given intra-articularly for post-operative pain and also to study synovial inflammatory biomarkers. We investigated whether ketorolac affects pro-inflammatory biomarkers in an invitro model, as well.

    Methods: In this placebo-controlled, blind, randomized study, we analysed intra-articular ketorolac (5mg) in ambulatory minor knee surgery patients with moderate or severe pain (n=44). We assessed post-operative pain intensity (n=44) and analysed microdialysis samples taken from knee synovial tissue every 20min (n=34). We also tested cyclooxygenase-independent effects of ketorolac in synovial cells stimulated by prostaglandin E-2 and chondroitin sulphate invitro.

    Results: Intra-articular ketorolac (5mg) administration did not reduce pain or synovial pro-inflammatory cytokines CXCL1, IL-8, and MCP-1, 0-120min after knee arthroscopy. Female gender was a risk factor for moderate or severe pain (relative risk 1.45, 95% confidence interval 1.04-2.01). Paradoxically, ketorolac increased the release of CXCL1 and IL-8 in prostaglandin E-2 and chondroitin sulphate-stimulated synovial cells invitro.

    Conclusion: Ketorolac prescribed at a low dose intra-articularly does not produce any detectable analgesic effect after minor knee surgery.

  • 326.
    Stenberg, Ylva
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lindelöf, Linnea
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Preoperative transthoracic echocardiography in ambulatory surgery- a cross sectional study.2020In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiac disease and aberrations in central volume statusare risk factors for perioperative complications,and should be identified prior to surgery. This study investigatedthe benefit of transthoracic echocardiography for preoperative identification of cardiac disease andhypovolemia in ambulatory surgery.

    METHODS: Ninety-six patients, with a mean age of 63.5±12.2 years and body mass index of 27.0±4.3 kg/m2 , scheduled for ambulatorysurgery (breast, thyroid, minor gastrointestinal), were consecutively enrolled in this prospective observational study. Preoperative comprehensive transthoracic echocardiographywas performed in order to assess heart failure, asymptomatic left ventricular dysfunction, valvular disease and aberrations incentral volume status.

    RESULTS: Preoperative transthoracic echocardiography identified a total of 28 cases of heart failure; thirteen cases of heart failure with reduced, or moderately reduced, ejection fraction and fifteen cases of heart failure with preserved ejection fraction. Furthermore, forty-six cases of asymptomatic left ventricular dysfunction were identified. 44/96 patients were hypovolemic, 16 of whom in severe hypovolemia.Seven cases of previously unknown obstructive valvular or myocardial diseaseand six cases of right ventricular systolic dysfunction were identified.A total of 24% (23/96) were classified as potential critical hemodynamic findings. The number needed to treat for preoperative TTE in order to find one critical finding was 4.2.

    CONCLUSION: In this ambulatory surgical cohort, a high prevalence of preoperative LV dysfunction and aberrations in volume status was observed. The results demonstrate that preoperative TTE contributed valuable hemodynamic information. The standard preoperative assessment for this cohort might need to be revised.

  • 327.
    Storm, Hanne
    et al.
    University of Oslo, Oslo, Norway.
    Günther, Anders
    Karolinska Univ Hosp, Stockholm.
    Sackey, Peter Victor
    Karolinska University Hospital, Stockholm.
    Bernhardsson, Jens
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Bjärtå, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Measuring pain: Physiological and self-rated measurements in relation to pain stimulation and anxiety2019In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 5, p. 668-675Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of the present study was to investigate how emotions influence pain, measured by one subjective self-rated measure, the numeric rating scale (NRS), and one objective physiological measure, the number of skin conductance responses (NSCR). Method: Eighteen volunteers were exposed to conditions with pictorial emotional stimuli (neutral, positive, negative), authentic ICU-sound (noise, no-noise) and electrical stimulation (pain, no-pain) individually titrated to induce moderate pain. When using all combinations of picture inducing emotions, sound, and pain, each of these conditions (12 conditions lasting for 60 seconds each) were followed by pain ratings. Ratings of arousal (low to high) and valence (pleasant to unpleasant) were used as indicators of affective state for each condition. Mean NSCR was also measured throughout the experiment for each condition. Results: Even though NRS and NSCR increased during painful stimuli, they did not correlate during the trial. However, NSCR was positively correlated with the strength of the electrical stimulation, r = 0.48, P = 0.046, whereas NRS showed positive correlations with the anxiety level, assessed by affective ratings (arousal, r = 0.61, P < 0.001, and valence, r = 0.37, P < 0.001). Conclusions: The NRS was strongly influenced by affective state, with higher pain ratings during more anxiety-like states, whereas NSCR correlated to the strength of electrical pain stimulation. That reported pain is moderated by anxiety, puts forward a discussion whether reduction of the anxiety level should be considered during analgesia treatment.

  • 328.
    Strand, Anna-Karin
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Nyqvist, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ekdahl, Anne
    Karolinska Inst, Sweden; Lund Univ, Sweden.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Eintrei, Christina
    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 (ANOPIVA).
    Is there a relationship between anaesthesia and dementia?2019In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 4, p. 440-447Article in journal (Refereed)
    Abstract [en]

    Background

    Long‐term cognitive problems are common among elderly patients after surgery, and it has been suggested that inhalation anaesthetics play a role in the development of dementia. This study aims to investigate the hypothesis that patients with dementia have been more exposed to surgery and inhalational anaesthetics than individuals without dementia.

    Methods

    Using 457 cases from a dementia‐registry and 420 dementia‐free controls, we performed a retrospective case‐control study. The medical records were reviewed to determine exposure to anaesthesia occurring within a 20‐year timeframe before the diagnosis or inclusion in the study. Data were analysed using multivariate logistic regression and propensity score analysis.

    Results

    Advanced age (70 years and older, with the highest risk in ages 80‐84 years) and previous head trauma were risk factors for dementia. History of exposure to surgery with anaesthesia was a risk factor for dementia (OR = 2.23, 95% CI 1.66‐3.00, P < 0.01). Exposure to inhalational anaesthetics with halogenated anaesthetics was associated with an increased risk of dementia, compared to no exposure to anaesthesia (OR = 2.47, 95% CI 1.17‐5.22, P = 0.02). Exposure to regional anaesthesia was not significantly associated with increased risk of dementia (P = 0.13).

    Conclusion

    In this 20‐year retrospective case‐control study, we found a potential association between dementia and prior anaesthesia. Exposure to general anaesthetics with halogenated anaesthetic gases was associated with an increased risk of dementia.

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  • 329.
    Strandberg, Gunnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lipcsey, Miklos
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Berglund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Eriksson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Analysis of intraosseous samples in endotoxemic shock: an experimental study in the anaesthetised pig2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 3, p. 337-344Article in journal (Refereed)
    Abstract [en]

    Background

    Intraosseous (IO) access is used in emergency situations to allow rapid initiation of treatment. IO access is also sometimes used for blood sampling, although data on accuracy of such sampling in critical illness are limited. There is also a potential risk that bone marrow fragments in IO samples may damage laboratory equipment. It is ethically questionable to perform a simultaneous comparison between IO and arterial/venous sampling in critically ill humans. We have, thus, studied the analytical performance of IO sampling in a porcine septic shock model using a cartridge-based analyser.

    Methods

    Eight pigs with endotoxin-induced septic shock were sampled hourly for 6 h, and analysed for blood gases, acid base status, haemoglobin, glucose and lactate using point of care instruments. Samples were taken from three IO cannulae (tibia bilaterally, one with infusion, and humerus), one arterial and one venous. An interaction test was used to assess changes in agreement between methods over time. Bland–Altman plots were constructed to study bias between methods.

    Results

    There were, to a varying extent, differences between IO and arterial/venous levels for all studied variables, but agreement did not change significantly during the experiment. A general finding was a large dispersion of differences between methods.

    Conclusions

    IO sample values should be treated with caution in this setting but may add useful information to the clinical picture. The tibia or humerus may be used for sampling. IO infusion decreases agreement, thus sampling during infusion should be avoided.

  • 330.
    Strandberg, Gunnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lipcsey, Miklos
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Michalek, J
    Eriksson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Intraosseous and intravenous administration of antibiotics yields comparable plasma concentrations during experimental septic shock2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 3, p. 346-353Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We aimed to investigate whether comparable antibiotic concentrations could be reached with intraosseous and intravenous administration during septic shock.

    METHODS: In this randomized, prospective experimental study conducted at an animal research laboratory at the University Hospital of Uppsala, eight anesthetized pigs, weighing 21.2 to 29.1 kg (mean: 25.2 ± 2.3 kg), received endotoxin infusion at 4 μg/kg/h for 6 h. At the onset of clinical shock, alternatively after 3 h of endotoxemia, they received 75 mg/kg of cefotaxime and 7 mg/kg of gentamicin either in a proximal tibial intraosseous catheter or in a peripheral intravenous catheter. Mixed venous samples were taken after 5, 15, 30, 60, 120 and 180 min and analyzed for antibiotic concentrations.

    RESULTS: For both antibiotics, plasma concentrations after intraosseous and intravenous administration followed similar curves throughout the observation period, and peak concentrations were comparable. Mean concentration area under the curve (AUC mg × h/l) for cefotaxime was 108.1 ± 19.5 after intraosseous and 116.5 ± 11.1 after intravenous administration; ratio 0.93, (95% CI 0.71-1.19). Mean AUC for gentamicin was 28.1 ± 6.8 for intraosseous and 32.2 ± 3.5 for intravenous administration; ratio 0.87 (95% CI 0.62-1.19).

    CONCLUSIONS: In this porcine septic shock model, intraosseous and intravenous administration of gentamicin and cefotaxime yielded comparable concentrations. In an emergency, intraosseous administration of these antibiotics may be considered in severe infections when venous access is difficult.

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  • 331.
    Strandberg, Gunnar
    et al.
    Uppsala Univ, Sweden.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Agvald Ohman, Christina
    Karolinska Univ Hosp Huddinge, Sweden.
    Lipcsey, Miklos
    Uppsala Univ, Sweden.
    Mortality after Severe Sepsis and Septic Shock in Swedish Intensive Care Units 2008-2016-A nationwide observational study2020In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed)
    Abstract [en]

    Background Recent studies have reported substantially decreased hospital mortality for sepsis, but data are scarcer on outcomes after hospital discharge. We studied mortality up to 1 year in Swedish intensive care unit (ICU) patients with and without sepsis. Methods Demographic and medical data for all registered adult general ICU patients admitted between 01-01-2008 and 30-09-2016 were retrieved from the Swedish Intensive Care Registry and linked with the National Patient Register for comorbidity data and the Cause of Death Register for death dates. The population was divided in two cohorts; (a) Patients with a diagnosis of severe sepsis or septic shock and (b) All other ICU patients. Crude yearly mortality was calculated, and logistic regression was used to analyse predictors of mortality. Results 28 886 sepsis and 221 941 nonsepsis ICU patients were identified. In the sepsis cohort, in 2008 unadjusted mortality was 32.6% at hospital discharge, 32.7% at 30 days, 39% at 90 days and 46.8% at 365 days. In 2016, mortality was 30.5% at hospital discharge, 31.9% at 30 days and 38% at 90 days. Mortality at 365 days was 45.3% in 2015. Corresponding nonsepsis mortality was 15.4%, 16.2%, 20% and 26% in 2008 and 15.6%, 17.1%, 20.7% and 26.7% in 2016/2015. No consistent decrease in odds of mortality was seen in the adjusted analysis. Conclusions Mortality in severe sepsis and septic shock is high, with more than one in three patients not surviving three months after ICU admission, and adjusted mortality has not decreased convincingly in Sweden 2008-2016.

  • 332.
    Strandberg, Gunnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Walther, Sten
    Uppsala Univ, Uppsala, Sweden..
    Öhman, Christina Agvald
    Uppsala Univ, Uppsala, Sweden..
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Long-term mortality after severe sepsis and septic shock in Swedish intensive care units 2005-20152017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1039-1039Article in journal (Other academic)
  • 333.
    Strang, Christof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Effect of differentintra-abdominal pressures during CO2-pneumoperitoneum on Ventilation-Perfusion Distributions in a porcine model2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Other academic)
  • 334.
    Strang, Christof M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Fredén, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Maripuu, E.
    Ebmeyer, U.
    Hachenberg, T.
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Improved ventilation-perfusion matching with increasing abdominal pressure during CO(2)-pneumoperitoneum in pigs2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 7, p. 887-896Article in journal (Refereed)
    Abstract [en]

    Background: CO(2)-pneumoperitoneum (PP) is performed at varying abdominal pressures. We studied in an animal preparation the effect of increasing abdominal pressures on gas exchange during PP. Methods: Eighteen anaesthetized pigs were studied. Three abdominal pressures (8, 12 and 16mmHg) were randomly selected in each animal. In six pigs, single-photon emission computed tomography (SPECT) was used for the analysis of V / Q distributions; in another six pigs, multiple inert gas elimination technique (MIGET) was used for assessing V / Q matching. In further six pigs, computed tomography (CT) was performed for the analysis of regional aeration. MIGET, CT and central haemodynamics and pulmonary gas exchange were recorded during anaesthesia and after 60min on each of the three abdominal pressures. SPECT was performed three times, corresponding to each PP level. Results: Atelectasis, as assessed by CT, increased during PP and in proportion to abdominal pressure [from 9 +/- 2% (mean +/- standard deviation) at 8mmHg to 15 +/- 2% at 16mmHg, P <0.05]. SPECT during increasing abdominal CO(2) pressures showed a shift of blood flow towards better ventilated areas. V / Q analysis by MIGET showed no change in shunt during 8 mmHg PP (9 +/- 1.9% compared with baseline 9 +/- 1.2%) but a decrease during 12mmHg PP (7 +/- 0.9%, P <0.05) and 16mmHg PP (5 +/- 1%, P <0.01). PaO(2) increased from 39 +/- 10 to 52 +/- 9 kPa (baseline to 16 mmHg PP, P <0.01). Arterial carbon dioxide (PCO(2)) increased during PP and increased further with increasing abdominal pressures. Conclusion: With increasing abdominal pressure during PP perfusion was redistributed more than ventilation away from dorsal, collapsed lung regions. This resulted in a better V / Q match. A possible mechanism is enhanced hypoxic pulmonary vasoconstriction mediated by increasing PCO(2).

  • 335.
    Strömbäck, Ulrica
    et al.
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Lundblad, Dan
    Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Time from onset of symptoms to medical presence at the first and at the second myocardial infarction: a comparative study2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no Suppl. 120, p. 27-Article in journal (Other academic)
  • 336. Sundeman, H.
    et al.
    Aneman, A.
    Broome, M.
    Umeå Universitet.
    Haney, M.
    Johansson, G.
    Haggmark, S.
    Biber, B.
    Winso, O.
    Effects of desflurane on the pig intestinal circulation during hypotension1999In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 43, no 10, p. 1069-1077Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of the present study was to analyze the perfusion pressure dependency for the splanchnic vascular effects of desflurane (DES). METHODS: We measured portal blood flow (QPORT, perivascular ultrasound) and jejunal mucosal perfusion (JMP; laser Doppler) in pentobarbital-anesthetized pigs (n=10). Experimentally, decreases in mean arterial pressure (MAP) were produced by pericardial infusions of dextran. The protocol included sets of measurements at incremental doses of DES (1, 2, 4 and 6%) prior to and during pericardial infusions. RESULTS: Although QPORT and JMP decreased significantly during pericardial infusions, DES, irrespective of dose, did not reduce QPORT until MAP had decreased below 65-70 mm Hg. In higher MAP ranges, vasodilation in pre-portal tissues was powerful enough to maintain QPORT in spite of concurrent decreases in driving arterial pressure, as produced by either DES or pericardial infusion, or by a combination of both. We found no effects of DES on JMP even at very low MAP (about 40 mm Hg during pericardial infusion), indicating that the normal physiological response of the small intestine to redistribute blood flow from deeper to more superficial layers during hypotension was unimpaired by DES. CONCLUSIONS: Our data suggest a wide dose-tolerability of DES as regards the splanchnic circulation during hypotensive states.

  • 337. Suominen, P. K.
    et al.
    Haney, Michael F.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Univ Hosp Umea, Dept Anaesthesia & Intens Care Med, Umea, Sweden.
    Fast-tracking and extubation in paediatric cardiac surgery2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 876-879Article in journal (Other academic)
  • 338. Søreide, E
    et al.
    Kalman, S
    Åneman, A
    Nørregaard, O
    Pere, P
    Mellin-Olsen, J
    Shaping the future of Scandinavian anaesthesiology: a position paper by the SSAI2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 9, p. 1062-1070Article in journal (Refereed)
    Abstract [en]

    Traditionally, Scandinavian anaesthesiologists have had a very broad scope of practice, involving intensive care, pain and emergency medicine. European changes in the different medical fields and the constant reorganising of health care may alter this. Therefore, the Board of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) decided to produce a Position Paper on the future of the speciality in Scandinavia. The training in the various Scandinavian countries is very similar and provides a stable foundation for the speciality. The Scandinavian practice in anaesthesia and intensive care is based on a team model where the anaesthesiologists work together with highly educated nurses and should remain like this. However, SSAI thinks that the role of the anaesthesiologists as perioperative physicians is not fully developed. There is an obvious need and desire for further training of specialists. The SSAI advanced educational programmes for specialists should be expanded and include formal assessment leading to a particular medical competency as defined by the European Union of Medical Specialists (UEMS). In this way, Scandinavian anaesthesiologists will remain leaders in perioperative, intensive care, pain and critical emergency medicine.

  • 339.
    Taxbro, Knut
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Hammarskjold, Fredrik
    Ryhov Cty Hosp, Sweden.
    Juhlin, David
    Ryhov Cty Hosp, Sweden.
    Hagman, Helga
    Skane Univ Hosp, Sweden.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Cost analysis comparison between peripherally inserted central catheters and implanted chest ports in patients with cancer-A health economic evaluation of the PICCPORT trial2020In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 64, no 3, p. 385-393Article in journal (Refereed)
    Abstract [en]

    Background A reliable central venous access device is a cornerstone in the treatment of cancer. Both peripherally inserted central catheters (PICC) and totally implanted chest ports (PORT) are commonly used for the delivery of chemotherapy. Both types of catheter can cause adverse events such as catheter-related deep venous thrombosis (CR-DVT), infection and mechanical complications. Method We conducted a randomized controlled trial including 399 patients with cancer and performed a health economic evaluation investigating the cost related to PICCs and PORTs using several clinically relevant dimensions from a healthcare perspective. The cost was determined using process and cost estimate models. Result PICCs are associated with a higher total cost when compared with PORTs. Combining the costs of all categories, the prize per inserted device was 824.58 EUR for PICC and 662.34 EUR for PORT. When adjusting for total catheter dwell time the price was 6.58 EUR/day for PICC and 3.01 EUR/day for PORT. The difference in CR-DVT was the main contributor to the difference in cost. The daily cost of PICC is approximately twice to that of PORT. Conclusion We have demonstrated that the cost from a healthcare perspective is higher in cancer patients receiving a PICC than to those with a PORT. The difference is driven mainly by the cost related to the management of adverse events. Our findings are relevant to anaesthetists, oncologists and vascular access clinicians and should be considered when choosing vascular access device prior to chemotherapy.

  • 340. Tegnestedt, C.
    et al.
    Gunther, A.
    Reichard, A.
    Bjurström, R.
    Alvarsson, Jesper
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Martling, C. -R
    Sackey, P.
    Levels and sources of sound in the intensive care unit - an observational study of three room types2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 8, p. 1041-1050Article in journal (Refereed)
    Abstract [en]

    Background: Many intensive care unit (ICU) patients describe noise as stressful and precluding sleep. No previous study in the adult setting has investigated whether room size impacts sound levels or the frequency of disruptive sounds. Methods: A-frequency S-time weighted equivalent continuous sound (L(AS)eq), A-frequency S-time weighted maximum sound level (L(AS)max) and decibel C peak sound pressure (L(C)peak) were measured during five 24-h periods in each of the following settings: three-bed room with nursing station (NS) alcove, single-bed room with NS alcove (1-BR with NSA) and single-bed room with bedside NS. Cumulative restorative time (CRT) (>5min with L(AS)max <55dB and L(C)peak <75dB) was calculated to describe calm periods. Two 8-h bedside observations were performed in each setting in order to note the frequency and sources of disruptive sounds. Results: Mean sound pressure levels (L(AS)eq) ranged between 52 and 58dBA, being lowest during night shifts. There were no statistically significant differences between the room types in mean sound levels or in CRT. However, disruptive sounds were 40% less frequent in the 1-BR with NSA than in the other settings. Sixty-four percent of disruptive sounds were caused by monitor alarms and conversations not related to patient care. Conclusions: Single-bed rooms do not guarantee lower sound levels per se but may imply less frequent disruptive sounds. Sixty-four percent of disruptive sounds were avoidable. Our findings warrant sound reducing strategies for ICU patients.

  • 341.
    Tegnestedt, C.
    et al.
    Karolinska University Hospital.
    Gunther, A.
    Karolinska University Hospital / Karolinska Institutet.
    Reichard, A.
    Karolinska University Hospital.
    Bjurström, R.
    Alvarsson, Jesper
    Stockholms universitet, Psykologiska institutionen.
    Martling, C. -R
    Karolinska University Hospital / Karolinska Institutet.
    Sackey, P.
    Karolinska University Hospital / Karolinska Institutet.
    Levels and sources of sound in the intensive care unit - an observational study of three room types2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 8, p. 1041-1050Article in journal (Refereed)
    Abstract [en]

    Background: Many intensive care unit (ICU) patients describe noise as stressful and precluding sleep. No previous study in the adult setting has investigated whether room size impacts sound levels or the frequency of disruptive sounds. Methods: A-frequency S-time weighted equivalent continuous sound (L(AS)eq), A-frequency S-time weighted maximum sound level (L(AS)max) and decibel C peak sound pressure (L(C)peak) were measured during five 24-h periods in each of the following settings: three-bed room with nursing station (NS) alcove, single-bed room with NS alcove (1-BR with NSA) and single-bed room with bedside NS. Cumulative restorative time (CRT) (>5min with L(AS)max <55dB and L(C)peak <75dB) was calculated to describe calm periods. Two 8-h bedside observations were performed in each setting in order to note the frequency and sources of disruptive sounds. Results: Mean sound pressure levels (L(AS)eq) ranged between 52 and 58dBA, being lowest during night shifts. There were no statistically significant differences between the room types in mean sound levels or in CRT. However, disruptive sounds were 40% less frequent in the 1-BR with NSA than in the other settings. Sixty-four percent of disruptive sounds were caused by monitor alarms and conversations not related to patient care. Conclusions: Single-bed rooms do not guarantee lower sound levels per se but may imply less frequent disruptive sounds. Sixty-four percent of disruptive sounds were avoidable. Our findings warrant sound reducing strategies for ICU patients.

  • 342.
    Tegnestedt, Charlotta
    et al.
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Günther, A
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Reichard, A
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Bjurström, R
    Department of Environmental Medicine, Karolinska Institutet, Stockholm.
    Alvarsson, J
    Gösta Ekman laboratory, Department of Psychology, Stockholm University, Stockholm.
    Martling, CR
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Sackey, P
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Levels and sources of sound in the intensive care unit: an observational study of three room types2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 8, p. 1041-1050Article in journal (Refereed)
    Abstract [en]

    Background

    Many intensive care unit (ICU) patients describe noise as stressful and precluding sleep. No previous study in the adult setting has investigated whether room size impacts sound levels or the frequency of disruptive sounds.

    Methods

    A-frequency S-time weighted equivalent continuous sound (LASeq), A-frequency S-time weighted maximum sound level (LASmax) and decibel C peak sound pressure (LCpeak) were measured during five 24-h periods in each of the following settings: three-bed room with nursing station (NS) alcove, single-bed room with NS alcove (1-BR with NSA) and single-bed room with bedside NS. Cumulative restorative time (CRT) (> 5 min with LASmax < 55 dB and LCpeak < 75 dB) was calculated to describe calm periods. Two 8-h bedside observations were performed in each setting in order to note the frequency and sources of disruptive sounds.

    Results

    Mean sound pressure levels (LASeq) ranged between 52 and 58 dBA, being lowest during night shifts. There were no statistically significant differences between the room types in mean sound levels or in CRT. However, disruptive sounds were 40% less frequent in the 1-BR with NSA than in the other settings. Sixty-four percent of disruptive sounds were caused by monitor alarms and conversations not related to patient care.

    Conclusions

    Single-bed rooms do not guarantee lower sound levels per se but may imply less frequent disruptive sounds. Sixty-four percent of disruptive sounds were avoidable. Our findings warrant sound reducing strategies for ICU patients.

  • 343. Tirkkonen, J.
    et al.
    Nurmi, J.
    Olkkola, K. T.
    Tenhunen, Jyrki
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hoppu, S.
    Cardiac arrest teams and medical emergency teams in Finland: a nationwide cross- sectional postal survey2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 4, p. 420-427Article in journal (Refereed)
    Abstract [en]

    BackgroundThe implementation, characteristics and utilisation of cardiac arrest teams (CATs) and medical emergency teams (METs) in Finland are unknown. We aimed to evaluate how guidelines on advanced in-hospital resuscitation have been translated to practice. MethodsA cross-sectional postal survey including all public hospitals providing anaesthetic services. ResultsOf the 55 hospitals, 51 (93%) participated in the study. All hospitals with intensive care units (university and central hospitals, n=24) took part. In total, 88% of these hospitals (21/24) and 30% (8/27) of the small hospitals had CATs. Most hospitals with CATs (24/29) recorded team activations. A structured debriefing after a resuscitation attempt was organised in only one hospital. The median incidence of in-hospital cardiac arrest in Finland was 1.48 (Q(1)=0.93, Q(3)=1.93) per 1000 hospital admissions. METs had been implemented in 31% (16/51) of the hospitals. A physician participated in MET activation automatically in half (8/16) of the teams. Operating theatres (13/16), emergency departments (10/16) and paediatric wards (7/16) were the most common sites excluded from the METs' operational areas. The activation thresholds for vital signs varied between hospitals. The lower upper activation threshold for respiratory rate was associated with a higher MET activation rate. The national median MET activation rate was 2.3 (1.5, 4.8) per 1000 hospital admissions and 1.5 (0.96, 4.0) per every cardiac arrest. ConclusionsCurrent guidelines emphasise the preventative actions on in-hospital cardiac arrest. Practices are changing accordingly but are still suboptimal especially in central and district hospitals. Unified guidelines on rapid response systems are required.

  • 344. Tirkkonen, J.
    et al.
    Olkkola, K. T.
    Huhtala, H.
    Tenhunen, J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hoppu, S.
    Vital dysfunctions after intensive care discharge: prevalence and impact on patient outcome2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 1, p. 56-62Article in journal (Refereed)
    Abstract [en]

    Background Patients discharged from the intensive care unit (ICU) are at increased risk for serious adverse events (SAEs). Recording vital functions and comprehending the consequences of altered vitals on general wards may be suboptimal. This potentially endangers recovery after successful intensive care. We aimed to determine the prevalence of vital dysfunctions after ICU discharge and their effect on patient outcome. Methods A prospective observational study. Adult patients discharged from a tertiary referral hospital ICU to general wards without treatment limitations were visited 24?h afterwards; their vitals were measured and reported to ward staff. Attending ward nurse responsible for patient was interviewed. Results The cohort consisted of 184 patients who had survived the first 24?h on the ward without complications (age: 57 +/- 16 years; male: 68%). The prevalence of objectively measured vital dysfunctions was 15%, and the attending nurse had been unusually concerned about the patient in 19% of cases. Of the 184 patients, 9.8% subsequently suffered an SAE. In a multivariate logistic regression model, only vital dysfunctions (odds ratio 3.79; 95% confidence interval 1.18-12.2) and nurse concern (3.63; 1.17-11.3) were independently associated with an increased incidence of SAE. Medical emergency team (MET) assistance was never considered necessary by ward staff. Sensitivity of observed altered vitals on SAEs was 50% and specificity 89%. Sensitivity of nurse concern was 26%, specificity 84%. Conclusions Simple vital function measurement and attending ward nurse's subjective assessment facilitate early detection of post-ICU patients at risk. The threshold in seeking assistance through MET remains high.

  • 345. Tirkkonen, Joonas
    et al.
    Olkkola, Klaus T.
    Huhtala, Heini
    Tenhunen, Jyrki
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hoppu, Sanna
    Medical emergency team activation: performance of conventional dichotomised criteria versus national early warning score2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 4, p. 411-419Article in journal (Refereed)
    Abstract [en]

    BackgroundTo activate the hospital's medical emergency team (MET), either conventional dichotomised activation criteria or an early warning scoring system may be used. The relative performance of these different activation patterns to discriminate high risk patients in a heterogenic general ward population after adjustment for multiple confounding factors has not been evaluated. We aimed to evaluate the dichotomised activation criteria used at our institution and the recently published national early warning score (NEWS, United Kingdom). Materials and MethodsProspective point prevalence study at a university hospital in Finland. On two separate days, the vital signs of all adult patients without treatment limitations were measured. Data on cumulative comorbidity (Charlson comorbidity index), age, gender, admission characteristics and subsequent mortality were collected. Univariate and multivariate logistic regression models were used for unadjusted and adjusted performance testing. ResultsThe cohort consisted of 615 patients. The dichotomised activation criteria were not associated with in-hospital serious adverse events (odds ratio 1.87, 95% confidence interval 0.55-6.30) or 30-day mortality (2.13, 0.79-5.72) after adjustments. For a NEWS of seven or more (the suggested trigger level for immediate MET activation), the adjusted odds ratios for the above mentioned outcomes were 7.45 (2.39-23.3) and 11.4 (4.40-29.6), respectively. Unlike the dichotomised activation criteria, NEWS was also independently associated with a higher 60- and 180-day mortality after adjustments. ConclusionsNEWS discriminates high risk patients in a heterogenic general ward population independently of multiple confounding factors. The conventional dichotomised activation criteria were not able to detect high risk patients.

  • 346. Tornell, S.
    et al.
    Ekeus, C.
    Hultin, M.
    Hakansson, S.
    Thunberg, J.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 4, p. 486-495Article in journal (Refereed)
    Abstract [en]

    BackgroundMaternal intrapartum fever (MF) is associated with neonatal sequelae, and women in labour who receive epidural analgesia (EA) are more likely to develop hyperthermia. The aims of this study were to investigate if EA and/or a diagnosis of MF were associated to adverse neonatal outcomes at a population level. MethodsPopulation-based register study with data from the Swedish Birth Register and the Swedish National Patient Register, including all nulliparae (n=294,329) with singleton pregnancies who gave birth at term in Sweden 1999-2008. Neonatal outcomes analysed were Apgar score (AS)<7 at 5min and ICD-10 diagnosis of neonatal encephalopathy (e.g. convulsions or neonatal cerebral ischaemia). Multivariate logistic regression was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI). ResultsEA was used in 44% of the deliveries. Low AS or encephalopathy was found in 1.26% and 0.39% of the children in the EA group compared with 0.80% and 0.29% in the control group. In multivariate analysis, EA was associated with increased risk with low AS, AOR 1.27 (95% CI 1.16-1.39), but not with diagnosis of encephalopathy, 1.11 (0.96-1.29). A diagnosis of MF was associated with increased risk for both low AS, 2.27 (1.71-3.02), and of neonatal encephalopathy, 1.97 (1.19-3.26). ConclusionDiagnosis of MF was associated with low AS and neonatal encephalopathy, whereas EA was only associated with low AS and not with neonatal encephalopathy. The found associations might be a result of confounding by indication, which is difficult to assess in a registry-based population study.

  • 347.
    Tunblad, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences, Division of Pharmacokinetics and Drug Therapy.
    Ederoth, Per
    Gärdenfors, Anna
    Hammarlund-Udenaes, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences, Division of Pharmacokinetics and Drug Therapy.
    Nordström, Carl-Henrik
    Altered brain exposure of morphine in experimental meningitis studied with microdialysis2004In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, no 3, p. 294-301Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    During pathologic conditions such as meningitis and traumatic brain injury the function of the blood-brain barrier (BBB) is disturbed. In the present study we examined the cerebral pharmacokinetic pattern of morphine in the intact brain and during experimentally induced meningitis using a pig model. Secondly, the use of intracerebral microdialysis as a potential tool for monitoring damage in the BBB by studying the pharmacokinetics of morphine is addressed.

    METHODS:

    Six pigs were studied under general anaesthesia. One occipital and two frontal microdialysis probes and one pressure transducer were inserted into the brain tissue. Another probe was placed into the jugularis interna. Morphine 1 mg kg(-1) was administered as a 10-min infusion, and morphine concentrations were then measured for 3 h. Meningitis was subsequently induced by injecting lipopoly-saccharide into the cisterna magna. When meningitis was established, the morphine experiment was repeated.

    RESULTS:

    The unbound area under the concentration-time curve (AUCu) ratio of morphine in brain to blood was 0.47 (0.19) during the control period, and 0.95 (0.20) (P < 0.001) during meningitis. The increase in the brain/blood AUCu ratio during meningitis implies decreased active efflux and increased passive diffusion of morphine over the BBB. The half-life of morphine in brain was longer than in blood during both periods, and was unaffected by meningitis.

    CONCLUSION:

    This study demonstrates that the morphine exposure to the brain is significantly increased during meningitis as compared with the control situation.

  • 348.
    TURNER, APF
    Cranfield University, UK.
    ELECTROCHEMICAL SENSORS FOR CONTINUOUS MONITORING DURING SURGERY AND INTENSIVE-CARE1995In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 39, p. 15-19Article in journal (Refereed)
    Abstract [en]

    The current state of development of electrochemical sensors and biosensors for continuous use during surgery and intensive care is briefly reviewed with an emphasis on recent developments. The clinical usefulness of invasive and non-invasive sensors is discussed. Recent advances in the design of electrochemical sensors and experience with ex vivo and in vivo applications are described. The importance of developing appropriate fabrication technology is emphasised in order to meet the demand for reliable and reproducible analytical devices.

  • 349. Tusman, G.
    et al.
    Suarez-Sipmann, F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Bohm, S. H.
    Borges, J. B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Capnography reflects ventilation/perfusion distribution in a model of acute lung injury2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 5, p. 597-606Article in journal (Refereed)
    Abstract [en]

    Background: Changes in the shape of the capnogram may reflect changes in lung physiology. We studied the effect of different ventilation/perfusion ratios (V/Q) induced by positive end-expiratory pressures (PEEP) and lung recruitment on phase III slope (S(III) ) of volumetric capnograms. Methods: Seven lung-lavaged pigs received volume control ventilation at tidal volumes of 6 ml/kg. After a lung recruitment maneuver, open-lung PEEP (OL-PEEP) was defined at 2 cmH(2) O above the PEEP at the onset of lung collapse as identified by the maximum respiratory compliance during a decremental PEEP trial. Thereafter, six distinct PEEP levels either at OL-PEEP, 4 cmH(2) O above or below this level were applied in a random order, either with or without a prior lung recruitment maneuver. Ventilation-perfusion distribution (using multiple inert gas elimination technique), hemodynamics, blood gases and volumetric capnography data were recorded at the end of each condition (minute 40). Results: S (III) showed the lowest value whenever lung recruitment and OL-PEEP were jointly applied and was associated with the lowest dispersion of ventilation and perfusion (Disp(R-E) ), the lowest ratio of alveolar dead space to alveolar tidal volume (VD(alv) /VT(alv) ) and the lowest difference between arterial and end-tidal pCO(2) (Pa-ETCO(2) ). Spearman's rank correlations between S(III) and Disp(R-E) showed a ρ=0.85 with 95% CI for ρ (Fisher's Z-transformation) of 0.74-0.91, P<0.0001. Conclusion: In this experimental model of lung injury, changes in the phase III slope of the capnograms were directly correlated with the degree of ventilation/perfusion dispersion.

  • 350.
    Tydén, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Herwald, H.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Walldén, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Johansson, Joakim
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Heparin-binding protein as a biomarker of acute kidney injury in critical illness2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 7, p. 797-803Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is no biomarker with high sensitivity and specificity for the development of acute kidney injury (AKI) in a mixed intensive care unit (ICU) population. Heparin-binding protein (HBP) is released from granulocytes and causes increased vascular permeability which plays a role in the development of AKI in sepsis and ischemia. The aim of this study was to investigate whether plasma levels of HBP on admission can predict the development of AKI in a mixed ICU population and in the subgroup with sepsis. METHODS: Longitudinal observational study with plasma HBP levels from 245 patients taken on admission to ICU. Presence and severity of AKI was scored daily for 1 week. RESULTS: Mean (95% CI) plasma concentrations of log HBP (ng/ml) in the groups developing different stages of AKI were: stage 0 (n = 175), 3.5 (3.4-3.7); stage 1 (n = 33), 3.7 (3.5-4.0), stage 2 (n = 20), 4.4 (3.5-4.8); and stage 3 (n = 17), 4.6 (3.8-5.2). HBP levels were significantly higher in patients developing AKI stage 3 (P < 0.01) compared to AKI stage 0 and 1. The area under the curve (AUC) for HBP to discriminate the group developing AKI stage 2-3 was 0.70 (CI: 0.58-0.82) and in the subgroup with severe sepsis 0.88 (CI: 0.77-0.99). CONCLUSION: Heparin-binding protein levels on admission to ICU are associated with the development of severe kidney injury. The relationship between HBP and AKI needs to be further validated in larger studies.

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