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  • 51.
    Colldén, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hultström, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Birgisdottir, Birgitta
    Akad Sjukhuset, Uppsala, Sweden..
    Case of subdural hematoma after labor epidural: implications for follow-up of post dural puncture head ache2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 985-985Article in journal (Other academic)
  • 52.
    Covaciu, Lucian
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Allers, M.
    Lunderquist, A.
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Intranasal cooling with or without intravenous cold fluids during and after cardiac arrest in pigs2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 4, p. 494-501Article in journal (Refereed)
    Abstract [en]

    Background: Intranasal balloon catheters circulated with cold saline have previously been used for the induction and maintenance of selective brain cooling in pigs with normal circulation. In the present study, we investigated the feasibility of therapeutic hypothermia initiation, maintenance and rewarming using such intranasal balloon catheters with or without addition of intravenous ice-cold fluids during and after cardiac arrest treatment in pigs. Material and methods: Cardiac arrest was induced in 20 anaesthetised pigs. Following 8 min of cardiac arrest and 1 min of cardiopulmonary resuscitation (CPR), cooling was initiated after randomisation with either intranasal cooling (N) or combined with intravenous ice-cold fluids (N+S). Hypothermia was maintained for 180 min, followed by 180 min of rewarming. Brain and oesophageal temperatures, haemodynamic variables and intracranial pressure (ICP) were recorded. Results: Brain temperatures reductions after cooling did not differ (3.8 +/- 0.7 degrees C in the N group and 4.3 +/- 1.5 degrees C in the N+S group; P=0.47). The corresponding body temperature reductions were 3.6 +/- 1.2 degrees C and 4.6 +/- 1.5 degrees C (P=0.1). The resuscitation outcome was similar in both groups. Mixed venous oxygen saturation was lower in the N group after cooling and rewarming (P=0.024 and 0.002, respectively) as compared with the N+S group. ICP was higher after rewarming in the N group (25.2 +/- 2.9 mmHg; P=0.01) than in the N+S group (15.7 +/- 3.3 mmHg). Conclusions: Intranasal balloon catheters can be used for therapeutic hypothermia initiation, maintenance and rewarming during CPR and after successful resuscitation in pigs.

  • 53.
    Darvish, B.
    et al.
    Orebro University Hospital.
    Gupta, Anil
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Alahuhta, S.
    University Oulu.
    Dahl, V.
    Asker and Baerum Hospital.
    Helbo-Hansen, S.
    Odense University Hospital.
    Thorsteinsson, A.
    Landspitali University Hospital.
    Irestedt, L.
    Karolinska University Hospital.
    Dahlgren, G.
    Karolinska University Hospital.
    Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 1, p. 46-53Article in journal (Refereed)
    Abstract [en]

    Background A major risk with epidural analgesia is accidental dural puncture (ADP), which may result in post-dural puncture headache (PDPH). This survey was conducted to explore the incidence of ADP, the policy for management of PDPH and the educational practices in epidural analgesia during labour in the Nordic countries. Methods A postal questionnaire was sent to the anaesthesiologist responsible for Obstetric anaesthesia service in all maternity units (n=153) with questions relating to the year 2008. Results The overall response rate was 93%. About 32% (22-47%) of parturients received epidural analgesia for labour. There were databases for registering obstetric epidural complications in 13% of Danish, 24% of Norwegian and Swedish, 43% of Finnish and 100% of hospitals in Iceland. The estimated incidence of ADP was 1% (n approximate to 900). Epidural blood patch (EBP) was performed in 86% (n approximate to 780) of the parturients. The most common time interval from diagnosis to performing EBP was 24-48 h. The success rate for EBP was greater than 75% in 67% (62-79%) of hospitals. The use of diagnostic CT/MRI before the first or the second EBP was exceptional. No major complication was reported. Teaching of epidurals was commonest (86%) in the non-obstetric population and 53% hospitals desired a formal training programme in obstetric analgesia. Conclusion We found the incidence of ADP to be approximately 1%. EBP was the commonest method used for its management, and the success rate was high in most hospitals. Formal training in epidural analgesia was absent in most countries and trainees first performed it in the non-obstetric population.

  • 54.
    Darvish, Bijan
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
    Dahlgren, G.
    Department of Anesthesia and Intensive Care, Capio St Görans Hospital, Stockholm, Sweden.
    Irestedt, L.
    Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
    Magnuson, A.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Swedish Institute of Disability Research, Örebro University, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
    Auditory function following post-dural puncture headache treated with epidural blood patch: a long-term follow-up2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 10, p. 1340-1354Article in journal (Refereed)
    Abstract [en]

    Background: Epidural analgesia is commonly used for pain management during labor. Sometimes, accidental dural puncture (ADP) occurs causing severely debilitating headache, which may be associated with transient hearing loss. We investigated if auditory function may be impaired several years after ADP treated with epidural blood patch (EBP).

    Methods: Sixty women (ADP group) without documented hearing disability, who received EBP following ADP during labor between the years 2005-2011 were investigated in 2013 for auditory function using the following tests: otoscopic examination, tympanometry, pure tone audiometry, and transient-evoked otoacoustic emissions. Additionally, they responded to a questionnaire, the Speech, Spatial and Qualities (SSQ) of hearing, concerning perceived hearing impairment. The results were compared to a control group of 20 healthy, non-pregnant women in the same age group.

    Results: The audiometric test battery was performed 5.2 (1.9)years after delivery. No significant differences were found between the ADP and the control groups in tympanometry or otoacoustic emissions. Pure tone audiometry revealed a significant but small (<5dB) difference between the ADP and control groups (P<0.05). The ability to hear speech in noise as measured by SSQ was significantly reduced in the ADP group compared to the control group (P<0.05).

    Conclusions: A minor hearing loss was detected in the ADP group compared to the control group in pure tone audiometry in some women and during speech-in-noise component several years after accidental dural puncture treated with an epidural blood patch. This small residual hearing loss has minor clinical significance.

  • 55.
    Darvish, Bijan
    et al.
    Karolinska University Hospital Solna, Stockholm, Sweden.
    Dahlgren, Gunnar
    Capio St Görans Hospital, Stockholm, Sweden.
    Irestedt, Lars
    Karolinska University Hospital, Solna, Sweden.
    Magnuson, Anders
    Örebro university, Örebro, Sweden.
    Möller, Claes
    School Medicine & Health Sci, Örebro University, Örebro, Sweden.
    Gupta, Anil
    Karolinska University Hospital Solna, Stockholm, Sweden.
    Auditory function following post dural puncture headache treated with epidural blood patch A long-term follow-up of parturients2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, p. 24-25Article in journal (Other academic)
  • 56.
    Darvish, Bijan
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Anesthesia & Intens Care, Sch Hlth & Med Sci, Örebro Univ Hosp, Örebro, Sweden.
    Gupta, Anil
    Dept Anesthesia & Intens Care, Sch Hlth & Med Sci, Örebro Univ Hosp, Örebro, Sweden; Dept Med & Hlth Sci, Div Anaesthesia, Linköping Univ, Linköping, Sweden..
    Alahuhta, S.
    Dept Anesthesiol, Univ Oulu, Oulu, Finland.
    Dahl, V.
    Asker & Baerum Hosp, Rud, Norway.
    Helbo-Hansen, S.
    Dept Anesthesiol & Intens Care Med, Odense Univ Hosp, Odense C, Denmark.
    Thorsteinsson, A.
    Dept Anesthesiol & Intens Care Med, Landspitali Univ Hosp, Reykjavik, Iceland.
    Irestedt, L.
    Dept Anesthesiol & Intens Care, Karolinska Univ Hospital, Stockholm, Sweden.
    Dahlgren, G.
    Dept Anesthesiol & Intens Care, Karolinska Univ Hospital, Stockholm, Sweden.
    Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 1, p. 46-53Article in journal (Refereed)
    Abstract [en]

    Background: A major risk with epidural analgesia is accidental dural puncture (ADP), which may result in post-dural puncture headache (PDPH). This survey was conducted to explore the incidence of ADP, the policy for management of PDPH and the educational practices in epidural analgesia during labour in the Nordic countries.

    Methods: A postal questionnaire was sent to the anaesthesiologist responsible for Obstetric anaesthesia service in all maternity units (n=153) with questions relating to the year 2008.

    Results: The overall response rate was 93%. About 32% (22-47%) of parturients received epidural analgesia for labour. There were databases for registering obstetric epidural complications in 13% of Danish, 24% of Norwegian and Swedish, 43% of Finnish and 100% of hospitals in Iceland. The estimated incidence of ADP was 1% (n approximate to 900). Epidural blood patch (EBP) was performed in 86% (n approximate to 780) of the parturients. The most common time interval from diagnosis to performing EBP was 24-48 h. The success rate for EBP was > 75% in 67% (62-79%) of hospitals. The use of diagnostic CT/MRI before the first or the second EBP was exceptional. No major complication was reported. Teaching of epidurals was commonest (86%) in the non-obstetric population and 53% hospitals desired a formal training programme in obstetric analgesia.

    Conclusion: We found the incidence of ADP to be approximately 1%. EBP was the commonest method used for its management, and the success rate was high in most hospitals. Formal training in epidural analgesia was absent in most countries and trainees first performed it in the non-obstetric population.

  • 57.
    de Geer, Lina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Oscarsson Tibblin, Anna
    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).
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Walther, Sten M.
    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.
    No association with cardiac death after sepsis: A nationwide observational cohort study2019In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 3, p. 344-351Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiac dysfunction is a well-known complication of sepsis, but its long-term consequences and implications for patients remain unclear. The aim of this study was to investigate cardiac outcome in sepsis by assessing causes of death up to 2 years after treatment in an Intensive Care Unit (ICU) in a nationwide register-based cohort collected from the Swedish Intensive Care Registry.

    METHODS: A cohort of 13 669 sepsis and septic shock ICU patients from 2008 to 2014 was collected together with a non-septic control group, matched regarding age, sex and severity of illness (n = 6582), and all without preceding severe cardiac disease. For a large proportion of the severe sepsis and septic shock patients (n = 7087), no matches were found. Information on causes of death up to 2 years after ICU admission was sought in the Swedish National Board of Health and Welfare's Cause of Death Registry.

    RESULTS: Intensive Care Unit mortality was nearly identical in a matched comparison of sepsis patients to controls (24% in both groups) but higher in more severely ill sepsis patients for whom no matches were found (33% vs 24%, P < 0.001). There was no association of sepsis to cardiac deaths in the first month (OR 1.03, 95%CI 0.87 to 1.20, P = 0.76) nor up to 2 years after ICU admission (OR 1.01, 95%CI 0.82 to 1.25, P = 0.94) in an adjusted between-group comparison.

    CONCLUSIONS: There was no association with an increased risk of death related to cardiac disease in patients with severe sepsis or septic shock when compared to other ICU patients with similar severity of illness.

  • 58.
    de Leon, A.
    et al.
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Thörn, Sven-Egron
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Ottosson, J.
    Örebro University Hospital, Örebro, Sweden.
    Wattwil, Magnus
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Body positions and esophageal sphincter pressures in obese patients during anesthesia2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 4, p. 458-463Article in journal (Refereed)
    Abstract [en]

    Background: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions.

    Methods: Using high-resolution solid-state manometry, we studied 17 patients (27-63 years) with a BMI>or=35 kg/m(2) who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20 degrees) and in the Trendelenburg position (-20 degrees). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordings in the different positions were repeated.

    Results: Before anesthesia, there were no differences in UES pressure in the different positions but compared with the other positions, it increased during the reverse Trendelenburg during anesthesia. LES pressure decreased in all body positions during anesthesia. The LES pressure increased during the Trendelenburg position before but not during anesthesia. The BP remained positive in all body positions both before and during anesthesia.

    Conclusion: LES pressure increased during the Trendelenburg position before anesthesia. This effect was abolished during anesthesia. LES and BPs decreased during anesthesia but remained positive in all patients regardless of the body position.

  • 59.
    de Leon, Alex
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Lundin, Stefan
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Stenqvist, Ola
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Esophageal multi-level tip manometry in morbidly obese patients during a PEEP step2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1028-1028Article in journal (Other academic)
    Abstract [en]

    Background: Esophageal pressure, a surrogate for pleural pressure, is used to determine transpulmonary pressure and to set appropriate PEEP levels. There is no consensus on the representativity of esophageal pressure for pleural pressure and how to position and inflate the catheter balloon. The aim of this retrospective study1 was to analyze esophageal pressure using multi-level tip manometry (no balloon).

    Methods: An esophageal catheter with 12 radially directed tip mano meters at 35 levels one centimeter apart, detecting pressure from pharynx to stomach was placed in 17 patients (BMI >35 kg/m2). Pressure was analyzed integrating measurements from five manometer levels at mid- and lower esophageal level and for all levels between the upper and lower esophageal sphincters at PEEP 0 cmH2O (ZEEP) and after increasing PEEP to 10 cmH2O.

    Results: End-expiratory esophageal pressure (PESEE) was 10–12 cmH2O at ZEEP and increased minimally and transiently in whole and mid esophagus when PEEP was increased. Lower esophageal pressure increased more, but started to recede after approximately 20 breaths.

    Conclusions: End-expiratory pressure is positive, 10–12 cmH2O at all esophageal levels at FRC in contrast to absolute pleural pressure, which according to established knowledge is negative. There was only a marginal, transient increase in PESEE in response to PEEP. The change in end-expiratory trans-pulmonary and respiratory system pressures in response to a PEEP increase is therefore equal, and lung elastance can be calculated as the chan ge in PEEP divided by the change in end-expiratory lung volume.

  • 60.
    de Leon, Alex
    et al.
    Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Thörn, Sven-Egron
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Raoof, M.
    Dept Surg, Lindesberg Hosp, Lindesberg, Sweden.
    Ottosson, J.
    Dept Surg, Lindesberg Hosp, Lindesberg, Sweden; Örebro University Hospital, Örebro, Sweden.
    Wattwil, Magnus
    Örebro University, School of Health and Medical Sciences.
    Effects of different respiratory maneuvers on esophageal sphincters in obese patients before and during anesthesia2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 10, p. 1204-1209Article in journal (Refereed)
    Abstract [en]

    Background: Data on esophageal sphincters in obese individuals during anesthesia are sparse. The aim of the present study was to evaluate the effects of different respiratory maneuvers on the pressures in the esophagus and esophageal sphincters before and during anesthesia in obese patients.

    Methods: Seventeen patients, aged 28-68 years, with a BMI >= 35 kg/m2, who were undergoing a laparoscopic gastric by-pass surgery, were studied, and pressures from the hypopharynx to the stomach were recorded using high-resolution solid-state manometry. Before anesthesia, recordings were performed during normal spontaneous breathing, Valsalva and forced inspiration. The effects of anesthesia induction with remifentanil and propofol were evaluated, and positive end-expiratory pressure (PEEP) 10 cmH(2)O was applied during anesthesia.

    Results: During spontaneous breathing, the lower esophageal sphincter (LES) pressure was significantly lower during end-expiration compared with end-inspiration (28.5 +/- 7.7 vs. 35.4 +/- 10.8 mmHg, P < 0.01), but barrier pressure (BrP) and intra-gastric pressure (IGP) were unchanged. LES, BrP (P < 0.05) and IGP (P < 0.01) decreased significantly during anesthesia. BrP remained positive in all patients. IGP increased during Valsalva (P < 0.01) but was unaffected by PEEP. Esophageal pressures were positive during both spontaneous breathing and mechanical ventilation. Esophageal pressures increased during PEEP from 9.4 +/- 3.8 to 11.3 +/- 3.3 mmHg (P < 0.01).

    Conclusion: During spontaneous breathing, the LES pressure was the lowest during end-expiration but there were no differences in BrP and IGP. LES, BrP and IGP decreased during anesthesia but BrP remained positive in all patients. During the application of PEEP, esophageal pressures increased and this may have a protective effect against regurgitation.

  • 61.
    Dobrydnjov, Igor
    et al.
    Departments of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Axelsson, Kjell
    Departments of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, A.
    Departments of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Lundin, A.
    Department of Orthopedic Surgery, University Hospital, Örebro, Sweden.
    Holmström, B.
    Departments of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Granath, B.
    Departments of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Improved analgesia with clonidine when added to local anesthetic during combined spinal-epidural anesthesia for hip arthroplasty: a double-blind, randomized and placebo-controlled study2005In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 49, no 4, p. 538-545Article in journal (Refereed)
    Abstract [en]

    Background:  The perioperative effects of intrathecal and epidural clonidine combined with local anesthetic were evaluated in 60 patients undergoing hip arthroplasty.

    Methods:  This was a double-blinded study and the patients were randomized into three groups, with 20 patients in each group. All patients received spinal anesthesia with 17.5 mg of plain bupivacaine with 15 µg of clonidine (Group BC-RC) or without clonidine (Groups B-R and B-RC). Postoperatively, epidural infusion was administered in the following way: Group B-R – ropivacaine 4 mg h−1; Groups B-RC and BC-RC: ropivacaine 4 mg h−1 and clonidine 40 µg h−1. Sensory block was assessed with light touch, pinprick, transcutaneous electrical stimulation at T12 and L2 dermatomes, and perception of thermal stimuli.

    Results:  The maximal upper level of sensory block measured by pin-prick (T6–T7) did not differ between the groups while the partial sensory block for cold and warmth were increased two dermatomes above pin-prick level in the group with intrathecal clonidine compared to the other two groups (P < 0.05). Duration of anesthesia, analgesia and motor block were longer in Group BC-RC compared to Groups B-R and B-RC (P < 0.02). Postoperatively, both VAS score on movement and PCA-morphine consumption were higher in Group B-R than in Groups B-RC and BC-RC (P < 0.01). The arterial pressure and heart rate in Groups B-RC and BC-RC were significantly lower than in Group B-R at 10–24 and 15–24 h, respectively, after spinal injection.

    Conclusion:  Low-dose intrathecal clonidine provided a better quality of anesthesia and longer-lasting analgesia. Epidural clonidine-ropivacaine infusion resulted in improved postoperative analgesia but was associated with a moderate decrease in blood pressure.

  • 62.
    Dobrydnjov, Igor
    et al.
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Sweden .
    Axelsson, Kjell
    Department of Anesthesiology and Intensive Care, Tartu University Hospital, Estonia.
    Samarütel, Juri
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Sweden .
    Holmström, Björn
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Sweden .
    Postoperative pain relief following intrathecal bupivacaine combined with intrathecal or oral clonidine2002In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 46, no 7, p. 806-814Article in journal (Refereed)
    Abstract [en]

    Background: The purpose of the present study was to evaluate the postoperative analgesic and adverse effects of equal doses of oral or intrathecal clonidine in spinal anaesthesia with bupivacaine plain.

    Methods: Forty-five ASA I-III orthopaedic patients scheduled for osteosynthesis of a traumatic femur fracture were randomised in a double-blind fashion to one of 3 groups. Patients received 15 mg of plain bupivacaine intrathecally (group B) or an intrathecal mixture of bupivacaine 15 mg and clonidine 150 mg (group CIT). In group CPO oral clonidine 150 mg was administered 60 min before intrathecal injection of bupivacaine 15 mg.

    Results: Oral and intrathecal clonidine prolonged the time until the first request for analgesics, 313 ± 29 and 337 ± 29 min, respectively, vs. 236 ± 27 min in group B (P < 0.01). The total 24- h PCA morphine dose was significantly lower in group CIT(19.3 ± 1.3 mg) compared to groups B and CPO(33.4 ± 2.0 and 31.2 ± 3.1 mg). MAP was decreased significantly during the first hour after intrathecal clonidine(14%) and during the first 5 h after oral clonidine(14–19%). HR decreased in CIT during the 5th and 6th postoperative hours(7–9%) and during the first 2 h(9%) in CPO (P < 0.01). The degree of sedation was more pronounced in group CPO during the first 3 h. Four patients had pruritus in group B.

    Conclusions: Addition of intrathecal clonidine prolonged analgesia and decreased morphine consumption postoperatively more than oral clonidine. Hypotension was more pronounced after oral than after intrathecal clonidine. Intrathecal clonidine is therefore recommended.

  • 63.
    Dobrydnjov, Igor
    et al.
    Departments of Anaesthesiology and Intensive Care, Kohtla-Järve Hospital, Kohtla-Järve.
    Samarütel, J.
    University of Tartu, Tartu, Estonia.
    Enhancement of intrathecal lidocaine by addition of local and systemic clonidine1999In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 43, no 5, p. 556-562Article in journal (Refereed)
    Abstract [en]

    Background: Enhancement of local anaesthetic-produced regional blocks by clonidine seems well established. There are insufficient data about dose-effect relationship of combinations of clonidine with individual agents, efficiency of local versus systemic administration of clonidine, and comparative evaluation of clonidine with vasoconstrictors. Because of unavailability of long-acting local anaesthetics at the time of study, our aim was to evaluate augmentation of lidocaine spinal block with local or systemic clonidine and to compare the results with the efficacy of intrathecal phenylephrine.

    Methods: Ninety pts of age 50–72 yrs with ASA 1–4 physical status, scheduled for open prostatectomies, hysterectomies or ostheosynthesis of fractured hip were randomized to one of 6 treatment groups, 15 pts in each. Patients received intrathecally (L3–L4) either 100 mg of plain lidocaine (group L100); or a mixture of lidocaine 40 and 80 mg with clonidine 100 μg (groups L40-C100 and L80-C100); or a combination of lidocaine 40 and 80 mg with clonidine 300 μg orally 60 min before spinal puncture (L40-C300 and L80-C300). Addition of intrathecal phenylephrine 5 mg to 80 mg of lidocaine was also investigated (L80-P5).

    Results: There were no significant intergroup differences concerning demographic data or type of surgery. All operations (duration up to 150 min) were completed without need for analgesic supplementation. The addition of clonidine resulted in a significant reduction of the onset time of spinal block and prolongation of the duration of sensory and motor blocks compared to plain lidocaine or lidocaine with phenylephrine. In spite of the well-known hypotensive action of α2-agonists, haemodynamic depression only in group L80-C300 was significantly more pronounced than in L100 and L80-P5 groups. The least decrease of BP and minimal need of rescue ephedrine among all patients studied were recorded in the group receiving low dosage of lidocaine with intrathecal clonidine (L40-C100). Sedation occurred in most patients receiving clonidine.

    Conclusion: Our results indicate that addition of clonidine to lidocaine, irrespective of the route of administration, prolongs the duration of spinal block and permits a reduction of the lidocaine dose needed for a given duration of block. Addition of phenylephrine results in a less pronounced statistically significant prolongation of anaesthesia. The regression of sensory block before restoration of motor function seems to be a specific (and unfortunate) effect of both clonidine and phenylephrine.

  • 64.
    Drobin, D.
    et al.
    Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Hjelmqvist, H.
    Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Piros, D.
    South Hospital, Stockholm, Sweden.
    Hahn, Robert G.
    Södertälje Hospital, Sweden.
    Monitoring of fluid absorption with nitrous oxide during transurethral resection of the prostate2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 4, p. 509-513Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The fluid absorption that occurs during transurethral resection of the prostate (TURP) can be indicated and quantified by the ethanol method. Recently, nitrous oxide (N(2)O) was tested in animals and volunteers and seemed to be more accurate and safe. The present study compared these two methods in surgical patients.

    METHODS: Eighty-six TURPs were performed at two hospitals using an irrigating fluid that contained 3% mannitol, 1% ethanol and 0.004% N(2)O (40 ml/l). The ethanol concentration was measured by end-expiratory tests every 10 min. The N(2)O concentration was measured by a flared nasal cannula every second. Fluid absorption was calculated based on a regression equation (ethanol method) from the area under the curve based on the samples where CO(2) >median (N(2)O method).

    RESULTS: Thirteen patients (15%) absorbed >300 ml of fluid as indicated by the ethanol method. The median volume was 707 ml (range 367-1422). Ethanol yielded higher figures for fluid absorption up to 700-800 ml, whereafter the N(2)O method indicated that the absorption was larger. Over the entire range, the mean difference between the two methods at the end of any 10-min period of TURP was only +45 ml, although the 95% limits of agreement were quite separated (-479 to +569 ml).

    CONCLUSIONS: The N(2)O method does not require forced breath sampling and was successfully apply clinically. However, there was a dose-dependent difference in result between the ethanol and N(2)O methods, which markedly separated the limits of agreement for a wider range of fluid absorption events.

  • 65.
    Edberg, M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Furebring, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Enblad, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Neurointensive care of patients with severe community-acquired meningitis2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 6, p. 732-739Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Reports about neurointensive care of severe community-acquired meningitis are few. The aims of this retrospective study were to review the acute clinical course, management and outcome in a series of bacterial meningitis patients receiving neurointensive care.

    METHODS:

    Thirty patients (median age 51, range 1-81) admitted from a population of 2 million people during 7 years were studied. The neurointensive care protocol included escalated stepwise treatment with mild hyperventilation, cerebrospinal fluid (CSF) drainage, continuous thiopentotal infusion and decompressive craniectomy. Clinical outcome was assessed using the Glasgow outcome scale.

    RESULTS:

    Twenty-eight patients did not respond to commands on arrival, five were non-reacting and five had dilated pupils. Twenty-two patients had positive CSF cultures: Streptococcus pneumoniae (n=18), Neisseria meningitidis (n=2), β-streptococcus group A (n=1) and Staphylococcus aureus (n=1). Thirty-five patients were mechanically ventilated. Intracranial pressure (ICP) was monitored in 28 patients (intraventricular catheter=26, intracerebral transducers=2). CSF was drained in 15 patients. Three patients received thiopentothal. Increased ICP (>20 mmHg) was observed in 7/26 patients with available ICP data. Six patients died during neurointensive care: total brain infarction (n=4), cardiac arrest (n=1) and treatment withdrawal (n=1). Seven patients died after discharge, three due to meningitis complications. At follow-up, 14 patients showed good recovery, six moderate disability, two severe disability and 13 were dead.

    CONCLUSION:

    Patients judged to have severe meningitis should be admitted to neurointensive care units without delay for ICP monitoring and management according to modern neurointensive care principles.

  • 66.
    Edmark, Lennart
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Auner, U
    Lindbäck, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Enlund, Mats
    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, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Post-operative atelectasis: a randomised trial investigating a ventilatory strategy and low oxygen fraction during recovery2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 6, p. 681-688Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Atelectasis is common during and after general anaesthesia. We hypothesized that a ventilation strategy with a combination of 1) continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP) and 2) a reduced end-expiratory oxygen concentration during recovery would reduce post-operative atelectasis.

    METHODS: Sixty patients were randomized into two groups. During anaesthesia induction, inspiratory oxygen fraction (FI O2 ) was 1.0, and depending on weight, CPAP 6, 7 or 8 cmH2 O was applied in both groups via facemask. During maintenance of anaesthesia, a laryngeal mask airway (LMA) was used, and PEEP was 6-8 cmH2 O in both groups. Before removal of the LMA, FI O2 was set to 0.3 in the intervention group and 1.0 in the control group. Atelectasis was studied by computed tomography (CT) approximately 14 min post-operatively.

    RESULTS: In one patient in the group given an FI O2 of 0.3 before removal of the LMA a CT scan could not be performed so the patient was excluded. The area of atelectasis was 5.5, 0-16.9 cm(2) (median and range), and 6.8, 0-27.5 cm(2) in the groups given FI O2 0.3 or FI O2 1.0 before removal of the LMA, a difference that was not statistically significant (P = 0.48). Post-hoc analysis showed dependence of atelectasis on smoking (despite all were clinically lung healthy) and American Society of Anesthesiologists class (P = 0.038 and 0.015, respectively).

    CONCLUSION: Inducing anaesthesia with CPAP/PEEP and FI O2 1.0 and deliberately reducing FI O2 during recovery before removal of the LMA did not reduce post-operative atelectasis compared with FI O2 1.0 before removal of the LMA.

  • 67.
    Edmark, Lennart
    et al.
    Departments of Anaesthesiology and Intensive Care, Central Hospital, Västerås, Sweden.
    Auner, Udo
    Enlund, Mats
    Departments of Anaesthesiology and Intensive Care, Central Hospital, Västerås, Sweden.
    Östberg, Erland
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Oxygen concentration and characteristics of progressive atelectasis formation during anaesthesia2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 1, p. 75-81Article in journal (Refereed)
    Abstract [en]

    Background:

    Atelectasis is a common consequence of pre-oxygenation with 100% oxygen during induction of anaesthesia. Lowering the oxygen level during pre-oxygenation reduces atelectasis. Whether this effect is maintained during anaesthesia is unknown.

    Methods:

    During and after pre-oxygenation and induction of anaesthesia with 60%, 80% or 100% oxygen concentration, followed by anaesthesia with mechanical ventilation with 40% oxygen in nitrogen and positive end-expiratory pressure of 3 cmH2O, we used repeated computed tomography (CT) to investigate the early (0–14 min) vs. the later time course (14–45 min) of atelectasis formation.

    Results:

    In the early time course, atelectasis was studied awake, 4, 7 and 14 min after start of pre-oxygenation with 60%, 80% or 100% oxygen concentration. The differences in the area of atelectasis formation between awake and 7 min and between 7 and 14 min were significant, irrespective of oxygen concentration (P<0.05). During the late time course, studied after pre-oxygenation with 80% oxygen, the differences in the area of atelectasis formation between awake and 14 min, between 14 and 21 min, between 21 and 28 min and finally between 21 and 45 min were all significant (P<0.05).

    Conclusion:

    Formation of atelectasis after pre-oxygenation and induction of anaesthesia is oxygen and time dependent. The benefit of using 80% oxygen during induction of anaesthesia in order to reduce atelectasis diminished gradually with time.

  • 68.
    Edmark, Lennart
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Östberg, Erland
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Scheer, H
    Wallquist, W
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Preserved oxygenation in obese patients receiving protective ventilation during laparoscopic surgery: a randomized controlled study2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 1, p. 26-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Venous admixture from atelectasis and airway closure impedes oxygenation during general anaesthesia. We tested the hypothesis that continuous positive airway pressure (CPAP) during pre-oxygenation and reduced fraction of inspiratory oxygen (FIO2 ) during emergence from anaesthesia can improve oxygenation in patients with obesity undergoing laparoscopic surgery.

    METHODS: In the intervention group (n = 20, median BMI 41.9), a CPAP of 10 cmH2 O was used during pre-oxygenation and induction of anaesthesia, but no CPAP was used in the control group (n = 20, median BMI 38.1). During anaesthesia, all patients were ventilated in volume-controlled mode with an FIO2 of 0.4 and a positive end-expiratory pressure (PEEP) of 10 cmH2 O. During emergence, before extubation, the control group was given an FIO2 of 1.0 and the intervention group was divided into two subgroups, which were given an FIO2 of 1.0 or 0.31. Oxygenation was assessed perioperatively by the estimated venous admixture (EVA).

    RESULTS: The median EVA before pre-oxygenation was about 8% in both groups. During anaesthesia after intubation, the median EVA was 8.2% in the intervention vs. 13.2% in the control group (P = 0.048). After CO2 pneumoperitoneum, the median EVA was 8.4% in the intervention vs. 9.9% in the control group (P > 0.05). One hour post-operatively, oxygenation had deteriorated in patients given an FIO2 of 1.0 during emergence but not in patients given an FIO2 of 0.31.

    CONCLUSIONS: A CPAP of 10 cmH2 O during pre-oxygenation and induction, followed by PEEP after intubation, seemed to preserve oxygenation during anaesthesia. Post-operative oxygenation depended on the FIO2 used during emergence.

  • 69. Eiken, O
    et al.
    Tesch, P.A
    Mekjavic, I.B
    Effect of nitrus oxide on human skeletal muscle function1996In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 40, no 4, p. 486-488Article in journal (Refereed)
  • 70.
    Eiken, Ola
    et al.
    Karolinska Institutet.
    Tesch, P. A.
    Mejkavic, I. B.
    Effect of nitrous oxide on human skeletal muscle function1996In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 40, no 4, p. 486-488Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nitrous oxide (N2O) is commonly administered in conjunction with parturition, which requires the performance of repeated high-force voluntary muscle actions. Therefore, we examined the effect of a subanesthetic dose of N2O on the force-velocity relationship of the quadriceps femoris muscle.

    METHODS: Nine healthy subjects performed maximal voluntary muscle actions once while breathing air and once while breathing a normoxic gas mixture containing 35% (N2O). Peak torque of the knee extensors was measured during concentric muscle contractions at different angular velocities (30, 60, 90, 150 and 210 degrees s-1), and eccentric (30, 60, 90, and 150 degrees s-1) and isometric (knee-joint angle approximately equal to 60 degrees) muscle actions. Maximal angular velocity was determined during unloaded knee extensions.

    RESULTS: N2O decreased peak torque at any given angular velocity. The overall decrease in peak averaged 4.8 +/- 2.2% (P < 0.0001). Likewise, N2O decreased maximal angular velocity by 5.7 +/- 4.3% (P < 0.01). Thus, the impairment in muscle function induced by a 35% N2O is only minute and hence most likely of little significance in clinical practice.

  • 71.
    Ekbäck, Gustav
    et al.
    Department of Anesthesiology and Intensive Care and Regional Blood Center, Örebro Medical Center Hospital, Örebro, Sweden.
    Schött, U.
    Department of Anesthesiology and Intensive Care and Regional Blood Center, Örebro Medical Center Hospital, Örebro, Sweden.
    Axelsson, K.
    Department of Anesthesiology and Intensive Care and Regional Blood Center, Örebro Medical Center Hospital, Örebro, Sweden.
    Carlberg, M.
    Department of Anesthesiology and Intensive Care and Regional Blood Center, Örebro Medical Center Hospital, Örebro, Sweden.
    Perioperative autotransfusion and functional coagulation analysis in total hip replacement1995In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 39, no 3, p. 390-395Article in journal (Refereed)
    Abstract [en]

    Functional coagulation analyses like Sonoclot and thromboelastography have not been evaluated during perioperative autotransfusion. We have prospectively studied three different transfusion regimes in 45 patients undergoing total hip arthroplasty. Blood losses were replaced either with heterologous erythrocyte concentrate (group I), intra- and postoperative autotransfusion of blood salvaged with cellsaver technique (group II) or predonated autologous erythrocyte concentrates together with salvaged blood (group III). Routine and functional coagulation analyses with a Sonoclot were performed preoperatively, 6 hours postoperatively (6 h), day 1–5 and 10. An early postoperative hypo- and late postoperadve hypercoagulative phase could be detected with Sonoclot signs of platelet function and fibrin deposition in all groups. Sonoclot coagulation analyses better correlated to both blood loss and dextran dosage than APTT and platelet count in the routine coagulation analyses. Functional coagulation analysis has a potential use in individualizing plasmasubstitution and thromboprophylaxis regimes during autotransfusion in THR.

  • 72. Ekman, A
    et al.
    Lindholm, ML
    Lennmarken, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Sandin, R
    Reduction in the incidence of awareness using BIS monitoring2004In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, no 1, p. 20-26Article in journal (Refereed)
    Abstract [en]

    Background: Explicit recall (ER) is evident in approximately 0.2% of patients given general anaesthesia including muscle relaxants. This prospective study was performed to evaluate if cerebral monitoring using BIS to guide the conduction of anaesthesia could reduce this incidence significantly. Patients and methods: A prospective cohort of 4945 consecutive surgical patients requiring muscle relaxants and/or intubation were monitored with BIS and subsequently interviewed for ER on three occasions. BIS values between 40 and 60 were recommended. The results from the BIS-monitored group of patients was compared with a historical group of 7826 similar cases in a previous study when no cerebral monitoring was used. Results: Two patients in the BIS-monitored group, 0.04%, had ER as compared with 0.18% in the control group (P < 0.038). Both BIS-monitored patients with ER were aware during intubation when they had high BIS values (>60) for 4 min and more than 10 min, respectively. However, periods with high BIS = 4 min were also evident in other patients with no ER. Episodes with high BIS, 4 min or more, were found in 19% of the monitored patients during induction, and in 8% of cases during maintenance. Conclusions: The use of BIS monitoring during general anaesthesia requiring endotracheal intubation and/or muscle relaxants was associated with a significantly reduced incidence of awareness as compared with a historical control population.

  • 73.
    El-Dash, S. A.
    et al.
    Univ Sao Paulo, Hosp Clin, Heart Inst InCor, Div Pulm, Sao Paulo, Brazil..
    Borges, João Batista
    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. Univ Sao Paulo, Hosp Clin, Heart Inst InCor, Div Pulm, Sao Paulo, Brazil.
    Costa, E. L. V.
    Univ Sao Paulo, Hosp Clin, Heart Inst InCor, Div Pulm, Sao Paulo, Brazil.;Hosp Sirio Libanes, Res & Educ Inst, Sao Paulo, Brazil..
    Tucci, M. R.
    Univ Sao Paulo, Hosp Clin, Heart Inst InCor, Div Pulm, Sao Paulo, Brazil..
    Ranzani, O. T.
    Univ Sao Paulo, Hosp Clin, Heart Inst InCor, Div Pulm, Sao Paulo, Brazil..
    Caramez, M. P.
    Univ Sao Paulo, Hosp Clin, Heart Inst InCor, Div Pulm, Sao Paulo, Brazil..
    Carvalho, C. R. R.
    Univ Sao Paulo, Hosp Clin, Heart Inst InCor, Div Pulm, Sao Paulo, Brazil..
    Amato, M. B. P.
    Univ Sao Paulo, Hosp Clin, Heart Inst InCor, Div Pulm, Sao Paulo, Brazil..
    There is no cephalocaudal gradient of computed tomography densities or lung behavior in supine patients with acute respiratory distress syndrome2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 6, p. 767-779Article in journal (Refereed)
    Abstract [en]

    Background: There is debate whether pressure transmission within the lungs and alveolar collapse follow a hydrostatic pattern or the compression exerted by the weight of the heart and the diaphragm causes collapse localized in the areas adjacent to these structures. The second hypothesis proposes the existence of a cephalocaudal gradient in alveolar collapse. We aimed to define whether or not lung density and collapse follow a 'liquid-like' pattern with homogeneous isogravitational layers along the cephalocaudal axis in acute respiratory distress syndrome lungs.

    Methods: Acute respiratory distress syndrome patients were submitted to full lung computed tomography scans at positive end-expiratory pressure (PEEP) zero (before) and 25 cmH(2)O after a maximum-recruitment maneuver. PEEP was then decreased by 2 cmH2O every 4 min, and a semi-complete scan performed at the end of each PEEP step.

    Results: Lung densities were homogeneous within each lung layer. Lung density increased along the ventrodorsal axis toward the dorsal region (beta = 0.49, P < 0.001), while there was no increase, but rather a slight decrease, toward the diaphragm along the cephalocaudal axis and toward the heart. Higher PEEP attenuated density gradients. At PEEP 18 cmH2O, dependent lung regions started to collapse massively, while best compliance was only reached at a lower PEEP.

    Conclusions: We could not detect cephalocaudal gradients in lung densities or in alveolar collapse. Likely, external pressures applied on the lung by the chest wall, organs, and effusions are transmitted throughout the lung in a hydrostatic pattern with homogeneous consequences at each isogravitational layer. A single cross-sectional image of the lung could fully represent the heterogeneous mechanical properties of dependent and non-dependent lung regions.

  • 74.
    Engström, Joakim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Bruno, E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Reinius, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Fröjd, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Jonsson, H.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sannervik, J.
    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 Surgical Sciences, Anaesthesiology and Intensive Care.
    Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 1, p. 62-72Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nursing procedures that are routinely performed in the intensive care unit (ICU) are assumed to have minimal side effects. However, these procedures may sometimes cause physiological changes that negatively affect the patient. We hypothesized that physiological changes associated with routine nursing procedures in the ICU are common.

    METHODS: A clinical observational study of 16 critically ill patients in a nine-bed mixed university hospital ICU. All nursing procedures were observed, and physiological data were collected and subsequently analyzed. Minor physiological changes were defined as minimal changes in respiratory or circulatory variables, and major physiological changes were marked as hyper/hypotension, bradycardia/tachycardia, bradypnea/tachypnea, ventilatory distress, and peripheral blood oxygen desaturation.

    RESULTS: In the 16 patients, 668 procedures generated 158 major and 692 minor physiological changes during 187 observational hours. The most common procedure was patient position change, which also generated the majority of the physiological changes. The most common major physiological changes were blood oxygen desaturation, ventilatory distress, and hypotension, and the most common minor changes were arterial pressure alteration, coughing, and increase in respiratory rate.

    CONCLUSION: In this pilot study, we examined physiological changes in connection with all regular routine nursing procedures in the ICU. We found that physiological changes were common and sometimes severe.

  • 75. Enlund, Mats
    et al.
    Berglund, Anders
    Ahlstrand, Rebecca
    Walldén, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lundberg, Johan
    Wärnberg, Fredrik
    Ekman, Andreas
    Sjöblom Widfeldt, Nina
    Enlund, Anna
    Bergkvist, Leif
    Survival after primary breast cancer surgery following propofol or sevoflurane general anesthesia: aretrospective, multicenter, database analysis of 6,305 Swedish patients2020In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Retrospective studies indicate that the choice of anesthetic can affect long-term cancer survival. Propofol seems to have an advantage over sevoflurane. However, this is questioned for breast cancer. We gathered a large cohort of breast cancer surgery patients from seven Swedish hospitals and hypothesized, that general anesthesia with propofol would be superior to sevoflurane anesthesia regarding long-term breast cancer survival.

    METHODS: We identified all patients who were anaesthetized for breast cancer surgery between 2006-2012. The patients were matched to the Swedish Breast Cancer Quality Register, to retrieve tumor characteristics, prognostic factors and adjuvant treatment as well as date of death. Overall survival between patients undergoing sevoflurane and propofol anesthesia were analyzed with different statistical approaches: 1) multiple Cox regression models adjusted for demographic, oncological, and multiple control variables, 2) propensity score matching on the same variables, but also including the participating centers as a cofactor in a separate analysis.

    RESULTS: The database analysis identified 6,305 patients. The five-year-survival rates were 91.0% and 81.8% for the propofol and sevoflurane group, respectively in the final model (P=0.126). Depending on the statistical adjustment method used, different results were obtained, from a non-significant to a "proposed" and even a "determined" difference in survival that favored propofol, with a maximum of 9.2 percentage points higher survival rate at five years (Hazard ratio 1.46, 95% CI 1.10-1.95).

    CONCLUSIONS: It seems that propofol may have a survival advantage compared with sevoflurane among breast cancer patients, but the inherent weaknesses of retrospective analyses were made apparent.

  • 76.
    Enlund, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Kietzmann, D.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Bouillon, T.
    Zuechner, K.
    Meineke, I.
    Population pharmacokinetics of sevoflurane in conjunction with the AnaConDa®: toward target-controlled infusion of volatiles into the breathing system2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 4, p. 553-560Article in journal (Refereed)
    Abstract [en]

    Background: The Anesthetic Conserving Device (AnaConDa (R)) uncouples delivery of a volatile anesthetic (VA) from fresh gas flow (FGF) using a continuous infusion of liquid volatile into a modified heat-moisture exchanger capable of adsorbing VA during expiration and releasing adsorbed VA during inspiration. It combines the simplicity and responsiveness of high FGF with low agent expenditures. We performed in vitro characterization of the device before developing a population pharmacokinetic model for sevoflurane administration with the AnaConDa (R), and retrospectively testing its performance (internal validation). Materials and methods: Eighteen females and 20 males, aged 31-87, BMI 20-38, were included. The end-tidal concentrations were varied and recorded together with the VA infusion rates into the device, ventilation and demographic data. The concentration-time course of sevoflurane was described using linear differential equations, and the most suitable structural model and typical parameter values were identified. The individual pharmacokinetic parameters were obtained and tested for covariate relationships. Prediction errors were calculated. Results: In vitro studies assessed the contribution of the device to the pharmacokinetic model. In vivo, the sevoflurane concentration-time courses on the patient side of the AnaConDa (R) were adequately described with a two-compartment model. The population median absolute prediction error was 27% (interquartile range 13-45%). Conclusion: The predictive performance of the two-compartment model was similar to that of models accepted for TCI administration of intravenous anesthetics, supporting open-loop administration of sevoflurane with the AnaConDa (R). Further studies will focus on prospective testing and external validation of the model implemented in a target-controlled infusion device.

  • 77.
    Eriksson, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Nelson, D
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Nordgren, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Increased platelet microvesicle formation is associated with mortality ina porcine model of endotoxemia1998In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 42, no 5, p. 551-557Article in journal (Refereed)
    Abstract [en]

    Background:

    Gram-negative sepsis in humans and endotoxemia in pigs induce the formation of platelet microvesicles. These microvesicles are active in homeostasis and may thus contribute to the outcome in patients with activated coagulation and fibrinolysis. We decided to prospectively evaluate the effects of endotoxemia on microvesicle formation and some common physiologic variables against survival in a porcine model.

    Methods:

    Nineteen included pigs were anesthetized, monitored and subjected to an infusion of E. coli endotoxin. Microvesicle formation was determined by flow cytometry.

    Results:

    The formation of microvesicles was significantly increased in the 6 pigs that died during endotoxin exposure. This increased formation became significant from the 3rd hour of endotoxemia. Microvesicle formation did not increase in surviving endotoxemic pigs. Cardiac index, mean arterial blood pressure, base excess and systemic vascular resistance index were distinctly reduced in the animals that died as compared to those surviving the endotoxemic period.

    Conclusion:

    The increased formation of platelet microvesicles seems to be associated with poor prognosis in porcine endotoxemia. Since microvesicles are active in coagulation, they may contribute to the derangement of the coagulation system caused by endotoxemia. Different degrees of microvesicle formation may reflect inter-individual responses to a given challenge.

  • 78.
    Ewaldsson, C-A
    et al.
    South Hospital, and Karolinska Institute, Stockholm, Sweden.
    Hahn, Robert G.
    South Hospital, and Karolinska Institute, Stockholm, Sweden.
    Bolus injection of Ringer's solution and dextran 1 kDa during induction of spinal anesthesia2005In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 49, no 2, p. 152-159Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Arterial hypotension following induction of spinal anesthesia is difficult to prevent with infusion fluids. In a randomized, unblinded and controlled study we evaluated whether a rapid fluid administration planned according to volume kinetic analysis is followed by a more stable blood pressure.

    METHODS: Spinal anesthesia was induced in 75 surgical patients, using one of three different fluid regimens: intravenous 'bolus injection' of 5 ml kg(-1) of Ringer's acetate over 3 min, 2 ml kg(-1) of low-molecular weight (1 kDa) dextran over 3 min, or a constant-rate infusion of 15 ml kg(-1) of Ringer's acetate over 40 min (controls). The kinetics of the fluid was studied in five patients in each group and also in eight volunteers.

    RESULTS: The decrease in mean arterial pressure averaged 28%, 27% and 26%, respectively, and was fully developed 16 min after the induction. The height of the block, but not the fluid programme, correlated with the hypotension. Nausea or near-fainting associated with marked hypotension or bradycardia was recorded in none, five (20%) and two (8%) of the patients, respectively. Both bolus injections were followed by translocation of fluid from the peripheral tissues to the bloodstream, which maintained the plasma dilution at about 10% for at least 30 min until surgery began.

    CONCLUSION: A brisk infusion of Ringer's solution or dextran 1 kDa over 3 min was followed by the same decrease in arterial pressure as a longer and 3-5-times larger infusion of Ringer's solution over 40 min during induction of spinal anesthesia.

  • 79.
    Feldheiser, A.
    et al.
    Department of Anesthesiology and Intensive Care Medicine Campus Charité, Mitte and Campus Virchow-Klinikum Charité, University Medicine, Berlin, Germany.
    Aziz, O.
    St. Mark’s Hospital, Harrow, UK.
    Baldini, G.
    Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal QC, Canada.
    Cox, B. P. B. W.
    Department of Anesthesiology and Pain Therapy, University Hospital Maastricht (azM), Maastricht, The Netherlands.
    Fearon, K. C. H.
    Clinical Surgery, The Royal Infirmary, University of Edinburgh, Edinburgh, UK.
    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 NC, USA.
    Kennedy, R. H.
    St. Mark’s Imperial College, London, UK; St. Mark’s Hospital, Harrow, UK.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Lobo, D. N.
    Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, UK.
    Miller, T.
    Department of Anesthesiology, Duke University Medical Center, Durham NC, USA.
    Radtke, F. F.
    Department of Anesthesiology and Intensive Care Medicine Campus Charité, Mitte and Campus Virchow-Klinikum Charité, University Medicine, Berlin, Germany.
    Ruiz Garces, T.
    Anestesiologa y Reanimacin, Hospital Clinico Lozano Blesa, Universidad de Zaragoza, Zaragoza, Spain.
    Schricker, T.
    Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital, Montreal QC, Canada.
    Scott, M. J.
    Royal Surrey County Hospital NHS Foundation Trust, University of Surrey, Guildford, UK.
    Thacker, J. K.
    Department of Surgery, Duke University Medical Center, Durham NC, USA.
    Ytrebø, L. M.
    Department of Anaesthesiology, University Hospital of North Norway, Tromsø, Norway.
    Carli, F.
    Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal QC, Canada.
    Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 3, p. 289-334Article, review/survey (Refereed)
    Abstract [en]

    Background: The present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing gastrointestinal surgery with an Enhanced Recovery after Surgery (ERAS) programme.

    Methods: Studies were selected with particular attention being paid to meta-analyses, randomized controlled trials and large prospective cohort studies. For each item of the perioperative treatment pathway, available English-language literature was examined and reviewed. The group reached a consensus recommendation after critical appraisal of the literature.

    Results: This consensus statement demonstrates that anaesthesiologists control several preoperative, intraoperative and postoperative ERAS elements. Further research is needed to verify the strength of these recommendations.

    Conclusions: Based on the evidence available for each element of perioperative care pathways, the Enhanced Recovery After Surgery (ERAS ((R))) Society presents a comprehensive consensus review, clinical considerations and recommendations for anaesthesia care in patients undergoing gastrointestinal surgery within an ERAS programme. This unified protocol facilitates involvement of anaesthesiologists in the implementation of the ERAS programmes and allows for comparison between centres and it eventually might facilitate the design of multi-institutional prospective and adequately powered randomized trials.

  • 80. Flaatten, H
    et al.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Wernerman, J
    The Scandinavian critical care trials group: producing important new findings in challenging times2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 2, p. 138-140Article in journal (Refereed)
  • 81. Flaatten, H.
    et al.
    Rasmussen, L. S.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Publication footprints and pitfalls of bibliometry2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 1, p. 3-5Article in journal (Other academic)
  • 82.
    Flaatten, H.
    et al.
    Gen ICU, Norway; University of Bergen, Norway.
    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.
    Activity- or severity-based scoring in the ICU?2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 1Article in journal (Other academic)
    Abstract [en]

    n/a

  • 83.
    Flaatten, Hans
    et al.
    Dep. of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Improving reporting of ICU outcome data2019In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed)
    Abstract [en]

    Clinical studies reporting outcomes after intensive care admissions are often published, including in this journal 1 . This is a field with much research activity, and with widespread clinical interest. For observational cohort studies, it is strongly recommended that authors form their reports using guidelines presented by the STROBE (Strengthening the reporting of observational studies in epidemiology) group 2 , and these recommendations are designed to strengthen the report based on their observations.

  • 84.
    Fridh, Isabell
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet.
    Forsberg, A
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Family presence and environmental factors at the time of a patient's death in an ICU.2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no 4, p. 395-401Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In an intensive care unit (ICU), privacy and proximity are reported to be important needs of dying patients and their family members. It is assumed that good communication between the ICU team and families about end-of-life decisions improves the possibilities of meeting families' needs, thus guaranteeing a dignified and peaceful death in accordance with end-of-life care guidelines. The aim of this study was to explore the circumstances under which patients die in Swedish ICUs by reporting on the presence of family and whether patients die in private or shared rooms. An additional aim was to investigate the frequency of end-of-life decisions and whether nurses and family members were informed about such decisions.

    METHODS: A questionnaire based on the research questions was completed when a patient died in the 10 ICUs included in the study. Data were collected on 192 deaths.

    RESULTS: Forty per cent of the patients died without a next of kin at the bedside and 46% of deaths occurred in a shared room. This number decreased to 37% if a family member was present. Patients without a family member at their bedside received less analgesics and sedatives. There was a significant relationship between family presence, expected death and end-of-life decisions.

    CONCLUSIONS: The results indicate the necessity of improving the ICU environment to promote the need for proximity and privacy for dying patients and their families. The study also highlights the risk of underestimating the needs of patients without a next of kin at their bedside at the time of death.

  • 85.
    Frykholm, P.
    et al.
    Uppsala University, Sweden .
    Pikwer, A.
    Lund University, Sweden .
    Hammarskjöld, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Larsson, A.T.
    Gavle Sandviken County Hospital, Sweden .
    Lindgren, S.
    University of Gothenburg, Sweden .
    Lindwall, R.
    Karolinska Institute, Sweden .
    Taxbro, K.
    Ryhov County Hospital, Sweden .
    Oberg, F.
    Karolinska University Hospital Solna, Sweden .
    Acosta, S.
    Lund University, Sweden .
    Akeson, J.
    Lund University, Sweden .
    Clinical guidelines on central venous catheterisation2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 5, p. 508-524Article, review/survey (Refereed)
    Abstract [en]

    Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.

  • 86.
    Frykholm, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Pikwer, A.
    Hammarskjold, F.
    Larsson, A. T.
    Lindgren, S.
    Lindwall, R.
    Taxbro, K.
    Oberg, F.
    Acosta, S.
    Akeson, J.
    Clinical guidelines on central venous catheterisation2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 5, p. 508-524Article, review/survey (Refereed)
    Abstract [en]

    Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.

  • 87.
    Fuchs, Gabriel
    et al.
    Sundsvall Reg Hosp, Sundsvall, Sweden..
    Berg, Niclas
    KTH, School of Engineering Sciences (SCI), Mechanics. KTH, School of Engineering Sciences (SCI), Centres, Linné Flow Center, FLOW.
    Broman, Mikael
    Karolinska Hosp, ECMO Ctr, Stockholm, Sweden..
    Prahl Wittberg, Lisa
    KTH, School of Engineering Sciences (SCI), Mechanics. KTH, School of Engineering Sciences (SCI), Centres, Linné Flow Center, FLOW.
    Blood clots in the ECMO-system - a theoretical platelet activation study2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 964-965Article in journal (Other academic)
  • 88.
    Fuchs, Gabriel
    et al.
    Sundsvall Reg Hosp, Sundsvall, Sweden..
    Broman, Mikael
    Karolinska Univ Hosp, ECMO Ctr, Stockholm, Sweden..
    Wittberg, Lisa Prahl
    KTH, School of Engineering Sciences (SCI), Mechanics. KTH, School of Engineering Sciences (SCI), Centres, Linné Flow Center, FLOW.
    Non-invasive detection of pump-associated blood clots in the ECMO-system2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 964-964Article in journal (Other academic)
  • 89.
    Gannedahl, Per E.
    et al.
    Departments of Anaesthesiology and Intensive Care, Karolinska Hospital and Institute, Stockholm, Sweden.
    Edner, Magnus M.
    Departments of Cardiology, Karolinska Hospital and Institute, Stockholm, Sweden.
    Lindahl, Sten
    Departments of Anaesthesiology and Intensive Care, Karolinska Hospital and Institute, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Departments of Anaesthesiology and Intensive Care, Karolinska Hospital and Institute, Stockholm, Sweden.
    Minimal influence of anaesthesia and abdominal surgery on computerized vectorcardiography recordings1995In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 39, no 1, p. 71-78Article in journal (Refereed)
    Abstract [en]

    Myocardial infarction still represents a major cause of morbidity and mortality following surgical procedures. Continuous computerized on‐line vector‐ECG has previously been shown to be useful in the detection of myocardial ischaemia, in acute myocardial infarction and unstable angina pectoris and for ischaemia monitoring after PTCA procedures. This method was presently tested for the possible influence of anaesthesia and surgery during cholecystectomy under general anaesthesia (n = 9), and during inguinal hernia repairs using a spinal block (n = 5). The patients had no history, symptoms or signs of ischaemic heart disease. Analyses of vectorcardiographic changes were made in relation to predefined standardized anaesthetic and surgical procedures, all of which potentially could influence the vector‐ECG. Three vectorcardiographic trend parameters were studied: QRS‐vector difference, ST‐vector magnitude and ST‐change vector magnitude. The overall vectorcardiographic changes were minimal and smaller than vectorcardiographic changes previously reported during myocardial ischaemia and infarction. Since anaesthetic and surgical procedures per se had only minor effects on the vector ECG recordings, it is concluded that continuous computerized on‐line vectorcardiography will not be skewed by these procedures. Hence, vectorcardiography has the potential of becoming a new monitor for the detection of perioperative myocardial ischaemia. 

  • 90.
    Gannerdahl, Per E.
    et al.
    Dept. Anaesthiol. and Intensive Care, Karolinska Institute and Hospital, Stockholm, Sweden.
    Odeberg, S.
    Dept. Anaesthiol. and Intensive Care, Huddinge Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska Institute and Hospital, Stockholm, Sweden.
    Sollevi, Alf
    Dept. Anaesthiol. and Intensive Care, Karolinska Institute and Hospital, Stockholm, Sweden.
    Vectorcardiographic changes during laparoscopiccholecystectomy may mimic signs of myocardial ischaemia1997In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 41, no 9, p. 1187-1192Article in journal (Refereed)
    Abstract [en]

    Laparoscopic surgery involves the use of intra-abdominal carbon dioxide insufflation (pneumoperitoneum). The increased intra-abdominal pressure causes marked haemodynamic changes, which may influence electrocardiographic monitoring. The aim of the present study was to elucidate the influence of pneumoperitoneum on vectorcardiographic recordings.

    METHODS:

    Vectorcardiographic changes (QRS vector difference = QRS-VD, QRS loop area, QRS magnitude, ST vector magnitude, spatial ST vector change) were recorded continuously applying computerized vectorcardiography in 12 anaesthetised cardiovascularly healthy patients, scheduled for laparoscopic cholecystectomy. Measurements were made before and during pneumoperitoneum in three different body positions (supine, Trendelenburg and reversed Trendelenburg), also employing transesophageal echocardiography and invasive blood pressure monitoring.

    RESULTS:

    Pneumoperitoneum significantly increased QRS-VD, in parallel with an enlargement in loop area and magnitude. The magnitude was significantly increased in the transversal and frontal planes and there was a tendency to increase the magnitude in the sagittal plane. The increase in QRS-VD reached levels previously associated with the development of myocardial ischaemia in patients with coronary artery disease. The ST-variables were not changed by the pneumoperitoneum. The positional changes also influenced QRS-VD significantly.

    CONCLUSIONS:

    When computerized vectorcardiography is used for ischaemia monitoring during pneumoperitoneum, the ST-variables seem reliable. However, vectorcardiographicQRS-changes should be interpreted with caution, as the QRS alterations found during pneumoperitoneum mimic the changes seen during myocardial ischaemia.

  • 91.
    Gonon, Adrian
    et al.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Richter, Arina
    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 Cardiology in Linköping.
    Cederholm, Ingemar
    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.
    Khan, Jehangir
    Karolinska Univ Hosp, Sweden.
    Novak, Jacek
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Milovanovic, Micha
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Janerot-Sjoberg, Birgitta
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden; Karolinska Univ Hosp, Sweden.
    Effects of thoracic epidural analgesia on exercise-induced myocardial ischaemia in refractory angina pectoris2019In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 4, p. 515-522Article in journal (Refereed)
    Abstract [en]

    Background Thoracic epidural analgesia (TEDA) was offered to patients with refractory angina pectoris. Our primary objectives were to evaluate TEDAs influence on quality of life (QoL, base for power analysis), and hypothesising that TEDA with bupivacaine during 1 month counteracts exercise-induced myocardial hypoperfusion and increase physical performance. Methods Patients with refractory angina and exercise inducible hypoperfusion, as demonstrated by myocardial perfusion imaging (MPI), were randomised to 1-month treatment with TEDA with bupivacaine (B-group, n = 9) or saline (P-group, n = 10) in a double-blind fashion. MPI and bicycle ergometry were performed before TEDA and after 1 month while subjective QoL on a visual analogue scale (VAS) reported by the patients was checked weekly. Results During this month VAS (mean [95%CI]) increased similarly in both groups (B-group from 33 [18-50] to 54 [30-78] P P amp;lt; 0.05). The B-group reduced their exertional-induced myocardial hypoperfusion (from 32% [12-52] to 21% [3-39]; n = 9; P amp;lt; 0.05), while the P-group showed no significant change (before 21% [6-35]; at 1 month 23% [6-40]; n = 10). MPI at rest did not change and no improvement in physical performance was detected in neither of the groups. Conclusions In refractory angina, TEDA with bupivacaine inhibits myocardial ischaemia in contrast to TEDA with saline. Regardless of whether bupivacaine or saline is applied intermittently every day, TEDA during 1 month improves the quality of life and reduces angina, even when physical performance remains low. A significant placebo effect has to be considered.

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  • 92.
    Gordh, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Commentary on: Lidocaine for spinal anesthesia. A study of the concentration in the spinal fluid2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no 8, p. 1016-1017Article in journal (Refereed)
  • 93.
    Gradin, Maria
    Department of Paediatrics, Örebro Medical Centre Hospital, Örebro, Sweden.
    Need for a reliable pain evaluation scale in the newborn in Sweden2000In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 44, no 5, p. 552-554Article in journal (Refereed)
    Abstract [en]

    Background: A major problem in pain treatment in the newborn is the ability to assess the degree of experienced pain. Several different methods for estimating pain in the newborn have been introduced in recent years. The objectives of this study were to see whether pain scoring was used in Swedish neonatal units, and by which method, and furthermore to observe whether any changes had occurred between 1993 and 1998.

    Method: A questionnaire was distributed to all Swedish neonatal units in 1993 and 1998.

    Results: In both 1993 and 1998, 86% of all clinics answered the questionnaire. Two-thirds of these clinics used some method for estimating pain in the newborn at both times. Eight clinics used a structured method in the latter period compared to one in the earlier period. A higher proportion of units having full intensive care measured pain compared to other units.

    Conclusion: The study shows that an unchanging low proportion of neonatal units in Sweden attempt to assess pain. There is a minor increase in the number of departments that use a structured method for pain scoring. Documentation of pain intensity is still inadequate and should be improved.

  • 94.
    Grossmann, Benjamin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. 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).
    Nilsson, Andreas
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. 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).
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Patient-controlled sedation with propofol for endoscopic procedures: A cost analysis2020In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 64, no 1, p. 53-62Article in journal (Refereed)
    Abstract [en]

    Background

    Patient‐controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation.

    Methods

    Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine‐scopolamine or glycopyrronium.

    Results

    Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine‐scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups.

    Conclusion

    Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.

  • 95. Grände, P-O
    et al.
    Koskinen, L-O
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurosurgery.
    Naredi, S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Reinstrup, P
    Romner, B
    Conventional treatments for severe head injury: are they effective, ineffective, or even harmful?2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no 10, p. 1294-1296Article in journal (Other academic)
    Download full text (pdf)
    FULLTEXT01
  • 96.
    Gudbjartsson, Tomas
    et al.
    Landspitali Univ Hosp, Dept Cardiothorac Surg, Reykjavik, Iceland;Univ Iceland, Fac Med, Reykjavik, Iceland.
    Helgadottir, Solveig
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sigurdsson, Martin Ingi
    Univ Iceland, Fac Med, Reykjavik, Iceland;Landspitali Univ Hosp, Dept Anaesthesia & Crit Care, Reykjavik, Iceland.
    Taha, Amar
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Jeppsson, Anders
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Cardiothorac Surg, Gothenburg, Sweden.
    Christensen, Thomas Decker
    Aarhus Univ Hosp, Dept Cardiothorac & Vasc Surg, Dept Clin Med, Aarhus, Denmark.
    Riber, Lars Peter Schoedt
    Univ Southern Denmark, Odense Univ Hosp, Dept Cardiothorac & Vasc Surg, Dept Clin Med, Odense, Denmark.
    New-onset postoperative atrial fibrillation after heart surgery2020In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 64, no 2, p. 145-155Article, review/survey (Refereed)
    Abstract [en]

    Background

    New‐onset postoperative atrial fibrillation (poAF) complicates approximately 20‐60% of all cardiac surgical procedures and is associated with an increased periprocedural mortality and morbitity, prolonged hospital stay, increased costs, and worse long‐term survival. Unfortunately multiple advances in surgery and perioperative care over the last two decades have not led to a reduction in the incidence of poAF or associated complications in the daily clinical practice.

    Methods

    A narrative review of the available literature was performed.

    Results

    An extensive review of the pathophysiology of poAF following cardiac surgery, clinical, and procedural risk‐factors is provided, as well as prophylactic measures and treatment.

    Conclusion

    Multiple strategies to prevent and manage poAF following heart surgery already exist. Our hope is that this review will facilitate more rigorous testing of prevention strategies, implementation of prophylaxis regimens as well as optimal treatment of this common and serious complication.

  • 97.
    Gudmundsson, M
    et al.
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Perchiazzi, G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Pellegrini, Mariangela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Vena, A
    Department of Emergency and Organ Transplant, Bari University, Bari, Italy.
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
    Rylander, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 1, p. 94-104Article in journal (Refereed)
    Abstract [en]

    Background

    In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning. The main purpose of this study was to determine the relation between PL and atelectasis in an experimental model representing weaning from mechanical ventilation.

    Methods

    Dynamic transverse computed tomography scans were acquired in ten anaesthetized, surfactant-depleted pigs with preserved spontaneous breathing, as ventilator support was lowered by sequentially reducing inspiratory pressure and positive end expiratory pressure in steps. The volumes of gas and atelectasis in the lungs were correlated with PL obtained using oesophageal pressure recordings. Work of breathing (WOB) was assessed from Campbell diagrams.

    Results

    Gradual decrease in PL in both end-expiration and end-inspiration caused a proportional increase in atelectasis and decrease in the gas content (linear mixed model with an autoregressive correlation matrix; P < 0.001) as the WOB increased. However, cyclic alveolar collapse during tidal ventilation did not increase significantly.

    Conclusion

    We found a proportional correlation between atelectasis and PL during the ‘weaning process’ in experimental mild lung injury. If confirmed in the clinical setting, a gradual tapering of ventilator support can be recommended for weaning without risk of sudden formation of atelectasis.

  • 98. Gunther, A. C.
    et al.
    Schandl, A. R.
    Berhardsson, J.
    Bjärtå, A.
    Wållgren, M.
    Sundin, O.
    Alvarsson, Jesper
    KTH, School of Engineering Sciences (SCI), Aeronautical and Vehicle Engineering, Marcus Wallenberg Laboratory MWL.
    Bottai, M.
    Martling, C. -R
    Sackey, P. V.
    Pain rather than induced emotions and ICU sound increases skin conductance variability in healthy volunteers2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 8, p. 1111-1120Article in journal (Refereed)
    Abstract [en]

    BackgroundAssessing pain in critically ill patients is difficult. Skin conductance variability (SCV), induced by the sympathetic response to pain, has been suggested as a method to identify pain in poorly communicating patients. However, SCV, a derivate of conventional skin conductance, could potentially also be sensitive to emotional stress. The purpose of the study was to investigate if pain and emotional stress can be distinguished with SCV. MethodsIn a series of twelve 1-min sessions with SCV recording, 18 healthy volunteers were exposed to standardized electric pain stimulation during blocks of positive, negative, or neutral emotion, induced with pictures from the International Affective PictureSystem (IAPS). Additionally, authentic intensive care unit (ICU) sound was included in half of the sessions. All possible combinations of pain and sound occurred in each block of emotion, and blocks were presented in randomized order. ResultsPain stimulation resulted in increases in the number of skin conductance fluctuations (NSCF) in all but one participant. During pain-free baseline sessions, the median NSCF was 0.068 (interquartile range 0.013-0.089) and during pain stimulation median NSCF increased to 0.225 (interquartile range 0.146-0.3175). Only small increases in NSCF were found during negative emotions. Pain, assessed with the numeric rating scale, during the sessions with pain stimulation was not altered significantly by other ongoing sensory input. ConclusionIn healthy volunteers, NSCF appears to reflect ongoing autonomous reactions mainly to pain and to a lesser extent, reactions to emotion induced with IAPS pictures or ICU sound.

  • 99.
    Gunther, A. C.
    et al.
    Karolinska Inst, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Cardiothorac Surg & Anesthesiol, S-17176 Stockholm, Sweden..
    Schandl, A. R.
    Karolinska Inst, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care, Stockholm; Karolinska Univ Hosp Solna, Dept Anesthesiol Surg Serv & Intens Care Med, Stockholm.
    Bernhardsson, Jens
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Bjärtå, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Wållgren, M.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Alvarsson, J.
    Royal Inst Technol, Marcus Wallenberg Lab, Dept Aeronaut & Vehicle Engn, Sch Engn Sci, Stockholm.
    Bottai, M.
    Karolinska Inst, Unit Biostat, Dept Environm Med, Stockholm.
    Martling, C. -R
    Karolinska Inst, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care, Stockholm; Karolinska Univ Hosp Solna, Dept Anesthesiol Surg Serv & Intens Care Med, Stockholm.
    Sackey, P. V.
    Karolinska Inst, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care, Stockholm; Karolinska Univ Hosp Solna, Dept Anesthesiol Surg Serv & Intens Care Med, Stockholm.
    Pain rather than induced emotions and ICU sound increases skin conductance variability in healthy volunteers2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 8, p. 1111-1120Article in journal (Refereed)
    Abstract [en]

    Background: Assessing pain in critically ill patients is difficult. Skin conductance variability (SCV), induced by the sympathetic response to pain, has been suggested as a method to identify pain in poorly communicating patients. However, SCV, a derivate of conventional skin conductance, could potentially also be sensitive to emotional stress. The purpose of the study was to investigate if pain and emotional stress can be distinguished with SCV.

    Methods: In a series of twelve 1-min sessions with SCV recording, 18 healthy volunteers were exposed to standardized electric pain stimulation during blocks of positive, negative, or neutral emotion, induced with pictures from the International Affective PictureSystem (IAPS). Additionally, authentic intensive care unit (ICU) sound was included in half of the sessions. All possible combinations of pain and sound occurred in each block of emotion, and blocks were presented in randomized order.

    Results: Pain stimulation resulted in increases in the number of skin conductance fluctuations (NSCF) in all but one participant. During pain-free baseline sessions, the median NSCF was 0.068 (interquartile range 0.013-0.089) and during pain stimulation median NSCF increased to 0.225 (interquartile range 0.146-0.3175). Only small increases in NSCF were found during negative emotions. Pain, assessed with the numeric rating scale, during the sessions with pain stimulation was not altered significantly by other ongoing sensory input.

    Conclusion: In healthy volunteers, NSCF appears to reflect ongoing autonomous reactions mainly to pain and to a lesser extent, reactions to emotion induced with IAPS pictures or ICU sound.

  • 100.
    Gunther, Anders
    et al.
    Karolinska Univ Hosp, Perioperat Med & Intes Care, Stockholm.
    Sackey, Peter
    Karolinska Univ Hosp, Perioperat Med & Intes Care, Stockholm.
    Storm, Hanne
    Univ Oslo, Inst Clin Med, Oslo, Norway.
    Wallgren, Max
    Bernhardsson, Jens
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Bjärtå, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Validation of physiological and self-rated pain assessment tools; how do they act when compared to the nociceptive spinal reflex?: A comparison between physiological and self-rated pain assessment during different affective states2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1047-1047, article id 137Article in journal (Other academic)
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