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Lennmarken, Claees
Alternative names
Publications (10 of 13) Show all publications
Nilsson, A., Sjöberg, F., Öster, S., Bek-Jensen, H. & Lennmarken, C. (2012). Patient-Controlled Sedation and Analgesia with Propofol and Alfentanil: A Preliminary Safety Evaluation Prior to Use of Non-Anaesthesiology Doctors. Open Journal of Anesthesiology, 2(2), 47-52
Open this publication in new window or tab >>Patient-Controlled Sedation and Analgesia with Propofol and Alfentanil: A Preliminary Safety Evaluation Prior to Use of Non-Anaesthesiology Doctors
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2012 (English)In: Open Journal of Anesthesiology, ISSN 2164-5558, Vol. 2, no 2, p. 47-52Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to evaluate safety aspects of patient-controlled sedation and analgesia (PCS) for extracor-poreal shockwave lithotripsy (ESWL) and PCS to be handled by non-anaesthesiology doctors. Methods: Thirty-four ASA I-III patients used PCS with propofol and alfentanil for ESWL in this interventional study. Strict safety limits were defined regarding respiratory rate (RR), heart rate (HR), mean arterial blood pressure (MAP), oxygen saturation from pulse oximetry (SpO2), and transcutaneous partial pressures of oxygen (PtcO2) and carbon dioxide (PtcCO2). The pa-tients’ levels of consciousness was graded on a five-point scale and monitored with Bispectral Index (BIS). A nurse anaesthetist was supervising the procedure but was instructed to intervene only if safety limits were breached. No sup-plementary oxygen was given. Results: All patients responded to verbal stimuli during treatment. Cardiovascular sta-bility was maintained, but respiratory variables were affected. Two patients with SpO2 < 90% and two cases of RR ≤ 8 were diagnosed, and seven patients became hypercarbic (PtcCO2 ≥ 6.5 kPa). In 18 patients hypoxaemia was indicated as PtcO2 ≤ 8.0 kPa. All these 18 patients were given supplementary oxygen. There was no correlation between dose of drugs, age, weight or any vital variable. The 34 patients would use PCS again in the case of future treatment. Conclu-sions: During ESWL treatment PCS can be used with good patients’ satisfaction, and maintained cardiovascular stabil-ity, but PCS had an indisputable effect on pulmonary function with hypoxemia (resulting in need for supplementary oxygen) or hypercarbia. The person in charge of PCS must therefore be trained to perform according to the guidelines for sedation and/or analgesia by non-anaesthesiology doctors.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2012
Keywords
Anaesthesia, Patient-Controlled Sedation, Safety, European Guidelines
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-99777 (URN)10.4236/ojanes.2012.22012 (DOI)
Available from: 2013-10-21 Created: 2013-10-21 Last updated: 2013-10-29Bibliographically approved
Zdolsek, J., Holmgren, S., Wedenberg, K. & Lennmarken, C. (2009). Circulatory arrest in late pregnancy: caesarean section a vital decision for both mother and child. Acta Anaesthesiologica Scandinavica, 53(6), 828-829
Open this publication in new window or tab >>Circulatory arrest in late pregnancy: caesarean section a vital decision for both mother and child
2009 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, no 6, p. 828-829Article in journal (Refereed) Published
Abstract [en]

Circulatory arrest during pregnancy is extremely rare and there should be a well-planned strategy for its management in all hospitals. To consider the priority of the mothers life over the childs and an unwarranted pre-term delivery may lead to hesitancy and uncertainty and jeopardize both of them. In these situations, speed is a priority. Cardiopulmonary resuscitation should commence immediately. The anaesthesiologist should be well aware of the possible advantage of a caesarean section. Even if the obstetrician is responsible for the decision to perform the operation, the anaesthesiologist should strongly support the action. An emergency caesarean kit with the essential surgical instruments should be immediately available in every labour ward and emergency department.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2009
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-19552 (URN)10.1111/j.1399-6576.2009.01970.x (DOI)000266796300020 ()19397501 (PubMedID)2-s2.0-67149128184 (Scopus ID)
Available from: 2009-06-29 Created: 2009-06-26 Last updated: 2017-12-13Bibliographically approved
Lindholm, M.-L., Traff, S., Granath, F., Greenwald, S. D., Ekbom, A., Lennmarken, C. & Sandin, R. H. (2009). Mortality Within 2 Years After Surgery in Relation to Low Intraoperative Bispectral Index Values and Preexisting Malignant Disease. ANESTHESIA AND ANALGESIA, 108(2), 508-512
Open this publication in new window or tab >>Mortality Within 2 Years After Surgery in Relation to Low Intraoperative Bispectral Index Values and Preexisting Malignant Disease
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2009 (English)In: ANESTHESIA AND ANALGESIA, ISSN 0003-2999, Vol. 108, no 2, p. 508-512Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A correlation between deep anesthesia (defined as time with Bispectral Index (BIS) &lt;45; T-BIS &lt;45 and death within 1. yr after surgery has previously been reported. In order to confirm or refute these findings, we evaluated T-BIS (&lt;45) as an independent risk factor for death within I and 2 yr after surgery and also the impact of malignancy, the predominant cause of death in the previous report.

METHODS: Mortality within 2 yr after surgery, causes of death and the occurrence of malignant disease at the time of surgery were identified in a cohort of 4087 BIS-monitored patients. Statistically significant univariate predictors of mortality were identified. In order to allow for comparison with previous data, the following multivariate analysis was first done without, and thereafter with, preexisting malignancy status, the predominant cause of death.

RESULTS: One-hundred-seventy-four (4.3%) patients died within I yr and another 92 during the second year (totaling 6.5% in 2 yr). T-BIS &lt;45 was a significant predictor of 1- and 2-yr mortality when preexisting malignant disease was not among the co-variates (hazard ratio [HR] 113 [1.01-1.27] and 1.18 [1.08-1.29], respectively). Further exploration confined the significant relation between postoperative mortality and T-BIS &lt;45 to Patients with preexisting malignant diagnoses associated with extensive Surgery and less favorable prognosis. The most powerful predictors of 2-yr mortality in the model, including preexisting malignancy, were ASA physical score class IV (HR 19.3 [7.31-51.1]), age &gt;80 yr (HR 2.93 [1.79-4.79]), and preexisting malignancy associated with less favorable prognosis (HR 9.30 [6.60-13.1]). When the initial multivariate regression was repeated using preexisting malignancy status among the co-variates in the model, the previously significant relation between 1, and 2-yr mortality and T-BIS &lt;45 did not reach statistical significance.

CONCLUSION: Using a similar set of co-variates as in previous work, we confirmed the statistical relation between 1-yr mortality and T-BIS &lt;45, and we extended this observation to 2-yr mortality. However, this relation is sensitive to the selection of co-variates in the statistical model, and a randomized study is required to demonstrate that there really is a causal impact from and T-BIS (&lt;45) on postoperative mortality and, if it does, the effect is probably very weak in comparison with co-morbidity as assessed by ASA physical score, the preexisting malignancy status at surgery and age.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16632 (URN)10.1213/ane.0b013e31818f603c (DOI)
Available from: 2009-02-08 Created: 2009-02-06 Last updated: 2010-04-08
Lennmarken, C. & Sydsjö, G. (2007). Psychological consequences of awareness and their treatment. Best Practice & Research Clinical Anaesthesiology, 21(3), 357-367
Open this publication in new window or tab >>Psychological consequences of awareness and their treatment
2007 (English)In: Best Practice & Research Clinical Anaesthesiology, ISSN 1521-6896, Vol. 21, no 3, p. 357-367Article in journal (Refereed) Published
Abstract [en]

Intraoperative awareness with subsequent recall is a rare but serious complication with an incidence of 0.1-0.2%. In approximately one third of the patients who have experienced awareness, late severe psychiatric sequelae may develop. The psychiatric symptoms in these patients fulfil the diagnostic criteria for post traumatic stress disorder. To prevent awareness as a negative outcome after anaesthesia, a thorough perioperative management of anaesthesia is necessary. The definite risk for post traumatic stress disorder following awareness indicates the necessity of postoperative clinical routines to identify awareness patients. The problem must be acknowledged. Professional psychiatric assessment and follow up should constitute standard practice. The treatments of choice are Eye Movement Desensitisation Reprocessing and Cognitive Behaviour Therapy. © 2007 Elsevier Ltd. All rights reserved.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-40014 (URN)10.1016/j.bpa.2007.04.005 (DOI)52056 (Local ID)52056 (Archive number)52056 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2010-05-17
Lennmarken, C. & Sandin, R. (2004). Neuromonitoring for awareness during surgery. The Lancet, 363(9423)
Open this publication in new window or tab >>Neuromonitoring for awareness during surgery
2004 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 363, no 9423, p. 1747-1748Other (Other academic)
Publisher
p. 1747-1748
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-48385 (URN)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Lennmarken, C. & Sandin, R. (2004). Neuromonitoring for awareness during surgery. The Lancet, 29, 1747-1748
Open this publication in new window or tab >>Neuromonitoring for awareness during surgery
2004 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 29, p. 1747-1748Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24259 (URN)3863 (Local ID)3863 (Archive number)3863 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Ekman, A., Lindholm, M., Lennmarken, C. & Sandin, R. (2004). Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiologica Scandinavica, 48(1), 20-26
Open this publication in new window or tab >>Reduction in the incidence of awareness using BIS monitoring
2004 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, no 1, p. 20-26Article in journal (Refereed) Published
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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24260 (URN)10.1111/j.1399-6576.2004.00260.x (DOI)3864 (Local ID)3864 (Archive number)3864 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Lennmarken, C., Bildfors, K., Enlund, G., Samuelsson, P. & Sandin, R. (2002). Victims of awareness. Acta Anaesthesiologica Scandinavica, 46, 229-231
Open this publication in new window or tab >>Victims of awareness
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2002 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 46, p. 229-231Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26986 (URN)11622 (Local ID)11622 (Archive number)11622 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
Järemo, P., Lindahl, T., Lennmarken, C. & Forsgren, H. (2001). The use of platelet density and volume measurements to estimate the severity of pre-eclampsia.. European Journal of Clinical Investigation, 30, 1113-1118
Open this publication in new window or tab >>The use of platelet density and volume measurements to estimate the severity of pre-eclampsia.
2001 (English)In: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 30, p. 1113-1118Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25233 (URN)9672 (Local ID)9672 (Archive number)9672 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Sandin, R. H., Enlund, G., Samuelsson, P. & Lennmarken, C. (2000). Awareness during anaesthesia: a prospective case study. The Lancet, 355(9205), 707-711
Open this publication in new window or tab >>Awareness during anaesthesia: a prospective case study
2000 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 355, no 9205, p. 707-711Article in journal (Refereed) Published
Abstract [en]

Background

Patients who are given general anaesthesia are not guaranteed to remain unconscious during surgery. Knowledge about the effectiveness of current protective measures is scarce, as is our understanding of patients' responses to this complication. We did a prospective case study to assess conscious awareness during anaesthesia.

Methods

11 785 patients who had undergone general anaesthesia were interviewed for awareness on three occasions: before they left the post-anaesthesia care unit, and 1–3 days and 7–14 days after the operation.

Findings

We identified 18 cases of awareness and one case of inadvertent muscle blockade that had occurred before unconsciousness. Incidence of awareness was 0·18% in cases in which neuromuscular blocking drugs were used, and 0·10% in the absence of such drugs. 17 cases of awareness were identified at the final interview, but no more than 11 would have been detected if an interview had been done only when the patients left the post-anaesthesia care unit. Four non-paralysed patients recalled intraoperative events, but none had anxiety during wakefulness or had delayed neurotic symptoms. This finding contrasts with anaesthesia with muscle relaxants, during which 11 of 14 patients had pain, anxiety, or delayed neurotic symptoms. After repeated discussion and information, the delayed neurotic symptoms resolved within 3 weeks in all patients. Analysis of individual cases suggests that a reduced incidence of recall of intraoperative events would not be achieved by monitoring of end-tidal anaesthetic gas concentration or by more frequent use of benzodiazepines.

Interpretation

The inability to prevent awareness by conventional measures may advocate monitoring of cerebral activity by neurophysiological techniques. However, the sensitivity of such techniques is not known, and in the light of our findings, at least 861 patients would need to be monitored to avoid one patient from suffering due to awareness during relaxant anaesthesia.

Place, publisher, year, edition, pages
Lancet, 2000
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-15402 (URN)10.1016/S0140-6736(99)11010-9 (DOI)
Available from: 2008-11-06 Created: 2008-11-06 Last updated: 2017-12-14Bibliographically approved
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