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Cederholm, Ingemar
Publications (9 of 9) Show all publications
Holm, J., Szabó, Z., Alehagen, U., Lindahl, T. & Cederholm, I. (2018). Copeptin Release in Cardiac Surgery: A New Biomarker to Identify Risk Patients?. Journal of Cardiothoracic and Vascular Anesthesia, 32(1), 245-250
Open this publication in new window or tab >>Copeptin Release in Cardiac Surgery: A New Biomarker to Identify Risk Patients?
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2018 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 32, no 1, p. 245-250Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe the dynamics of copeptin in open cardiac surgery during the perioperative course.

DESIGN: Prospective cohort study.

SETTING: Single tertiary hospital.

PARTICIPANTS: Twenty patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB).

INTERVENTIONS: No intervention.

MEASUREMENTS AND MAIN RESULTS: Copeptin concentrations were measured pre-, peri-, and postoperatively until day 6 after surgery. Patients were analyzed as a whole cohort (n = 20) and in a restricted "normal cohort" consisting of patients with normal preoperative copeptin concentration (<10 pmol/L) and perioperative uneventful course (n = 11). In the whole cohort, preoperative copeptin concentration was 7.0 pmol/L (interquartile range: 3.1-11 pmol/L). All patients had an early rise of copeptin, with 80% having peak copeptin concentration at weaning from CPB or upon arrival in the intensive care unit. Patients in the "normal cohort" had copeptin concentration at weaning from CPB of 194 pmol/L (98-275), postoperative day 1, 27 pmol/L (18-31); and day 3, 8.9 pmol/L (6.3-12).

CONCLUSIONS: Regardless of cardiac surgical procedure and perioperative course, all patients had an early significant rise of copeptin concentrations, generally peaking at weaning from CBP or upon arrival in the intensive care unit. Among patients with normal copeptin concentration preoperatively and uneventful course, the postoperative copeptin concentrations decreased to normal values within 3-to-4 days after cardiac surgery. Furthermore, the restricted "normal cohort" generally tended to display lower levels of copeptin concentration postoperatively. Further studies may evaluate whether copeptin can be a tool in identifying risk patients in cardiac surgery.

Place, publisher, year, edition, pages
Saunders Elsevier, 2018
Keywords
cardiac surgery, copeptin, kinetics, perioperative care
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-144019 (URN)10.1053/j.jvca.2017.06.011 (DOI)000424730300032 ()29102258 (PubMedID)2-s2.0-85033433737 (Scopus ID)
Available from: 2018-01-03 Created: 2018-01-03 Last updated: 2018-03-08Bibliographically approved
Svensson, A. S., Escobar Kvitting, J.-P., Kovesdy, C. P., Cederholm, I. & Szabó, Z. (2016). Changes in serum cystatin C, creatinine, and C-reactive protein after cardiopulmonary bypass in patients with normal preoperative kidney function.. Nephrology (Carlton. Print), 21(6), 519-525
Open this publication in new window or tab >>Changes in serum cystatin C, creatinine, and C-reactive protein after cardiopulmonary bypass in patients with normal preoperative kidney function.
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2016 (English)In: Nephrology (Carlton. Print), ISSN 1320-5358, E-ISSN 1440-1797, Vol. 21, no 6, p. 519-525Article in journal (Refereed) Published
Abstract [en]

AIM: The use of cardiopulmonary bypass (CPB) can cause changes in serum creatinine and cystatin C independent of glomerular filtration rate. We aimed to quantify the temporal changes of these biomarkers and C-reactive protein (CRP) after CPB.

METHODS: This was a prospective study at an academic medical center between April and October 2013. We compared postoperative changes in serum creatinine and cystatin C in 38 patients with normal preoperative kidney function who underwent cardiac surgery using CPB and did not develop perioperative acute kidney injury (AKI). The effect of inflammation on intra-individual changes was examined in mixed effects regressions, using measurements of pre- and postoperative CRP.

RESULTS: Both serum creatinine (79.9 ± 22.7 vs. 92.6 ± 21.4 µmol/L, p = 0.001) and cystatin C (1.16 ± 0.39 vs. 1.33 ± 0.37 mg/L, p = 0.012) decreased significantly in the first 8 hours postoperatively compared to preoperatively, as a result of hemodilution. Thereafter serum creatinine returned to preoperative levels, whereas serum cystatin C continued to rise and was significantly elevated at 72 hours post-CPB compared to preoperative levels (1.53 ± 0.48 vs. 1.33 ± 0.37 mg/L, p = 0.003). CRP levels increased significantly post-CPB and were significantly associated with increases in both serum creatinine and cystatin C.

CONCLUSIONS: Serum creatinine and cystatin C appear not to be interchangeable biomarkers during and immediately after CPB. Processes unrelated to kidney function such as acute inflammation have a significant effect on post-CPB changes in these biomarkers, and may result in significant increases in serum cystatin C that could erroneously be interpreted as AKI. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-122030 (URN)10.1111/nep.12630 (DOI)000379594600010 ()26396066 (PubMedID)
Note

Funding agencies: county council of Ostergotland [LIO-205491, LIO-277491]

Available from: 2015-10-16 Created: 2015-10-16 Last updated: 2017-12-01
Svensson, A., Kovesdy, C. P., Escobar Kvitting, J.-P., Cederholm, I. & Szabó, Z. (2014). Serum cystatin C as disgnostic marker of acute kidney injury after cardiopulmonary bypass: a word of caution. In: : . Paper presented at Journal of the American Society of Nephrology 2014.
Open this publication in new window or tab >>Serum cystatin C as disgnostic marker of acute kidney injury after cardiopulmonary bypass: a word of caution
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2014 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114950 (URN)
Conference
Journal of the American Society of Nephrology 2014
Available from: 2015-03-06 Created: 2015-03-06 Last updated: 2015-06-11
Svensson, A. S., Kovesdy, C. P., Escobar Kvitting, J.-P., Rosén, M., Cederholm, I. & Szabó, Z. (2013). Comparison of serum cystatin C and creatinine changes after cardiopulmonary bypass in patients with normal preoperative kidney function. International Urology and Nephrology, 45(6), 1597-1603
Open this publication in new window or tab >>Comparison of serum cystatin C and creatinine changes after cardiopulmonary bypass in patients with normal preoperative kidney function
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2013 (English)In: International Urology and Nephrology, ISSN 0301-1623, E-ISSN 1573-2584, Vol. 45, no 6, p. 1597-1603Article in journal (Refereed) Published
Abstract [en]

Purpose

Serum creatinine is used ubiquitously to estimate glomerular filtration rate and to diagnose acute kidney injury after cardiac surgery. Serum cystatin C is a novel biomarker that has emerged as a possible diagnostic alternative to serum creatinine. It is unclear if the dynamic changes in serum cystatin C immediately following cardiopulmonary bypass (CPB) differ from those of serum creatinine in patients with normal preoperative kidney function.

Methods

We compared changes in serum levels of creatinine and cystatin C by measuring them serially in 19 patients undergoing CPB. Within-patient differences for serum creatinine and serum cystatin C were compared by repeated measures ANOVA.

Results

Serum creatinine and cystatin C levels showed significant correlation with each other. Both biomarkers showed a significant decrease after CPB, but their serum concentrations reverted to pre-CPB levels within 12 h. Serum levels of serum creatinine remained unchanged from baseline levels throughout 72-h post-CPB. In contrast, serum cystatin C levels rose further and became significantly higher compared to baseline within 48 h. Serum cystatin C remained significantly elevated at 48- and 72-h post-CPB.

Conclusions

Processes that determine the serum concentrations of serum creatinine and cystatin C in the post-CPB period affect the two biomarkers differently, suggesting that the two are not interchangeable as diagnostic markers of glomerular filtration rate. Future studies are needed to examine if these discrepancies are related to differences in their production rates, in their ability to detect small changes in glomerular filtration rate, or to a combination of these, and to determine the effect of such differences on the diagnostic and prognostic accuracy of the two biomarkers.

Place, publisher, year, edition, pages
Springer Netherlands, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90057 (URN)10.1007/s11255-013-0403-5 (DOI)000327950000009 ()
Available from: 2013-03-19 Created: 2013-03-19 Last updated: 2017-12-06
Richter, A., Cederholm, I., Fredrikson, M., Mucchiano, C., Träff, S. & Janerot Sjöberg, B. (2012). Effect of Long-Term Thoracic Epidural Analgesia on Refractory Angina Pectoris: A 10-Year Experience. Journal of Cardiothoracic and Vascular Anesthesia, 26(5), 822-828
Open this publication in new window or tab >>Effect of Long-Term Thoracic Epidural Analgesia on Refractory Angina Pectoris: A 10-Year Experience
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2012 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 26, no 5, p. 822-828Article in journal (Refereed) Published
Abstract [en]

Objectives

In patients with refractory angina, the adjuvant effects of long-term home self-treatment with thoracic epidural analgesia on angina, quality of life, and safety were evaluated.

Design

A prospective, consecutive study.

Setting

A university hospital.

Participants and Intervention

Between January 1998 and August 2007, 152 consecutive patients with refractory angina began treatment with thoracic epidural analgesia by intermittent injections of bupivacaine (139 home treatment and 13 palliative). Data were collected until August 2008; therefore, the follow-up for each patient was between 1 and 9 years.

Measurements and Main Results

All but 7 of the patients improved symptomatically, and the improvement was maintained throughout the period of treatment (median = 19 months; range, 1 month-8.9 years). After 1 to 2 weeks, the median (interquartile range [IQR]) Canadian Cardiovascular Society angina class decreased from 4.0 (3.0-4.0) to 2.0 (1.0-2.0), the mean ± standard deviation frequency of anginal attacks decreased from 36 ± 19 to 4.4 ± 6.8 a week, the nitroglycerin intake decreased from 27.7 ± 15.7 to 2.7 ± 4.9 a week, and the median (IQR) overall self-rated quality of life assessed by the visual analog scale increased from 25 (20-30) to 70 (50-75) (all p < 0.001). About one-third of the patients had a dislodgement of the epidural catheter. Apart from 1 epidural hematoma that appeared in 1 patient with a previously undiagnosed bleeding defect, no other serious catheter-related complications occurred.

Conclusions

Long-term self-administered home treatment with thoracic epidural analgesia is a safe, widely available adjuvant treatment for patients with severe refractory angina. It produces symptomatic relief of angina and improves quality of life. The technical development of the method to protect the catheter against dislodgement is needed.

Place, publisher, year, edition, pages
Saunders Elsevier, 2012
Keywords
coronary artery disease, refractory angina pectoris, horacic epidural analgesia, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84740 (URN)10.1053/j.jvca.2012.01.047 (DOI)000309020900012 ()
Note

Funding Agencies|Research Board of the County Council of Ostergotland, Ostergotland, Sweden||

Available from: 2012-10-19 Created: 2012-10-19 Last updated: 2017-12-07
Ahlgren, E., Cederholm, I., Gårdelöf, B., Hübbert, L. & Josefsson, A. (2011). Planerat kejsarsnitt på en kvinna med uttalat hypertrof obstruktiv kardiomyopati. Svensk Förening för Anestesi och Intensivvård, 17(1), 40-41
Open this publication in new window or tab >>Planerat kejsarsnitt på en kvinna med uttalat hypertrof obstruktiv kardiomyopati
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2011 (Swedish)In: Svensk Förening för Anestesi och Intensivvård, Vol. 17, no 1, p. 40-41Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-113392 (URN)
Available from: 2015-01-17 Created: 2015-01-17 Last updated: 2015-01-23
Ricther, A., Cederholm, I., Jonasson, L., Mucchiano, C., Janerot-Sjöberg, B. & Uchto, M. (2002). Effect of thoracic epidural analgesia on refractory angina pectoris: Long-term home self-treatment. Journal of Cardiothoracic and Vascular Anesthesia, 16(6), 679-684
Open this publication in new window or tab >>Effect of thoracic epidural analgesia on refractory angina pectoris: Long-term home self-treatment
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2002 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 16, no 6, p. 679-684Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate the effects of long-term home self-treatment with thoracic epidural analgesia (TEA) on angina, quality of life, and safety. Design: Prospective consecutive pilot study. Setting: Department of Cardiology, Heart Center, Link÷ping University Hospital. Participants: Between January 1998 and January 2000, 37 consecutive patients with refractory angina began treatment with TEA, using a subcutaneously tunnelled epidural catheter. Interventions: The patients were trained to provide self-treatment at home with intermittent injections of bupivacaine. Data were collected until January 2001, and the follow-up for each patient was 1 to 3 years. Measurements and Main Results: All but 1 of the patients improved symptomatically. The improvement was maintained throughout the treatment period (4 days to 3 years). The Canadian Cardiovascular Society angina class decreased from 3.6 to 1.7, frequency of anginal attacks decreased from 46 to 7 a week, nitroglycerin intake decreased from 32 to 5 a week, and the overall self-rated quality of life assessed by visual analog scale increased from 24 to 76 (all p < 0.001). No serious catheter-related complications occurred, however, 51% of the catheters became displaced and a new one had to be inserted during the study. Conclusion: Long-term self-administered home treatment with TEA seems to be an effective and safe adjuvant treatment for patients with refractory angina. It produces symptomatic relief of angina and improves the quality of life.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26837 (URN)10.1053/jcan.2002.128419 (DOI)11455 (Local ID)11455 (Archive number)11455 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
Richter, A., Cederholm, I., Janerot-Sjoberg, B., Jonasson, L., Mucchiano, C., Traff, S. & Uchto, M. (2000). Effect of thoracic epidural analgesia on refractory angina pectoris: long-term home self-treatment. European Heart Journal, 21
Open this publication in new window or tab >>Effect of thoracic epidural analgesia on refractory angina pectoris: long-term home self-treatment
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2000 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, p. 3263-Conference paper, Published paper (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-49535 (URN)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Cederholm, I. (1994). Ropivacaine: An experimental and clinical study with special reference to analgesic, circulatory and antiinflammatory effects. (Doctoral dissertation). Linköping: Linköpings universitet
Open this publication in new window or tab >>Ropivacaine: An experimental and clinical study with special reference to analgesic, circulatory and antiinflammatory effects
1994 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims of the study: 1. to compare ropivacaine, a new long-acting amino-amide local anaesthetic drug, and bupivacaine (with/without adrenaline) concerning dermal analgesia and local vascular effects, 2. to design a suitable test procedure to evaluate changes in skin blood flow after intradermal injection of local anaesthetics, 3. to evaluate changes in skin blood flow of various concentrations of ropivacaine with/without adrenaline, 4. to investigate the influence of ropivacaine, bupivacaine, lidocaine, mepivacaine and prilocaine on the production of oxygen metabolites in human polymorphonuclear leukocytes (PMNL) (intra- and extracellular reactions), and 5. to examine the neural blocking characteristics on sensory, motor and sympathetic pathways using ropivacaine for epidural analgesia.

72 male patients scheduled for transurethral surgery and 50 male volunteers participated in this work. Heparinized blood was obtained from a total of 29 healthy adult blood donors.

Dermal analgesia was evaluated by pin-prick, skin colour changes by visual inspection, skin blood flow by laser Doppler flowmetry, sensory blockade by pin-prick, motor blockade by a modified Bromage scale, sympathetic blockade by assessments of skin resistance level (SRL) and response (SRR), skin temperature and skin blood flow (laser Doppler flowmetry). Production of oxygen metabolites by PMNLs was measured by luminal-enhanced chemiluminescence (intra- and extracellular reactions).

Ropivacaine produced significantly longer duration of dermal analgesia, following intradermal injection (0.1 ml, 30-G needle), compared with bupivacaine, in comparable concentrations. Addition of adrenaline increased the duration of both local anaesthetics. Local blanching was more frequent for plain solutions of ropivacaine.

The effect of drugs on local circulation may well be studied by intradennal injection (0.1 ml, 30-G needle, volar surface, forearms) and recording of changes in skin blood flow (laser Doppler flowmetry). The intradennal injection of a local anaesthetic drug may produce not only a further increase but also a decrease in skin blood flow, if the effect of an intradermal saline injection, causing a very reproducible flow increase, is considered in the evaluation of the net circulatory effect of the tested drug.

Intradermal injection of lidocaine 1% and bupivacaine 0.75% produced an increase in skin blood flow. Ropivacaine 1% produced a flow similar to saline, while a decrease was seen for ropivacaine 0.75%. Ropivacaine0.5%, 0.375%, 0.25%, 0.125% and 0.063% showed a gradual further reduction in flow, where 0.063% produced a flow similar to adrenaline-injection (5 Jlg/ml) and almost as low as at the untreated control sites. The combination of ropivacaine 1%, 0.5% , 0.25% and adrenaline did not accentuate but instead decreased the vasoconstrictive effect of adrenaline.

By and large a decrease in response of chemiluminescence for PMNLs was seen with the higher concentrations of the various local anaesthetics. Lidocaine showed a minor decrease even at lower concentrations. Ropivacaine 1000 J.Lg/ml showed a depression of both intra- and extracellular responses that was similar to, and even somewhat more pronounced than lidocaine 1000 J.Lg/ml. This effect could be of great interest e.g. for local antiinflammatory effects by topical administration, but it has to be further investigated. A marked increase for prilocaine (1000 Jlg/ml) in intracellular response accompanied with a reduction in extracellular response was noted.

Ropivacaine (0.5%, 0.75% with/without adrenaline) 20 ml administered epidurally provided a good sensory blockade and a motor blockade satisfactory for transurethral surgery. The maximum sensory level of analgesia was high, median Th 2-3. The majority of patients had a marked or complete sympathetic blockade in the lower limbs. Besides mild or moderate hypotension, which responded well to treatment with ephedrine, no other serious adverse reactions were seen, Addition of adrenaline did not provide any significant prolongation of the epidural blockade, and did not alter the influence upon the sympathetic blockade nor the hemodynamic changes during onset.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 1994. p. 56
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 407
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27469 (URN)12122 (Local ID)91-7871-949-0 (ISBN)12122 (Archive number)12122 (OAI)
Public defence
1994-01-21, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 21:00 (Swedish)
Note
Papers, included in the Ph.D. thesis, are not registered and included in the posts from 1999 and backwards.Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-07-23Bibliographically approved
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