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

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

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

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

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

    DESIGN: A randomised controlled study.

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

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

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

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

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

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

    TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01416077.

  • 3.
    Bergek, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
    Zdolsek, Joachim
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Hahn, Robert G
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Accuracy of noninvasive haemoglobin measurement by pulse oximetry depends on the type of infusion fluid2012In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 29, no 12, p. 586-592Article in journal (Refereed)
    Abstract [en]

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

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

    Design: Open interventional crossover study.

    Setting: Single university hospital.

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

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

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

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

  • 4.
    CHEW, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions A statement from the ESA-ESICM joint taskforce on perioperative outcome measures2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 3, p. 88-105Article in journal (Refereed)
    Abstract [en]

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

  • 5.
    Chew, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Surgery was successful – but how did it go for the patient? Experiences from and hopes for the Swedish Perioperative Register2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, p. 453-454Article, review/survey (Refereed)
  • 6.
    Chew, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Swedish surgical outcomes study (SweSOS): An observational study on 30-day and 1-year mortality after surgery2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 5, p. 317-325Article in journal (Refereed)
    Abstract [en]

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

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

    DESIGN An observational cohort study.

    SETTING Six universities and two regional hospitals in Sweden.

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

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

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

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

  • 7.
    Chew, Michelle
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Dalesjö, Lina
    Hallands Hosp Halmstad, Sweden.
    Life-threatening ketoacidosis in a lactating woman2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 12, p. 984-986Article in journal (Other academic)
    Abstract [en]

    n/a

  • 8.
    Chew, Michelle S
    et al.
    Department of Anaesthesia and Intensive Care, Hallands sjukhus Halmstad.
    Mangelus, Claes
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Enlund, Gunnar
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Spetz, Peter
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Lyckner, Sara
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Surgery was successful--but how did it go for the patient? Experiences from and hopes for the Swedish Perioperative Register.2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 7, p. 453-454Article in journal (Other academic)
  • 9.
    Chew, Michelle S
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Walder, Bernhard
    University Hospital Geneva, Switzerland.
    Improving perioperative outcome: time to update protocols2017In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 4, p. 185-188Article in journal (Other academic)
    Abstract [en]

    n/a

  • 10.
    De Geer, Lina
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Oscarsson Tibblin, Anna
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Amino-terminal pro-brain natriuretic peptide as a predictor of outcome in patients admitted to intensive care. A prospective observational study2012In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 29, no 6, p. 275-279Article in journal (Refereed)
    Abstract [en]

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

  • 11.
    De Hert, Stefan
    et al.
    Univ Ghent, Belgium.
    Staender, Sven
    Reg Hosp Mannedorf Zurich, Switzerland; Paracelsus Med Univ Salzburg, Austria.
    Fritsch, Gerhard
    Paracelsus Med Univ Salzburg, Austria; AUVA Traumactr Vienna, Austria.
    Hinkelbein, Jochen
    Univ Hosp Cologne, Germany.
    Afshari, Arash
    Univ Copenhagen, Denmark.
    Bettelli, Gabriella
    Univ San Marino, San Marino.
    Bock, Matthias
    Paracelsus Med Univ Salzburg, Austria; Merano Hosp Franz Tappeiner, Italy.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Coburn, Mark
    Rhein Westfal TH Aachen, Germany.
    De Robertis, Edoardo
    Univ Naples Federico II, Italy.
    Drinhaus, Hendrik
    Univ Hosp Cologne, Germany.
    Feldheiser, Aarne
    Charite Univ Med Berlin, Germany.
    Geldner, Gotz
    RKH Klinikum Ludwigsburg, Germany.
    Lahner, Daniel
    AUVA Traumactr Vienna, Austria; Ludwig Boltzmann Inst Expt and Clin Traumatol, Austria.
    Macas, Andrius
    Lithuanian Univ Hlth Sci, Lithuania.
    Neuhaus, Christopher
    Univ Hosp Heidelberg, Germany.
    Rauch, Simon
    Merano Hosp Franz Tappeiner, Italy; EURAC Res, Italy.
    Santos-Ampuero, Maria Angeles
    Hosp Schwyz, Switzerland.
    Solca, Maurizio
    Danube Univ Krems, Austria.
    Tanha, Nima
    Not Found:Linkoping Univ, Linkoping Univ Hosp, Dept Anaesthesia and Intens Care, Linkoping, Sweden; Linkoping Univ, Linkoping Univ Hosp, Dept Med and Hlth Sci, Linkoping, Sweden.
    Traskaite, Vilma
    Lithuanian Univ Hlth Sci, Lithuania.
    Wagner, Gernot
    Danube Univ Krems, Austria.
    Wappler, Frank
    Univ Witten Herdecke, Germany.
    Pre-operative evaluation of adults undergoing elective noncardiac surgery Updated guideline from the European Society of Anaesthesiology2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 6, p. 407-465Article in journal (Refereed)
    Abstract [en]

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

  • 12.
    Gillies, Michael A.
    et al.
    Royal Infirm Edinburgh NHS Trust, Scotland.
    Pearse, Rupert
    Royal London Hosp, England.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Peri-operative goal-directed therapy A definitive answer remains elusive2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 7, p. 467-468Article in journal (Other academic)
    Abstract [en]

    n/a

  • 13.
    Golster, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Seven years of patient-controlled epidural analgesia in a Swedish hospital A prospective survey2014In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 31, no 11, p. 589-596Article in journal (Refereed)
    Abstract [en]

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

  • 14.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Editorial Material: Why are crystalloid and colloid fluid requirements similar during surgery and intensive care?2013In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 30, no 9, p. 515-518Article in journal (Other academic)
    Abstract [en]

    n/a

  • 15.
    Hahn, Robert
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lyons, Gordon
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    The half-life of infusion fluids An educational review2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 7, p. 475-482Article, review/survey (Refereed)
    Abstract [en]

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

  • 16.
    Jammer, Ib
    et al.
    Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Anaesthesia and Intensive Care, Haukeland University Hospital,.
    Wickboldt, Nadine
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Geneva, Geneva, Switzerland.
    Sander, Michael
    Department of Anaesthesia and Intensive Care, Charite, Berlin, Germany.
    Smith, Andrew
    Royal Lancaster Infirmary, Lancaster University, Lancaster, UK.
    Schultz, Marcus J
    Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
    Pelosi, Paolo
    Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Hospital,University of Genoa, Genoa, Italy.
    Leva, Brigitte
    European Society of Anaesthesiology, Brussels, Belgium.
    Rhodes, Andrew
    Critical Care, St George’s Hospital, London, UK.
    Hoeft, Andreas
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany .
    Walder, Bernhard
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Geneva, Geneva, Switzerland.
    Chew, Michelle S
    Department of Anaesthesia and Intensive Care Medicine, Hallands Sjukhus, Halmstad, Sweden Institute of Clinical Sciences, Lund University, Sweden.
    Pearse, Rupert M
    Queen Mary University of London, London, UK.
    Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 2, p. 88-105Article in journal (Refereed)
    Abstract [en]

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

  • 17.
    Jawad, Monir
    et al.
    Department of Anaesthesiology and Intensive Care, Central Hospital in Kristianstad, Kristianstad, Sweden.
    Baigi, Amir
    Department of Primary Healthcare, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Oldner, Anders
    Department of Anaesthesiology, Karolinska University Hospital and Institute, Surgical Services and Intensive Care, Stockholm, Sweden.
    Pearse, Rupert M
    Queen Mary University of London and Adult Critical Care Unit, Royal London Hospital, London, UK.
    Rhodes, Andrew
    Department of Intensive Care Medicine, St George's Healthcare NHS Trust, London, UK.
    Seeman-Lodding, Helen
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Chew, Michelle S
    Institute of Clinical Sciences Malmö, Lund University, Lund and the Department of Anaesthesiology and Intensive Care, Halland Hospital, Halmstad, Sweden.
    Swedish surgical outcomes study (SweSOS): An observational study on 30-day and 1-year mortality after surgery.2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 5, p. 317-325Article in journal (Refereed)
    Abstract [en]

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

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

    DESIGN: An observational cohort study.

    SETTING: Six universities and two regional hospitals in Sweden.

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

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

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

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

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

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

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

    DESIGN: Prospective observational study.

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

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

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

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

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

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

  • 21.
    Navarro, Lais H.
    et al.
    Botucatu Medical School, UNESP, Botucatu, Sao Paulo, Brazil (LHN.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Postoperative acute kidney injury A never-ending challenge2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 9, p. 639-640Article in journal (Other academic)
  • 22.
    Nilsson, Lena
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Johansson, Anders
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Kalman, Sigga
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    The phase of the respiratory variation in the photoplethysmographic signal is not affected by sympathetic tone2004In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 21, p. 76-77Article in journal (Refereed)
  • 23.
    Nilsson, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lindenberger, Marcus
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    The effect of positive end-expiratory pressure and tripled tidal volume on pleth variability index during hypovolaemia in conscious subjects A volunteer study2013In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 30, no 11, p. 671-677Article in journal (Refereed)
    Abstract [en]

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

  • 24.
    Nilsson, Ulrica
    et al.
    Örebro University Hospital, Sweden.
    Berg, Katarina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Kalmar County Council.
    Idvall, Ewa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Relation between personality and quality of postoperative recovery in day surgery patients2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 8, p. 671-675Article in journal (Refereed)
    Abstract [en]

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

  • 25.
    Nilsson, Urban
    et al.
    Örebro universitet Örebro.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Rawal, Narinder
    Örebro universitet Örebro.
    Stress reduction and analgesia in patients exposed to calming music postoperatively: A randomized controlled trial2005In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 22, no 2, p. 96-102Article in journal (Refereed)
    Abstract [en]

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

  • 26.
    Reini, Kirsi
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiothoracic Anaesthesia and Intensive care. Linköping University, Faculty of Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Oscarsson Tibblin, Anna
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    The prognostic value of the Modified Early Warning Score in critically ill patients: a prospective, observational study2012In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 29, no 3, p. 152-157Article in journal (Refereed)
    Abstract [en]

    Context The Modified Early Warning Score is a validated assessment tool for detecting risk of deterioration in patients at risk on medical and surgical wards. less thanbrgreater than less thanbrgreater thanObjective To assess the prognostic ability of the Modified Early Warning Score in predicting outcome after critical care. less thanbrgreater than less thanbrgreater thanDesign A prospective observational study. less thanbrgreater than less thanbrgreater thanSetting A tertiary care general ICU. less thanbrgreater than less thanbrgreater thanPatients Five hundred and eighteen patients aged at least 16 years admitted to the ICU at Linkoping University Hospital were included. less thanbrgreater than less thanbrgreater thanIntervention The Modified Early Warning Score was documented on arrival at the ICU and every hour for as long as the patient was breathing spontaneously, until discharge from the ICU. less thanbrgreater than less thanbrgreater thanMain outcome measures The primary endpoint was mortality in the ICU. Secondary endpoints were 30-day mortality, length of stay and readmission to the ICU. less thanbrgreater than less thanbrgreater thanResults Patients with a Modified Early Warning Score of at least six had significantly higher mortality in the ICU than those with a Modified Early Warning Score andlt;6 (24 vs. 3.4%, Pandlt; 0.001). A Modified Early Warning Score of at least six was an independent predictor of mortality in the ICU [odds ratio (OR) 5.5, 95% confidence interval (CI) 2.4-20.6]. The prognostic ability of the Modified Early Warning Score on admission to the ICU [area under the curve (AUC) 0.80, 95% CI 0.72-0.88] approached those of the Simplified Acute Physiology Score III (AUC 0.89, 95% CI 0.83-0.94) and the Sequential Organ Failure Assessment score on admission (AUC 0.91, 95% CI 0.86-0.97). A Modified Early Warning Score of at least six on admission was also an independent predictor of 30-day mortality (OR 4.3, 95% CI 2.3-8.1) and length of stay in the ICU (OR 2.3, 95% CI 1.4-3.8). In contrast, the Modified Early Warning Score on discharge from the ICU did not predict the need for readmission. less thanbrgreater than less thanbrgreater thanConclusion This study shows that the Modified Early Warning Score is a useful predictor of mortality in the ICU, 30-day mortality and length of stay in the ICU.

  • 27.
    Snygg, Johan
    et al.
    Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Anaesthesiol & Intens Care, Gothenburg, Sweden, Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Gothenburg, Sweden.
    Andersson, Henrik
    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 Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Chew, Michelle S
    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).
    Nordström, Rasmus (Contributor)
    Region Östergötland.
    Linhardt, Michael (Contributor)
    Region Östergötland.
    de Geer, Lina (Contributor)
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland.
    Myocardial injury in noncardiac surgery in Sweden: Study protocol for a multicentre, observational cohort study of patients undergoing elective, major abdominal surgery2019In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 36, no 5, p. 383-385Article in journal (Other academic)
    Abstract [en]

    [No abstract available]

  • 28.
    Wilhelms, Daniel
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine.
    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.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Emergency medicine is about collaboration, not monopolisation2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 3, p. 231-232Article in journal (Other academic)
    Abstract [en]

    n/a

  • 29.
    Ylinenvaara, Sandra I
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Elisson, Olof
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Berg, Kim
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Zdolsek, Joachim H
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Krook, Helena
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Hahn, Robert G
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Research Unit, Södertälje Hospital, Södertälje, Sweden.
    Preoperative urine-specific gravity and the incidence of complications after hip fracture surgery: A prospective, observational study2014In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 31, no 2, p. 85-90Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mild to moderately severe dehydration is common in the elderly, but its relationship to surgical outcome is unclear.

    OBJECTIVES: To study the incidence of dehydration prior to hip fracture surgery and its relationship to postoperative complications.

    DESIGN: Prospective observational study.

    SETTING: Operation department and orthopaedic ward at a regional hospital.

    PATIENTS: Forty-five patients [median (interquartile range) age 78 (75 to 86) years] undergoing acute hip fracture surgery.

    INTERVENTIONS: A urine sample was taken on admission to the operating theatre. Complications were assessed 2 days postoperatively using a check-list.

    MAIN OUTCOME MEASURES: Dehydration was considered to be present if the urinary specific gravity was 1.020 or higher, indicating renal water conservation. The number and type of postoperative complications were recorded.

    RESULTS: Dehydration was present in one third of the patients. Sixty percent of these patients had at least one postoperative complication, whereas the corresponding proportion was 30% in the euhydrated patients (P <0.01). Only one patient (3%) had more than one complication in the euhydrated group compared with six patients (40%) in the dehydrated group (P <0.01). Euhydrated patients had a mean of 0.3 postoperative complications per surgery, whereas dehydrated patients scored 1.1 complications (P <0.015). The higher incidence included confusion, arterial desaturation and cardiovascular events.

    CONCLUSION: Dehydration before surgery nearly quadrupled the number of postoperative complications after hip fracture repair.

     

  • 30.
    Zetterlund, Eva-Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Green, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Oscarsson, Anna
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Linköping University, Department of Medical and Health Sciences, Division of Drug Research.
    Vikingsson, Svante
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Vrethem, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Lindholm, Maj-Lis
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Kalmar Hospital, Sweden.
    Eintrei, Christina
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Determination of loss of consciousness: a comparison of clinical assessment, bispectral index and electroencephalogram: An observational study2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 12, p. 922-928Article in journal (Refereed)
    Abstract [en]

    BACKGROUNDComputer-processed algorithms of encephalographic signals are widely used to assess the depth of anaesthesia. However, data indicate that the bispectral index (BIS), a processed electroencephalography monitoring system, may not be reliable for assessing the depth of anaesthesia.OBJECTIVEThe aim of this study was to evaluate the ability of the BIS monitoring system to assess changes in the level of unconsciousness, specifically during the transition from consciousness to unconsciousness, in patients undergoing total intravenous anaesthesia with propofol. We compared BIS with the electroencephalogram (EEG), and clinical loss of consciousness (LOC) defined as loss of verbal commands and eyelash reflex.DESIGNThis was an observational cohort study.SETTINGUniversity Hospital Linkoping, University Hospital orebro, Finspang Hospital and Kalmar Hospital, Sweden from October 2011 to April 2013.PATIENTSA total of 35 ASA I patients aged 18 to 49 years were recruited.INTERVENTIONSThe patients underwent total intravenous anaesthesia with propofol and remifentanil for elective day-case surgery. Changes in clinical levels of consciousness were assessed by BIS and compared with assessment of stage 3 neurophysiological activity using the EEG. The plasma concentrations of propofol were measured at clinical LOC and 20 and 30min after LOC.MAIN OUTCOME MEASURESThe primary outcome was measurement of BIS, EEG and clinical LOC.RESULTSThe median BIS value at clinical LOC was 38 (IQR 30 to 43), and the BIS values varied greatly between patients. There was no correlation between BIS values and EEG stages at clinical LOC (r=-0.1, P=0.064). Propofol concentration reached a steady state within 20min.CONCLUSIONThere was no statistically significant correlation between BIS and EEG at clinical LOC. BIS monitoring may not be a reliable method for determining LOC.CLINICAL TRIALS REGISTRYThis trial was not registered because registration was not mandatory at the time of the trial.

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