liu.seSearch for publications in DiVA
Change search
Refine search result
12 1 - 50 of 87
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the 'Create feeds' function.
  • 1.
    Andersson, Elin
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Kroon, Anna
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Nationell kartläggning av farmakologiska rutiner och information i samband med tonsilloperation2013Conference paper (Other academic)
    Abstract [sv]

    Studien är en del i ett större nationellt projekt med syfte att kartlägga smärtbehandling vid tonsillkirurgi i samband med utformning av nationella farmakologiska riktlinjer. De vanligaste postoperativa komplikationerna vid tonsillkirurgi är postoperativt illamående och kräkningar (PONV), smärta, blödning och dehydrering. Tonsillkirurgin utförs idag antingen som dagkirurgiskt ingrepp eller som slutenvårdsingrepp med en vårdtid på ca ett dygn. Därmed sker den postoperativa vården i hemmet. Ett flertal studier har beskrivit patienternas upplevelse av höggradig smärta efter tonsillkirurgi. Obehandlad smärta leder till svårigheter att svälja och därmed otillräckligt dryckes- och matintag, vilket leder till dehydrering, ökad blödningsbenägenhet, sämre läkningsförmåga samt negativa  postoperativa beteendeförändringar hos barnet.

    Syftet var att i en nationell studie kartlägga farmakologiska rutiner och informationen i samband med tonsilloperation hos barn och ungdomar.

  • 2.
    Andersson, Elin
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Kroon, Anna
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Nationell kartläggning av farmakologiska rutiner och information i samband med tonsilloperation2013In: Ventilen, ISSN 0348-6257, Vol. 4, no 48, p. 16-17Article in journal (Other academic)
    Abstract [sv]

    Studien är en del i ett större nationellt projekt med syfte att kartlägga smärtbehandling vid tonsillkirurgi i samband med utformning av nationella farmakologiska riktlinjer. De vanligaste postoperativa komplikationerna vid tonsillkirurgi är postoperativt illamående och kräkningar (PONV), smärta, blödning och dehydrering. Tonsillkirurgin utförs idag antingen som dagkirurgiskt ingrepp eller som slutenvårdsingrepp med en vårdtid på ca ett dygn. Därmed sker den postoperativa vården i hemmet. Ett flertal studier har beskrivit patienternas upplevelse av höggradig smärta efter tonsillkirurgi. Obehandlad smärta leder till svårigheter att svälja och därmed otillräckligt dryckes- och matintag, vilket leder till dehydrering, ökad blödningsbenägenhet, sämre läkningsförmåga samt negativa  postoperativa beteendeförändringar hos barnet.

    Syftet var att i en nationell studie kartlägga farmakologiska rutiner och informationen i samband med tonsilloperation hos barn och ungdomar.

  • 3.
    Andersson, Elin
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Kroon, Anna
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Nationell kartläggning av farmakologiska rutiner och information i samband med tonsilloperation2012In: Nationellt kvalitetsregister Öron-, Näs- och Halssjukvård: Årsrapport 2012, Nationellt kvalitetsregister för Öron-, Näs- och Halssjukvård. , 2012, p. 77-81Chapter in book (Other academic)
    Abstract [sv]

    Studien är en del i ett större nationellt projekt med syfte att kartlägga smärtbehandling vid tonsillkirurgi i samband med utformning av nationella farmakologiska riktlinjer. De vanligaste postoperativa komplikationerna vid tonsillkirurgi är postoperativt illamående och kräkningar (PONV), smärta, blödning och dehydrering. Tonsillkirurgin utförs idag antingen som dagkirurgiskt ingrepp eller som slutenvårdsingrepp med en vårdtid på ca ett dygn. Därmed sker den postoperativa vården i hemmet. Ett flertal studier har beskrivit patienternas upplevelse av höggradig smärta efter tonsillkirurgi. Obehandlad smärta leder till svårigheter att svälja och därmed otillräckligt dryckes- och matintag, vilket leder till dehydrering, ökad blödningsbenägenhet, sämre läkningsförmåga samt negativa  postoperativa beteendeförändringar hos barnet.

    Syftet var att i en nationell studie kartlägga farmakologiska rutiner och informationen i samband med tonsilloperation hos barn och ungdomar.

  • 4.
    Andersson, Henrik
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Drug Research.
    Björnström-Karlsson, Karin
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Eintrei, Christina
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Orexin A Phosphorylates the gamma-Aminobutyric Acid Type A Receptor beta(2) Subunit on a Serine Residue and Changes the Surface Expression of the Receptor in SH-SY5Y Cells Exposed to Propofol2015In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547, Vol. 93, no 11, p. 1748-1755Article in journal (Refereed)
    Abstract [en]

    Propofol activates the gamma-aminobutyric acid type A receptor (GABA(A)R) and causes a reversible neurite retraction, leaving a thin, thread-like structure behind; it also reverses the transport of vesicles in rat cortical neurons. The awakening peptide orexin A (OA) inhibits this retraction via phospholipase D (PLD) and protein kinase CE (PKCE). The human SH-SY5Y cells express both GABA(A)Rs and orexin 1 and 2 receptors. These cells are used to examine the interaction between OA and the GABAAR. The effects of OA are studied with flow cytometry and immunoblotting. This study shows that OA stimulates phosphorylation on the serine residues of the GABA(A)R beta(2) subunit and that the phosphorylation is caused by the activation of PLD and PKCE. OA administration followed by propofol reduces the cell surface expression of the GABA(A)R, whereas propofol stimulation before OA increases the surface expression. The GABA(A)R beta(2) subunit is important for receptor recirculation, and the effect of OA on propofol-stimulated cells may be due to a disturbed recirculation of the GABA(A)R. (C) 2015 Wiley Periodicals, Inc.

  • 5.
    Banck, M
    et al.
    Hallands Hospital, Halmstad, Sweden.
    Heller, Ute
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Samuelsson, C
    Hallands Hospital, Halmstad, Sweden.
    Wickerts, CJ
    Danderyd Hospital and Karolinska Institutet, Stockholm, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Women with out-of-hospital cardiac arrest are less likely to receive therapeutic hypothermia and more likely to die than men: Swedish nationwide cohort study2013Conference paper (Refereed)
  • 6.
    Banck, M
    et al.
    Svenska Intensivvårdsregistret, Karlstad.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Karlström, G
    Svenska Intensivvårdsregistret, Karlstad.
    Nolin, T
    Svenska Intensivvårdsregistret, Kristianstad.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Samuelsson, C
    Svenska Intensivvårdsregistret, Karlstad.
    Är svensk intensivvård könsjämlik?2013Conference paper (Refereed)
  • 7.
    Banck, Malin
    et al.
    Hallands sjukhus, Halmstad.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Karlström, Göran
    Centralsjukhuset, Karlstad.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Samuelsson, Carolina
    Hallands sjukhus, Halmstad.
    Män intensivvårdas mer än kvinnor: Med det är ändå oklart om intensivvården i Sverige är könsojämlik2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 9-10, p. 388-390Article in journal (Other academic)
  • 8.
    Bergek, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Zdolsek, Joachim H.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Research Unit, Södertälje Hospital, Södertälje, Sweden.
    Non-invasive blood haemoglobin and plethysmographic variability index during brachial plexus block2015In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 114, no 5, p. 812-817Article in journal (Refereed)
    Abstract [en]

    Background Plethysmographic measurement of haemoglobin concentration (SpHb  ), pleth variability index (PVI), and perfusion index (PI) with the Radical-7 apparatus is growing in popularity. Previous studies have indicated that SpHb  has poor precision, particularly when PI is low. We wanted to study the effects of a sympathetic block on these measurements.

    Methods Twenty patients underwent hand surgery under brachial plexus block with one Radical-7 applied to each arm. Measurements were taken up to 20 min after the block had been initiated. Venous blood samples were also drawn from the non-blocked arm.

    Results During the last 10 min of the study, SpHb  had increased by 8.6%. The PVI decreased by 54%, and PI increased by 188% in the blocked arm (median values). All these changes were statistically significant. In the non-blocked arm, these parameters did not change significantly.

    Conclusions Brachial plexus block significantly altered SpHb  , PVI, and PI, which indicates that regional nervous control of the arm greatly affects plethysmographic measurements obtained by the Radical-7. After the brachial plexus block, SpHb  increased and PVI decreased.

  • 9.
    Bergstrand, Sara
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Källman, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Department of Dermatology, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lindgren, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions2014In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 21, no 8, p. 761-771Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To characterize pressure-induced vasodilatation and reactive hyperemia at different sacral tissue depths in different populations under clinically relevant pressure exposure.

    METHODS: Forty-two subjects (< 65 years), 38 subjects (≥ 65 years), and 35 patients (≥ 65 years) participated. Interface pressure, skin temperature, and blood flow at tissue depths of 1 mm, 2 mm, and 10 mm (using laser Doppler flowmetry and photoplethysmography) were measured in the sacral tissue before, during, and after load in a supine position.

    RESULTS: pressure-induced vasodilatation and reactive hyperemia were observed at three tissue depths. At 10 mm depth, the proportion of subjects with a lack of pressure-induced vasodilatation was higher compared to superficial depths. The patients had higher interface pressure during load than the healthy individuals, but there were no significant differences in blood flow. Twenty-nine subjects in all three study groups were identified with a lack of pressure-induced vasodilatation and reactive hyperemia.

    CONCLUSIONS: pressure-induced vasodilatation and reactive hyperemia can be measured at different tissue depths. A lack of these responses was found in healthy individuals as well as in patients indicating an innate susceptibility in some individuals, and are potential important factors to evaluate in order to better understand the etiology of pressure ulcers.

  • 10.
    Berkius, Johan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Department of Anaesthesia and Intensive Care, Västervik County Hospital, Västervik, Sweden.
    Engerström, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Orwelius, Lotti
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nordlund, Peter
    Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jönköping,.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten M
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences.
    A prospective longitudinal multicentre study of health related quality of life in ICU survivors with COPD2013In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, p. R211-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.

    METHODS: Fifty-one COPD patients (COPD-ICU group) with an ICU stay longer than 24 hours received a questionnaire at 6, 12 and 24 months after discharge from ICU. HRQL was measured using two generic instruments: the EuroQoL instrument (EQ-5D and EQ-VAS) and the Short Form 36 Health Survey (SF-36). The results were compared to HRQL of two reference groups from the general population; an age- and sex-adjusted reference population (Non-COPD reference) and a reference group with COPD (COPD reference).

    RESULTS: HRQL of the COPD-ICU group at 6 months after discharge from ICU was lower compared to the COPD reference group: Median EQ-5D was 0.66 vs. 0.73, P=0.08 and median EQ-VAS was 50 vs.55, P<0.05. There were no significant differences in the SF-36 dimensions between the COPD-ICU and COPD-reference groups, although the difference in physical functioning (PF) approached statistical significance (P=0.059). Patients in the COPD-ICU group who were lost to follow-up after 6 months had low HRQL scores at 6 months. Scores for patients who died were generally lower compared to patients who failed to respond to the questionnaire. The PF and social functioning (SF) scores in those who died were significantly lower compared to patients with a complete follow up. HRQL of patients in the COPD-ICU group that survived a complete 24 months follow up was low but stable with no statistically significant decline from 6 to 24 months after ICU discharge. Their HRQL at 24 months was not significantly different from HRQL in the COPD reference group.

    CONCLUSIONS: HRQL in COPD survivors after intensive care was low but did not decline from 6 to 24 months after discharge from ICU. Furthermore, HRQL at 24 months was similar to patients with COPD who had not received ICU treatment.

  • 11.
    Björnström-Karlsson, Karin
    et al.
    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.
    Turina, Dean
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences.
    Strid, Tobias
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Eintrei, Christina
    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.
    Orexin A Inhibits Propofol-Induced Neurite Retraction by a Phospholipase D/Protein Kinase C-epsilon-Dependent Mechanism in Neurons2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5, p. e0097129-Article in journal (Refereed)
    Abstract [en]

    Background: The intravenous anaesthetic propofol retracts neurites and reverses the transport of vesicles in rat cortical neurons. Orexin A (OA) is an endogenous neuropeptide regulating wakefulness and may counterbalance anaesthesia. We aim to investigate if OA interacts with anaesthetics by inhibition of the propofol-induced neurite retraction. Methods: In primary cortical cell cultures from newborn rats brains, live cell light microscopy was used to measure neurite retraction after propofol (2 mu M) treatment with or without OA (10 nM) application. The intracellular signalling involved was tested using a protein kinase C (PKC) activator [phorbol 12-myristate 13-acetate (PMA)] and inhibitors of Rho-kinase (HA-1077), phospholipase D (PLD) [5-fluoro-2-indolyl des-chlorohalopemide (FIPI)], PKC (staurosporine), and a PKC epsilon translocation inhibitor peptide. Changes in PKC epsilon Ser(729) phosphorylation were detected with Western blot. Results: The neurite retraction induced by propofol is blocked by Rho-kinase and PMA. OA blocks neurite retraction induced by propofol, and this inhibitory effect could be prevented by FIPI, staurosporine and PKC epsilon translocation inhibitor peptide. OA increases via PLD and propofol decreases PKC epsilon Ser(729) phosphorylation, a crucial step in the activation of PKC epsilon. Conclusions: Rho-kinase is essential for propofol-induced neurite retraction in cortical neuronal cells. Activation of PKC inhibits neurite retraction caused by propofol. OA blocks propofol-induced neurite retraction by a PLD/PKC epsilon-mediated pathway, and PKC epsilon maybe the key enzyme where the wakefulness and anaesthesia signal pathways converge.

  • 12.
    Borendal Wodlin, Ninnie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    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.
    The development of fast-track principles in gynecological surgery2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 1, p. 17-27Article, review/survey (Refereed)
    Abstract [en]

    Fast-track is a multimodal strategy aimed at reducing the physiological burden of surgery to achieve an enhanced postoperative recovery. The strategy combines unimodal evidence-based interventions in the areas of preoperative preparation, anesthesia, surgical factors and postoperative care. The advantages of fast-track most likely extend to gynecology, although so far have scarcely been reported. This review summarizes current evidence concerning use of fast-track in general and in gynecological surgery. The main findings of this review are that there are benefits within elective gynecological surgery, but studies of quality of life, patient satisfaction and health economics in elective surgery are needed. Studies of fast-track within the field of non-elective gynecological surgery are lacking. Widespread education is needed to improve the rate of implementation of fast-track. Close involvement of the entire surgical team is imperative to ensure a structured perioperative care aiming for enhanced postoperative recovery.

  • 13.
    Borendal Wodlin, Ninnie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    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.
    Arestedt, Kristofer
    Linnaeus University, Sweden.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 4, p. 369-379Article in journal (Refereed)
    Abstract [en]

    Objective. To determine whether postoperative symptoms differ between women who undergo abdominal benign hysterectomy in a fast-track model under general anesthesia or spinal anesthesia with intrathecal morphine. Design. Secondary analysis from a randomized, open, multicenter study. Setting. Five hospitals in south-east Sweden. Population. One-hundred and eighty women scheduled for benign hysterectomy were randomized; 162 completed the study; 82 were allocated to spinal and 80 to general anesthesia. Methods. The Swedish Postoperative Symptoms Questionnaire, completed daily for 1 week and thereafter once a week until 5 weeks postoperatively. Main Outcome Measures. Occurrence, intensity and duration of postoperative symptoms. Results. Women who had hysterectomy under spinal anesthesia with intrathecal morphine experienced significantly less discomfort postoperatively compared with those who had the operation under general anesthesia. Spinal anesthesia reduced the need for opioids postoperatively. The most common symptoms were pain, nausea and vomiting, itching, drowsiness and fatigue. Abdominal pain, drowsiness and fatigue occurred significantly less often and with lower intensity among the spinal anesthesia group. Although postoperative nausea and vomiting was reported equally in the two groups, vomiting episodes were reported significantly more often during the first day after surgery in the spinal anesthesia group. Spinal anesthesia was associated with a higher prevalence of postoperative itching. Conclusions. Spinal anesthesia with intrathecal morphine carries advantages regarding postoperative symptoms and recovery following fast-track abdominal hysterectomy.

  • 14.
    Borendal Wodlin, Ninnie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    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.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Cost-effectiveness of general anesthesia versus spinal anesthesia in fast track abdominal benign hysterectomy2011In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 205, no 4, p. 043-Article in journal (Refereed)
    Abstract [en]

    Objective: The study objective was to compare total costs for hospital stay and postoperative recovery for two groups of women who underwent fast track abdominal benign hysterectomy, one group under general anesthesia, the other under spinal anesthesia. Costs were evaluated in relation to health related quality of life.

    Study Design: Costs of treatment using data from a randomized multicenter study at five hospitals in Sweden were analyzed retrospectively. Of 180 women scheduled for benign abdominal hysterectomy; 162 were randomized for the study, 80 allocated to general anesthesia and 82 to spinal anesthesia.

    Results: Total costs (hospital costs plus costs reduced productivity costs) were lower for the spinal anesthesia group. Women who had spinal anesthesia had a faster recovery measured by health related quality of life and QALYs gained in postoperative month one.

    Conclusion: Use of spinal anesthesia for fast track benign abdominal hysterectomy was more cost-effective than general anesthesia.

  • 15.
    Borendal Wodlin, Ninnie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    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.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Health-related quality of life and postoperative recovery in fast-track hysterectomy2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 4, p. 362-368Article in journal (Refereed)
    Abstract [en]

    Objective. To determine whether health-related quality of life (HRQoL) and postoperative recovery of women who undergo abdominal hysterectomy in a fast-track program under general anesthesia (GA) differ from women who receive spinal anesthesia with intrathecal morphine (SA). Design. Secondary analysis from an open randomized controlled multicenter study. Setting. Five hospitals in south-east Sweden. Population. One hundred and eighty women admitted for abdominal hysterectomy for benign disease were randomized; 162 completed the study, 80 with GA and 82 with SA. Methods. The HRQoL was measured preoperatively using the EuroQoL EQ-5D and the Short-Form-36 health survey (SF-36) questionnaires. The EQ-5D was used daily for 1 week; thereafter, once weekly for 4 weeks and again 6 months after operation. The SF-36 was completed at 5 weeks and 6 months. Dates of commencing and ending sick leave were registered. Main Outcome Measures. Changes in HRQoL; duration of sick leave. Results. The HRQoL improved significantly faster in women after SA than after GA. Sick leave was significantly shorter after SA than after GA (median 22.5 vs. 28 days). Recovery of HRQoL and duration of sick leave were negatively influenced by postoperative complications. In particular, the mental component of HRQoL was negatively affected by minor complications, even 6 months after the operation. Conclusions. Spinal anesthesia with intrathecal morphine provided substantial advantages in fast-track abdominal hysterectomy for benign gynecological disorders by providing faster recovery and shorter sick leave compared with general anesthesia.

  • 16.
    Borendal Wodlin, Ninnie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    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.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Snabbspår har fördelar vid elektiv gynekologisk kirurgi.2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 25-26, p. 2-7Article in journal (Refereed)
    Abstract [en]

    Fast-track is a multimodal strategy aimed at achieving an improved and accelerated postoperative recovery. The strategy combines unimodal evidence-based interventions concerning preoperative preparation, peroperative principles and postoperative care. There is substantial evidence for the benefits of following fast-track concepts in general elective surgery to enhance postoperative recovery. The main findings of this review are that there are benefits likewise within elective gynecological surgery, but studies of quality of life, patient satisfaction and health economics are needed. Studies of fast-track within non-elective surgery and gynaecological oncology surgery are lacking. Widespread information and education is needed to improve the rate of implementation of fast-track. Comprehensive involvement of the entire staff dealing with the patient in the perioperative period is crucial to ensure implementation and development of surgical care aiming for enhanced postoperative recovery.

  • 17.
    Borendal Wodlin, Ninnie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    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.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    The impact of mode of anaesthesia on postoperative recovery from fast-track abdominal hysterectomy: a randomised clinical trial2011In: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 118, no 3, p. 299-308Article in journal (Refereed)
    Abstract [en]

    Objective To determine whether the duration of hospital stay after abdominal hysterectomy in a fast-track setting differed between women operated under general anaesthesia or in spinal anaesthesia with intrathecal morphine. Design An open randomised controlled multicentre study. Setting Five hospitals in the south-east of Sweden. Population One hundred and eighty women scheduled for benign hysterectomy were randomised: 162 completed the study, 82 were allocated to spinal anaesthesia and 80 were allocated to general anaesthesia. Methods Fast-track model comprising no use of sedatives for premedication, pre-emptive anti-emetic therapy, intravenous fluid restriction, analgesics based on non-opioids, early enteral nutrition and mobilisation, and standard criteria for discharge. Spinal anaesthesia with 20 mg hyperbaric bupivacaine and 0.2 mg morphine. General anaesthesia with propofol, fentanyl and rocuronium, and with continuous propofol and ventilation with oxygen-in-air for maintenance of anaesthesia. Main outcome measures Hospital stay, consumption of analgesics, vomiting, pruritus and bowel function recovery. Results Median hospitalisation did not differ significantly between women who had hysterectomy with spinal or general anaesthesia (46 and 50 hours, respectively). Spinal anaesthesia was associated with a significantly lower use of opioids and a faster recovery of bowel function, although vomiting and pruritus were more prevalent. Conclusions In a fast-track model the duration of hospitalisation after abdominal hysterectomy was andlt; 50 hours, independent of the mode of anaesthesia. Spinal anaesthesia reduced the need for postoperative morphine compared with general anaesthesia. In order to improve patient recovery after gynaecological surgery further studies based on fast-track programmes are needed.

  • 18.
    Elfstrom, J.
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Patient Security.
    Nilsson, Lena
    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. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre.
    Sturnegk, C.
    Östergötlands Läns Landsting, Patient Security.
    Sjukvårdens händelse-analyser bör skärpas och involvera läkare2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 48, p. 3262-3267Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 19.
    Elmasry, Moustafa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Suez Canal University, Egypt .
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Letter: "Is the length of time in acute burn surgery associated with poorer outcomes?"2014In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 40, no 4, p. 772-773Article in journal (Other academic)
    Abstract [en]

    n/a

  • 20.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Farmakologisk smärtbehandling (& illamående) i samband med tonsilloperation2012Conference paper (Refereed)
  • 21.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)2013Conference paper (Other academic)
    Abstract [sv]

    Premedicinering kan göras enligt sjukhusets vanliga rutiner. En möjlig kombination som oral premedicinering (= start av multimodal smärtbehandling) är paracetamol (40 mg/kg), klonidin (2–3 mikrog/kg) och betametason (0,2 mg/kg, max 8 mg) enligt kroppsvikt eller 4 mg vid vikt under 50 kg, 8 mg vid vikt över 50 kg som ges cirka 90 minuter innan anestesistart.

    Alternativt ges ovanstående läkemedel i samband med inledningen av anestesin men med doseringsförslag som anges under smärtbehandling per operativt nedan.

    Smärtbehandling peroperativt

    Paracetamol bör ges intravenöst (20 mg/kg) och intravenöst betametason (0,2 mg(kg) om inte det ingått i premedicineringen. Vid slutet av operationen ges en dos av COX hämmare (diklofenak 1 mg/kg rektalt eller intravenöst, alternativt ibuprofen 5–7 mg/kg rektalt). Om klonidin inte givits som premedicinering kan en intravenös dos ges vid inledningen av anestesin, 1 mikrog/kg intravenöst. Med klonidin kan övriga underhållsanestetika ofta reduceras med cirka 25%. För att minska den tidiga smärtan kan också kompresser indränkta med bupivacain 5 mg/ml läggas på sårområdet i cirka 5 minuter.

    Initial postoperativ smärta behandlas med intravenösa opioider, paracetamol och klonidin titrerat till för individen acceptabel smärtnivå. Smärtskattning ska göras med ålderadekvat instrument.

    Illamående, profylax och behandling

    I samband med anestesiinledningen ges betametason samt vid indikation ondansetron 0,1 mg/kg för att förbygga postoperativt illamående. Behandling kan ske med ondansetron 0,1 mg/kg, prometazin 0,1 mg/kg (licenspreparat) eller droperidol 30 mikrog/kg. En kombination av antiemetika ger bättre effekt. En fördel är att inducera anestesin med propofol om intravenös infart finns.

    Smärtbehandling i hemmet

    Paracetamol 24 mg/kg x 4 i tre dygn och därefter minska till 18 mg/kg x 4 (paracetamolmixturen är 24 mg/ml vilket innebär att den initiala behandlingen blir 1 ml/kg x 4 om mixturen används). Kombinera paracetamol med COXhämmare ibuprofen 5–7mg/kg x 4 eller diklofenak 1–1,5 mg/kg x 3. Vid blödningsrisk kan selektiv COX-2 hämmare användas, celecoxib 2 mg/kg x 2, som alternativ till ibuprofen och diklofenak. COX hämmare och paracetamol utgör basen i analgetikabehandlingen och ska ges regelbundet.

    För ytterligare smärtbehandling kan t. ex klonidin ges i dosen 1–2 mikrog/kg x 3 per os. Opioider kan behövas i vissa fall men insättning bör göras efter kontakt med ÖNH kliniken. Ur praktisk synvinkel rekommenderas att doser av klonidin- eller opioidmixtur (oxikodon eller morfin) dras upp i sprutor med engångsdoser när analgetika skickas med vid utskrivningen. Antalet doser som skickas hem med patienten bestäms av behovet och lokala rutiner. När smärtan avklingar kan man börja sätta ut analgetika: först opioider, därefter klonidin, paracetamol och sist COX hämmare. (Enstaka doser av COX hämmare ger en bättre analgetisk effekt än enstaka doser av paracetamol).

    Smärtbehandling kan behövas upp till 2–3 veckor efter tonsillektomi, och drygt en vecka efter tonsillotomi. Vid tonsillotomi räcker det oftast med paracetamol kombinerat med COX-hämmare. Som förslag i nationella riktlinjer föreslås en behandlingslängd med COX-hämmare i kombination med paracetamol i 3–5 dygn vid tonsillotomi och 5–8 dygn vid tonsillektomi.

  • 22.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Processen med utformning av nationella farmakologiska riktlinjer i samband med tonsilloperation2013In: Ventilen, ISSN 0348-6257, Vol. 4, no 48, p. 17-Article in journal (Other academic)
  • 23.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Vägen till webbaserad information vid tonsilloperation2012Conference paper (Refereed)
  • 24.
    Ericsson, Elisabeth
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Brattwall, Metha
    Västra Götalandsregionen.
    Lundeberg, Stefan
    Karolinska Institutet, Stockholm.
    Farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar2013In: Nationellt kvalitetsregister Öron-, Näs- och Halssjukvård: Årsrapport 2012, Svensk förening för Otorhinolarungologi, Huvud- och Halskirurgi , 2013, p. 64-71Chapter in book (Other academic)
    Abstract [sv]

    Premedicinering kan göras enligt sjukhusets vanliga rutiner. En möjlig kombination som oral premedicinering (= start av multimodal smärtbehandling) är paracetamol (40 mg/kg), klonidin (2–3 mikrog/kg) och betametason (0,2 mg/kg, max 8 mg) enligt kroppsvikt eller 4 mg vid vikt under 50 kg, 8 mg vid vikt över 50 kg som ges cirka 90 minuter innan anestesistart.

    Alternativt ges ovanstående läkemedel i samband med inledningen av anestesin men med doseringsförslag som anges under smärtbehandling per operativt nedan.

    Smärtbehandling peroperativt

    Paracetamol bör ges intravenöst (20 mg/kg) och intravenöst betametason (0,2 mg(kg) om inte det ingått i premedicineringen. Vid slutet av operationen ges en dos av COX hämmare (diklofenak 1 mg/kg rektalt eller intravenöst, alternativt ibuprofen 5–7 mg/kg rektalt). Om klonidin inte givits som premedicinering kan en intravenös dos ges vid inledningen av anestesin, 1 mikrog/kg intravenöst. Med klonidin kan övriga underhållsanestetika ofta reduceras med cirka 25%. För att minska den tidiga smärtan kan också kompresser indränkta med bupivacain 5 mg/ml läggas på sårområdet i cirka 5 minuter.

    Initial postoperativ smärta behandlas med intravenösa opioider, paracetamol och klonidin titrerat till för individen acceptabel smärtnivå. Smärtskattning ska göras med ålderadekvat instrument.

    Illamående, profylax och behandling

    I samband med anestesiinledningen ges betametason samt vid indikation ondansetron 0,1 mg/kg för att förbygga postoperativt illamående. Behandling kan ske med ondansetron 0,1 mg/kg, prometazin 0,1 mg/kg (licenspreparat) eller droperidol 30 mikrog/kg. En kombination av antiemetika ger bättre effekt. En fördel är att inducera anestesin med propofol om intravenös infart finns.

    Smärtbehandling i hemmet

    Paracetamol 24 mg/kg x 4 i tre dygn och därefter minska till 18 mg/kg x 4 (paracetamolmixturen är 24 mg/ml vilket innebär att den initiala behandlingen blir 1 ml/kg x 4 om mixturen används). Kombinera paracetamol med COXhämmare ibuprofen 5–7mg/kg x 4 eller diklofenak 1–1,5 mg/kg x 3. Vid blödningsrisk kan selektiv COX-2 hämmare användas, celecoxib 2 mg/kg x 2, som alternativ till ibuprofen och diklofenak. COX hämmare och paracetamol utgör basen i analgetikabehandlingen och ska ges regelbundet.

    För ytterligare smärtbehandling kan t. ex klonidin ges i dosen 1–2 mikrog/kg x 3 per os. Opioider kan behövas i vissa fall men insättning bör göras efter kontakt med ÖNH kliniken. Ur praktisk synvinkel rekommenderas att doser av klonidin- eller opioidmixtur (oxikodon eller morfin) dras upp i sprutor med engångsdoser när analgetika skickas med vid utskrivningen. Antalet doser som skickas hem med patienten bestäms av behovet och lokala rutiner. När smärtan avklingar kan man börja sätta ut analgetika: först opioider, därefter klonidin, paracetamol och sist COX hämmare. (Enstaka doser av COX hämmare ger en bättre analgetisk effekt än enstaka doser av paracetamol).

    Smärtbehandling kan behövas upp till 2–3 veckor efter tonsillektomi, och drygt en vecka efter tonsillotomi. Vid tonsillotomi räcker det oftast med paracetamol kombinerat med COX-hämmare. Som förslag i nationella riktlinjer föreslås en behandlingslängd med COX-hämmare i kombination med paracetamol i 3–5 dygn vid tonsillotomi och 5–8 dygn vid tonsillektomi.

  • 25.
    Ericsson, Elisabeth
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Brattwall, Metha
    Västra Götalandsregionen.
    Lundeberg, Stefan
    Karolinska Institutet, Stockholm.
    Grunddokument till nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)2013In: Svensk ÖNH-tidskrift, ISSN 1400-0121, Vol. 20, no 3, p. 6p. 18-26Article in journal (Refereed)
    Abstract [sv]

    I Sverige utförs 13000 tonsilloperationer varje år, över 50 % utförs på barn under 15 år. Tonsilloperation medför svår och långvarig smärta samt hög frekvens av illamående.

    Smärtan är ofta värst dag 3 till 5 efter tonsillektomi. Tonsillotomi ger generellt upphov till mindre smärta än tonsillektomi. Dehydrering och sämre näringsintag kan vara en orsak till större smärtproblematik vid tonsillektomier. Äldre barn som genomfört tonsilloperation skattar högre postoperativ smärta vilket kräver ökat behov av analgetika.

    Olika interventioner inklusive farmakologiska används för att behandla och förebygga smärta och illamående. De vanligaste systemiska analgetika som används är paracetamol, COX-hämmare samt opioider. Användande av opioider vid tonsillektomi på barn med och obstruktiv sömnapné kan ge upphov till allvarliga komplikationer 4. Alfa-2 adrenerga agonister som klonidin har en analgetisk effekt utan påverkan på andningsdriven. Klonidin kan vara ett bra komplement då paracetamol i kombination med COX-hämmare inte har tillräcklig analgetisk effekt. Olika regionala metoder med bl.a. lokalbedövningsmedel används också med viss effekt.

  • 26.
    Ericsson, Elisabeth
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lundeberg, Stefan
    Smärtbehandlingsenheten, Astrid Lindgrens Barnsjukhus, Stockholm.
    Brattwall, Metha
    An/Op/IVA/Sc Sahlgrenska Universitetssjukhuset, Mölndal.
    Stalfors, Joacim
    ÖNH-Kliniken, Sahlgrenska Universitetssjukhuset, Göteborg.
    Hemlin, Claes
    ÖNH-Kliniken, Aleris Specialistvård Sabbatsberg, Stockholm.
    Hessén-Söderman, Anne Charlotte
    ÖNH-Kliniken, Aleris Specialistvård Sabbatsberg, Stockholm.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Sunnergren, Ola
    ÖNH- Kliniken, Länssjukhuset Ryhov, Jönköping.
    Odhagen, Erik
    ÖNH-Kliniken, Södra Älvsborgs Sjukhus, Borås.
    Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)2013In: Ventilen, ISSN 0348-6257, Vol. 4, no 48, p. 18-19Article in journal (Other academic)
  • 27.
    Ericsson, Elisabeth
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lundeberg, Stefan
    Smärtbehandlingsenheten, Astrid Lindgrens Barnsjukhus, Stockholm.
    Brattwall, Metha
    An/Op/IVA/Sc Sahlgrenska Universitetssjukhuset, Mölndal.
    Stalfors, Joacim
    ÖNH-Kliniken, Sahlgrenska Universitetssjukhuset, Göteborg.
    Hemlin, Claes
    ÖNH-Kliniken, Aleris Specialistvård Sabbatsberg, Stockholm.
    Hessén-Söderman, Anne-Charlotte
    ÖNH-Kliniken, Aleris Specialistvård Sabbatsberg, Stockholm.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Sunnergren, Ola
    ÖNH- Kliniken, Länssjukhuset Ryhov, Jönköping.
    Odhagen, Erik
    ÖNH-Kliniken, Södra Älvsborgs Sjukhus, Borås.
    Nationella riktlinjer för farmakologisk behandling av smärta och illamående i samband med tonsillotomi och tonsillektomi på barn och ungdomar (<18 år)2013In: Svensk ÖNH-tidskrift, ISSN 1400-0121, Vol. 30, no 3, p. 4p. 1-5Article in journal (Refereed)
    Abstract [sv]

    Riktlinjerna är framtagna av referensgruppen för Tonsilloperation. Syftet med dessa riktlinjer är att optimera det perioperativa omhändertagandet (premedicinering - peroperativt - postoperativt smärtomhändertagande) i samband med tonsilloperationer på barn och ungdomar. Bakgrund och referenser till riktlinjerna finns i ett separat dokument.

    Riktlinjerna gäller för friska barn. Finns det riskfaktorer som ex grav sömnapné, kraftig övervikt, komplicerande sjukdomstillstånd eller organpåverkan behöver den farmakologiska behandlingen anpassas efter situationen.

    Tonsillkirurgi medför svår och långvarig smärta samt hög frekvens av illamående. Smärtan är ofta värst dag 3 till 5 efter tonsillektomi. Tonsillotomi ger generellt upphov till mindre smärta än tonsillektomi. För att uppnå effekt behöver den farmakologiska smärtbehandlingen påbörjas redan vid premedicineringen och fortlöpa under själva anestesin/ingreppet. En multimodal behandling ska eftersträvas och målsättningen är att uppnå en för individen acceptabel smärtnivå i det postoperativa skedet och i hemmet.

    Den farmakologiska behandlingen ska kombineras med preoperativ information om ingreppet till patienten och vårdnadshavare. En lugn och trygg situation före anestesistart ökar chanserna för ett lugnt postoperativt förlopp.

  • 28.
    Ericsson, Elisabeth
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Nilsson, A
    Lundberg, L
    Kjellman, B-M
    Karlsson-Björnström, K
    Zetterlund, E-L
    Post Graduate utbildning för specialistutbildade sjuksköterskor inom anestesiologisk vård ett unikt samarbete mellan landsting och universitet2013Conference paper (Other academic)
  • 29.
    Gerdin, Bengt
    et al.
    Uppsala University Hospital.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Professor Gösta Arturson (1927–2013): Obituary2013In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 8, p. 1654-1655Article in journal (Other (popular science, discussion, etc.))
  • 30.
    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.

  • 31.
    Hahn, R 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.
    Letter: Haemodilution made difficult2013In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 111, no 4, p. 679-680Article in journal (Other academic)
    Abstract [en]

    n/a

  • 32.
    Hahn, Robert
    et al.
    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.
    Bahlmann, Hans
    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.
    Nilsson, Lena
    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.
    Dehydration and fluid volume kinetics before major open abdominal surgery2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 10, p. 1258-1266Article in journal (Refereed)
    Abstract [en]

    Introduction: Assessment of dehydration in the preoperative setting is of potential clinical value. The present study uses urine analysis and plasma volume kinetics, which have both been validated against induced changes in body water in volunteers, to study the incidence and severity of dehydration before open abdominal surgery begins. Methods: Thirty patients (mean age 64 years) had their urine analysed before major elective open abdominal surgery for colour, specific weight, osmolality and creatinine. The results were scored and the mean taken to represent a dehydration index. Thereafter, the patients received an infusion of 5ml/kg of Ringers acetate intravenously for over 15min. Blood was sampled for 70min and the blood haemoglobin concentration used to estimate the plasma volume kinetics. Results: Distribution of fluid occurred more slowly (Pless than0.01) and the elimination half-life was twice as long (median 40min, not significant) in the 11 patients (37%) diagnosed to be moderately dehydrated as compared with euhydrated patients. The dehydration index indicated that the fluid deficit in these patients corresponded to 2.5% of the body weight, whereas the deficit in the others was 1%. In contrast, the 11 patients who later developed postoperative nausea and vomiting had a very short elimination half-life, only 9min (median, Pless than0.01). These patients were usually euhydrated but had microalbuminuria (Pless than0.03) and higher natriuresis (Pless than0.01). Conclusions: The degree of dehydration before major surgery was modest as evidenced both by urine sampling and volume kinetic analysis.

  • 33.
    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, Sweden.
    Should anaesthetists stop infusing isotonic saline?2014In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 112, no 1, p. 4-6Article in journal (Refereed)
  • 34.
    Hahn, Robert
    et al.
    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.
    Geback, Tobias
    Chalmers, Sweden .
    Fluid volume kinetics of dilutional hyponatremia; a shock syndrome revisited2014In: Clinics, ISSN 1807-5932, E-ISSN 1980-5322, Vol. 69, no 2, p. 120-127Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate whether the pathophysiology of shock syndromes can be better understood by comparing central hemodynamics with kinetic data on fluid and electrolyte shifts. METHODS: We studied the dilutional hyponatremic shock that developed in response to overhydration with electrolyte-free irrigating fluid - the so-called transurethral resection syndrome - by comparing cardiac output, arterial pressures, and volume kinetic parameters in 17 pigs that were administered 150 ml/kg of either 1.5% glycine or 5% mannitol by intravenous infusion over 90 minutes. RESULTS: Natriuresis appeared to be the key factor promoting hypovolemic hypotension 15-20 minutes after fluid administration ended. Excessive sodium excretion, due to osmotic diuresis caused by the irrigant solutes, was associated with high estimates of the elimination rate constant (k(10)) and low or negative estimates of the rate constant describing re-distribution of fluid to the plasma after translocation to the interstitium (k(21)). These characteristics indicated a high urinary flow rate and the development of peripheral edema at the expense of plasma volume and were correlated with reductions in cardiac output. The same general effects of natriuresis were observed for both irrigating solutions, although the volume of infused 1.5% glycine had a higher tendency to enter the intracellular fluid space. CONCLUSION: Comparisons between hemodynamics and fluid turnover showed a likely sequence of events that led to hypovolemia despite intravenous administration of large amounts of fluid.

  • 35.
    Iredahl, Fredrik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Tesselaar, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Sarker, Saikat
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Farnebo, Simon
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    The Microvascular Response to Transdermal Iontophoresis of Insulin is Mediated by Nitric Oxide2013In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 20, no 8, p. 717-723Article in journal (Refereed)
    Abstract [en]

    ObjectiveInsulin has direct effects on blood flow in various tissues, most likely due to endothelial NO production. We investigated whether insulin delivered to the skin by iontophoresis increases microvascular perfusion and whether this effect is partly or completely mediated by the release of NO. MethodsIn healthy subjects, regular insulin and monomeric insulin were delivered to the skin by cathodal iontophoresis. The skin was pretreated either with L-NAME or control solution (PBS) using anodal iontophoresis. Microvascular responses were measured using laser Doppler flowmetry. ResultsA dose-dependent increase in perfusion was observed during iontophoresis of regular and monomeric insulin. The maximum perfusion was significantly elevated compared with control after PBS (regular insulin 53.6 (12.7-95.6) PU vs. 4.2 (3.4-4.8) PU, p = 0.002; monomeric insulin 32.6 (8.9-92.6) PU vs. 5.9 (3.4-56.0) PU, p = 0.03). The microvascular response to insulin was abolished after L-NAME (regular insulin: 25.6 (11.6-54.4) PU vs. control: 4.7 (2.9-11.5) PU, p = 0.15; monomeric insulin 10.9 (5.4-56.8) PU vs. control: 4.7 (2.9-11.5) PU, p = 0.22). ConclusionsThe main finding is that iontophoresis of insulin induces a dose-dependent vasodilation in the skin, which could be suppressed after pretreatment with a NO synthase inhibitor. This suggests that vasodilation in the skin after iontophoresis of insulin is mediated by the NO pathway.

  • 36.
    Johansson, J
    et al.
    Ostersund Hospital, Sweden .
    Brattstrom, O
    Karolinska Institute, Sweden .
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lindbom, L
    Karolinska Institute, Sweden .
    Herwald, H
    Lund University, Sweden .
    Weitzberg, E
    Karolinska Institute, Sweden .
    Oldner, A
    Karolinska Institute, Sweden .
    Heparin-binding protein (HBP): an early marker of respiratory failure after trauma?2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 5, p. 580-586Article in journal (Refereed)
    Abstract [en]

    Background Trauma and its complications contribute to morbidity and mortality in the general population. Trauma victims are susceptible to acute respiratory distress syndrome (ARDS) and sepsis. Polymorphonuclear leucocytes (PMNs) are activated after trauma and there is substantial evidence of their involvement in the development of ARDS. Activated PMNs release heparin-binding protein (HBP), a granule protein previously shown to be involved in acute inflammatory reactions. We hypothesised that there is an increase in plasma HBP content after trauma and that the increased levels are related to the severity of the trauma or later development of severe sepsis and organ failure (ARDS). Methods and Material We investigated HBP in plasma samples within 36h from trauma in 47 patients admitted to a level one trauma centre with a mean injury severity score (ISS) of 26 (2134). ISS, admission sequential organ failure assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded at admission. ARDS and presence of severe sepsis were determined daily during intensive care. Results We found no correlation between individual maximal plasma HBP levels at admission and ISS, admission SOFA or APACHE II. We found, however, a correlation between HBP levels and development of ARDS (P=0.026, n=47), but not to severe sepsis. Conclusion HBP is a potential biomarker candidate for early detection of ARDS development after trauma. Further research is required to confirm a casual relationship between plasma HBP and the development of ARDS.

  • 37.
    Johansson, Joakim
    et al.
    The research and development unit, Jämtland county council, Östersund, Sweden.
    Sjöberg, Jonas
    Department of Anaesthesiology and Intensive Care, Östersund hospital, Östersund, Sweden.
    Nordgren, Marie
    Department of Anaesthesiology and Intensive Care, Östersund hospital, Östersund, Sweden.
    Sandström, Erik
    Department of Anaesthesiology and Intensive Care, Östersund hospital, Östersund, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Zetterström, Henrik
    Department of Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
    Prehospital analgesia using nasal administration of S-ketamine – a case series2013In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, no 38Article in journal (Refereed)
    Abstract [en]

    Pain is a problem that often has to be addressed in the prehospital setting. The delivery of analgesia may sometimes prove challenging due to problems establishing intravenous access or a harsh winter environment. To solve the problem of intravenous access, intranasal administration of drugs is used in some settings. In cases where vascular access was foreseen or proved hard to establish (one or two missed attempts) on the scene of the accident we use nasally administered S-Ketamine for prehospital analgesia. Here we describe the use of nasally administered S-Ketamine in 9 cases. The doses used were in the range of 0,45-1,25 mg/kg. 8 patients were treated in outdoor winter-conditions in Sweden. 1 patient was treated indoor. VAS-score decreased from a median of 10 (interquartile range 8-10) to 3 (interquartile range 2-4). Nasally administered S-Ketamine offers a possible last resource to be used in cases where establishing vascular access is difficult or impossible. Side-effects in these 9 cases were few and non serious. Nasally administered drugs offer a needleless approach that is advantageous for the patient as well as for health personnel in especially challenging selected cases. Nasal as opposed to intravenous analgesia may reduce the time spent on the scene of the accident and most likely reduces the need to expose the patient to the environment in especially challenging cases of prehospital analgesia. Nasal administration of S-ketamine is off label and as such we only use it as a last resource and propose that the effect and safety of the treatment should be further studied.

  • 38.
    Kallunki, Jenny
    et al.
    Östergötlands Läns Landsting, Public Dental Health Care.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Ericsson, Elisabeth
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Tonsillotomy versus tonsillectomy--a randomized trial regarding dentofacial morphology and post-operative growth in children with tonsillar hypertrophy2014In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 36, no 4, p. 471-478Article in journal (Refereed)
    Abstract [en]

    Objectives:The primary aim of this study was to analyse two different methods of tonsil surgery, tonsillectomy (TE) and tonsillotomy (TT), regarding post-operative dentofacial growth in children with tonsillar hypertrophy. A secondary aim was to analyse these results in relation to cephalometric standards.Material and methods:The study group consisted of 64 subjects (39 boys and 25 girls), mean age 4.8 years ± 4 months. They were randomized to a complete removal of the pharyngeal tonsil, TE, (n = 31) or a partial removal, TT, (n = 33). Pre-operative and 2 years post-operative study material were obtained and analysed. The results were compared with cephalometric standards.Results:Pre-operative, children with hypertrophic tonsils displayed an increased vertical relation (P < 0.05) compared with cephalometric standards. Post-operative, no significant difference could be detected between the two surgical procedures regarding dentofacial growth. Mandibular growth with an anterior inclination was significant (P < 0.001/TE, P < 0.01/TT) for both groups. An increased upper and lower incisor inclination was noted (P < 0.01/TE,TT). The vertical relation decreased (P < 0.001/TE, P < 0.05/TT) as well as the mandibular angle (P < 0.01/TE, P < 0.001/TT). Reduction was also significant for the sagittal intermaxillar (P < 0.001/TE,TT) relation. These post-operative results, together with a more prognatic mandible (P < 0.05/TE,TT) and chin (P < 0.001/TE, P < 0.01/TT), might indicate a more horizontal direction of mandibular growth.Conclusion:TE and TT yielded equal post-operative dentofacial growth in children treated for hypertrophic tonsils. This result should be considered when deciding upon surgical technique.

  • 39.
    Kjölhede, Preben
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Borendal Wodlin, Ninnie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    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.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Impact of stress coping capacity on recovery from abdominal hysterectomy in a fast-track programme: a prospective longitudinal study2012In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, no 8, p. 998-1007Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the effect of stress coping capacity in combination with mode of anaesthesia on postoperative recovery in fast-track abdominal hysterectomy. Design Prospective longitudinal study. Setting Five hospitals in the south-east of Sweden. Population A cohort of 162 women undergoing fast-track abdominal hysterectomy for benign conditions. Methods Self-administered questionnaires, the Stress Coping Inventory (SCI) and the Swedish Postoperative Symptom Questionnaire (SPSQ), and clinical information were collected prospectively. Stress coping capacity was categorised as high or low according to the summed score of the SCI. Comparisons of effect variables were adjusted using a propensity score-matching model. Main outcome measures Associations between stress coping capacity and hospital stay, sick leave, use of analgesic and self-reported postoperative symptoms. Results Women with high stress coping capacity had a significantly shorter sick leave, experienced postoperative symptoms significantly less often, and with lower intensity, than women with low stress coping capacity. With the exception of symptom intensity, these findings were related to having had the operation under spinal anaesthesia as opposed to general anaesthesia. Hospital stay, use of analgesics and abdominal pain were not related to stress coping capacity. Conclusions In patients for whom spinal anaesthesia was applied, high stress coping seems to be a quality that helps patients manage the burden of surgery. It is desirable for the individual, as well as for the healthcare system, to enhance recovery by using intervention programmes designed to improve or manage stress coping, particularly for individuals with low stress coping capacity. This recommendation merits further investigation.

  • 40.
    Kjölhede, Preben
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Langström, Petra
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Nilsson, Pernilla
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Borendal Wodlin, Ninnie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    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.
    Quality of sleep the night after surgery, does it matter? A prospective cohort study of women undergoing fast track abdominal hysterectomy in ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, vol 91, issue SI, pp 18-182012In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, Informa Healthcare / Wiley-Blackwell , 2012, Vol. 91, no SI, p. 18-18Conference paper (Refereed)
    Abstract [en]

    n/a

  • 41.
    Kjölhede, Preben
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Langström, Petra
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Nilsson, Pernilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Borendal Wodlin, Ninnie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lena
    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.
    The Impact of Quality of Sleep on Recovery from Fast-Track Abdominal Hysterectomy2012In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 8, no 4, p. 395-402Article in journal (Refereed)
    Abstract [en]

    Study Objectives: To examine the impact of mode of anesthesia on perceived quality of sleep and to analyze the perceived quality of sleep in affecting recovery from surgery. less thanbrgreater than less thanbrgreater thanMethods: A randomized, controlled, open multicenter trial was conducted in 5 hospitals in Southeast Sweden. One-hundred eighty women scheduled for fast-track abdominal hysterectomy for benign conditions were randomized to spinal anesthesia or general anesthesia; 162 women completed the trial; 82 allocated to spinal anesthesia and 80 to general anesthesia. Symptoms and perceived quality of sleep after surgery were registered daily in the Swedish Postoperative Symptoms Questionnaire. less thanbrgreater than less thanbrgreater thanResults: Women in the general anesthesia group experienced bad quality of sleep the night after surgery significantly more often than the women who had spinal anesthesia (odds ratio [OR] 2.45; p = 0.03). This was almost exclusively attributed to a significantly higher consumption of opioids postoperatively in the general anesthesia group. Risk factors for bad quality of sleep during the first night postoperatively were: opioids (OR 1.07; p = 0.03); rescue antiemetics (OR 2.45; p = 0.05); relative weight gain (OR 1.47; p = 0.04); summary score of postoperative symptoms (OR 1.13; p = 0.02); and stress coping capacity (OR 0.98; p = 0.01). A longer hospital stay was strongly associated with a poorer quality of sleep the first night postoperatively (p = 0.002). less thanbrgreater than less thanbrgreater thanConclusions: The quality of sleep the first night after abdominal hysterectomy is an important factor for recovery. In fast-track abdominal hysterectomy, it seems important to use anesthesia and multimodal analgesia reducing the need for opioids postoperatively and to use strategies that diminish other factors that may interfere negatively with sleep. Efforts to enhance quality of sleep postoperatively by means of preventive measures and treatment of sleep disturbances should be included in fast-track programs.

  • 42.
    Landström, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Rehn, Ing-Marie
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Perceptions of registered and enrolled nurses on thirst in mechanically ventilated adult patients in intensive care units-a phenomenographic study.2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 3, p. 133-139Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Thirst is a commonly experienced source of discomfort among patients receiving mechanical ventilation during intensive care. Dehydration, endotracheal tubes, electrolyte disturbances and the use of various medicines can contribute to the feeling of thirst. At present, the knowledge of nurses' perceptions of the feelings of thirst in mechanically ventilated patients are limited. PURPOSE: The purpose of this study was to describe registered and enrolled intensive care nurses' perceptions of the feelings of thirst in mechanically ventilated adult patients and to investigate the interventions to reduce thirst. METHOD: Ten registered intensive care nurses and 10 enrolled nurses, aged 32-59 years, were interviewed. They all had at least one year's experience in caring for adult, mechanically ventilated patients. The data were analysed using a phenomenographic methodology. FINDINGS: Four categories of perceptions among registered and enrolled nurses, regarding thirst in mechanically ventilated patients were identified: reasons for thirst, signs of thirst, preventing or reducing thirst and the perception that patients had no feelings of thirst. CONCLUSIONS: Registered and enrolled nurses wish to reduce sources of discomfort among their patients but they do not always realise that patients feel thirst and therefore relieving it has a low priority among staff. Relieving thirst is a human need that must be recognised in nursing education and on intensive care units.

  • 43.
    Li, Yuhong
    et al.
    Shaoxing Peoples Hospital, Peoples R China; Zhejiang University, Peoples R China.
    He, Rui
    Shaoxing Peoples Hospital, Peoples R China.
    Ying, Xiaojiang
    Shaoxing Peoples Hospital, Peoples R China.
    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 Intensive Care in Linköping. Sodertalje Hospital, Sweden.
    Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia2014In: Clinics, ISSN 1807-5932, E-ISSN 1980-5322, Vol. 69, no 12, p. 809-816Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Fluid volume optimization guided by stroke volume measurements reduces complications of colorectal and high-risk surgeries. We studied whether dehydration or a strong hemodynamic response to general anesthesia increases the probability of fluid responsiveness before surgery begins. METHODS: Cardiac output, stroke volume, central venous pressure and arterial pressures were measured in 111 patients before general anesthesia (baseline), after induction and stepwise after three bolus infusions of 3 ml/kg of 6% hydroxyethyl starch 130/0.4 (n = 86) or Ringers lactate (n = 25). A subgroup of 30 patients who received starch were preloaded with 500 ml of Ringers lactate. Blood volume changes were estimated from the hemoglobin concentration and dehydration was estimated from evidence of renal water conservation in urine samples. RESULTS: Induction of anesthesia decreased the stroke volume to 62% of baseline (mean); administration of fluids restored this value to 84% (starch) and 68% (Ringers). The optimized stroke volume index was clustered around 35-40 ml/m(2)/beat. Additional fluid boluses increased the stroke volume by greater than= 10% (a sign of fluid responsiveness) in patients with dehydration, as suggested by a low cardiac index and central venous pressure at baseline and by high urinary osmolality, creatinine concentration and specific gravity. Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness. The blood volume expanded 2.3 (starch) and 1.8 (Ringers) times over the infused volume. CONCLUSIONS: Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia. Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness.

  • 44.
    Li, Yuhong
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Shaoxing People's Hospital of Zhejiang University, China.
    Tesselaar, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Borges, J. B.
    Uppsala University, Sweden; University of Sao Paulo, Brazil .
    Böhm, S. H.
    Swisstom AG, Landquart, Switzerland.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Janerot-Sjöberg, B.
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden; KTH, Royal Institute of Technology, Stockholm, Sweden.
    Hyperoxia affects the regional pulmonary ventilation/perfusion ratio: an electrical impedance tomography study2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 6, p. 716-725Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The way in which hyperoxia affects pulmonary ventilation and perfusion is not fully understood. We investigated how an increase in oxygen partial pressure in healthy young volunteers affects pulmonary ventilation and perfusion measured by thoracic electrical impedance tomography (EIT).

    METHODS:

    Twelve semi-supine healthy male volunteers aged 21-36 years were studied while breathing room air and air-oxygen mixtures (FiO2) that resulted in predetermined transcutaneous oxygen partial pressures (tcPO2) of 20, 40 and 60 kPa. The magnitude of ventilation (ΔZv) and perfusion (ΔZQ)-related changes in cyclic impedance variations, were determined using an EIT prototype equipped with 32 electrodes around the thorax. Regional changes in ventral and dorsal right lung ventilation (V) and perfusion (Q) were estimated, and V/Q ratios calculated.

    RESULTS:

    There were no significant changes in ΔZv with increasing tcPO2 levels. ΔZQ in the dorsal lung increased with increasing tcPO2 (P = 0.01), whereas no such change was seen in the ventral lung. There was a simultaneous decrease in V/Q ratio in the dorsal region during hyperoxia (P = 0.04). Two subjects did not reach a tcPO2 of 60 kPa despite breathing 100% oxygen.

    CONCLUSION:

    These results indicate that breathing increased concentrations of oxygen induces pulmonary vasodilatation in the dorsal lung even at small increases in FiO2. Ventilation remains unchanged. Local mismatch of ventilation and perfusion occurs in young healthy men, and the change in ventilation/perfusion ratio can be determined non-invasively by EIT.

  • 45.
    Lindahl, Andreas E.
    et al.
    Uppsala University, Sweden .
    Stridsberg, Mats
    Uppsala University, Sweden .
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Ekselius, Lisa
    Uppsala University, Sweden .
    Gerdin, Bengt
    Uppsala University, Sweden .
    Natriuretic peptide type B in burn intensive care2013In: JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, ISSN 2163-0755, Vol. 74, no 3, p. 855-861Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The plasma concentration of natriuretic peptide type B (BNP) or NT-proBNP (P-BNP or P-NT-proBNP) reflects cardiac load. In intensive care unit settings and in chronic inflammation, it is also affected by non-heart-related mechanisms. It has been suggested to be a marker of hydration after severe burns and to predict outcome in critically ill patients, but results are contradictory. We therefore measured P-NT-proBNP after severe burns and related it to injury related variables and to organ dysfunction. less thanbrgreater than less thanbrgreater thanMETHODS: Fifty consecutive patients with a burn size greater than 10% were studied for the first 2 weeks. P-NT-proBNP changes were analyzed in relation to burn size, age, changes in body weight, C-reactive protein in plasma, and organ function assessed as Sequential Organ Failure Assessment (SOFA) scores less thanbrgreater than less thanbrgreater thanRESULTS: P-NT-proBNP showed large day-to-day and between patient variations. Daily change in body weight correlated with P-NT-proBNP only on Day 2, when maximum mobilization of edema occurred. Thereafter, P-NT-proBNP correlated with C-reactive protein in plasma as well as with SOFA scores. Burn size correlated with maximal weight change, which in turn correlated with both time for and value of maximum P-NT-proBNP. Maximal P-NT-proBNP was related to mortality and correlated better with SOFA score on Day 14 compared with age and burn size. In linear regressions, together with age at injury and total body surface area, P-NT-proBNP assessed on Days 3 to 8 was an independent predictor for every subsequent SOFA score measured one or more days later up to Day 14. less thanbrgreater than less thanbrgreater thanCONCLUSION: P-NT-proBNP exhibited considerable interindividual and day-to-day variations. Values were related to mortality, burn size, water accumulation, posttraumatic response, and organ function. Maximum P-NT-proBNP correlated stronger with length of stay and with organ function on Day 14, compared with age and burn size. High values in Days 3 through 8 were also independent predictors of subsequent organ function up to 2 weeks after injury. (J Trauma Acute Care Surg. 2013;74: 855-861.

  • 46.
    Ljunggren, Stefan
    et al.
    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.
    Nyström, Thomas
    Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: A double-blind, randomised controlled clinical trial2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 3, p. 392-398Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Surgery initiates a series of physiological stress processes in the body, inducing transient insulin resistance. Preoperative carbohydrate treatment can reduce the latter phenomenon. We investigated the effects of carbohydrate loading on insulin sensitivity and beta-cell function after elective hip replacement.

    METHODS: Twenty-three nondiabetic patients (mean age of 68 years) who underwent elective hip replacement surgery participated in this double-blind controlled study. The patients were randomised to a nutrition group, which ingested a carbohydrate-rich fluid (50 kcal/100 ml) (Preop(®)), or a control group (tap water flavoured with lemon) 800 ml + 400 ml before the surgery. The insulin response (beta-cell function) and the insulin sensitivity were measured with an intravenous glucose tolerance test (IVGTT) and a hyperinsulinaemic euglycaemic glucose clamp, respectively, one day before and two days after the surgery.

    RESULTS: Insulin sensitivity decreased by 51% (median; 25-75th percentiles 35-61) after ingesting Preop(®) and by 39% (21-51) after ingesting in the control group (n.s.). The postoperative IVGTT in the nutrition group was followed by a significantly larger area under the curve (AUC) for plasma insulin (+54% versus the preoperative IVGTT) compared to the control group (+7%). This difference was already apparent during the first phase (0-10 min) of insulin secretion (+20 and -21%, respectively; P < 0.05).

    CONCLUSIONS: The patients randomised to the carbohydrate oral fluid or the water prior to the surgery demonstrated a significant but similar decrease in insulin sensitivity. The carbohydrates increased the beta-cell function as a compensatory response to the disposition index, resulting in a smaller reduction in surgery-induced insulin resistance compared to the tap water. The study was registered at http://www.clinicaltrials.gov (NCT01774084).

  • 47.
    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.

  • 48.
    Nielsen, Niklas
    et al.
    Helsingborg Hospital.
    Wetterslev, Jorn
    Copenhagen University Hospital.
    al-Subaie, Nawaf
    University of London St Georges Hospital.
    Andersson, Bertil
    Sahlgrens University Hospital.
    Bro-Jeppesen, John
    Copenhagen University Hospital.
    Bishop, Gillian
    Campelltown Hospital.
    Brunetti, Iole
    IRCCS San Martino University Hospital.
    Cranshaw, Julius
    Royal Bournemouth Hospital.
    Cronberg, Tobias
    Skåne University Hospital.
    Edqvist, Kristin
    Central Hospital Karlstad.
    Erlinge, David
    Skåne University Hospital.
    Gasche, Yvan
    University Hospital Geneva.
    Glover, Guy
    Guys and St Thomas Hospital.
    Hassager, Christian
    Copenhagen University Hospital.
    Horn, Janneke
    University of Amsterdam.
    Hovdenes, Jan
    Oslo University Hospital.
    Johnsson, Jesper
    Helsingborg Hospital.
    Kjaergaard, Jesper
    Copenhagen University Hospital.
    Kuiper, Michael
    Leeuwarden Medical Centre.
    Langorgen, Jorund
    Haukeland Hospital.
    Macken, Lewis
    Royal N Shore Hospital.
    Martinell, Louise
    Sahlgrens University Hospital.
    Martner, Patrik
    Sahlgrens University Hospital.
    Pellis, Thomas
    Department Intens Care, Pordenone.
    Pelosi, Paolo
    IRCCS San Martino University Hospital.
    Petersen, Per
    Örebro University Hospital.
    Rundgren, Malin
    Skåne University Hospital.
    Saxena, Manoj
    St George Hospital.
    Svensson, Robert
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Stammet, Pascal
    Centre Hospital Luxembourg.
    Thoren, Anders
    Sahlgrens University Hospital.
    Unden, Johan
    Skåne University Hospital.
    Walden, Andrew
    Royal Berkshire Hospital.
    Wallskog, Jesper
    Kungalv Hospital.
    Wanscher, Michael
    Copenhagen University Hospital.
    Wise, Matthew P
    University of Wales Hospital.
    Wyon, Nicholas
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Faculty of Health Sciences.
    Aneman, Anders
    Liverpool Hospital.
    Friberg, Hans
    Skåne University Hospital.
    Target temperature management after out-of-hospital cardiac arrest-a randomized, parallel-group, assessor-blinded clinical trial-rationale and design2012In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 163, no 4, p. 541-548Article in journal (Refereed)
    Abstract [en]

    Background Experimental animal studies and previous randomized trials suggest an improvement in mortality and neurologic function with induced hypothermia after cardiac arrest. International guidelines advocate the use of a target temperature management of 32 degrees C to 34 degrees C for 12 to 24 hours after resuscitation from out-of-hospital cardiac arrest. A systematic review indicates that the evidence for recommending this intervention is inconclusive, and the GRADE level of evidence is low. Previous trials were small, with high risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management strategy is not known. less thanbrgreater than less thanbrgreater thanMethods The TTM trial is an investigator-initiated, international, randomized, parallel-group, and assessor-blinded clinical trial designed to enroll at least 850 adult, unconscious patients resuscitated after out-of-hospital cardiac arrest of a presumed cardiac cause. The patients will be randomized to a target temperature management of either 33 degrees C or 36 degrees C after return of spontaneous circulation. In both groups, the intervention will last 36 hours. The primary outcome is all-cause mortality at maximal follow-up. The main secondary outcomes are the composite outcome of all-cause mortality and poor neurologic function (cerebral performance categories 3 and 4) at hospital discharge and at 180 days, cognitive status and quality of life at 180 days, assessment of safety and harm. less thanbrgreater than less thanbrgreater thanDiscussion The TTM trial will investigate potential benefit and harm of 2 target temperature strategies, both avoiding hyperthermia in a large proportion of the out-of-hospital cardiac arrest population.

  • 49.
    Nilsson, Andreas
    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.
    Patient-controlled sedation in procedural care2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The need for procedural sedation is extensive and on the increase in numbers of patients. Minor treatments or diagnostic procedures are being performed with inadequate sedation or even without any sedatives or analgesics. Also, sedation techniques that support advanced, high-quality, in-patient care procedures representing easy performance and rapid recovery are requested for increased effectiveness. In this doctoral thesis, patient-controlled sedation (PCS) using propofol and alfentanil for surgical and diagnostic procedures was studied. The overall aim was to study aspects of safety, procedural feasibility and patients’ experiences. The main hypothesis was that PCS using only propofol is a safe and effective method for the induction and maintenance of moderate procedural sedation. The studies included were prospective, interventional, and in some cases, randomized and double-blinded.

    Data on cardiopulmonary changes, level of conscious sedation (bispectral index and Observer’s assessment of alertness/sedation [OAA/S]), pain, discomfort, anxiety, nausea (visual analogue scales), interventions performed by nurse anaesthetists, surgeons’ evaluation of feasibility, procedure characteristics, recovery (Aldrete score) and pharmacokinetic simulation of concentrations of drugs at the effect site supported the analysis and comparison between PCS and anaesthetist-controlled sedation and propofol PCS with or without alfentanil.

    PCS can be adjusted to cover a broad range of areas where sedation is needed, which, in this thesis, included burn care, gynaecological out-patient surgery and endoscopic procedures for the diagnosis and treatment of diseases in the bile ducts (endoscopic retrograde cholangiopancreatography [ERCP]). PCS for burn wound treatment demands the addition of alfentanil, but still seems to be safe. PCS was preferred by the patients instead of anaesthetist-controlled sedation. The addition of alfentanil to PCS as an adjunct to gynaecological surgical procedures also using local anaesthesia increases the surgeon’s access to the patients, but impairs safety. Apnoea and other such conditions requiring interventions to restore respiratory function were seen in patients receiving both alfentanil and propofol for PCS. Patients’ experiencing perioperative pain and anxiety did not explain the effect-site concentrations of drugs. Different gynaecological procedures and patients’ weights seemed to best explain the concentrations. For discomfort and pain during the endoscopic procedure (ERCP), propofol PCS performs almost the same as anaesthetist-performed sedation. Overall, as part of the pre-operative procedures, PCS does not seem to be time-consuming. In respect to the perioperative perspective, PCS supports rapid recovery with a low incidence of tiredness, pain, and post-operative nausea and vomiting (PONV).

    The data suggest that PCS further needs to be adapted to the patient, the specific procedure and the circumstances of sedation for optimal benefit and enhanced safety.

    List of papers
    1. Patient controlled sedation using a standard protocol for dressing changes in burns: Patients' preference, procedural details and a preliminary safety evaluation
    Open this publication in new window or tab >>Patient controlled sedation using a standard protocol for dressing changes in burns: Patients' preference, procedural details and a preliminary safety evaluation
    2008 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 7, p. 929-934Article in journal (Refereed) Published
    Abstract [en]

    Background: Patient controlled sedation (PCS) enables patients to titrate doses of drugs by themselves during different procedures involving pain or discomfort. Methods: We studied it in a prospective crossover design using a fixed protocol without lockout time to examine it as an alternative method of sedation for changing dressings in burned patients. Eleven patients with >10% total burn surface area (TBSA) had their dressings changed, starting with sedation by an anaesthetist (ACS). The second dressing change was done with PCS (propofol/alfentanil) and the third time the patients had to choose ACS or PCS. During the procedures, data on cardiopulmonary variables, sedation (bispectral index), pain intensity (VAS), procedural details, doses of drugs, and patients' preferences were collected to compare the two sedation techniques. Results: The study data indicated that wound care in burned patients is feasible with a standardized PCS protocol. The patients preferred PCS to ACS on the basis of self-control, and because they had less discomfort during the recovery period. Wound care was also considered adequate by the staff during PCS. No respiratory (respiratory rate/transcutaneous PCO2) or cardiovascular (heart rate/blood pressure) adverse events were recorded at any time during any of the PCS procedures. The doses of propofol and alfentanil and BIS index decrease were less during PCS than ACS. Procedural pain was higher during PCS but lower after the procedure. Conclusion: We suggest that PCS using a standard protocol is an interesting alternative to anaesthetist-provided sedation during dressing changes. It seems effective, saves resources, is safe, and at same time is preferred by the patients. The strength of these conclusions is, however, hampered by the small size of this investigation and therefore further studies are warranted. © 2008 Elsevier Ltd and ISBI.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-43402 (URN)10.1016/j.burns.2008.04.002 (DOI)73753 (Local ID)73753 (Archive number)73753 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
    2. Alfentanil and patient-controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events
    Open this publication in new window or tab >>Alfentanil and patient-controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events
    2012 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 9, p. 1123-1129Article in journal (Refereed) Published
    Abstract [en]

    Background

    Widespread use of patient-controlled sedation (PCS) demands simplicity and a predictable outcome. We evaluated patients’ safety and ease of use of PCS for gynaecological outpatient procedures.

    Methods

    In a prospective double-blind study, 165 patients were randomized to use propofol or propofol with alfentanil as PCS combined with local anaesthetic for pain control. Data on cardiopulmonary function, consciousness, and need for interventions were collected at baseline and every fifth minute. The surgeons’ evaluation of the ease and the duration of the procedure were recorded.

    Results

    One hundred and fifty-five patients used PCS for the entire procedure, 76 patients propofol, and 79 patients propofol/alfentanil. Fifteen procedures in the propofol group were limited or could not be done, compared with four in the propofol/alfentanil group (P = 0.02). The duration of surgery was not affected. The addition of alfentanil affected respiratory function compared with the propofol group: five patients compared with none were manually ventilated (P = 0.03), and two thirds, compared with a quarter, were given supplementary oxygen as their saturation decreased below 90% (P <0.001). Overall cardiovascular stability was maintained. The propofol group had deeper conscious sedation as measured by the bispectral index (P  = 0.03), but all patients could be roused. In the propofol/alfentanil group, five patients became apnoeic and could not be roused.

    Conclusions

    PCS using propofol alone supports patients’ safety, as the addition of alfentanil increased the need for specific interventions to maintain respiratory stability. However, alfentanil increases the feasibility of the procedure, as complementary doses of propofol were not required.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2012
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84741 (URN)10.1111/j.1399-6576.2012.02749.x (DOI)000308635200007 ()
    Note

    Funding Agencies|Department of Anesthesiology and Intensive Care, Linkoping University Hospital, Linkoping, Sweden|581 85|

    Available from: 2012-10-19 Created: 2012-10-19 Last updated: 2017-12-07
    3. Should Propofol and Alfentanil Be Combined in Patient-Controlled Sedation? A Randomised Controlled Trial Using Pharmacokinetic Simulation
    Open this publication in new window or tab >>Should Propofol and Alfentanil Be Combined in Patient-Controlled Sedation? A Randomised Controlled Trial Using Pharmacokinetic Simulation
    Show others...
    2015 (English)In: Open Journal of Anesthesiology, ISSN 2164-5558, Vol. 5, no 6, p. 122-129Article in journal (Refereed) Published
    Abstract [en]

    Background: Patient-controlled sedation (PCS) is increasingly used for moderate sedation. Detailed understanding is essential for maintaining safety and giving the most benefit. We wanted to explore the associations between patients’ characteristics, perioperative pain and anxiety, the procedure, and the calculated concentrations at the effect site (Ce) of propofol. We also wanted to analyse the pharmacokinetic profiles of propofol and alfentanil during PCS, and their association with respiratory complications.

    Methods: 155 patients were double-blinded and randomised to have propofol or propofol and alfentanil for PCS during gynaecological surgery. Pharmacokinetic simulation of Ce and multiple regressions aided the search for correlations between explanatory variables and concentrations of drugs.

    Results: In group propofol, treatment for incontinence, anterior repair, and the patient’s weight correlated the best (B-coef = 0.20, 0.20 and 0.01; r = 0.69; r² = 0.48). When alfentanil was added, alfentanil and the patient’s weight were associated with Ce of propofol (B-coef = -0.40 and 0.01; r = 0.70; r² = 0.43). Logistic regression indicated that age and Ce of drugs were related to ten cases of respiratory complications.

    Conclusions: Patients’ weights and the type of surgery performed were associated with the Ce of propofol; this knowledge could be used for refinement of the doses given during PCS. Because the pharmacokinetic profiles of propofol and alfentanil are different, the alfentanil effect becomes predominant during the time course of sedation. In order to reduce the risk of early and late respiratory depression, alfentanil should not be added to propofol in the same syringe.

    Place, publisher, year, edition, pages
    Scientific Research Publishing, 2015
    Keywords
    Anaesthetics, Intravenous, Propofol, Analgesics, Opioids, Alfentanil, Sedation
    National Category
    Surgery
    Identifiers
    urn:nbn:se:liu:diva-126606 (URN)10.4236/ojanes.2015.56023 (DOI)
    Note

    At the time for thesis presentation publication was in status: Manuscript

    Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2016-12-16Bibliographically approved
    4. Sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled study of patient-controlled propofol sedation and that given by a nurse anaesthetist
    Open this publication in new window or tab >>Sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled study of patient-controlled propofol sedation and that given by a nurse anaesthetist
    Show others...
    2015 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, no 10, p. 1285-1292Article in journal (Refereed) Published
    Abstract [en]

    Objective: Different regimens are used for sedation during ERCP (endoscopic retrograde cholangiopancreatography). Our objectives were to compare safety, ease of treatment, time to recovery and patients’ experiences using PCS (patient-controlled sedation) with propofol as well as sedation given by a nurse anaesthetist (ACS) with propofol or midazolam during ERCP.

    Material and methods: The study included 281 adults in 301 procedures. The PCS group (n=101) delivered bolus doses of 5 mg of propofol according to their need for sedation. The ACS group (n=100) had 2-8 mg/kg/hour of propofol infused, with the target for sedation being Level 3 of the Observer’s Assessment of Alertness/Sedation scale (OAA/S). The control group was given 2-3 mg of midazolam for induction and additional 1 mg if required.

    Results: PCS and ACS increased the ease of the procedure and reduced the numbers of sedation failures compared to midazolam sedation (ACS n=0; PCS n=4; midazolam n=20). The ACS group had more deeply sedated patients (OAA/S Level 2), desaturations and obstructed airways than the PCS and midazolam groups. Over 90% of all patients had recovered (Aldrete score≥9) by the time they returned to the ward. PCS resulted in the least fatigue and pain after the procedure. Patients’ preference for PCS and ACS were the same.

    Conclusion: PCS with propofol is superior to midazolam and comparable to ACS. PCS resulted in a rapid recovery, tended to be the safest and was almost as effective as ACS in ensuring a successful examination.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2015
    Keywords
    Conscious sedation, propofol, Cholangiopancreatography, Endoscopic Retrograde
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:liu:diva-112371 (URN)10.3109/00365521.2015.1038848 (DOI)000361324600013 ()
    Available from: 2014-11-24 Created: 2014-11-24 Last updated: 2017-12-05Bibliographically approved
  • 50.
    Nilsson, Andreas
    et al.
    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.
    Grossmann, Benjamin
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Kullman, Eric
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Uustal, Eva
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled study of patient-controlled propofol sedation and that given by a nurse anaesthetist2015In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, no 10, p. 1285-1292Article in journal (Refereed)
    Abstract [en]

    Objective: Different regimens are used for sedation during ERCP (endoscopic retrograde cholangiopancreatography). Our objectives were to compare safety, ease of treatment, time to recovery and patients’ experiences using PCS (patient-controlled sedation) with propofol as well as sedation given by a nurse anaesthetist (ACS) with propofol or midazolam during ERCP.

    Material and methods: The study included 281 adults in 301 procedures. The PCS group (n=101) delivered bolus doses of 5 mg of propofol according to their need for sedation. The ACS group (n=100) had 2-8 mg/kg/hour of propofol infused, with the target for sedation being Level 3 of the Observer’s Assessment of Alertness/Sedation scale (OAA/S). The control group was given 2-3 mg of midazolam for induction and additional 1 mg if required.

    Results: PCS and ACS increased the ease of the procedure and reduced the numbers of sedation failures compared to midazolam sedation (ACS n=0; PCS n=4; midazolam n=20). The ACS group had more deeply sedated patients (OAA/S Level 2), desaturations and obstructed airways than the PCS and midazolam groups. Over 90% of all patients had recovered (Aldrete score≥9) by the time they returned to the ward. PCS resulted in the least fatigue and pain after the procedure. Patients’ preference for PCS and ACS were the same.

    Conclusion: PCS with propofol is superior to midazolam and comparable to ACS. PCS resulted in a rapid recovery, tended to be the safest and was almost as effective as ACS in ensuring a successful examination.

12 1 - 50 of 87
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf