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  • 51.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Att lindra och trösta2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, p. 3534-3535Article in journal (Other academic)
  • 52.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Avliva termen "återupplivning"2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, p. 3058-3058Article in journal (Other (popular science, discussion, etc.))
  • 53.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Debriefing som bofink - får den se ur hur som helst?2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 2234-2234Article in journal (Other (popular science, discussion, etc.))
  • 54.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Dialog förutsätter ömsesidig respekt.2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 3515-3515Article in journal (Other (popular science, discussion, etc.))
  • 55.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Frågan om chkelhjälm inte enbart den resandes ensak2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 26-27, p. 2294-2294Article in journal (Other academic)
  • 56.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    För femtielfte gången - evidensbasering är inte detsamma som randomiserade studier!2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 3164-3164Article in journal (Other (popular science, discussion, etc.))
  • 57.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Hur dog egentligen KarlXII?2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 5399-5399Article in journal (Other (popular science, discussion, etc.))
  • 58.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    I huvudet på Göran Greider2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, p. 3947-3947Article in journal (Other academic)
  • 59.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Mechanical ventilation during transport of critically ill patients2001In: International Journal of Intensive Care, ISSN 1350-2794, Vol. 8, no 3, p. 178-179Article in journal (Other (popular science, discussion, etc.))
  • 60.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    När kan vi avsluta försök med hjärt-lungräddning?2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 40, p. 3093-3094Article in journal (Other academic)
  • 61.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Om bristen på organdonatorer - vänd på problemet!2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 2648-2648Article in journal (Other (popular science, discussion, etc.))
  • 62.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Patientansvarig läkares ansvar för hela patienten - obligat ellen när PAL behagar?2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, p. 4086-4087Article in journal (Other (popular science, discussion, etc.))
  • 63.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Prioritering sker utifrån symton, inte diagnoser.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 3843-3843Article in journal (Other (popular science, discussion, etc.))
  • 64.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Rökridåer från en gubbkalsong.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 3965-3965Article in journal (Other (popular science, discussion, etc.))
  • 65.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Sjuksköterskor i ambulanserna - problemet är värre än så.2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, p. 3540-3540Article in journal (Other (popular science, discussion, etc.))
  • 66.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Språket får gärna märkas!2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 3250-3250Article in journal (Other (popular science, discussion, etc.))
  • 67.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Språklig stringens önskvärd i fackspråk.2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, p. 3325-3325Article in journal (Other (popular science, discussion, etc.))
  • 68.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Ställningstagande eller formuleringsmiss2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, p. 3145-3145Article in journal (Other (popular science, discussion, etc.))
  • 69.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Svarte Petter i den svenska sjukvården.2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 2464-2464Article in journal (Other (popular science, discussion, etc.))
  • 70.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Tänk, vad en nallebjörn kan betyda!2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 3499-3499Article in journal (Other (popular science, discussion, etc.))
  • 71.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Undersköterskor får inte hantera läkemedel - fast bara lite.2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 4046-4049Article in journal (Other (popular science, discussion, etc.))
  • 72.
    Gårdelöf, Bror
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Vasopressi9n förstahandspreparat vid hjärtstopp?2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 35, p. 2631-2631Article in journal (Other academic)
  • 73.
    Gårdelöf, Bror
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Blomberg, Thomas
    Västernorrland.
    Fotografering av olyckan? Vi är överens om det mesta.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 2500-2500Article in journal (Other (popular science, discussion, etc.))
  • 74.
    Gårdelöf, Bror
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Blomberg, Thomas
    Västernorrland.
    Vem skall fotografera olyckan?2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 523-525Article in journal (Other academic)
  • 75.
    Hammar, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Asp, Malin
    Linköping University, Department of Medicine and Care.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Eintrei, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Ekdahl, Anne
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Ledin, Torbjörn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Maller, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    A new program for better clinical supervision of students. A joint project at the Halsouniversitet and county council in Ostergotland2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, p. 649-654Article in journal (Other academic)
  • 76.
    Hammar, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Asp, Malin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Eintrei, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Ekdahl, Anne
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Ledin, Torbjörn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Maller, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Ny handlingsplan för bättre klinisk handledning av studenter.2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, p. 649-654Article in journal (Other academic)
    Abstract [sv]

        

  • 77. Hammas, B
    et al.
    Thörn, S-E
    Wattwil, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology.
    Superior prolonged antiemetic prophylaxis with a four-drug multimodal regimen- comparison with propofol or placebo2002In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 46, p. 232-237Article in journal (Refereed)
  • 78.
    Huss, Fredrik
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Steinvall, Ingrid
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Brännskador i Sverige 1987-1996. Antalet sjukhusvårdade har minskat och dödligheten sjunkit med 70 procent.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 2184-2188Article in journal (Other academic)
  • 79.
    Hällgren, Anita
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology.
    Burman, L
    Olsson-Liljequist, B
    Isaksson, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Saedi, B
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hanberger, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Hög frekvens an korskolonisering med resistenta enterokocker hos "långliggare" på IVA2004In: Hygiea,2004, 2004, p. 57-57Conference paper (Other academic)
  • 80.
    Håkansson, E
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Konstantinov, I
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Fransson, Sven Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Management of life-threatening haemoptysis2002In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 88, p. 291-295Article in journal (Refereed)
    Abstract [en]

    Massive haemoptysis represents a major medical emergency that is associated with a high mortality. Here we present two cases of life-threatening haemoptysis, the first caused by rupture of an aortic aneurysm into the lung in a 37-yr-old woman with polyarteritis nodosa and the second caused by massive bleeding from an angiectatic vascular malformation in the right main bronchus in a 21-yr-old woman. Fibreoptic bronchoscopy played an essential role in the diagnostic process and management of the respiratory tract. Diagnosis in the first case was obtained by CT scan and the aneurysm was treated surgically. In the second case, bronchial arteriography contributed to both definitive diagnosis and treatment. Initial cardiorespiratory management, diagnostic procedures and definitive therapy are described and reviewed. Adequate early management of the cardiorespiratory system is essential to the outcome. Aggressive measures to elucidate the cause of haemoptysis and prompt therapy are warranted because of the high risk of recurrence.

  • 81.
    Håkansson, Erik
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Konstatinov, I
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Fransson, Sven Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Invited reply to dr Savage on management of life-thretening haemotysis2002In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 89, p. 185-186Article in journal (Other (popular science, discussion, etc.))
  • 82.
    Johansson, Anders
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Nilsson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Kalman, Sigga
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Öberg, Åke
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Respiratory monitoring using photoplethysmography - evaluation in the postoperative care unit1998In: Annual International Conference of th IEEE Engineering in Medicine and Biology Society,1998, 1998Conference paper (Refereed)
  • 83.
    Johansson, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Flatebö, Torun
    Nicolaysen, Anne
    Nicolaysen, Gunnar
    Walther, Sten M
    Influence of posture and PEEP on V/Q inhomogeneity in mechanically ventilated sheep2006In: European Society of Critical Care Medicine,2006, 2006Conference paper (Other academic)
  • 84.
    Johansson, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Flatebö, Torun
    Nicolaysen, Anne
    Nicolaysen, Gunnar
    Walther, Sten M
    Minor influence of endogenous nitric oxide on pulmonary perfusion distribution in prone sheep with PEEP ventilation2005In: 28th Congress of the Scandinavian Society of Anaesthesiology and Intensive care,2005, 2005Conference paper (Other academic)
  • 85.
    Johansson, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Wiklund, Andreas
    Department of Anaesthesia and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
    Flatebø, Torun
    Institute of Basic Medical Sciences, Department of Physiology, University of Oslo, Norway..
    Nicolaysen, Anne
    Institute of Basic Medical Sciences, Department of Physiology, University of Oslo, Norway.
    Nicolaysen, Gunnar
    Institute of Basic Medical Sciences, Department of Physiology, University of Oslo, Norway..
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Positive end-expiratory pressure affects regional redistribution of ventilation differently in prone and supine sheep2004In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 32, no 10, p. 2039-2044Article in journal (Refereed)
    Abstract [en]

    Objective: To examine interactions between positive end-expiratory pressure (PEEP) and posture on regional distribution of ventilation and to compare measurements of regional ventilation with two aerosols: a wet fluorescent microsphere aerosol (FMS, median mass aerodynamic diameter 1.1 μm) and a dry 99mTc-labeled carbon particle aerosol (Technegas, TG, median mass aerodynamic diameter ≈0.1 μm). Design: Experimental study. Setting. Academic laboratory. Subjects: Anesthetized and mechanically ventilated sheep (n = 16). Interventions: Four conditions were studied: prone or supine posture with of without 10 cm H2O PEEP. Measurements and Main results: Comparisons of FMS and TG were made in five animals. The median correlation coefficient of the two ventilation tracers was .95 (range, .91-.96). The mean ventilation per unit weight of dry lung for horizontal planes was almost identical whether measured with TG or FMS. The distribution of ventilation was assessed by analyzing deposition of aerosol in about 1,000 lung regions per animal. Distribution of ventilation down the vertical axis was linear in prone (the slope indicated a dorsal-to-ventral three-fold difference in ventilation) but unimodal in supine animals with the mode in the center of the lung. Redistribution of ventilation with 10 PEEP differed between posture, shifting the mode in supine toward dependent lung regions while eliminating the dorsal-to-ventral gradient in prone. The regional heterogeneity in ventilation was greater in supine sheep at both levels of PEEP, and this was due mostly to greater isogravitational heterogeneity in supine than in prone position. Conclusions: The wet fluorescent microsphere aerosol was as reliable as Technegas for high-resolution measurements of regional ventilation. The markedly different effects of 10 PEEP in supine and prone sheep may have important implications for gas exchange both in noninjured and injured lungs.

  • 86.
    Johansson, Torsten
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Lisander, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Ivarsson, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Mild hypothermia does not increase blood loss during total hip arthroplasty.1999In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 43, p. 1005-1010Article in journal (Refereed)
  • 87.
    Johnson, Anders
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Breathe without pain: Clinical and experimental studies in patients and volunteers with special reference to ventilatory regilation1992Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The major aims were, first, to study the advantages and disadvantages of intrathecal analgesia with bupivacaine and morphine with special reference to ventilation and pain relief and, second, to develop a method for studies of the ventilatory response to carbon dioxide and hypoxaemia in volunteers and in patients with varying degrees of ventilation-perfusion ratios.

    341 elderly patients undergoing major hip surgery perfonned under intrathecal analgesia or general anaesthesia and 31 young and healthy volunteers participated in this work. There were fewer complications and a shorter postoperative hospital stay in patients undergoing surgery under intrathecal analgesia with 0.3 mg morphine added to 20-22.5 mg bupivacaine without glucose compared to the general anaesthesia group as evaluated with the aid of case records. Postoperative pain after intrathecal morphine was evaluated by systemic morphine consumption and a visual analogue scale and was found to be of good quality for at least 40 h in the majority of the patients. Postoperative naloxone infusion rate was lowered stepwise between patient groups receiving intrathecal morphine. The dose 1 pg/kglh IV for 12 h and 0.25 pg/kg/h IV for the next 12 h had no influence on pain relief obtained by the intrathecal morphine.

    A non-rebreathing cireuit was designed and evaluated in volunteers and patients. The apparatus had no influence on ventilation of air over time, the results could be reproduced and the method was found to be suitable and safe for patients with varying ventilation-perfusion ratios. The ventilatory response to C02 was measured after 1.5 times the time taken to reach a new steady-state in FIITC02 after stimulation with 6% C02. The ventilatory response to hypoxaemia was measured when S02 had declined from normal values to 85%. The responses were evaluated before operation and 8 and 24 h after intrathecal injection in three patient groups: intrathecal analgesia with bupivacaine, with bupivacaine-morphine and with bupivacaine-morphine plus an IV infusion of naloxone. Intrathecal morphine had, on the whole, no effect on the ventilatorytesponses. However, additional systemic morphine or sedatives attenuated the responses. Naloxone infusion was judged to counteract ventilatory depression. The response to hypoxaemia was poor or absent in 1/3 of the elderly before operation,

    In conclusion, intrathecal analgesia with a mixture of bupivacaine and morphine offers excellent operative conditions in major hip surgery and a favourable postoperative course without pain for the elderly patient. Postoperative care of these elderly patients for at least 24 h is recommended and experienced personnel should continuously evaluate patients' status for detection of signs of ventilatory depression. The staff should have the knowledge and the facilities to treat ventilatory depression. Naloxone infusion can well be used as prophylaxis against ventilatory depression. Oxygen therapy is also recommended in these elderly patients both during and after operation until normal or near normal oxygenation, without oxygen therapy, is proven present.

  • 88.
    Järemo, Peter
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Lindahl, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Lennmarken, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology.
    Forsgren, H
    The use of platelet density and volume measurements to estimate the severity of pre-eclampsia.2001In: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 30, p. 1113-1118Article in journal (Refereed)
  • 89.
    Jönsson, Björn
    et al.
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Laurent, Claes
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Eneling, Martin
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Skau, Tommy
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Automatic ankle pressure measurements using PPG in ankle-brachial pressure index determination2005In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 30, no 4, p. 395-401Article in journal (Refereed)
    Abstract [en]

    Objective

    To evaluate a new technique using a photoplethysmographic (PPG) probe for automatic ankle pressure measurements.

    Design

    Comparative study on two techniques for ankle pressure measurement.

    Setting

    University hospital.

    Material

    Thirty-five patients with leg arterial disease and eight healthy volunteers. Ankle-brachial indices (ABPI) were measured using conventional CW Doppler technique and PPG-based prototype equipment for the ankle pressure recordings.

    Chief outcome measures

    ABPIs calculated from CW Doppler and PPG ankle pressure measurements. The PPG signals were analysed both by visual judgement and by a software based, automatic algorithm.

    Main results

    The mean difference between ABPIs calculated from CW Doppler recordings and PPG (visual analysis) was −0.01 (limits of agreement (±two standard deviations) +0.16 to −0.19). The correlation coefficient was 0.93. When the algorithm was used, the mean difference (CW Doppler−PPG) was 0.05 (limits of agreement 0.28 to −0.18, r=0.89).

    Conclusions

    The PPG method is a promising technique with an inherent potential for automatisation of the ankle pressure measurements, thereby reducing the observer-dependency in ABPI recordings.

  • 90.
    Kalman, Sigga
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Studies on the halothane-diethyl-ether azeotrope1994Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Requirements for a safe standard for anaesthesia under primitiveconditions differ from those under peaceful circumstances. It is important not to blunt the reflexes that guard vital functions. Safety requirements concerning breathing, circulation, and drug interaction must be sharpened because professional surveillance of the patient may be restricted. The halothane-diethyl-ether azeotrope (HE azeotrope) has properties that could make it suitable for anaesthesia under adverse circumstances. We have re-evaluated the HE azeotrope with special reference to safety in studies on 102 patients and 19 pigs.

    The vaporizers were calibrated to guarantee their performance. Guidelines for the use of Auotec® Mark Ill and Servo® vaporizer for halothane combined with the HE azeotrope are set out. Minimum alveolar concentration (MAC) for the HE azeotrope has not previously been published. The MAC for the HE azeotrope was determined in man (0.71 vol.%± 0.03, ± SEM) and pig (0.99 vol.%± 0.07) to allow comparison with other inhalation anaesthetics. The safety ratio defined as the ratio between fatal alveolar concentration and minimum alveolar concentration was found to be 3.1 in pig, which is about twice as high as previously reported data for halothane anaesthesia alone.

    Ventilation during surgical anaesthesia (1.1-1.2 MAC), both when resting and during challenge with raised inspiratory levels of carbon dioxide and decreased inspiratory concentration of oxygen, was measured. Ventilation was maintained during resting. Response to hypercarbia was preserved, in contrast to what was seen under isoflurane anaesthesia. Response to hypoxia was abolished.

    The central circulation was well preserved under normovolaemia in pigs during HE azeotrope anaesthesia. Haemorrhage. with a loss of30% of the blood volume was well tolerated, no matter whether the pig had received HE azeotrope or isoflurane. Isoflurane is considered in the literature to be an anaesthetic well tolerated by pigs.

    Most inhalation anaesthetics potentiate neuromuscular blockade, which is an important and sometimes dangerous component of anaesthesia. We therefore thought it important to investigate whether interaction takes place between vecuronium induced neuromuscular blockade and the HE azeotrope. Potentiation similar to that occurring during halothane anaesthesia was found.

    Early postoperative liver function was studied by tests of cellular metabolic capacity, cell integrity, cholestasis, and synthesizing capacity. No major impact on hepatic function after HE azeotrope anaesthesia was seen.

    Thus, the halothane-diethyl-ether azeotrope has properties that could make it interesting as an alternative anaesthetic drug under difficult circumstances.

  • 91.
    Kalman, Sigga
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Ekbäck, Gustav
    Örebro.
    Nilsson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Metcalf, Kerstin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Ranklev Twetman, Eva
    Anestesiläkarnas arbetsmiljö kan förbättras. Slutrapport från ett arbetsmiljöprojekt2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, p. 1603-1610Article in journal (Refereed)
  • 92.
    Kalman, Sigga
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Linderfalk, C
    Wårdell, Karin
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Eintrei, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Lisander, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology.
    Differential effect on vasodilatation and pain after intradermal capsaicin in humans during decay of intravenous regional anesthesia with mepivacaine1998In: Regional anesthesia and pain medicine, ISSN 1098-7339, E-ISSN 1532-8651, Vol. 23, no 4, p. 402-408Article in journal (Refereed)
  • 93.
    Kalman, Sigga
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Svensson, H
    Lisander, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Boive, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Quantitative sensory changes in humans after itravenous regional block with mepivacaine.1999In: Regional anesthesia, ISSN 0146-521X, Vol. 24, p. 236-241Article in journal (Refereed)
  • 94.
    Kalman, Sigga
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Österberg, Anders
    Linköping University, Department of Neuroscience and Locomotion, Neurology. Linköping University, Faculty of Health Sciences.
    Sörensen, Jan
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Boivie, Jörgen
    Linköping University, Department of Neuroscience and Locomotion, Neurology. Linköping University, Faculty of Health Sciences.
    Bertler, Åke
    Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Morphine responsiveness in a group of well-defined multiple sclerosis patients: a study with i.v. morphine2002In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 6, no 1, p. 69-80Article in journal (Refereed)
    Abstract [en]

    Pain in multiple sclerosis (MS) is more common than has previously been believed. About 28% of all MS patients suffer from central pain (CP), a pain that is difficult to treat. In the present study we have investigated the responsiveness of this pain to morphine. Fourteen opioid-free patients (eight woman and six men) with constant, non-fluctuating, long-lasting CP caused by MS were investigated. Placebo (normal saline), morphine and naloxone were given intravenously in a standardized manner. The study design was non-randomized, single blind and placebo controlled. Ten patients experienced less than 50% pain reduction by placebo and less than 50% pain reduction by morphine. Four patients were opioid responders, i.e. had minimal or no effect on pain by placebo, >50% pain reduction after morphine and >25% pain increase after naloxone, given intravenously following morphine. However, this response was obtained after high doses of morphine (43 mg, 47 mg, 50 mg and 25 mg; mean 41 mg). Thus, compared with nociceptive pain, only a minority of the patients with CP due to MS responded to morphine and only at high doses. The present results are in accord with experimental studies indicating that neuropathic pain is poorly responsive but not totally unresponsive to opioids. The results do not support the routine use of strong opioids in MS patients with CP.

  • 95.
    Karlander, Lars-Erik
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Gustavsson, Urban
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Lidman, Disa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Severe contusion of the femoral vessels in rats alters tissue oxygenation and microvascular blood flow regulation in the skeletal muscles of the limb2000In: Journal of Trauma - Injury, Infection and Critical Care, ISSN 1079-6061, Vol. 48, no 2, p. 286-291Article in journal (Refereed)
    Abstract [en]

    Background: Severe contusion of an artery often presents clinical problems in that it affects flow distal to the injury. However, the effect of a contusion on the microvascular flow regulation in the distal part of the limb is still largely unknown. Methods: A multipoint microelectrode technique was used to assess both tissue oxygenation (P(t)O2) and microflow (hydrogen clearance) on the skeletal muscle surface in a standard contusion injury to the femoral vessels in rats. Results: A significant increase in and an altered distribution of (P(t)O2) as well as a reduction in and altered distribution of microflow on the muscle surface distal to the injury was found in all animals (n = 27) compared with the uninjured control leg. These findings could not be reproduced experimentally by sympathectomy or when the adjacent skeletal muscle alone was injured. Conclusion: The results suggest that the changes observed distal to the injury are of vascular origin, possibly as a result of endothelial damage at the site of the contusion.

  • 96. Kazama, S
    et al.
    Nie, Masaki
    Miyoshi, Yutak
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Arteriovenous fistula complicationg chest tube insertion.1999In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 67, p. 294-295Article in journal (Refereed)
  • 97.
    Kimme, Peter
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Intrinsic and extrinsic protection of the brain2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The brain is a complex organ and critically dependent on its oxygen metabolism and blood supply. The purpose of the present study was twofold: firstly to design, evaluate, and adopt a physiologically stable experimental model for repeated measurements of cerebral cortical microvascular perfusion by a new laser Doppler technique (experimental part (I) - intrinsic model). Secondly, to examine the complication rates of a brief period of hypothermia for protection of the brain in patients who  were operated on for subarachnoid aneurysms (clinical part (II) - extrinsic model).

    Method. Part I. In contrast to conventional laser Doppler flowmetry, the laser Doppler perfusion imager (LDPI) creates a two-dimensional map of the tissue perfusion in an area of up to 120 x 120 mm, comprising 4096 measurement points. Measurements were made in a closed cranial window in ventilated anaesthetised pigs (n=25). Provocations that altered cerebral blood flow (CBF) were those that can occur during anaesthesia and critical care, including varying arterial concentration of carbon dioxide and mean arterial blood pressure (MABP), and those caused by different types (isoflurane and sevoflurane) and concentrations (minimum alveolar concentration, MAC, 0.3-1.2) of volatile anaesthetics.

    Part II. The feasibility and complication rates of rapidly-induced moderate hypothermia in 359 operations were examined prospectively. The complications that we sought were: altered haemostasis, infections, haemodynamic instability, and increased need for postoperative ventilatory support. Hypothermia was produced by cold (4°C) intravenous infusions and convective cooling. This lowered the body temperature at a mean (SD) 4 (0.4)oC h1 to 32.5 (0.4)oC. The body temperature returned to normal in all patients by 5 (2) hours postoperatively.

    Results. Part I. Cortical CBF was distributed highly heterogeneously and it was strongly dependent on MABP, as well as concentrations of CO2 During decreasing MABP the lower limit of autoregulation varied locally in the cortex and the 'classic' autoregulatory pressure-flow relation was present in only a few areas. Alterations in PaC02 concentration did not affect the pressure-flow relation at low perfusion pressures, whereas at normal or above normal values, hypercapnia increased CBF considerably (p < 0.001). CBF was not affected by the anaesthetic (isoflurane or sevoflurane) or dose (MAC 0.3-1.2) used.

    Part II. Perioperative and postoperative complications itcluded: circulatory instability (10%), arrhythmias (5%), abnormalities of coagulation, need for blood transfusions (47%), infections (8%), and puhnonary complications including infiltrates or oedema while on ventilatory support (27%). There was no correlation between the extent of hypothermia and any of the complications. However, there was a strong correlation (p < 0.001) between the incidence of complications and the severity of the underlying neurological disease as assessed by the Hunt and Hess score.

    Conclusion Part I. The LDPI method was useful and relevant for measurement of cortical CBF in this experimental model. 'Classic' autoregulatory patterns were found only when all values sampled wereclustered together, whereas the autoregulatory capacity is often lacking at the local level in the cortex. Volatile anaesthestics (isoflurane and sevoflurane) in the doses 0.3 - 1.2 (MAC) did not affect the regulation of CBF in this model. Part II. Moderate hypothermia can be achieved within 1 hour of induction of anaesthesia and seems to be safe as far as the risks of perioperative and postoperative complications are concerned.

    List of papers
    1. Cerebral blood flow of the exposed brain surface measured by laser Doppler perfusion imaging
    Open this publication in new window or tab >>Cerebral blood flow of the exposed brain surface measured by laser Doppler perfusion imaging
    Show others...
    1997 (English)In: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 159, no 1, p. 15-22Article in journal (Refereed) Published
    Abstract [en]

    A novel application of laser Doppler flowmetry (LDF), laser Doppler perfusion imaging (LDPI), was used to study cerebral cortical blood flow (CBFcortex). In contrast to the conventional laser Doppler perfusion monitor, LDPI creates two-dimensional maps of the tissue perfusion in a well defined area of up to 120×120 mm comprising 4096 measurement points. Measurements of CBFcortex were made through an optically transparent polyester film applied to a cranial window preparation in ventilated anaesthetized pigs. Temporal and spatial heterogeneity in CBFcortex were visualized by LDPI during provocations which are known to alter CBF (varying arterial PCO2 or MABP, or infusion of adenosine at constant MABP (concomitant angiotensin administration) or by hyperoxemia). During hypercapnia the recorded CBFcortex increased homogeneously. The adenosine-mediated increase in recorded CBFcortex was concentrated on the lower flow interval, as was the hyperoxemia-caused decline. At decreasing MABP the autoregulatory threshold was found to vary locally within the cortex. The results suggest that LDPI, apart from detecting localized changes in CBFcortex, also visualizes flow changes within different vascular segments. Together with the practical advantages of the system, i.e. not necessitating direct contact with the tissues, this feature makes the technique suitable for studies of CBFcortex distributions.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-82034 (URN)10.1046/j.1365-201X.1997.560333000.x (DOI)
    Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2017-12-07Bibliographically approved
    2. Cortical blood flow autoregulation revisited using laser Doppler perfusion imaging
    Open this publication in new window or tab >>Cortical blood flow autoregulation revisited using laser Doppler perfusion imaging
    2002 (English)In: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 176, no 4, p. 255-262Article in journal (Refereed) Published
    Abstract [en]

    Methods of laser Doppler perfusion monitoring (LDPM) and imaging (LDPI) have been validated and found useful for measurements of brain blood flow in several studies. The present work was undertaken to examine the cortical blood flow autoregulatory phenomenon as it has lately been questioned and claimed to be method-dependent and related to sample volume. Spatial variations in cerebral cortical blood flow (CBFcortex) in the pressure range 20–140 mmHg (static cerebral autoregulation; caval block/angiotensin infusion) were studied in six mechanically ventilated (hypocapnic, normocapnic and hypercapnic) pigs anaesthetized with propofol and fentanyl. Although the cortical blood flow values sampled were highly heterogeneously distributed, they were strongly pressure-dependent as well as CO2-dependent (P < 0.001). A cumulative cerebral blood flow (CBF)–pressure (MAP) plot comprising all values obtained indicated a pressure range between 70 and 120 mmHg where CBF remained almost constant. However, at the local level in the cortex (mm2) the same type of ‘classic’ autoregulatory flow : pressure graphs (FPG) were found in only a few of the cases of the cortical areas examined (n = 96). Alterations in blood PaCO2 saturation did not affect the pressure : flow relationship at low perfusion pressures, whereas at normal or above normal values, and as anticipated, hypercapnia considerably increased CBF (P < 0.001). ‘Classic’ autoregulatory FPGs were found only when all values sampled were clustered together, whereas, as a new finding, data are presented indicating that autoregulatory capacity is lacking at the local level at some cortical surface areas.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25358 (URN)10.1046/j.1365-201X.2002.01034.x (DOI)9800 (Local ID)9800 (Archive number)9800 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    3. Dose effect of sevoflurane and isoflurane anesthetics on cortical blood flow during controlled hypotension in the pig
    Open this publication in new window or tab >>Dose effect of sevoflurane and isoflurane anesthetics on cortical blood flow during controlled hypotension in the pig
    2007 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no 5, p. 607-613Article in journal (Refereed) Published
    Abstract [en]

    Background:  The ability of the brain to preserve adequate cerebral blood flow (CBF) during alterations in systemic perfusion pressure is of fundamental importance. At increasing concentrations, isoflurane and sevoflurane have been known to alter CBF, which may be disadvantageous for patients with increased intracranial pressure. The aim was to examine the effects of isoflurane and sevoflurane at increasing minimum alveolar concentrations (MAC) on CBF, during controlled hypotension.

    Methods:  We studied eight pigs during variations in perfusion pressure induced by caval block (100, 60, 50, and 40 mmHg) under normocapnia. CBF was measured locally in a defined area (4 × 5 measurement points covering 1 cm2) of the motor cortex using laser Doppler perfusion imaging. Physiological variables, assessed by analysis of arterial O2 and CO2, hemoglobin and hematocrit, were controlled. CBF was measured during propofol (10 mg × kg−1× h−1) and fentanyl (0.002 mg × kg−1× h−1) anesthesia, and then during anesthesia with either isoflurane or sevoflurane (given in random order) at increasing MAC (0.3–1.2). After a washout period, the measurements were repeated with the other gas.

    Results:  CBF was significantly higher in the cortex during normotensive (control) settings, MAP ∼100 mmHg, compared with during hypotension (MAP 40–60 mmHg). Neither different anesthetic nor MAC or local measurement sites were found to influence CBF at any perfusion pressure.

    Conclusion:  In this experimental model, the effect of hypotension on CBF was not altered by the anesthetics used [isoflurane, sevoflurane (MAC 0.3–1.2) or propofol (10 mg × kg−1× h−1)]. In this aspect (cortical tissue perspective), these volatile agents appear as suitable as propofol for neurosurgical anesthesia for patients at risk.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-39479 (URN)10.1111/j.1399-6576.2007.01281.x (DOI)48851 (Local ID)48851 (Archive number)48851 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
    4. Moderate hypothermia for 359 operations to clip cerebral aneurysms
    Open this publication in new window or tab >>Moderate hypothermia for 359 operations to clip cerebral aneurysms
    Show others...
    2004 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 93, no 3, p. 343-347Article in journal (Refereed) Published
    Abstract [en]

    Background. Experimental data have suggested that hypothermia (32–34°C) may improve outcome after cerebral ischaemia, but its efficacy has not yet been established conclusively in humans. In this study we examined the feasibility and safety of deliberate moderate perioperative hypothermia during operations for subarachnoid aneurysms.

    Methods. A total of 359 operations for intracranial cerebral aneurysms were included in this prospective study. By using cold intravenous infusions (4°C) and convective cooling our aim was to reduce the patient's core temperature to more than 34°C within 1 h before operation. The protocol assessed postoperative complications such as infections, prolonged mechanical ventilation, pulmonary complications and coagulopathies.

    Results. During surgery, the body temperature was reduced to a mean of 32.5 (sd 0.4) °C. Cooling was accomplished at a rate of 4.0 (sd 0.4) °C h−1. All patients were normothermic at 5 (sd 2) h postoperatively. Peri/postoperative complications included circulatory instability (n=36, 10%), arrhythmias (n=17, 5%) coagulation abnormalities and blood transfusion (n=169, 47%), infections (n=29, 8%) and pulmonary complications (infiltrate or oedema while on ventilatory support) (n=97, 27%). Eighteen patients died within 30 days (5%). There was no significant correlation between the extent of hypothermia and any of the complications. However, there was a strong correlation between the occurrence of complications and the severity of the underlying neurological disease as assessed by the Hunt and Hess score.

    Conclusion. Moderate hypothermia accomplished within 1 h of induction of anaesthesia and maintained during surgery for subarachnoid aneurysms appears to be a safe method as far as the risks of peri/postoperative complications such as circulatory instability, coagulation abnormalities and infections are concerned.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-24033 (URN)10.1093/bja/aeh206 (DOI)3589 (Local ID)3589 (Archive number)3589 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
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