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- Jildenstål, Pether, 1970-, et al.
(författare)
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Spectral edge frequency during general anaesthesia : A narrative literature review.
- 2022
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Ingår i: Journal of international medical research. - : Sage Publications. - 0300-0605 .- 1473-2300. ; 50:8
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Forskningsöversikt (refereegranskat)abstract
- Previous studies have attempted to determine the depth of anaesthesia with different anaesthetic agents using electroencephalogram (EEG) measurements with variable success. Measuring depth of anaesthesia is confounded by the complexity of the EEG and the fact that different agents create different pattens. A narrative review was undertaken to examine the available research evidence on the effect and reliability of spectral edge frequency (SEF) for assessing the depth of anaesthesia in adult patients under general anaesthesia. A systematic search of the PubMed®, Scopus®, CINAHL and Cochrane databases identified six randomized controlled trials and five observational studies. The findings of these studies suggest that SEF varies according to the anaesthetic drugs used. Remifentanil and age are two factors that can affect SEF, while other opioids and benzodiazepine (administered separately) seem to have no effect. No patients experienced intraoperative awareness. However, this does not indicate that SEF can provide full protection against it and the number of articles in which intraoperative awareness was studied was too small to afford any certainty. None of the studies demonstrated a reliable SEF interval associated with adequate general anaesthesia. SEF must be adapted to the anaesthetic drug used, the patient's age and state while under general anaesthesia.
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- Warrén Stomberg, Margareta, et al.
(författare)
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Day surgery, variations in routines and practices a questionnaire survey.
- 2013
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Ingår i: International journal of surgery (London, England). - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 11:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Day surgery is expanding however little is known about every day practice and routines. METHODS: A web-based questionnaire including 34 questions with fixed multiple choice responses around routine and practice for the perioperative handling of patients scheduled for day case surgery was send to 100 hospitals. RESULTS: There was an overall response rate of 70%. Most centres had a dedicated day surgery unit (87%). Preoperative assessment routines, when, how and by whom varied. Patient self-assessment questionnaires were common practice (87%). Upper age limit was uncommon (10%), lower age limit common (77%), and fixed high body mass index-limitation showed a mixed pattern, mean 40%. Postoperative nauseas and vomiting-risk stratification varied mean 46%. Anxiolytic premedication was uncommon. Administration of oral analgesics varied, mean 70%; paracetamol (94%), NSAIDs (80%) and opioid (28%). Preferred general anaesthesia technique varied considerable. Laryngeal mask airway was consistently used. Management of pain while in hospital was consistently performed. A majority centres provided take-home analgesics "tablet-package" (69%) or as prescription (80%). Strong opioids to be taken at home were given or prescribed by 59% of units. Written information about the postoperative care was common practice (90%), written instruction about management of pain was less frequently provided (69%). Most hospitals (93%) had standardised discharge criteria, including demand of an escort (75%) and not being alone first postoperative night (81%). CONCLUSIONS: We found that regime for day surgical anaesthesia practice varied between as well as within countries. There is obvious room for further research on how to achieve safe and cost-effective logistics and practice for day case surgery.
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- Warrén Stomberg, Margareta, et al.
(författare)
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Preoperative centre improving patients' satisfaction?
- 2013
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Ingår i: International journal of surgery (London, England). - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 11:5
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Tidskriftsartikel (refereegranskat)
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- Jildenstål, Pether, et al.
(författare)
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Agreement between frontal and occipital regional cerebral oxygen saturation in infants during surgery and general anesthesia an observational study
- 2019
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Ingår i: Pediatric Anesthesia. - : Wiley. - 1460-9592 .- 1460-9592 .- 1155-5645. ; 29:11, s. 1122-1127
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: Advances in perioperative pediatric care have resulted in an increased number of procedures requiring anesthesia. During anesthesia and surgery, the patient is subjected to factors that affect the circulatory homeostasis, which can influence oxygenation of the brain. Near‐infrared spectroscopy (NIRS) is an easy applicable noninvasive method for monitoring of regional tissue oxygenation (rScO₂%). Alternate placements for NIRS have been investigated; however, no alternative cranial placements have been explored. Aim: To evaluate the agreement between frontal and occipital recordings of rScO₂% in infants using INVOSTM during surgery and general anesthesia. Method: A standard frontal monitoring of rScO₂% with NIRS was compared with occipital rScO₂% measurements in fifteen children at an age <1 year, ASA 1‐2, undergoing cleft lip and/or palate surgery during general anesthesia with sevoflurane. An agreement analysis was performed according to Bland and Altman. Results: Mean values of frontal and occipital rScO₂% at baseline were largely similar (70.7 ± 4.77% and 69.40 ± 5.04%, respectively). In the majority of the patients, the frontal and occipital recordings of rScO2 changed in parallel. There was a moderate positive correlation between frontal and occipital rScO₂% INVOS™ readings (rho[ρ]: 0.513, P < .01). The difference between frontal and occipital rScO₂ ranged from −31 to 28 with a mean difference (bias) of −0.15%. The 95% limit of agreement was −18.04%‐17.74%. The error between frontal and occipital rScO₂ recordings was 23%. Conclusion: The agreement between frontal and occipital recordings of brain rScO₂% in infants using INVOSTM during surgery and general anesthesia was acceptable. In surgical procedures where the frontal region of the head is not available for monitoring, occipital recordings of rScO₂% could be an option for monitoring.
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- Kilic, Mert, et al.
(författare)
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Clinical Performance of a Novel Main-Stream Anaesthetic End-Tidal Gas Monitors during Routine Low Flow Anaesthesia
- 2010
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Ingår i: Journal of Anesthesia & Clinical Research. - : OMICS Publishing Group. - 2155-6148. ; 1:3
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Tidskriftsartikel (refereegranskat)abstract
- End-tidal anaesthetic gas concentration monitoring during inhalation anaesthesia has become standard of care. Explorative study comparing the end-tidal anaesthetic gas measured by a new main-stream anaesthetic gas monitor (IRMA, Phasein, Stockholm, Sweden) as compared to standard Datex side-stream monitoring during routine low flow anaesthesia Day surgical centre in StockholmThirty two healthy, ASA 1-2, patients undergoing elective day case anaesthesia with low flow 0.2-0.5 L/min. Simultaneous recording of the end-tidal gas concentration during routine day case anaesthesia with low flow sevoflurane or desflurane anaesthesia. The new monitor was found to be clinically acceptable. The mean bias between IRMA and Datex measures -0.125 vol % (± 0.145, limits of agreement were -0.41 – 0.16). The new main stream gas monitor is clinically acceptable alternative for end-tidal anaesthetic gas monitoring during routine anaesthesia with low flow, 0.2-0.5 L/min.
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- Sjöstedt, Lisbeth, et al.
(författare)
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Patients' need for information prior to colonic surgery.
- 2011
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Ingår i: Gastroenterology nursing. - 1538-9766. ; 34:5, s. 390-397
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Tidskriftsartikel (refereegranskat)abstract
- Perioperative information and communication between patients and health professionals is central to the quality of care and patient involvement for elective colon surgery. Enhanced recovery after surgery (ERAS) means that the care process is accelerated with comprehensive information and additional requirements on an individual. The purpose of this study was to identify nurses' and doctors' experience of patients' need for information before intraoperative care. Nurses (n = 39) with different specialties and professional experience were interviewed in focus groups. Ten anesthesiologists with differing professional experience were interviewed individually. Data were analyzed with qualitative content analysis. The result shows the need to provide information to reduce anxiety, to make the patient feel safe, to explain postoperative pain management, and to provide a comprehensive care pathway. There was no difference between the informants' perception of patients' information needs. All respondents agreed that patients generally have a great need for information. The perioperative information should be repeated at different points in time. The patients' need for information on diagnosis is recurrent. Knowledge, good communication, and attitude from a multiprofessional perspective support the patient's feeling comfortable and involved in the care prior to surgery.
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- Brattwall, Metha, 1952, et al.
(författare)
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Brief review: Theory and practice of minimal fresh gas flow anesthesia.
- 2012
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Ingår i: Canadian journal of anaesthesia. - : Springer Science and Business Media LLC. - 1496-8975 .- 0832-610X. ; 59:8, s. 785-797
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this brief review is to provide an update on the theory regarding minimal fresh gas flow techniques for inhaled general anesthesia. The article also includes an update and discussion of the practical aspects associated with minimal-flow anesthesia, including the advantages, potential limitations, and safety considerations of this important anesthetic technique. PRINCIPAL FINDINGS: Reducing the fresh gas flow to < 1 L·min(-1) during maintenance of anesthesia is associated with several benefits. Enhanced preservation of temperature and humidity, cost savings through more efficient utilization of inhaled anesthetics, and environmental considerations are three key reasons to implement minimal-flow and closed-circuit anesthesia, although potential risks are hypoxic gas mixtures and inadequate depth of anesthesia. The basic elements of the related pharmacology need to be considered, especially pharmacokinetics of the inhaled anesthetics. The third-generation inhaled anesthetics, sevoflurane and desflurane, have low blood and low tissue solubility, which facilitates rapid equilibration between the alveolar and effect site (brain) concentrations and makes them ideally suited for low-flow techniques. The use of modern anesthetic machines designed for minimal-flow techniques, leak-free circle systems, highly efficient CO(2) absorbers, and the common practice of utilizing on-line real-time multi-gas monitor, including essential alarm systems, allow for safe and cost-effective minimal-flow techniques during maintenance of anesthesia. The introduction of new anesthetic machines with built-in closed-loop algorithms for the automatic control of inspired oxygen and end-tidal anesthetic concentration will further enhance the feasibility of minimal-flow techniques. CONCLUSIONS: With our modern anesthesia machines, reducing the fresh gas flow of oxygen to 0.3-0.5 L·min(-1) and using third-generation inhaled anesthetics provide a reassuringly safe anesthetic technique. This environmentally friendly practice can easily be implemented for elective anesthesia; furthermore, it will facilitate cost savings and improve temperature homeostasis.
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