| 1. |
- Bartha, Erzsebet, et al.
(författare)
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Could benefits of epidural analgesia following oesophagectomy be measured by perceived perioperative patient workload?
- 2008
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 52:10, s. 1313-1318
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Tidskriftsartikel (refereegranskat)abstract
- Background: A controversy exists whether beneficial analgesic effects of epidural analgesia over intravenous analgesia influence the rate of post-operative complications and the length of hospital stay. There is some evidence that favours epidural analgesia following major surgery in high-risk patients. However, there is a controversy as to whether epidural analgesia reduces the intensive care resources following major surgery. In this study, we aimed at comparing the post-operative costs of intensive care in patients receiving epidural or intravenous analgesia.Methods: Clinical data and rates of post-operative complications were extracted from a previously reported trial following thoraco-abdominal oesophagectomy. Cost data for individual patients included in that trial were retrospectively obtained from administrative records. Two separate phases were defined: costs of pain treatment and the direct cost of intensive care.Results: Higher calculated costs of epidural vs. intravenous pain treatment, 1,037 vs. 410 Euros/patient, were outweighed by lower post-operative costs of intensive care 5,571 vs. 7,921 Euros/patient (NS).Conclusion: Higher costs and better analgesic effects of epidural analgesia compared with intravenous analgesia do not reduce total costs for post-operative care following major surgery.
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| 2. |
- Ederoth, Per, et al.
(författare)
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Local metabolic changes in subcutaneous adipose tissue during intravenous and epidural analgesia.
- 2002
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 46:5, s. 585-591
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This clinical study aimed at investigating the impact of postoperative thoracic epidural analgesia on extracellular glycerol concentration and glucose metabolism in subcutaneous adipose tissue, using the microdialysis technique. The sympathetic nervous activity, which can be attenuated by epidural anesthesia, influences lipolysis and the release of glycerol. METHODS: Fourteen patients who underwent major abdominal or thoraco-abdominal surgery were studied postoperatively over 3 days. For postoperative analgesia the patients were prospectively randomized to receive either thoracic epidural analgesia with a bupivacaine/morphine infusion (EPI-group, n=6) or a continuous i.v. infusion of morphine (MO-group, n=8). The concentration of glycerol, glucose and lactate in the abdominal and deltoid subcutaneous adipose tissue were measured using a microdialysis technique. RESULTS: The abdominal glycerol levels were equal in both groups. In the deltoid region of the EPI-group, glycerol concentrations started to increase on Day 2, and reached significantly higher levels on Day 3 compared with the MO-group. The glucose and lactate levels showed no differences between groups in the two regions. CONCLUSION: The uniform glycerol levels in abdominal subcutaneous adipose tissue in conjunction with the difference in glycerol levels in the deltoid area indicate that the local lipolysis is different in the two study groups. This might be explained by a regional metabolic influence of thoracic epidural analgesia, possibly via the sympathetic nervous system.
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| 3. |
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| 4. |
- Bansch, Peter, et al.
(författare)
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Changes in the sublingual microcirculation during major abdominal surgery and post-operative morbidity.
- 2014
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 58:1, s. 89-97
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about perioperative microcirculatory changes during major abdominal surgery, and the main objectives of this study were to evaluate perioperative microcirculatory alterations in this setting, and if changes in microcirculatory parameters are associated with post-operative morbidity and/or with changes in parameters reflecting oxygen delivery.
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| 5. |
- Flisberg, Per, et al.
(författare)
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Apnea and bradypnea in patients receiving epidural bupivacaine-morphine for postoperative pain relief as assessed by a new monitoring method.
- 2002
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Ingår i: Journal of Clinical Anesthesia. - 1873-4529. ; 14:2, s. 129-134
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE: To evaluate postoperative breathing patterns with a new monitoring device in patients given bupivacaine-morphine epidural analgesia. DESIGN: Open explorative study. SETTING: Inpatient anesthesia in a university hospital setting. PATIENTS: 15 ASA physical status I and II patients aged 28 to 87 years and scheduled for major abdominal surgery. INTERVENTIONS: All patients underwent abdominal surgery with epidural anesthesia combined with general anesthesia. Postoperatively, they continued with epidural analgesia consisting of bupivacaine and morphine. On the first postoperative night, the breathing pattern was studied with a new noninvasive monitoring device measuring respiratory frequency and apnea. Arterial blood gas analysis was performed in case of apnea or low respiratory frequency. MEASUREMENTS AND MAIN RESULTS: A total of 84 alarm events were registered in 11 patients. Twenty-one percent (18/84) of the alarms were associated with arterial carbon dioxide tension (PaCO2) levels greater than 48.8 mmHg. Three of the four patients with PaCO2 levels greater than 48.8 mmHg were older than 80 years of age. CONCLUSION: The tested noninvasive monitoring device may detect abnormal respiratory breathing patterns in patients at risk for respiratory depression during epidural analgesia with bupivacaine-morphine.
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| 6. |
- Flisberg, Per
(författare)
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Aspects of Postoperative Pain Relief with Special Emphasis on Epidural Analgesia and Major Non-Cardiac Surgery
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Postoperative pain relief with opioids after major non-cardiac surgery may give rise to adverse effects. The fear of dangerous side effects may therefore limit the optimal use of different treatment modalities in surgical wards. Opioids can be administered alone as an intravenous infusion, or in combination with local anaesthetics as an epidural infusion. Both regimes can be tailored with a patient-controlled option. In the present thesis we evaluated postoperative efficacy and adverse effects of morphine and local anaesthetics administered for postoperative pain relief either as intravenous pain relief (morphine), or as thoracic epidural analgesia (local anaesthetic/morphine) in conjunction with major non-cardiac surgery. 1) It was found that preoperative thoracic epidural analgesia did not add any benefits regarding pain relief or improved pulmonary function compared to thoracic epidural analgesia started after completion of surgery. 2) In patients undergoing thoraco-abdominal surgery, the use of postoperative thoracic epidural analgesia improved dynamic pain perception compared to intravenously administered morphine for five postoperative days. No inter-group differences were found regarding postoperative attenuation of pulmonary function. 3) A new monitoring technique revealed that epidural opioids caused respiratory disturbances, i.e. apnea and bradypnea combined with elevated PaCO2 levels in elderly patients during the first postoperative night. This indicates that elderly patients may need closer postoperative respiratory monitoring. 4) Pump administered pain relief in 2,696 patients in surgical wards for several days demonstrate few serious adverse effects. However, continuous intravenous morphine PCA was associated with a higher incidence of respiratory depression, hallucinations, sedation, and nightmares compared to the use of thoracic epidural analgesia. The latter was also found to mitigate pain more effectively, both at rest and during mobilization, compared to intravenous morphine.
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| 7. |
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| 8. |
- Flisberg, Per, et al.
(författare)
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Epidural techniques - can we improve outcome?
- 2005
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Ingår i: Proceedings of the 8th Biennial Congress of the Asian & Oceanic Society of Regional Anesthesia and Pain Medicine. - 887587204X ; , s. 105-110
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In epidural studies it has been hard to find evidence supporting the outcome benefits of epidural treatment. A lot of epidurals have a high incidence of postoperative malfunctions. Several technical factors can be behind this. By knowing the relevant anatomy, the epidural insertion can be more optimal. Using saline instead of air as loss of resistance medium, a better working epidural with less morbidity can be achieved. The type of epidural catheter used is also important in order to reduce the frequency of inadequate analgesia. To rule out intravenous or subarachnoid position of the catheter the test dose is still very important. In the near future newly develop techniques may be helpful in recognizing the epidural space/catheter position. Finally, a particularly important aspect is the correct epidural catheter position at the right dermatomal level.
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| 9. |
- Flisberg, Per, et al.
(författare)
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Induction dose of propofol in patients using cannabis.
- 2009
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Ingår i: European Journal of Anaesthesiology. - 1365-2346. ; 26:3, s. 192-195
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVE: An estimated 150 million people worldwide use cannabis. The effect of cannabis on anaesthetic requirements in humans does not appear to have been studied. METHODS: In this prospective, randomized, single-blinded study, 30 male patients using cannabis more than once per week (group C) and 30 nonusers (group NC), aged 18-50 years, were induced with propofol 1.5, 2, 2.5, 3 or 3.5 mg kg. Additional doses were given when required. The primary outcome was the 50% effective dose of propofol and successful induction was determined by loss of consciousness with a bispectral index value of less than 60 and satisfactory insertion of a laryngeal mask. Propofol requirements to achieve these outcomes were recorded. RESULTS: The dose required to achieve the target bispectral index value was not significantly higher in group C, but group C required a significantly higher propofol dose to achieve laryngeal mask insertion (314.0 +/- 109.3 vs. 263.2 +/- 69.5 mg, P < 0.04). The estimated effective propofol induction dose in 50-95% of patients did not significantly differ between groups. CONCLUSION: We conclude that cannabis use increases the propofol dose required for satisfactory clinical induction when inserting a laryngeal mask.
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| 10. |
- Flisberg, Per, et al.
(författare)
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Pain relief after esophagectomy: Thoracic epidural analgesia is better than parenteral opioids
- 2001
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1532-8422 .- 1053-0770. ; 15:3, s. 282-287
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare postoperative pain relief and pulmonary function in patients after thoracoabdominal esophagectomy treated by continuing perioperative thoracic epidural anesthesia or changing to parenteral opioids. DESIGN: Prospective, randomized study. SETTING: University teaching hospital. PARTICIPANTS: Thirty-three patients undergoing thoracoabdominal esophagectomy. INTERVENTIONS: General anesthesia was combined with thoracic epidural anesthesia during surgery. The patients either continued with thoracic epidural analgesia (n = 18) or were switched to patient-controlled analgesia with intravenous morphine (n = 15) for 5 postoperative days. Pain scores were estimated twice daily, at rest and after mobilization. Peak expiratory flow, forced expiratory volume, and vital capacity were measured the day before surgery, postoperative day 2, and postoperative day 6. Adverse events and complications were recorded. MEASUREMENTS AND MAIN RESULTS: At rest, there were no differences in pain relief between the groups. Pain scores at mobilization showed a significantly lower value in the epidural group (p < 0.027). No intergroup differences were found regarding pulmonary function, which decreased on postoperative day 2, but was improved on postoperative day 6. CONCLUSION: Continuation of intraoperative thoracic epidural anesthesia for 5 postoperative days provides better pain relief at mobilization compared with a switch to patient-controlled analgesia with intravenous morphine. There was no intergroup difference in the impact on measures of pulmonary function.
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