| 1. |
- Bucin, Dragan, et al.
(författare)
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Heart transplantation across the antibodies against HLA and ABO
- 2006
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Ingår i: Transplant International. - : Frontiers Media SA. - 1432-2277 .- 0934-0874. ; 19:3, s. 239-244
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Tidskriftsartikel (refereegranskat)abstract
- We have intentionally performed heart transplantation in a 5-year-old child, despite the most unfavourable risk factors for patient survival; the presence of high level of antibodies against donor's human leucocyte antigen (HLA) class I/II and blood group antigens. Pretransplant treatment by mycophenolate mofetil, prednisolone, tacrolimus, intravenous immunoglobulin, rituximab, protein-A immunoadsorption (IA) and plasma exchange reduced antibody titres against the donor's lymphocytes from 128 to 16 and against the donor's blood group antigen from 256 to 0. The patient was urgently transplanted with a heart from an ABO incompatible donor (A(1) to O). A standard triple-drug immunosuppressive protocol was used. No hyperacute rejection was seen. Antibodies against the donor's HLA antigens remained at a low level despite three acute rejections. Rising anti-A(1) blood group antibodies preceded the second rejection and were reduced by two blood group-specific IAs and remained at a low level. The patient is doing well despite the persistence of donor-reactive antibodies.
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| 2. |
- Gelberg, Jan
(författare)
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Aspects of intravenous anaesthesia
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background:Developments in anaesthesia during the recent decades include new drugs with limited unwanted side effects and the need for anaesthesia in new interventions, together with new groups of patients that in the past were considered to be beyond help. Aims:Study I: To determine the bolus dose of remifentanil that depresses the ventilatory drive as deeply as 1 µg/kg of fentanyl.Study II: To test the hypothesis that the combination of rocuronium (0.2 mg/kg) with modest doses of propofol and remifentanil during anaesthesia induction always achieves good or excellent intubation conditions in infants.Study III: To compare the safety of propofol in a large cohort of patients with a known sensitization to soy and/or peanuts to that of non-propofol hypnotic use in a control group.Study IV: To assess muscular endurance from subparalyzing doses of rocuronium on awake subjects.Methods:Study I: A randomised, double-blinded, placebo-controlled study in healthy subjects comparing the effect on ventilation of three different doses of remifentanil and one dose of fentanyl.Study II: A randomised, double-blinded, placebo-controlled clinical trial investigating intubation conditions with and without a low-dose of rocuronium in combination with propofol and remifentanil.Study III: A retrospective observational cohort study in patients sensitised to peanut and/or soy anaesthetized with either propofol or another anaesthetic agent.Study IV: A randomised, double-blinded, placebo-controlled study where the effect on muscular endurance of subparalyzing doses of rocuronium was studied in healthy subjects.Results:A remifentanil bolus of 0.5 µg/kg give similar ventilatory depression as a fentanyl bolus of 1 µg/kg.Intubation conditions were classified as ‘poor’ in 14 of 34 (41 %) patients given placebo and in 10 of 36 (28 %) patients given rocuronium. There were no identifiable allergic reactions in either the propofol or in the non-propofol group in patients sensitised to soy and/or peanuts. The sustained handgrip strength after rocuronium (0.08 mg/kg) was one third compared to placebo.Conclusions:Remifentanil bolus is twice as potent as fentanyl bolus in producing ventilatory depression.Adding a low-dose rocuronium did not significantly improve intubation conditions compared to placebo. Propofol was safe to use in a cohort of patients sensitised to soy and/or peanut. Recommendations to withhold propofol because of soy or peanut allergy should be questioned. Low doses of rocuronium may partly exert its effect by reducing muscular endurance.
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| 3. |
- Gelberg, Jan, et al.
(författare)
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Improving survival and neurologic function for younger age groups after out-of-hospital cardiac arrest in Sweden : a 20-year comparison
- 2015
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535 .- 1947-3893. ; 16:8, s. 750-757
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe changes in the epidemiology of out-of-hospital cardiac arrest in Sweden with the emphasis on the younger age groups.Design: Prospective observational study. Setting: Sweden.Patients: Patients were recruited from the Swedish Registry of Cardiopulmonary Resuscitation from 1990 to 2012. Only non-crew-witnessed cases were included.Intervention: Cardiopulmonary resuscitation.Measurement and Main Results: The endpoint was 30-day survival. Cerebral function among survivors was estimated according to the cerebral performance category scores. In all, 50,879 patients in the survey had an out-of-hospital cardiac arrest, of which 1,321 (2.6%) were 21 years old or younger and 1,543 (3.0%) were 22-35 years old. On the basis of results from 2011 and 2012, we estimated that there are 4.9 cases per 100,000 person-years in the age group 0-21 years. The highest survival was found in the 13- to 21-year age group (12.6%). Among patients 21 years old or younger, the following were associated with an increased chance of survival: increasing age, male gender, witnessed out-of-hospital cardiac arrest, ventricular-fibrillation, and a short emergency medical service response time. Among patients 21 years old or younger, there was an increase in survival from 6.2% in 1992-1998 to 14.0% in 2007-2012. Among 30-day survivors, 91% had a cerebral performance category score of 1 or 2 (good cerebral performance or moderate cerebral disability) at hospital discharge.Conclusions: In Sweden, among patients 21 years old or younger, five out-of-hospital cardiac arrests per 100,000 person-years occur and survival in this patient group has more than doubled during the past two decades. The majority of survivors have good or relatively good cerebral function.
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| 4. |
- Gelberg, Jan, et al.
(författare)
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Intravenous boluses of fentanyl, 1 μg kg-1, and remifentanil, 0.5 μg kg-1, give similar maximum ventilatory depression in awake volunteers.
- 2012
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 1471-6771 .- 0007-0912. ; 108:6, s. 1028-1034
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: /st>The relative respiratory effects of fentanyl and remifentanil, administered as i.v. bolus, have not previously been studied. We determined what remifentanil bolus dose gave the same maximum depression of ventilation as 1 µg kg(-1) of fentanyl. METHODS: /st>Twelve healthy volunteers rebreathed in a system designed to dampen variations in end-tidal carbon dioxide tension so that measurements would be obtained at similar levels of CO(2) stimulation. The minute ventilation was measured before (V(preinj)) and after injection (V(nadir)) of fentanyl, 1 µg kg(-1), and remifentanil, 0.25, 0.5, and 1 µg kg(-1). The remifentanil doses were plotted against V(nadir)/V(preinj) in a log-probit diagram to determine what amount gave the same maximum ventilatory depression as the fentanyl dose. RESULTS: /st>V(nadir) was [median (inter-quartile range)] 51 (38-64)% of V(preinj) after fentanyl, and 70 (61-77), 50 (46-56), and 29 (24-38)%, respectively, after remifentanil. The nadir occurred 5.0 (4.4-7.0) min after fentanyl, and 3.8 (2.7-4.6), 2.9 (2.7-3.2), and 3.0 (2.7-3.2) min after remifentanil injection. at ventilation nadir was 6.26 (5.98-6.62) kPa after fentanyl, and 6.18 (6.12-6.50), 6.11 (5.91-6.45), and 6.11 (5.93-6.45) kPa after remifentanil 0.25, 0.5, and 1 µg kg(-1), respectively. A remifentanil dose of 0.47 (0.42-0.62) µg kg(-1) was equidepressant to 1 µg kg(-1) of fentanyl. Fifteen minutes after fentanyl injection, the median minute ventilation was 30-40% less than after injection of remifentanil, 0.25 and 0.5 µg kg(-1) (P<0.05). CONCLUSIONS: /st>Fentanyl, 1 µg kg(-1), and remifentanil, 0.5 µg kg(-1), gave similar maximum ventilatory depression. The onset of and recovery from ventilatory depression were faster with remifentanil.
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| 5. |
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| 6. |
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| 7. |
- Gelberg, Jan, et al.
(författare)
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Subparalyzing Doses of Rocuronium Reduce Muscular Endurance without Detectable Effect on Single Twitch Height in Awake Subjects
- 2019
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Ingår i: Anesthesiology Research and Practice. - : Hindawi Limited. - 1687-6962 .- 1687-6970. ; 2019
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. To test the hypothesis that a low-dose rocuronium acts mainly by means of reducing muscular endurance rather than by reducing momentary force. Methods. In a randomized placebo-controlled double-blinded study, eight healthy volunteers were studied in two sets of experiments. In the first set, the subjects made a sustained maximum effort with the dominant hand for 80 seconds while squeezing an electronic handgrip dynamometer at three minutes after intravenous administration of placebo, 0.04 or 0.08 mg/kg rocuronium. Handgrip force at initiation of testing (maximum handgrip force) and after 60 seconds was evaluated. In the second set, the ulnar nerve of the subjects was electrically stimulated every tenth second for at least 10 and a maximum of 30 minutes following the administration of placebo and 0.08 mg/kg rocuronium. Single twitch height of the adductor pollicis muscle was recorded. Results. There was no significant difference in the effect on maximum handgrip force at time 0 between the three different doses of rocuronium. As compared with placebo, handgrip force after 0.08 mg/kg rocuronium was reduced to approximately a third at 60 seconds (214 N (120-278) vs. 69 (30-166); p=0.008), whereas only a slight reduction was seen after 0.04 mg/kg (187 (124-256); p=0.016). Based on these results, the sustained handgrip force after 0.2 mg/kg at 60 seconds was calculated to be 1.27% (95% CI [0.40, 4.03]) of the maximum force of placebo. No effect on single twitch height after 0.08 mg/kg rocuronium at four minutes after drug administration could be detected. Conclusions. Subparalyzing doses of rocuronium show a distinct effect on muscular endurance as opposed to momentary force. The findings support the hypothesis that low doses of rocuronium act mainly by reducing muscular endurance, thereby facilitating, for example, tracheal intubation.
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| 8. |
- Herlitz, Johan, et al.
(författare)
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Characteristics of cardiac arrest and resuscitation by age group : an analysis from the Swedish Cardiac Arrest Registry
- 2007
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Ingår i: American Journal of Emergency Medicine. - : W. B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 25:9, s. 1025-1031
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The objective of this study was to describe patients who experienced an out-of-hospital cardiac arrest (OHCA) by age group.METHODS: All patients who suffered from an OHCA between 1990 and 2005 and are included in the Swedish Cardiac Arrest Registry (n = 40,503) were classified into the following age groups: neonates, younger than 1 year; young children, between 1 and 4 years; older children, between 5 and 12 years; adolescents, between 13 and 17 years; young adults, between 18 and 35 years; adults not retired, between 36 and 64 years; adults retired, between 65 and 79 years; and older adults, 80 years or older.RESULTS: Ventricular fibrillation was lowest in young children (3%) and highest in adults (35%). Survival to 1 month was lowest in neonates (2.6%) and highest in older children (7.8%). Children (<18 years), young adults (18-35 years), and adults (>35 years) survived to 1 month 24.5%, 21.2%, and 13.6% of cases, respectively (P = .0003 for trend) when found in a shockable rhythm. The corresponding figures for nonshockable rhythms were 3.8%, 3.2%, and 1.6%, respectively (P < .0001 for trend).CONCLUSIONS: There is a large variability in characteristics and outcome among patients in various age groups who experienced an OHCA. Among the large age groups, there was a successive decline in survival with increasing age in shockable and nonshockable rhythms.
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| 9. |
- Herlitz, Johan, et al.
(författare)
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Svenska rådet för HLR ska öka överlevnaden vid hjärtstopp
- 2007
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Ingår i: Läkartidningen. - 0023-7205. ; 104:8, s. 588-590
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Tidskriftsartikel (refereegranskat)abstract
- It is estimated that about 30 000 people a year are successfully resuscitated after having suffered an out-of-hospital cardiac arrest in Europe. The number of patients that are successfully resuscitated after an in-hospital cardiac arrest is not known, but it can be assumed that this figure is even higher than that after an out-of-hospital cardiac arrest. The aim of the Swedish Resuscitation Council is to gather together people with specific skills in the field of cardiac arrest in a single organisation. The council has five specific aims: 1) To develop guidelines for the treatment of cardiac arrest, 2) To develop specific educational programmes for the treatment of cardiac arrest, 3) To develop ethical guidelines for the treatment of cardiac arrest, 4) To spread knowledge in the community and in health care about the treatment of cardiac arrest and 5) To follow the effect of these efforts in terms of survival and cerebral function after cardiac arrest. In the present article, the Swedish Resuscitation Council is presented in greater detail.
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