| 1. |
- Ejnell, Hasse, et al.
(författare)
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Nationella rekommendationer för trakeotomi och trakeostomivård : [National recommendations for tracheotomy and tracheostomy care. Consensus for safe tracheostomy care of adult patients]
- 2020
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Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- This article describes new Swedish guidelines for the care of adult patients having a tracheostomy. A national expert panel of ENT and anaesthesiology specialists appointed by each national specialist association reviewed fatal patient cases involving tracheostomy failure as well as national and international guidelines to produce a "best of practice" document. The main recommendation is that the health care provider has the full responsibility to ensure that the combined surgical competence at the hospital can handle acute airway problems also under difficult anatomical conditions. The distribution of percutaneous and surgical tracheotomy should be weighted to ensure the competence in both.
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| 2. |
- Jildenstål, Pether, et al.
(författare)
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Monitoring the Nociception Level Intraoperatively - An Initial Experiences : Monitoring the Nociception Level Intraoperatively - An Initial Experiences
- 2018
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Ingår i: Journal of Anesthesia & Intensive Care Medicine. - 2474-7653. ; 7:2, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: Estimating pain stimuli in the anesthetized patient can be difficult when based solely upon physiological parameters, especially when vasopressors are used as well. There is an increasing interest during general anesthesia to understand how optimal anesthesia changes by the level of noxious stimulation. Objectively, noxious stimulation measurement monitoring techniques are gaining interest. Although currently, its exact use in routine clinical practice is still not well proven. The aim of this study was to identify relationships between PMD 200 monitoring, Nociception Level (NOL-index) and monitored known physiological signs as well as outcomes during general anesthesia. Method: Eight patients between the ages of 43 and 83 years old and scheduled for major head and neck surgery under general anesthesia were observed in this study. NoL index sensor was placed on one of the patient’s fingers before anesthesia was induced, and values were extracted during the intraoperative period. Results: NoL index values increased intraoperatively during nociceptive stimuli such as jaw lift, endotracheal intubation, catheterization of the bladder, and with surgical skin incision. NoL index increased at several occasions faster, and were more prominent than physiological parameters (BP, HR). Conclusion: There are identified relationships between PMD 200 monitoring, NOL-index and nociceptive stimulation. NoL index tends to indicate nociceptive responses earlier and more often than hemodynamic outcomes. NoL index can be a physiological marker for optimal analgesic administration and an interesting complement to monitoring equipment intraoperatively worth further studies.
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| 3. |
- Nellgard, Per, et al.
(författare)
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Fourth Swedish difficult airway guidelines
- 2017
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Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 61:8, s. 1035-1036
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Nellgård, Per, et al.
(författare)
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National recommendations for tracheotomy and for tracheostomy care
- 2017
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Ingår i: Abstracts from the Scandinavian Society of Anesthesiology and Intensive Care Medicine 34th Congress. - : John Wiley & Sons. ; , s. 1034-1035
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Konferensbidrag (refereegranskat)abstract
- Background: Every year 2000 tracheotomies are performed in Sweden. Severe or lethal complications and shortcomings in the valuation of risks pre-, per- and postoperatively occurs. This work intends, based on best available evidence, to reduce injuries related to tracheotomy.Material and Method: Anaesthesiologists and otorhinolaryngologists from University Hospitals compiled a document with guidelines to reduce risks to cause severe complications and death at tracheotomy operations. Landstingens Omse- € sidiga Fors € €akringsbolag (LOF, Swedish insur- € ance company for publicly funded health care providers) also took part.Results: Surgical tracheotomy is recommended for children and adults with known or expected difficult intubation such as Cormack-Lehane IIIIV, short/thick neck, distance between cricoid cartilage and jugulum<15 mm, neck circumference >45 cm, tumors in head and neck area, BMI >35, rheumatoid arthritis, severe obstructive sleep apnea syndrome, high intracranial pressure, unstable neck fracture and coagulopathies. Acta Anaesthesiologica Scandinavica 61 (2017) 962–1062 1034 ª 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd SSAI ABSTRACTS Percutaneous tracheostomy (PCT) could be performed in intensive care patients. A tracheotomy cannula with an inner cannula should be used. Common complications include acute obstruction of tracheal cannula, dislocation, emphysema of the neck, trauma to dorsal tracheal wall. Some deaths have occurred due to lack of education to perform a surgical tracheotomy in patients where percutaneous tracheostomy were not possible to perform.Conclusion: Tracheotomy should be performed at hospitals where competence exist for surgical tracheotomy, including patients with difficult anatomy, regardless of the tracheotomy technique. At each hospitals the distribution between percutaneous and surgical tracheostomies must be weighted as to preserve overall competence for both techniques. A guideline of acute tracheal cannula occlusion is presented (Figure).
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| 5. |
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| 6. |
- Andersson, Emelie, et al.
(författare)
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Costs of diabetes complications : hospital-based care and absence from work for 392,200 people with type 2 diabetes and matched control participants in Sweden
- 2020
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Ingår i: Diabetologia. - : Springer. - 0012-186X .- 1432-0428. ; 63:12, s. 2582-2594
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Tidskriftsartikel (refereegranskat)abstract
- AIMS/HYPOTHESIS: The risk of complications and medical consequences of type 2 diabetes are well known. Hospital costs have been identified as a key driver of total costs in studies of the economic burden of type 2 diabetes. Less evidence has been generated on the impact of individual diabetic complications on the overall societal burden. The objective of this study was to analyse costs of hospital-based healthcare (inpatient and outpatient care) and work absence related to individual macrovascular and microvascular complications of type 2 diabetes in Sweden in 2016.METHODS: Data for 2016 were retrieved from a Swedish national retrospective observational database cross-linking individual-level data for 1997-2016. The database contained information from population-based health, social insurance and socioeconomic registers for 392,200 people with type 2 diabetes and matched control participants (5:1). Presence of type 2 diabetes and of diabetes complications were derived using all years, 1997-2016. Costs of hospital-based care and of absence from work due to diabetes complications were estimated for the year 2016. Regression analysis was used for comparison with control participants to attribute absence from work to individual complications, and to account for joint presence of complications.RESULTS: Use of hospital care for complications was higher in type 2 diabetes compared with control participants in 2016: 26% vs 12% had ≥1 hospital contact; there were 86,104 vs 24,608 outpatient visits per 100,000 people; and there were 9894 vs 2546 inpatient admissions per 100,000 people (all p < 0.001). The corresponding total costs of hospital-based care for complications were €919 vs €232 per person (p < 0.001), and 74.7% of costs were then directly attributed to diabetes (€687 per person). Regression analyses distributed the costs of days absent from work across diabetes complications per se, basic type 2 diabetes effect and unattributed causes. Diabetes complications amounted to €1317 per person in 2016, accounting for possible complex interactions (25% of total costs of days absent). Key drivers of costs were the macrovascular complications angina pectoris, heart failure and stroke; and the microvascular complications eye diseases, including retinopathy, kidney disease and neuropathy. Early mortality in working ages cost an additional €579 per person and medications used in risk-factor treatment amounted to €418 per person.CONCLUSIONS/INTERPRETATION: The economic burden of complications in type 2 diabetes is substantial. Costs of absence from work in this study were found to be greater than of hospital-based care, highlighting the need for considering treatment consequences in a societal perspective in research and policy. Graphical abstract.
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| 7. |
- Covacu, Ruxandra, et al.
(författare)
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Nitric oxide exposure diverts neural stem cell fate from neurogenesis towards astrogliogenesis
- 2006
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Ingår i: Stem Cells. - : Oxford University Press (OUP). - 1066-5099 .- 1549-4918. ; 178, s. 268-268
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Regeneration of cells in the central nervous system is a process that might be affected during neurological disease and trauma. Because nitric oxide (NO) and its derivatives are powerful mediators in the inflammatory cascade, we have investigated the effects of pathophysiological concentrations of NO on neurogenesis, gliogenesis, and the expression of proneural genes in primary adult neural stem cell cultures. After exposure to NO, neurogenesis was downregulated, and this corresponded to decreased expression of the proneural gene neurogenin-2 and beta-III-tubulin. The decreased ability to generate neurons was also found to be transmitted to the progeny of the cells. NO exposure was instead beneficial for astroglial differentiation, which was confirmed by increased activation of the Janus tyrosine kinase/signal transducer and activator of transcription transduction pathway. Our findings reveal a new role for NO during neuroinflammatory conditions, whereby its proastroglial fate-determining effect on neural stem cells might directly influence the neuroregenerative process.
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| 8. |
- Florentzson, Rut, 1957, et al.
(författare)
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Alström syndrome and chchlear implantation
- 2010
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Ingår i: 11th International Conference on Cochlear Implants ande Other Implantable Auditory Technologies.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Poster, Stockholm, Sweden June 30-July 3 2010
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| 9. |
- Hallén, Katarina, et al.
(författare)
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A simple method for isocapnic hyperventilation evaluated in a lung model.
- 2016
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 60:5, s. 597-606
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Tidskriftsartikel (refereegranskat)abstract
- Isocapnic hyperventilation (IHV) has the potential to increase the elimination rate of anaesthetic gases and has been shown to shorten time to wake-up and post-operative recovery time after inhalation anaesthesia. In this bench test, we describe a technique to achieve isocapnia during hyperventilation (HV) by adding carbon dioxide (CO2 ) directly to the breathing circuit of a standard anaesthesia apparatus with standard monitoring equipment.
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| 10. |
- Hallén, Katarina, et al.
(författare)
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Evaluation of a method for isocapnic hyperventilation: a clinical pilot trial.
- 2018
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 62:2, s. 186-195
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Tidskriftsartikel (refereegranskat)abstract
- Isocapnic hyperventilation (IHV) is a method that shortens time to extubation after inhalation anaesthesia using hyperventilation (HV) without lowering airway CO2 . In a clinical trial on patients undergoing long-duration sevoflurane anaesthesia for major ear-nose-throat (ENT) surgery, we evaluated the utility of a technique for CO2 delivery (DCO2 ) to the inspiratory limb of a closed breathing circuit, during HV, to achieve isocapnia.Fifteen adult ASA 1-3 patients were included. After end of surgery, mechanical HV was started by doubling baseline minute ventilation. Simultaneously, CO2 was delivered and dosed using a nomogram developed in a previous experimental study. Time to extubation and eye opening was recorded. Inspired (FICO2 ) and expired (FETCO2 ) CO2 and arterial CO2 levels were monitored during IHV. Cognition was tested pre-operatively and at 20, 40 and 60 min after surgery.A DCO2 of 285 ± 45 ml/min provided stable isocapnia during HV (13.5 ± 4.1 l/min). The corresponding FICO2 level was 3.0 ± 0.3%. Time from turning off the vaporizer (1.3 ± 0.1 MACage) to extubation (0.2 ± 0.1 MACage) was 11.3 ± 1.8 min after 342 ± 131 min of anaesthesia. PaCO2 and FETCO2 remained at normal levels during and after IHV. In 85% of the patients, post-operative cognition returned to pre-operative values within 60 min.In this cohort of patients, a DCO2 nomogram for IHV was validated. The patients were safely extubated shortly after discontinuing long-term sevoflurane anaesthesia. Perioperatively, there were no adverse effects on arterial blood gases or post-operative cognition. This technique for IHV can potentially be used to decrease emergence time from inhalation anaesthesia.
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