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- Akner, Gunnar, 1953-, et al.
(författare)
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Vi står gärna bakom en utfallsbaserad vård
- 2017
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Ingår i: Dagens Samhälle. - 1652-6511.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Jörgen Nordenström försöker få det till att vår kritik av värdebaserad vård egentligen handlar om att vi vill ha mer resurser. Han har helt missuppfattat oss, skriver 26 specialistläkare i en replik.
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- 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
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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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| 6. |
- 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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| 7. |
- Hallén, Katarina, et al.
(författare)
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Isocapnic hyperventilation provides early extubation after head and neck surgery: A prospective randomized trial
- 2018
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 62:8, s. 1064-1071
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIsocapnic hyperventilation (IHV) shortens recovery time after inhalation anaesthesia by increasing ventilation while maintaining a normal airway carbon dioxide (CO2)-level. One way of performing IHV is to infuse CO2 to the inspiratory limb of a breathing circuit during mechanical hyperventilation (HV). In a prospective randomized study, we compared this IHV technique to a standard emergence procedure (control). MethodsThirty-one adult ASA I-III patients undergoing long-duration (>3hours) sevoflurane anaesthesia for major head and neck surgery were included and randomized to IHV-treatment (n=16) or control (n=15). IHV was performed at minute ventilation 13.64.3L/min and CO2 delivery, dosed according to a nomogram tested in a pilot study. Time to extubation and eye-opening was recorded. Inspired (FICO2) and expired (FETCO2) CO2 and arterial CO2 levels (PaCO2) were monitored. Cognition was tested preoperatively and at 20, 40 and 60minutes after surgery. ResultsTime from turning off the vapourizer to extubation was 13.7 +/- 2.5minutes in the IHV group and 27.4 +/- 6.5minutes in controls (P<.001). Two minutes after extubation, PaCO2 was 6.2 +/- 0.5 and 6.2 +/- 0.6 kPa in the IHV and control group respectively. In 69% (IHV) vs 53% (controls), post-operative cognition returned to pre-operative values within 40 minutes after surgery (NS). Incidences of pain and nausea/vomiting did not differ between groups. ConclusionsIn this randomized trial comparing an IHV method with a standard weaning procedure, time to extubation was reduced with 50% in the IHV group. The described IHV method can be used to decrease emergence time from inhalation anaesthesia.
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- Hallén, Katarina, et al.
(författare)
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Isocapnic hyperventilation shortens washout time for sevoflurane - an experimental in vivo study
- 2016
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 60:9, s. 1261-1269
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIsocapnic hyperventilation (IHV) is a method that fastens weaning from inhalation anaesthesia by increasing airway concentration of carbon dioxide (CO2) during hyperventilation (HV). In an animal model, we evaluated a technique of adding CO2 directly to the breathing circuit of a standard anaesthesia apparatus. MethodsEight anaesthetised pigs weighing 28 2 kg were intubated and mechanically ventilated. From a baseline ventilation of 5 l/min, HV was achieved by doubling minute volume and fresh gas flow. Respiratory rate was increased from 15 to 22/min. The CO2 absorber was disconnected and CO2 was delivered (DCO2) to the inspiratory limb of a standard breathing circuit via a mixing box. Time required to decrease end-tidal sevoflurane concentration from 2.7% to 0.2% was defined as washout time. Respiration and haemodynamics were monitored by blood gas analysis, spirometry, electric impedance tomography and pulse contour analysis. ResultsA DCO2 of 261 +/- 19 ml/min was necessary to achieve isocapnia during HV. The corresponding FICO2-level remained stable at 3.1 +/- 0.3%. During IHV, washout of sevoflurane was three times faster, 433 +/- 135 s vs. 1387 +/- 204 s (P < 0.001). Arterial CO2 tension and end-tidal CO2, was 5.2 +/- 0.4 kPa and 5.6 +/- 0.4%, respectively, before IHV and 5.1 +/- 0.3 kPa and 5.7 +/- 0.3%, respectively, during IHV. ConclusionsIn this experimental in vivo model of isocapnic hyperventilation, the washout time of sevoflurane anaesthesia was one-third compared to normal ventilation. The method for isocapnic hyperventilation described can potentially be transferred to a clinical setting with the intention to decrease emergence time from inhalation anaesthesia.
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- Lindgren, Sophie, 1971, et al.
(författare)
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Comment on De Baerdemaeker et al.
- 2019
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 63:6, s. 833-834
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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