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- 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. |
- Bartha, Erzsébet, 1957-, et al.
(författare)
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Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery
- 2006
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 96:1, s. 111-117
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Tidskriftsartikel (refereegranskat)abstract
- Background. The outcome of different treatment strategies for postoperative pain has been an issue of controversy. Apart from efficacy and effectiveness a policy decision should also consider cost-effectiveness. Since economic analyses on postoperative pain treatment are rare we developed a decision model in a pilot cost-effectiveness analysis (CEA) comparing epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) after major abdominal surgery in routine care. Methods. Using a decision-tree model, treatment with EDA (ropivacaine and morphine) was compared with PCIA (morphine). Effects and costs of treatment were established. The number of pain-free days at rest (pain intensity <30 using visual analogue scale 1-100 mm) was the primary measure of effect. An incremental cost-effectiveness ratio (ICER) was calculated as the difference in direct costs divided by the difference in effect. A database on 644 patients collected for the purpose of quality control during the period of 1997 to 1999 was the main data source. Sensitivity analysis was used to test uncertain data. Results. EDA was more effective in terms of pain-free days but more expensive. The additional cost for each pain-free day was 5652 Euros. Conclusion. It is a judgement of value if the additional cost is reasonable. When the cost of around 55 000 Euros per gained life-year with full health for other interventions is debated, our result indicates poor cost-effectiveness for EDA. Before any conclusion can be drawn concerning policy recommendations the difference in costs has to be related to other outcome measures as length of hospital stay, morbidity and mortality are required. © The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved.
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| 3. |
- Bartha, Erzsébet, 1957-, et al.
(författare)
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Postoperativ smärtlindring - till vilket pris? : En hälsoekonomisk modellanalys av två smärtlindringsmetoder
- 2006
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Utgångspunkten för denna rapport var en kvalitetskontroll av rutiner för postoperativ smärtlindring vid Anestesikliniken på US i Linköping under 1997-1999. Vid denna kontroll upptäckte vi en del svagheter i rutiner, bl.a. att epiduralsmärtlindring avslutades tidigare än avsetts i högre frekvens än väntat. Under denna period registrerades en mängd uppgifter om aktuell behandling och olika utfall i en databas. Resultatet pekade på att den mest använda metoden i praktiken var förenad med extrainsatser som bidrog till högre kostnader. Denna kunskap ledde fram till en vidare frågeställning än vad som traditionellt diskuterats i dessa sammanhang nämligen hur de aktuella metoderna förhåller sig till varandra när även kostnader för behandlingen tas i beaktande. Det första steget att besvara denna fråga var ett projektarbete i kursen om Klinisk Utvärderingsvetenskap (KLUV) som anordnades av Linköpings universitet med stöd av Forskningsrådet i Sydvästra Sjukvårdsregionen. Studien har sedan vidareutvecklats och färdigställts vid CMT med ekonomiskt stöd från Landstinget i Östergötland.Syftet med rapporten är att belysa hur två metoder för postoperativ smärtlindring (epiduralbedövning och intravenös opioidbehandling med patientkontrollerad pump) fungerar i vardagssjukvård med hänsyn tagen till både kostnader och effekten på smärta. Frågan om vilken metod som är den bättre av dessa har diskuterats under senaste decenniet. Epiduralbedövning tycks ge bättre smärtlindring, men det är oklart vilket mervärde som den skillnaden i smärtintensitet ger oavsett om den mäts som patientupplevd, medicinsk eller samhällelig nytta. Frågan om vilken behandlingsform som är mest kostnadseffektiv är intressant eftersom den här typen av smärtlindring är vanlig och berör ett stort antal patienter i sjukvården. Vår förhoppning är att vi med hjälp av denna hälsoekonomiska modellanalys av beslutsproblemet kan bidra till ett bättre beslutsunderlag men också väcka ett intresse för att göra hälsoekonomiska utvärderingar av smärtlindringsmetoder vilket hittills varit relativt ovanligt.Studien har genomförts i samarbete mellan CMT och AnOp Centrum vid US i Linköping. Flera personer har bidragit till denna rapport och vi vill tacka Mona Lindblad och Lilian Adamsson som var ansvariga för databasen under åren 1997-1999. Vi vill vidare tacka Martin Henriksson vid CMT för värdefulla synpunkter.
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| 4. |
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| 7. |
- Kalman, Sigga, 1952-, et al.
(författare)
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Morphine responsiveness in a group of well-defined multiple sclerosis patients : a study with i.v. morphine
- 2002
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 6:1, s. 69-80
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Tidskriftsartikel (refereegranskat)abstract
- Pain in multiple sclerosis (MS) is more common than has previously been believed. About 28% of all MS patients suffer from central pain (CP), a pain that is difficult to treat. In the present study we have investigated the responsiveness of this pain to morphine. Fourteen opioid-free patients (eight woman and six men) with constant, non-fluctuating, long-lasting CP caused by MS were investigated. Placebo (normal saline), morphine and naloxone were given intravenously in a standardized manner. The study design was non-randomized, single blind and placebo controlled. Ten patients experienced less than 50% pain reduction by placebo and less than 50% pain reduction by morphine. Four patients were opioid responders, i.e. had minimal or no effect on pain by placebo, >50% pain reduction after morphine and >25% pain increase after naloxone, given intravenously following morphine. However, this response was obtained after high doses of morphine (43 mg, 47 mg, 50 mg and 25 mg; mean 41 mg). Thus, compared with nociceptive pain, only a minority of the patients with CP due to MS responded to morphine and only at high doses. The present results are in accord with experimental studies indicating that neuropathic pain is poorly responsive but not totally unresponsive to opioids. The results do not support the routine use of strong opioids in MS patients with CP.
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| 8. |
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| 9. |
- Kalman, Sigga, 1952-
(författare)
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Studies on the halothane-diethyl-ether azeotrope
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Requirements for a safe standard for anaesthesia under primitiveconditions differ from those under peaceful circumstances. It is important not to blunt the reflexes that guard vital functions. Safety requirements concerning breathing, circulation, and drug interaction must be sharpened because professional surveillance of the patient may be restricted. The halothane-diethyl-ether azeotrope (HE azeotrope) has properties that could make it suitable for anaesthesia under adverse circumstances. We have re-evaluated the HE azeotrope with special reference to safety in studies on 102 patients and 19 pigs.The vaporizers were calibrated to guarantee their performance. Guidelines for the use of Auotec® Mark Ill and Servo® vaporizer for halothane combined with the HE azeotrope are set out. Minimum alveolar concentration (MAC) for the HE azeotrope has not previously been published. The MAC for the HE azeotrope was determined in man (0.71 vol.%± 0.03, ± SEM) and pig (0.99 vol.%± 0.07) to allow comparison with other inhalation anaesthetics. The safety ratio defined as the ratio between fatal alveolar concentration and minimum alveolar concentration was found to be 3.1 in pig, which is about twice as high as previously reported data for halothane anaesthesia alone.Ventilation during surgical anaesthesia (1.1-1.2 MAC), both when resting and during challenge with raised inspiratory levels of carbon dioxide and decreased inspiratory concentration of oxygen, was measured. Ventilation was maintained during resting. Response to hypercarbia was preserved, in contrast to what was seen under isoflurane anaesthesia. Response to hypoxia was abolished.The central circulation was well preserved under normovolaemia in pigs during HE azeotrope anaesthesia. Haemorrhage. with a loss of30% of the blood volume was well tolerated, no matter whether the pig had received HE azeotrope or isoflurane. Isoflurane is considered in the literature to be an anaesthetic well tolerated by pigs.Most inhalation anaesthetics potentiate neuromuscular blockade, which is an important and sometimes dangerous component of anaesthesia. We therefore thought it important to investigate whether interaction takes place between vecuronium induced neuromuscular blockade and the HE azeotrope. Potentiation similar to that occurring during halothane anaesthesia was found.Early postoperative liver function was studied by tests of cellular metabolic capacity, cell integrity, cholestasis, and synthesizing capacity. No major impact on hepatic function after HE azeotrope anaesthesia was seen.Thus, the halothane-diethyl-ether azeotrope has properties that could make it interesting as an alternative anaesthetic drug under difficult circumstances.
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| 10. |
- Nilsson, Lena, 1956-, et al.
(författare)
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Age and gender do not influence the ability to detect respiration by photoplethysmography
- 2006
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Ingår i: Journal of clinical monitoring and computing. - : Springer Science and Business Media LLC. - 1387-1307 .- 1573-2614. ; 20:6, s. 431-436
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Tidskriftsartikel (refereegranskat)abstract
- Objective The non-invasive technique photopl- ethysmography (PPG) can detect changes in blood volume and perfusion in a tissue. Respiration causes variations in the peripheral circulation, making it possible to monitor breaths using an optical sensor attached to the skin. The respiratory-synchronous part of the PPG signal (PPGr) has been used to monitor respiration during anaesthesia, and in postoperative and neonatal care. Studies addressing possible differences in PPGr signal characteristics depending on gender or age are lacking.Methods We studied three groups of 16 healthy subjects each during normal breathing; young males, old males and young females, and calculated the concordance between PPGr, derived from a reflection mode PPG sensor on the forearm, and a reference CO2 signal. The concordance was quantified by using a squared coherence analysis. Time delay between the two signals was calculated. In this process, we compared three different methods for calculating time delay.Results Coherence values ≥0.92 were seen for all three groups without any significant differences depending on age or gender (p = 0.67). Comparison between the three different methods for calculating time delay showed a correlation r = 0.93.Conclusions These results demonstrate clinically important information implying the possibility to register qualitative PPGr signals for respiration monitoring, regardless of age and gender.
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