| 1. |
- Ander, Fredrik, 1978-
(författare)
-
Perioperative complications in obese patients : A thesis on risk reducing strategies
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aspiration of gastric content and delayed or failed intubation are the leading causes of anesthesia-related mortality and morbidity. In the recovery period, airway obstruction with subsequent hypoxia is a relatively common cause of morbidity, and is highly associated to the amount of opioids administered, especially in obese patients.The overall aim of this thesis was to study these risk factors for airway complications and postoperative hypoxia in obese patients, and to evaluate possible strategies for their prevention.In Study I, intubation times and incidence of failed intubation in obese patients were compared between direct laryngoscopy and videolaryngoscopy with the Stortz® C-MAC™. In Studies II and III, the effect of esmolol vs. remifentanil on the esophageal junction, and the possible analgesic properties of low-dose esmolol vs. placebo were evaluated using high-resolution manometry and the cold pressor test, respectively. Finally, in Study IV, the possible opioid-sparing effect of esmolol after laparoscopic gastric bypass surgery was evaluated.The use of videlaryngoscopy did not shorten intubation times, however appeared to reduce the incidence of failed intubation. Our results also show that esmolol has a favorable profile, compared to remifentanil, with regard to the protection against passive regurgitation and aspiration of gastric content. No analgesic effect of low-dose esmolol was however demonstrated. The intraoperative administration of esmolol instead of remifentanil also did not reduce the requirement of morphine for treatment of post-operative pain.The use of Stortz® C-MAC™ may be recommended for intubation of obese patients. Further studies are however required to clarify the possible role of esmolol in anesthesia.
|
|
| 2. |
- Andersson Raeder, Johanna, 1964-
(författare)
-
Hellre hustru än änka : Äktenskapets ekonomiska betydelse för frälsekvinnor i senmedeltidens Sverige
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation studies the economic partnership between husband and wife amongst the Swedish nobility during the fifteenth century. Medieval marriages have been seen as an institution that first and foremost was economically and socially beneficial to men. The dissertation aims to broaden this view by emphasizing the marriages’ importance to women’s economic agency within the prevailing patriarchal structure of medieval society.Through arranged marriages noble families formed political and social networks in order to uphold and secure their positions. In scholarly literature the role of women is often reduced to being a link between men, the father and the husband, enabling property transfers between lineages. This dissertation describes how spouses circumvented the regulations of inheritance to benefit each other and their conjugal family. Furthermore, it discusses how these strategies were economically advantageous for married women whilst sustaining the patriarchal structure.The legal status of women changed when they became widows, and it has often been pointed out that widows had opportunities and agency that neither unmarried nor married women had. The autonomy that women gained when they married was conditional on the guardianship of her husband. The widow had no guardian, thus being her own mistress. However, based on the high rate of remarriage amongst noble widows this dissertation argues that widow’s legal freedom to handle economic and juridical matters was considerably constrained within the existing gender system. Furthermore, it argues that remarried women’s freedom of action was larger than that of widows. Hence, marriage offered the possibility of forming an economic partnership with a man that represented their conjugal estate in economic transactions.
|
|
| 3. |
- Halaas, Nathalie Bodd, et al.
(författare)
-
Neurofilament Light in Serum and Cerebrospinal Fluid of Hip Fracture Patients with Delirium.
- 2018
-
Ingår i: Dementia and geriatric cognitive disorders. - : S. Karger AG. - 1421-9824 .- 1420-8008. ; 46:5-6, s. 346-357
-
Tidskriftsartikel (refereegranskat)abstract
- Delirium is associated with new-onset dementia, suggesting that delirium pathophysiology involves neuronal injury. Neurofilament light (NFL) is a sensitive biomarker for neuroaxonal injury.NFL was measured in cerebrospinal fluid (CSF) (n = 130), preoperative serum (n = 192), and postoperative serum (n = 280) in hip fracture patients, and in CSF (n = 123) and preoperative serum (n = 134) in cognitively normal older adults undergoing elective surgery. Delirium was diagnosed with the Confusion Assessment Method.Median serum NFL (pg/mL) was elevated in delirium in hip fracture patients (94 vs. 54 pre- and 135 vs. 92 postoperatively, both p < 0.001). Median CSF NFL tended to be higher in hip fracture patients with delirium (1,804 vs. 1,636, p = 0.074). Serum and CSF NFL were positively correlated (ρ = 0.56, p < 0.001).Our findings support an association between neuroaxonal injury and delirium. The correlation between serum and CSF NFL supports the use of NFL as a blood biomarker in future delirium studies.
|
|
| 4. |
- Idland, Ane Victoria, et al.
(författare)
-
Preclinical amyloid-β and axonal degeneration pathology in delirium
- 2016
-
Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 55:1, s. 371-379
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The clinical relevance of brain β-amyloidosis in older adults without dementia is not established. As delirium and dementia are strongly related, studies on patients with delirium may give pathophysiological clues. Objective: To determine whether the Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers amyloid-β 1-42 (Aβ42), total tau (T-tau), and phosphorylated tau (P-tau) are associated with delirium in hip fracture patients with and without dementia. Methods: CSF was collected in conjunction to spinal anesthesia in 129 patients. Delirium was assessed using the Confusion Assessment Method once daily in all patients, both pre- and postoperatively. The diagnosis of dementia at admission was based upon clinical consensus. CSF levels of Aβ42, T-tau, and P-tau were analyzed. Results: In patients without dementia, we found lower CSF Aβ42 levels (median, 310ng/L versus 489ng/L, p=0.006), higher T-tau levels (median, 505ng/L versus 351ng/L, p=0.02), but no change in P-tau in patients who developed delirium (n=16) compared to those who remained lucid (n=49). Delirious patients also had lower ratios of Aβ42 to T-tau (p<0.001) and P-tau (p=0.001) relative to those without delirium. CSF Aβ42 and T-tau remained significantly associated with delirium status in adjusted analyses. In patients with dementia, CSF biomarker levels did not differ between those with (n=54) and without delirium (n=10). Conclusion: The reduction in CSF Aβ42, indicating β-amyloidosis, and increase in T-tau, indicating neurodegeneration, in hip fracture patients without dementia developing delirium indicates that preclinical AD brain pathology is clinically relevant and possibly plays a role in delirium pathophysiology.
|
|
| 5. |
-
Overview of the JET results
- 2015
-
Ingår i: Nuclear Fusion. - : IOP Publishing. - 0029-5515 .- 1741-4326. ; 55:10
-
Tidskriftsartikel (refereegranskat)
|
|
| 6. |
- Samuelsson, Peter, 1961-
(författare)
-
Awareness and Dreaming during Anaesthesia : Incidence and Importance
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The definition of awareness used consistently in this thesis is: Explicit recall of intraoperative events during general anaesthesia. Since there is no objective method to detect awareness, the patients must be interviewed after anaesthesia. The form and timing of the interview is crucial. To rely on spontaneous disclosure of awareness episodes is not sufficient. The total number of awareness-victims is considerable although the incidence may seem modest. A number of these patients look upon the awareness experience as the worst experience in their life. Suffering can include pain, mental distress and delayed psychological symptoms. However, the experience of awareness is not uniform and not all patients suffer.A comprehensible definition for dreaming during anaesthesia is: Any recalled experience, excluding awareness, which occurred between induction of anaesthesia and the first moment of consciousness upon emergence. Some findings point in the direction that dreaming during anaesthesia may be related to light or insufficient anaesthesia, but other findings do not. Some patients find dreaming during anaesthesia distressing, but generally the overall impression is that consequences of dreaming during anaesthesia seem to be small and of minor importance to the majority of patients.In this thesis I have found the following:The incidence of awareness is approximately 0.2% when neuromuscular blocking drugs are used and awareness also exists without these drugs, albeit to a lesser extent. These findings represent standard practice in an adult population at normal risk. 50% of awareness cases may have delayed recall of awareness.Using a consecutive inclusion design we found initial awareness suffering comparable to previous studies, but a lower incidence and less pronounced severity of late psychological symptoms. The incidences found among the awareness-victims in our study were; experience of pain 46%, immediate mental distress 65%, any late psychological symptom 33%, and PTSD below 10%.A memory of an intraoperative dream after general anaesthesia is not an early interpretation of delayed awareness, indicating that no routine follow up of dreaming-only patients is indicated.Dreams reported after anesthesia are generally not related to insufficient anesthesia defined as high BIS, and should not be regarded as near awareness.
|
|
| 7. |
- Watne, Leiv Otto, et al.
(författare)
-
Cerebrospinal fluid quinolinic acid is strongly associated with delirium and mortality in hip fracture patients.
- 2023
-
Ingår i: The Journal of clinical investigation. - 1558-8238. ; 133:2
-
Tidskriftsartikel (refereegranskat)abstract
- The kynurenine pathway (KP) has been identified as a potential mediator linking acute illness to cognitive dysfunction by generating neuroactive metabolites in response to inflammation. Delirium (acute confusion) is a common complication of acute illness and is associated with increased risk of dementia and mortality. However, the molecular mechanism underlying delirium, particularly in relation to the KP, remain elusive.We undertook a multi-center observational study with 586 hospitalized patients (248 with delirium) and investigated associations between delirium and KP metabolites measured in cerebrospinal fluid (CSF) and serum by targeted metabolomics. We also explored associations between KP metabolites and markers of neuronal damage and one-year mortality.In delirium, we found concentrations of the neurotoxic metabolite quinolinic acid in CSF (CSF-QA, OR 2.26 [1.78, 2.87], p<0.001) to be increased, as well as increases in several other KP metabolites in serum and CSF. In addition, CSF-QA was associated with the neuronal damage marker neurofilament light chain (NfL, β 0.43, p<0.001) and was a strong predictor of one-year mortality (HR 4.35 [2.93, 6.45] for CSF-QA ≥ 100 nmol/L, p<0.001). The associations between CSF-QA and delirium, neuronal damage, and mortality remained highly significant following adjustment for confounders and multiple comparisons.Our data identified how systemic inflammation, neurotoxicity, and delirium are strongly linked via the KP, and should inform future delirium prevention and treatment clinical trials that target enzymes of the KP.Norwegian Health Association and the South-Eastern Norway Regional Health Authorities.
|
|
