| 1. |
- Chew, Michelle, et al.
(författare)
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Decreases in myocardial glucose and increases in pyruvate but not ischaemia are observed during porcine endotoxaemia
- 2008
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 52:7, s. 959-968
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Tidskriftsartikel (refereegranskat)abstract
- Background: Myocardial dysfunction occurs commonly in septic shock. It is not known whether this is due to local ischaemia and metabolic disturbances. Our hypothesis was that endotoxaemic myocardial dysfunction may be associated with interstitial ischaemic and metabolic changes, measured using interstitial microdialysis (MD). Methods: Eighteen pigs were randomized to control (n=6) or endotoxin infusion (n=12). MD catheters were inserted into the myocardium for measurement of interstitial glucose, pyruvate and lactate concentrations. Plasma glucose and lactate concentrations and systemic haemodynamic parameters were measured simultaneously. Results: Compared with the control group, the endotoxaemic animals had significantly decreased left ventricular stroke work and venous oxygen saturation (SvO2), and increased mean pulmonary artery pressure and plasma lactate. In the endotoxaemic group, decreases in interstitial glucose were observed, occurring simultaneously with increases in interstitial pruvate. Interstitial lactate : pyruvate ratios decreased with time in all animals. Conclusions: Despite severe systemic and pulmonary haemodynamic changes, interstitial MD measurements revealed no evidence of anaerobic metabolism in the myocardium of endotoxaemic pigs. There were, however, changes in glucose and pyruvate concentrations, suggesting local energy metabolic disturbances. © 2008 The Authors.
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| 2. |
- Grände, Per-Olof, et al.
(författare)
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Active cooling in traumatic brain-injured patients: a questionable therapy?
- 2009
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 53, s. 1233-1238
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Tidskriftsartikel (refereegranskat)abstract
- Hypothermia is shown to be beneficial for the outcome after a transient global brain ischaemia through its neuroprotective effect. Whether this is also the case after focal ischaemia, such as following a severe traumatic brain injury (TBI), has been investigated in numerous studies, some of which have shown a tendency towards an improved outcome, whereas others have not been able to demonstrate any beneficial effect. A Cochrane report concluded that the majority of the trials that have already been published have been of low quality, with unclear allocation concealment. If only high-quality trials are considered, TBI patients treated with active cooling were more likely to die, a conclusion supported by a recent high-quality Canadian trial on children. Still, there is a belief that a modified protocol with a shorter time from the accident to the start of active cooling, longer cooling and rewarming time and better control of blood pressure and intracranial pressure would be beneficial for TBI patients. This belief has led to the instigation of new trials in adults and in children, including these types of protocol adjustments. The present review provides a short summary of our present knowledge of the use of active cooling in TBI patients, and presents some tentative explanations as to why active cooling has not been shown to be effective for outcome after TBI. We focus particularly on the compromised circulation of the penumbra zone, which may be further reduced by the stress caused by the difference in thermostat and body temperature and by the hypothermia-induced more frequent use of vasoconstrictors, and by the increased risk of contusional bleedings under hypothermia. We suggest that high fever should be reduced pharmacologically.
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| 3. |
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| 4. |
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| 5. |
- Almgren, M, et al.
(författare)
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The Richmond Agitation-Sedation Scale: translation and reliability testing in a Swedish intensive care unit.
- 2010
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 54, s. 729-735
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Tidskriftsartikel (refereegranskat)abstract
- Background: Awareness about adequate sedation in mechanically ventilated patients has increased in recent years. The use of a sedation scale to continually evaluate the patient's response to sedation may promote earlier extubation and may subsequently have a positive effect on the length of stay in the intensive care unit (ICU). The Richmond Agitation-Sedation Scale (RASS) provides 10 well-defined levels divided into two different segments, including criteria for levels of sedation and agitation. Previous studies of the RASS have shown it to have strong reliability and validity. The aim of this study was to translate the RASS into Swedish and to test the inter-rater reliability of the scale in a Swedish ICU. Methods: A translation of the RASS from English into Swedish was carried out, including back-translation, critical review and pilot testing. The inter-rater reliability testing was conducted in a general ICU at a university hospital in the south of Sweden, including 15 patients mechanically ventilated and sedated. Forty in-pair assessments using the Swedish version of the RASS were performed and the inter-rater reliability was tested using weighted kappa statistics (linear weighting). Result: The translation of the RASS was successful and the Swedish version was found to be satisfactory and applicable in the ICU. When tested for inter-rater reliability, the weighed kappa value was 0.86. Conclusion: This study indicates that the Swedish version of the RASS is applicable with good inter-rater reliability, suggesting that the RASS can be useful for sedation assessment of patients mechanically ventilated in Swedish general ICUs.
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| 6. |
- 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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| 7. |
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| 8. |
- Björkman Björkelund, Karin, et al.
(författare)
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Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study.
- 2010
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; Apr 7, s. 678-688
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. Methods: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (>/=65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. Results: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had >4 prescribed drugs at admission and scored less well in the SPMSQ test. Conclusion: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.
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| 9. |
- Broman, M, et al.
(författare)
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Malignant hyperthermia and central core disease causative mutations in Swedish patients.
- 2007
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 51:Nov 1, s. 50-53
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Tidskriftsartikel (refereegranskat)abstract
- Background: Malignant hyperthermia (MH) susceptibility is a pharmacogenetic disorder of intracellular calcium homeostasis. In susceptible individuals, halogenated anaesthetics and/or suxamethonium may trigger an MH reaction. The diagnosis of MH susceptibility is made by an in vitro contracture test of biopsied muscle strips. Methods: In 27 MH susceptible (MHS) probands and four MH negative (MHN) probands, exons 17, 39, 40, 45 and 46 of the RYR1 gene were screened for MH causative mutations. In addition, in three patients with established central core disease (CCD), exons 17, 39, 40, 45 and 46 and exons 95, 100, 101 and 102 were screened for MH and CCD causative mutations. All screenings were performed by direct sequencing of the entire exons. Results: MH causative mutations were found in five of the 27 MHS probands (19%). CCD causative mutations were found in two of three CCD patients in the C-terminal exons. None of the CCD patients showed a mutation in N-terminal exon 17 or in the central exons. Conclusions: In a Swedish population, screening of N-terminal exon 17 and the central exons for MH causative mutations in the RYR1 gene covers 19% of families. Thus, other mutations must also be responsible for MH susceptibility in Sweden. Although the number of CCD patients in this study was small, screening of the C-terminal exons for CCD causative mutations seems to be a promising tool in the process of making a diagnosis.
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| 10. |
- Ciornei, Cristina
(författare)
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Vascular actions of antimicrobial peptides
- 2006
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 50:5, s. 631-631
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Tidskriftsartikel (refereegranskat)
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| 11. |
- Covaciu, Lucian, et al.
(författare)
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Intranasal cooling with or without intravenous cold fluids during and after cardiac arrest in pigs
- 2010
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 54:4, s. 494-501
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intranasal balloon catheters circulated with cold saline have previously been used for the induction and maintenance of selective brain cooling in pigs with normal circulation. In the present study, we investigated the feasibility of therapeutic hypothermia initiation, maintenance and rewarming using such intranasal balloon catheters with or without addition of intravenous ice-cold fluids during and after cardiac arrest treatment in pigs. Material and methods: Cardiac arrest was induced in 20 anaesthetised pigs. Following 8 min of cardiac arrest and 1 min of cardiopulmonary resuscitation (CPR), cooling was initiated after randomisation with either intranasal cooling (N) or combined with intravenous ice-cold fluids (N+S). Hypothermia was maintained for 180 min, followed by 180 min of rewarming. Brain and oesophageal temperatures, haemodynamic variables and intracranial pressure (ICP) were recorded. Results: Brain temperatures reductions after cooling did not differ (3.8 +/- 0.7 degrees C in the N group and 4.3 +/- 1.5 degrees C in the N+S group; P=0.47). The corresponding body temperature reductions were 3.6 +/- 1.2 degrees C and 4.6 +/- 1.5 degrees C (P=0.1). The resuscitation outcome was similar in both groups. Mixed venous oxygen saturation was lower in the N group after cooling and rewarming (P=0.024 and 0.002, respectively) as compared with the N+S group. ICP was higher after rewarming in the N group (25.2 +/- 2.9 mmHg; P=0.01) than in the N+S group (15.7 +/- 3.3 mmHg). Conclusions: Intranasal balloon catheters can be used for therapeutic hypothermia initiation, maintenance and rewarming during CPR and after successful resuscitation in pigs.
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| 12. |
- Dubniks, Maris, et al.
(författare)
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The effects of activated protein C and prostacyclin on arterial oxygenation and protein leakage in the lung and the gut under endotoxaemia in the rat.
- 2008
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 52, s. 381-387
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Tidskriftsartikel (refereegranskat)abstract
- Background: Based on the anti-adhesive/anti-aggregatory and permeability-reducing properties of activated protein C (APC) and prostacyclin (PGI(2)), we analysed and compared these substances regarding their efficacy in counteracting transcapillary leakage of albumin in the lung and the gut, and in improving arterial oxygenation under a condition of inflammation. Methods: The randomized and blinded study was performed on 31 adult male Sprague-Dawley rats. Inflammation was induced by continuous infusion of Escherichia coli endotoxin (lipopolysaccharide, LPS). Six hours after the start of the LPS infusion (240,000 U/kg/h), a simultaneous infusion of saline (control group) or 8 mug/kg/min of human recombinant APC or 2 ng/kg/min of PGI(2) was started and continued for 24 h (n=8 per group). The study also included a sham group. Transcapillary leakage of albumin was measured from the ratio between tissue radioactivity [counts per minute (cpm)/g tissue] and actual amount of radioactivity given (cpm/g body weight of (125)I-albumin). Oxygenation was assessed from arterial and central venous blood samples. Results: LPS induced albumin leakage in the gut and the lung, and impaired blood oxygenation. In the lung, the leakage was lower in the PGI(2) group than in the APC and the control groups (P<0.05). In the gut, it was lower in the APC and the PGI(2) groups than in the control group (P<0.05). Oxygenation was better in the APC and PGI(2) groups than in the control group. Conclusion: Our data suggest that both APC and low-dose PGI(2) are beneficial in LPS-induced inflammation in the rat, by reducing albumin leakage and improving blood oxygenation.
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| 13. |
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| 14. |
- Gardenfors, F, et al.
(författare)
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Adverse biochemical and physiological effects of prostacyclin in experimental brain oedema
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:10, s. 1316-1321
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prostacyclin (PGI(2)) and its stable analogues are known to reduce capillary hydraulic permeability. This study explores the biochemical and physiological effects of i.v. infusion of low-dose PGI(2) in an experimental model of vasogenic brain oedema. Methods: Twenty-seven anaesthetized and mechanically ventilated piglets with brain oedema induced by intrathecal injection of lipopolysaccharide (LPS) were used. Five of the animals received a continuous infusion of PGI(2) (1 ng kg(-1) min(-1)) i.v. Four microdialysis catheters were placed in the brain to measure interstitial concentrations of glucose, lactate, and glycerol. Mean arterial pressure (MAP), intracranial pressure (ICP) and temperature were monitored continuously. Low-dose infusion of PGI(2) started 1 h before the LPS injection and was constant during the study period. Results: Intracranial pressure increased significantly in animals treated with PGI(2). The increase in ICP was associated with significant cerebral biochemical changes: decrease in glucose, increase in lactate, increase in lactate/glucose ratio and increase in glycerol. Conclusion: In LPS-induced brain oedema i.v. infusion of low-dose PGI(2) caused a further increase in ICP and a perturbation of energy metabolism, indicating cerebral ischemia and degradation of cellular membranes.
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| 15. |
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| 16. |
- Grände, Per-Olof
(författare)
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Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture - a physiological approach.
- 2005
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 49:5, s. 619-626
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Tidskriftsartikel (refereegranskat)abstract
- Background: The cause of postspinal headache and its specific characteristics are unknown, and whether lumbar dural puncture (LP) triggers brain-stem compression in patients with brain oedema is still controversial. Methods: Hydrostatic effects of distal opening of the dural sac towards the atmosphere are described and applied to the normal brain and the brain with disrupted BBB. Analogue analyses from previous results using an isolated skeletal muscle enclosed in a rigid shell were applied to the brain in an attempt to simulate and verify the haemodynamic effects of distal opening of the spinal canal. Results: The theoretical considerations and the experimental results are compatible with the hypothesis that hydrostatic effects of distal opening of the fluid-filled spinal canal may obliterate the normal subdural venous collapse after a change from the horizontal to vertical position, which may be compatible with postural postspinal headache as occurring close to pain-sensitive meningeal regions. The hydrostatic forces may also initiate transcapillary filtration and aggravate oedema when permeability is increased, which may cause a narrower situation in the brain stem region, perhaps aggravated by venous stasis and a Cushing reflex-induced increase in blood pressure. An magnetic resonance imaging (MRI) picture illustrates how this scenario may separate the subdural space into an upper high- and a lower low-pressure cavity, pressing the brain downwards with sagging of the brain. A life-threatening positive feedback situation for brain-stem compression may develop. Conclusion: The present study strongly suggests that postspinal headache and brain-stem compression and other LP-related effects are predictable following LP, without involving CSF leakage, and can be explained by hydrostatic effects triggered by distal opening of the normally closed dural space to the atmosphere.
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| 17. |
- Gullberg, N., et al.
(författare)
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Immediate and 5-year cumulative outcome after paediatric intensive care in Sweden
- 2008
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 52:8, s. 1086-95
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Tidskriftsartikel (refereegranskat)abstract
- Background: Little has been reported about intensive care of children in Sweden. The aims of this study are to (I) assess the number of admissions, types of diagnoses and length-of-stay (LOS) for all Swedish children admitted to intensive care during the years 1998-2001, and compare paediatric intensive care units (PICUs) with other intensive care units (adult ICUs) (II) assess immediate (ICU) and cumulative 5-year mortality and (III) determine the actual consumption of paediatric intensive care for the defined age group in Sweden. Methods: Children between 6 months and 16 years of age admitted to intensive care in Sweden were included in a national multicentre, ambidirectional cohort study. In PICUs, data were also collected for infants aged 1-6 months. Survival data were retrieved from the National Files of Registration, 5 years after admission. Results: Eight-thousand sixty-three admissions for a total of 6661 patients were identified, corresponding to an admission rate of 1.59/1000 children per year. Median LOS was 1 day. ICU mortality was 2.1% and cumulative 5-year mortality rate was 5.6%. Forty-four per cent of all admissions were to a PICU. Conclusions: This study has shown that Sweden has a low immediate ICU mortality, similar in adult ICU and PICU. Patients discharged alive from an ICU had a 20-fold increased mortality risk, compared with a control cohort for the 5-year period. Less than half of the paediatric patients admitted for intensive care in Sweden were cared for in a PICU. Studies are needed to evaluate whether a centralization of paediatric intensive care in Sweden would be beneficial to the paediatric population.
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| 18. |
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| 19. |
- Holmström, Anders, et al.
(författare)
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Desflurane results in higher cerebral blood flow than sevoflurane or isoflurane at hypocapnia in pigs.
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:4, s. 400-404
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Tidskriftsartikel (refereegranskat)abstract
- Background: In clinical neuroanaesthesia, the increase in cerebral blood flow (CBF) and intracranial pressure caused by the cerebral vasodilative effects of an inhalational anaesthetic agent is counteracted by the cerebral vasoconstriction induced by hypocapnia. Desflurane and sevoflurane may have advantages over the more traditionally used isoflurane in neuroanaesthesia but their dose-dependent vasodilative effects at hypocapnia have not been compared in the same model using truly equipotent minimal alveolar concentrations (MACs). Method: Desflurane, sevoflurane and isoflurane were administered in a randomized order to six pigs at 0.5 and 1.0 MAC. The intra-arterial xenon clearance technique was used to calculate CBF. Blood pressure was invasively monitored. Cerebral and systemic physiological variables were recorded first at normocapnia (PaCO2 5.6 kPa) and then at hypocapnia (PaCO2 3.5 kPa). Electroencephalographic (EEG) activity was continuously recorded. Results: None of the three agents abolished cerebrovascular reactivity to hyperventilation, and at 0.5 MAC all had similar effects on CBF at hypocapnia. Desflurane at 1.0 MAC was associated with 16% higher CBF (P = 0.027) at hypocapnia than isoflurane, and with 24% higher CBF (P = 0.020) than sevoflurane. There was no seizure activity in the EEG. Conclusion: More cerebral vasodilation at hypocapnia with high doses of desflurane than with sevoflurane or isoflurane indicates that desflurane might be less suitable for neuroanaesthesia than sevoflurane and isoflurane.
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| 20. |
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| 21. |
- Ihrman, Lilian, et al.
(författare)
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Changes in blood lactate predict outcome better than absolute values in severe SIRS
- 2009
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 53:s119, s. 54-54
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Konferensbidrag (refereegranskat)abstract
- Introduction: Serum lactate is considered to be a marker of tissue hypoxia (1) Cut-off values >4 mM predict poor outcome, yet many patients after resuscitation according Surviving Sepsis Campaign guidelines (SSCG) (2) have high mortality despite decreases in blood lactate. Our hypothesis was that dynamic, rather than absolute blood lactate concentrations predict survival. Further we tested the ability of microdialysis lactate (MD-lac) to follow dynamic changes in blood levels, and whether this was also predictive of survival. Methods: Prospective, observational, single-centre cohort study in a mixed-bed university hospital ICU. About 53 consecutive patients with SIRS and circulatory failure despite adequate fluid resuscitation according to the SSCG were included. Arterial blood lactate (B-lac) was measured 6- hourly and MD-lac in subcutaneous tissue measured 4- hourly. Changes in B- and MD-lac from baseline were also calculated. Results: There were no differences in absolute values of B- lac or MD-lac between survivors and non-survivors during the first 24 h, nor were there differences in the change in MD-lac. In contrast changes in B-lac were greater in survivors. Among patients who reached P-lac > 4 mM during the study period of 7 days, the mortality rate was 37% as compared to 21% in the others, although this did not reach statistical significance. Conclusions: Survivors of severe SIRS were characterized by greater changes in B-lac compared to baseline. This supports the concept of lactate clearance, rather than absolute values, as a useful end point for fluid resuscitation, as opposed to the traditional endpoints used in the SSCG. In contrast MD- lac was not a useful predictor of mortality in this population.
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| 22. |
- Islander, Gunilla, et al.
(författare)
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Male preponderance of patients testing positive for malignant hyperthermia susceptibility.
- 2007
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 51:5, s. 614-620
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Tidskriftsartikel (refereegranskat)abstract
- Malignant hyperthermia susceptibility is diagnosed using an in vitro contracture test (IVCT). In families in which the mutation is known, genetic tests are also available. The inheritance pattern is regarded as autosomal dominant, which predicts equal proportions of men and women affected. The aim of this study was to investigate whether there were sex differences in the diagnostic outcome of the 1407 patients tested for malignant hyperthermia in Sweden between 1985 and 2005. Methods: Information about sex, diagnosis, IVCT result and kinship was analysed. Comparisons were made between the two sexes. Probands and relatives were analysed separately in order to eliminate bias caused by the type of surgery performed in the two sexes. Results: Males, more than females, revealed a pathological outcome in IVCT. Amongst male relatives, the fraction of pathological outcome in IVCT was 0.70 [95% confidence interval (CI), 0.66-0.74]; the corresponding value for females was 0.40 (95% CI, 0.36-0.44). Conclusion: A significant difference was observed in the sex distribution of outcome of IVCT, with significantly more males revealing a pathological IVCT. This indicates the influence of one or several factors related to sex in the outcome of IVCT, for example different expression of calcium handling proteins in the sexes, a complex pattern of inheritance or unknown environmental factors.
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| 23. |
- Kalliomäki, Maija-L, et al.
(författare)
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Persistent pain after groin hernia surgery : a qualitative analysis of pain and its consequences for quality of life
- 2009
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 53:2, s. 236-246
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Tidskriftsartikel (refereegranskat)abstract
- Despite a high prevalence of persistent groin pain after hernia repair, the specific nature of the pain and its clinical manifestation are poorly known. The aim of this study was to determine the type of post-herniorrhaphy pain and its influence on daily life. In order to assess long-term pain qualitatively and to explore how it affects quality of life, 100 individuals with persisting pain, identified in a cohort study of patients operated for groin hernia, were neurologically examined, along with 100 pain-free controls matched for age, gender and type of operation. The patients were asked to answer the SF-36 questionnaire, the hospital anxiety and depression scale, the Swedish Scales of Personality (SSP) and a standardised questionnaire for assessing everyday life coping. The patients were approached approximately 4.9 years after surgery. Twenty-two patients from the pain group had become pain free by the time of examination, whereas 76 patients still had pain, of whom 47 (68%) suffered from neuropathic pain and 11 from nociceptive pain. The remaining patients suffered from mixed pain, neuropathic and nociceptive, or were found to have another reason for pain. All dimensions of SF-36 were poorer for the pain group than the control group. Persistent post-herniorrhaphy pain is mainly neuropathic and has a substantial impact on health-related quality of life.
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| 24. |
- Klarin, Bengt, et al.
(författare)
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Lactobacillus plantarum 299v reduces colonisation of Clostridium difficile in critically ill patients treated with antibiotics
- 2008
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 52:8, s. 1096-1102
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Tidskriftsartikel (refereegranskat)abstract
- Background: The incidence of Clostridium difficile-associated disease (CDAD) in hospitalised patients is increasing. Critically ill patients are often treated with antibiotics and are at high risk of developing CDAD. Lactobacillus plantarum 299v (Lp299v) has been found to reduce recurrence of CDAD. We investigated intensive care unit (ICU) patients regarding the impact of Lp299v on C. difficile colonisation and on gut permeability and parameters of inflammation and infection in that context. Methods: Twenty-two ICU patients were given a fermented oatmeal gruel containing Lp299v, and 22 received an equivalent product without the bacteria. Faecal samples for analyses of C. difficile and Lp299v were taken at inclusion and then twice a week during the ICU stay. Other cultures were performed on clinical indication. Infection and inflammation parameters were analysed daily. Gut permeability was assessed using a sugar probe technique. Main Results: Colonisation with C. difficile was detected in 19% (4/21) of controls but in none of the Lp299v-treated patients (p < 0.05). Conclusions: Enteral administration of the probiotic bacterium Lp299v to critically ill patients treated with antibiotics reduced colonisation with C. difficile. Trial registration: Current Controlled Trials ISRCTN85655545
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| 25. |
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