| 1. |
- Ahlström, Katarina, 1966, et al.
(författare)
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Exogenous carbon monoxide does not affect cell membrane energy availability assessed by sarcolemmal calcium fluxes during myocardial ischaemia-reperfusion in the pig
- 2011
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Ingår i: European Journal of Anaesthesiology. - 0265-0215 .- 1365-2346. ; 28:5, s. 356-362
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Tidskriftsartikel (refereegranskat)abstract
- Carbon monoxide is thought to be cytoprotective and may hold therapeutic promise for mitigating ischaemic injury. The purpose of this study was to test low-dose carbon monoxide for protective effects in a porcine model of acute myocardial ischaemia and reperfusion. In acute open-thorax experiments in anaesthetised pigs, pretreatment with low-dose carbon monoxide (5% increase in carboxyhaemoglobin) was conducted for 120 min before localised ischaemia (45 min) and reperfusion (60 min) was performed using a coronary snare. Metabolic and injury markers were collected by microdialysis sampling in the ventricular wall. Recovery of radio-marked calcium delivered locally by microperfusate was measured to assess carbon monoxide treatment effects during ischaemia/reperfusion on the intracellular calcium pool. Coronary occlusion and ischaemia/reperfusion were analysed for 16 animals (eight in each group). Changes in glucose, lactate and pyruvate from the ischaemic area were observed during ischaemia and reperfusion interventions, though there was no difference between carbon monoxide-treated and control groups during ischaemia or reperfusion. Similar results were observed for glycerol and microdialysate Ca-45(2+) recovery. These findings show that a relatively low and clinically relevant dose of carbon monoxide did not seem to provide acute protection as indicated by metabolic, energy-related and injury markers in a porcine myocardial ischaemia/reperfusion experimental model. We conclude that protective effects of carbon monoxide related to ischaemia/reperfusion either require higher doses of carbon monoxide or occur later after reperfusion than the immediate time frame studied here. More study is needed to characterise the mechanism and time frame of carbon monoxide-related cytoprotection.
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| 2. |
- Bergek, Christian, et al.
(författare)
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Accuracy of noninvasive haemoglobin measurement by pulse oximetry depends on the type of infusion fluid
- 2012
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Ingår i: European Journal of Anaesthesiology. - : Lippincott Williams & Wilkins. - 0265-0215 .- 1365-2346. ; 29:12, s. 586-592
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Tidskriftsartikel (refereegranskat)abstract
- Context: Measurement of blood haemoglobin concentration by pulse oximetry could be of value in determining when erythrocytes should be transfused during surgery, but the effect of infusion fluids on the results is unclear.Objective: To study the effect of crystalloid and colloid fluid on the accuracy (bias) and precision of pulse oximetry haemoglobin estimation to indicate the venous haemoglobin concentration in volunteers.Design: Open interventional crossover study.Setting: Single university hospital.Participants: Ten male volunteers aged 18–28 (mean 22) years.Interventions: Each volunteer underwent three infusion experiments on separate days and in random order. The infusions were Ringer's acetate (20 ml kg−1), hydroxyethyl starch 130/0.4 (10 ml kg−1) and a combination of both.Results: At the end of the infusions of Ringer's acetate, pulse oximetry haemoglobin concentration had decreased more than the true haemoglobin concentration (15 vs. 8%; P < 0.005; n = 10) whereas starch solution decreased pulse oximetry haemoglobin concentration less than true haemoglobin concentration (7 vs. 11%; P < 0.02; n = 20). The same differences were seen when the fluids were infused separately and when they were combined. The overall difference between all 956 pairs of pulse oximetry haemoglobin concentration and true haemoglobin concentrations (the bias) averaged only −0.7 g l−1 whereas the 95% prediction interval was wide, ranging from −24.9 to 23.7 g l−1. In addition to the choice of infusion fluid, the bias was strongly dependent on the volunteer (each factor, P < 0.001).Conclusion: The bias of measuring haemoglobin concentration by pulse oximetry is dependent on whether a crystalloid or a colloid fluid is infused.
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| 3. |
- De Geer, Lina, et al.
(författare)
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Amino-terminal pro-brain natriuretic peptide as a predictor of outcome in patients admitted to intensive care. A prospective observational study
- 2012
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Ingår i: European Journal of Anaesthesiology. - : Lippincott, Williams and Wilkins / Wiley-Blackwell. - 0265-0215 .- 1365-2346. ; 29:6, s. 275-279
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Tidskriftsartikel (refereegranskat)abstract
- Context: Amino-terminal pro-brain-type natriuretic peptide is known to predict outcome in patients with heart failure, but its role in an intensive care setting is not yet fully established. Objective: To assess the incidence of elevated amino-terminal pro-brain natriuretic peptide (NT-pro-BNP) on admission to intensive care and its relation to death in the ICU and within 30 days. Design: Prospective, observational cohort study. Setting: A mixed noncardiothoracic tertiary ICU in Sweden. Patients and main outcome measures NT-pro-BNP was collected from 481 consecutive patients on admission to intensive care, in addition to data on patient characteristics and outcome. A receiver-operating characteristic curve was used to identify a discriminatory level of significance, a stepwise logistic regression analysis to correct for other clinical factors and a Kaplan-Meier analysis to assess survival. The correlation between Simplified Acute Physiology Score (SAPS) 3, Sequential Organ Failure Assessment score (SOFA) and NT-pro-BNP was analysed using Spearmans correlation test. Quartiles of NT-pro-BNP elevation were compared for baseline data and outcome using a logistic regression model. Results: An NT-pro-BNP more than 1380 ng l(-1) on admission was an independent predictor of death in the ICU and within 30 days [odds ratio (OR) 2.6; 95% confidence interval (CI), 1.5 to 4.4] and was present in 44% of patients. Thirty-three percent of patients with NT-pro-BNP more than 1380 ng l(-1), and 14.6% of patients below that threshold died within 30 days (log rank P 0.005). NT-pro-BNP correlated moderately with SAPS 3 and with SOFA on admission (Spearmans rho 0.5552 and 0.5129, respectively). In quartiles of NT-pro-BNP elevation on admission, severity of illness and mortality increased significantly (30-day mortality 36.1%; OR 3.9; 95% CI, 2.0 to 7.3 in the quartile with the highest values, vs. 12.8% in the lowest quartile). Conclusion: We conclude that NT-pro-BNP is commonly elevated on admission to intensive care, that it increases with severity of illness and that it is an independent predictor of mortality.
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| 4. |
- de Leon, Alex, et al.
(författare)
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Effects of propofol on oesophageal sphincters : a study on young and elderly volunteers using high-resolution solid-state manometry
- 2011
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Ingår i: European Journal of Anaesthesiology. - : Lippincott Williams & Wilkins. - 0265-0215 .- 1365-2346. ; 28:4, s. 273-278
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVE:The oesophageal sphincters play an important role in protecting the airway. During manometric studies, administration of an anxiolytic agent is often required to make insertion of the catheter acceptable for the patient. The anxiolytic should not affect the results of the measurements. This study evaluates the effects of two different doses of propofol on the pressures in the oesophageal sphincters. The effect of increased abdominal pressure was also studied.METHODS:Twenty healthy volunteers, 10 young (mean age 25 years) and 10 elderly (mean age 71 years), were recruited. The effects of a low dose of propofol [0.3 mg kg(-1) intravenously (i.v.)] and a high dose of propofol (young group 0.9 mg kg(-1) i.v. and elderly group 0.6 mg kg(-1) i.v.) were studied with and without external abdominal pressure.RESULTS:There were no statistically significant changes in lower oesophageal sphincter (LOS) pressure after the low dose of propofol. After the high dose, there was an increase in LOS pressure, which was statistically significant in the young group (P < 0.05). The upper oesophageal sphincter (UOS) pressure decreased after both doses of propofol (P < 0.01 for the higher dose and P < 0.05 for the lower dose).CONCLUSION:A low dose of propofol (0.3 mg kg(-1) i.v.) leaves the LOS unaffected in young and elderly volunteers and can be used safely as an anxiolytic agent during studies of the LOS without influencing the results. However, the UOS is more sensitive to the effects of propofol and we do not recommend the use of propofol as an anxiolytic agent during manometric studies of the UOS.
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| 5. |
- Garcia-Fernandez, Javier, et al.
(författare)
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Pressure safety range of barotrauma with lung recruitment manoeuvres : A randomised experimental study in a healthy animal model
- 2013
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Ingår i: European Journal of Anaesthesiology. - 0265-0215 .- 1365-2346. ; 30:9, s. 567-574
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXTRecruitment manoeuvres aim at reversing atelectasis during general anaesthesia but are associated with potential risks such as barotrauma.OBJECTIVETo explore the range of pressures that can be used safely to fully recruit the lung without causing barotrauma in an ex-vivo healthy lung rabbit model.DESIGNProspective, randomised, experimental study.SETTINGExperimental Unit, La Paz University Hospital, Madrid, Spain.ANIMALSFourteen healthy young New Zealand rabbits of 12 weeks of age.INTERVENTIONSAnimals were euthanised, the thorax and both pleural spaces were opened and the animals were allocated randomly into one of two groups submitted to two distinct recruitment manoeuvre strategies: PEEP-20 group, in which positive end-expiratory pressure (PEEP) was increased in 5-cmH(2)O steps from 0 to 20cmH(2)O and PEEP-50 group, in which PEEP was increased in 5-cmH(2)O steps from 0 to 50cmH(2)O. In both groups, a driving pressure of 15cmH(2)O was maintained until maximal PEEP and its corresponding maximal inspiratory pressures (MIPs) were reached. From there on, driving pressure was progressively increased in 5-cmH(2)O steps until detectable barotrauma occurred. Two macroscopic conditions were defined: anatomically open lung and barotrauma.MAIN OUTCOME MEASURESWe measured open lung and barotrauma MIP, PEEP and driving pressure obtained using each strategy. A pressure safety range, defined as the difference between barotrauma MIP and anatomically open lung MIP, was also determined in both groups.RESULTSOpen lung MIP was similar in both groups: 23.63.8 and 23.3 +/- 4.1cmH(2)O in the PEEP-50 and PEEP-20 groups, respectively (P=0.91). However, barotrauma MIP in the PEEP-50 group was higher (65.7 +/- 3.4cmH(2)O) than in the PEEP-20 group (56.7 +/- 5 0.2cmH(2)O) (P=0.003) resulting in a safety range of pressures of respectively 33.3 +/- 8.7 and 42.1 +/- 3.9cmH(2)O (P=0.035).CONCLUSIONIn this ex-vivo model, we found a substantial difference between recruitment and barotrauma pressures using both recruitment strategies. However, a higher margin of safety was obtained when a higher PEEP and lower driving pressure strategy was used for recruiting the lung.
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| 6. |
- Golster, Martin
(författare)
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Seven years of patient-controlled epidural analgesia in a Swedish hospital A prospective survey
- 2014
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Ingår i: European Journal of Anaesthesiology. - : Lippincott, Williams and Wilkins / Wiley: No OnlineOpen. - 0265-0215 .- 1365-2346. ; 31:11, s. 589-596
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Epidural analgesia for postoperative pain relief needs to be monitored regularly in order to evaluate benefits and avoid potential hazards. OBJECTIVES To evaluate efficacy and safety profile of a ward- based regimen for postoperative epidural analgesia combining patient-controlled epidural analgesia (PCEA) and continuous epidural infusion (CEI). DESIGN We conducted a prospective survey in all patients who received postoperative epidural analgesia between March 2004 and February 2011. PATIENTS We analysed 4663 patients undergoing elective and acute surgery. SETTING University hospital in Sweden. RESULTS The median level of catheter insertion ranged from T8 in high abdominal surgery to T11 in gynaecological surgery. Mean infusion rate was 5.4 +/- 1.6ml h (-1) and was adjusted for age. Mean duration was 3.3 +/- 2.1 days. Eighty-seven percent of the patients rated satisfaction 8 to 10 out of 10 on a post-treatment scale. Reasons for termination were elective in 77.1%, due to inadequate pain relief in 11.4%, due to suspected infection in 0.7% and due to other causes in 10.9%. Of the latter, dislodgement of the catheter (4.0%) and leakage from the puncture site (1.4%) dominated. Catheter reinsertion was performed in 5.3% of the patients, and in 5.0%, the treatment was converted into an intravenous (i. v.) morphine patientcontrolled analgesia regimen. The incidence of motor blockade was 1.7%, sedation 2.1%, nausea 12.8% and pruritus 18.8%. Bolus doses accounted for 16% of the total infusion volume. No epidural haematoma was seen. One epidural abscess requiring antibiotic treatment occurred. CONCLUSION Our prospective survey indicates that PCEA in combination with CEI is effective and relatively well tolerated. The incidence of side effects is generally low and severe adverse events very rare.
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| 7. |
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| 8. |
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| 9. |
- Jildenstål,, Pether K., et al.
(författare)
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Effect of auditory evoked potential-guided anaesthesia on consumption of anaesthetics and early postoperative cognitive dysfunction : a randomised controlled trial
- 2011
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Ingår i: European Journal of Anaesthesiology. - Philadelphia, USA : Lippincott Williams & Wilkins. - 0265-0215 .- 1365-2346. ; 28:3, s. 213-219
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Tidskriftsartikel (refereegranskat)abstract
- Background: Post-operative cognitive dysfunction (POCD) after non-cardiac surgery is a well known problem in some categories of patients. This study aims to evaluate the influence of auditory evoked potential (AEP)-guided anaesthesia on the requirement for anaesthetic drugs and their influence on POCD.Methods: Four hundred and fifty patients aged between 18 and 92 years scheduled for ophthalmic surgery under general anaesthesia were assigned randomly to one of two groups. In group A (AEP group), the depth of anaesthesia (DoA) was aimed at an AEP index (AAI) between 15 and 25. In group C (control group), DoA was guided by clinical signs. Hypotension was treated with fluids and vasopressors using a standardised algorithm. A mini-mental test and the Cognitive Failure Questionnaire were used to evaluate cognitive function.Results: Anaesthetic drug requirements were significantly lower in group A than in group C: propofol 92.526.5 vs. 103.839.5mg (P¼<0.001) and desflurane end-tidal concentration 2.50.58 vs. 3.30.79% (P<0.001). In group A, 36 patients (16%) received additional fluids and vasopressors compared to 65 patients (29%) in group C (P<0.01). AAI values differed significantly between the groups: 18 (11–21) in group A vs. 12 (10–19) in group C (P<0.001). The number of patients with POCD was 16 in group C compared to two in group A (P<0.001) at day 1 post-operation.Conclusion: AEP monitoring allows dose reduction of anaesthetic agents, leading to better cardiovascular stability and decreased requirements for intra-operative fluids and vasopressors. Cognitive decline seen following minor ophthalmic surgery, even when anaesthesia is assessed clinically, is short-lived with no long-term sequelae.
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| 10. |
- Ljunggren, Stefan, et al.
(författare)
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Accuracy and precision of commonly used methods for quantifying surgery-induced insulin resistance : Prospective observational study
- 2014
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Ingår i: European Journal of Anaesthesiology. - : Lippincott Williams & Wilkins. - 0265-0215 .- 1365-2346. ; 31:2, s. 110-116
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Insulin resistance develops in the perioperative setting and has an adverse influence on postoperative recovery and well-being.OBJECTIVES: To evaluate the effectiveness of commonly used methods for quantifying surgery-induced insulin resistance.DESIGN: Prospective observational study.SETTING: Surgery department and orthopaedic ward at two regional hospitals.PATIENTS: Twenty-two patients (mean age 68 years) scheduled for elective hip replacement.INTERVENTIONS: A short seven-sample intravenous glucose tolerance test (IVGTT) followed by a euglycaemic hyperinsulinaemic glucose clamp 1 day before and 2 days after the surgery.MAIN OUTCOME MEASURES: Insulin resistance shown by dynamic tests (the IVGTT and the glucose clamp) were compared to static tests [the quantitative insulin sensitivity check index (QUICKI) and the homeostatic model assessment-insulin resistance (HOMA-IR)], which use only the plasma glucose and insulin concentrations at baseline.RESULTS: The linear correlation coefficients for the relationship between insulin resistance as obtained with the glucose clamp and the other methods before or after surgery were 0.76 (IVGTT), 0.58 (QUICKI) and -0.65 (HOMA). The prediction errors (precision) averaged 18, 29 and 31%, respectively. Surgery-induced insulin resistance amounted to 45% (glucose clamp), 26% (IVGTT), 4% (QUICKI) and 3% (HOMA).CONCLUSION: Despite reasonably good linear correlations, the static tests grossly underestimated the degree of insulin resistance that developed in response to surgery.
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