| 1. |
- Jildenstål, Pether K., 1970-, et al.
(författare)
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AAI-guided anaesthesia is associated with lower incidence of 24-h MMSE < 25 and may impact the IL-6 response
- 2014
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Ingår i: International Journal of Surgery. - : Elsevier. - 1743-9191 .- 1743-9159. ; 12:4, s. 290-295
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Trauma stress and neuro-inflammation caused by surgery/anaesthesia releases cytokines. This study analysed impact of Auditory Evoked Potential Index (AAI) depth-of-anaesthesia titration on the early plasma IL-6 release after eye surgery under general anaesthesia.Method: This is a subgroup analysis of a prospective randomized study on the effect of auditory evoked potential guided anaesthesia for eye surgery. Plasma IL-6 levels taken before, 5 and 24 h after end of surgery from 450 patients undergoing elective ophthalmic surgery under desflurane anaesthesia were analysed. Minimal mental state examination (MMSE) was also tested at 24-h.Results: IL-6 increased significantly at both 5 and further at 24 h after surgery (3.2, 4.5 and 5.1 base-line, 5 and 24-h respectively), the IL-6 increase showed different patterns between the 2 groups; IL-6 was significantly increased in the control group of patients between preoperative baseline and 24 h after surgery (p = 0.008) also between 5 h and 24 h, (p = 0.006) after surgery while the AAI-group had only minor non-significant changes. The 18 patients that showed a 24-h MMSE score less than 25 had a significant higher 24-h IL-6 compared to the 390 patients with a MMSE score > 24 (p = 0.002).Conclusion: The IL-6 increase after surgery was less pronounced in patients where anaesthesia was titrated by AAI compared to anaesthesia adjusted on clinical signs only. IL-6 were also found to be higher in patients with a MMSE < 25 at 24-h. Further studies are warranted evaluating the role of depth of anaesthesia monitoring on the risk for early cognitive impairment and neuro-inflammation.
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| 2. |
- Jildenstål, Pether K., 1970-, et al.
(författare)
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Does depth of anesthesia influence postoperative cognitive dysfunction or inflammatory response following major ENT surgery?
- 2012
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Ingår i: Journal of Anesthesia & Clinical Research. - : OMICS Publishing Group. - 2155-6148. ; 3:6, s. 220-
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the role of depth of anesthesia on POCD after major ENT surgery and to assess changes in postoperative inflammatory markers in patients undergoing major ENT surgery. Thirty two patients aged 40 to 94 yrs, scheduled for surgery under general anesthesia were randomly assigned to one of two groups. In group A (AEP group) depth of anesthesia (DOA) was measured with auditory evoked potential (AEP). In the control group (group C) DOA was monitored according to clinical signs. Cognitive function was evaluated using Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM) and Cognitive Failure Questionnaire (CFQ). Inflammatory markers were measured before and after anesthesia. Perioperative requirements for desflurane and fentanyl were significantly lower in group A. On the first postoperative day MMSE changes indicating POCD were noted in 1 patient in group A and 7 patients in group C (P<0.03). One month follow up did not show any difference between the groups regarding POCD. Our study indicates that AEP-guided anesthesia allows dose reduction of anesthetic agents including opioids leading to better cardiovascular stability and less early POCD. Anesthesia depth did not influence the inflammatory response to surgery.
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| 3. |
- 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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| 4. |
- Jildenstål, Pether K, 1970-, et al.
(författare)
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Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction : Results from a Swedish web-based survey
- 2014
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Ingår i: Annals of Medicine and Surgery. - : Elsevier. - 2049-0801. ; 3:3, s. 100-107
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive side-effects such as emergence agitation (EA), postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are not infrequently complicating the postoperative care especially in elderly and fragile patients. The aim of the present survey was to gain insight regarding concern and interest in prevention and treatment strategies for postoperative delirium and dysfunction, and the use of EEG-based depth-of-anaesthesia monitoring possibly reducing the risk for cognitive side effects among anaesthesia personnel.METHODS: A web-based validated questionnaire was sent to all Swedish anaesthesiologists and nurse anaesthetists during summer 2013. The questionnaire consisted of 3 sections, subjective preferences, routines and practices related to the perioperative handling of EA, POD, POCD.RESULTS: The response rate was 52%. Cardiovascular/pulmonary risks where assessed as importance by 98, 97% of responders while 69% considered the risk of neurocognitive side-effects important. When asked explicitly around cognitive side-effects 89%, 37% and 44% assessed awareness, POC and POD respectively of importance. EEG-based depth-of-anaesthesia monitors were used in 50% of hospitals. The responders were not convinced about the benefits of such monitors even in at-risk patients. Structured protocols for the management of postoperative cognitive side-effects were available only in few hospitals.CONCLUSION: Swedish anaesthesia personnel are concerned about the risk of postoperative cognitive side-effects but are more concerned about cardiovascular/pulmonary risks, pain, PONV and the rare event of awareness. Most respondents were not convinced about the use of depth-of-anaesthesia monitors. There is a need to improve knowledge around risk factors, prevention and management of postoperative cognitive side effects.
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| 5. |
- Jildenstål, Pether K., 1970-, et al.
(författare)
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Routines for reducing the occurrence of emergence agitation during awakening in children, a national survey
- 2014
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Ingår i: SpringerPlus. - : Springer. - 2193-1801. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Emergence agitation following anesthesia in children is not uncommon. It is, although generally self-limiting, associated with both patient and parents distress. We conducted a national survey around the management of behavioral and neurocognitive disturbances after surgery/anesthesia including a case scenario about a child at risk for emergence reaction. Premedication with clonidine or midazolam would have been used 58 and 37% of responders respectively. A propofol based anesthesia was the most common anesthetic technique, however sevoflurane or desflurane was an option for 45 and 8% of responders. Before awakening 65% would have administered an opioid, 48% a low-dose of propofol and 25% clonidine. Sign or symptoms of behavioral disturbance was not assessed by standardize assessment tools.A majority of Swedish anesthesia personnel would undertake some preventive action when handling a child at risk for an emergence reaction, the preventive measure differed and it seems as there is an obvious room for further improvements.
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| 6. |
- Rothaug, J., et al.
(författare)
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Patients' perception of postoperative pain management : Validation of the international pain outcomes (IPO) questionnaire
- 2013
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Ingår i: Journal of Pain. - : Elsevier BV. - 1526-5900 .- 1528-8447. ; 14:11, s. 1361-1370
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Tidskriftsartikel (refereegranskat)abstract
- PAIN OUT is a European Commission-funded project aiming at improving postoperative pain management. It combines a registry that can be useful for quality improvement and research using treatment and patient-reported outcome measures. The core of the project is a patient questionnaire - the International Pain Outcomes questionnaire - that comprises key patient-level outcomes of postoperative pain management, including pain intensity, physical and emotional functional interference, side effects, and perceptions of care. Its psychometric quality after translation and adaptation to European patients is the subject of this validation study. The questionnaire was administered to 9,727 patients in 10 languages in 8 European countries and Israel. Construct validity was assessed using factor analysis. Discriminant validity assessment used Mann-Whitney U tests to detect mean group differences between 2 surgical disciplines. Internal consistency reliability was calculated as Cronbach's alpha. Factor analysis resulted in a 3-factor structure explaining 53.6% of variance. Cronbach's alpha at overall scale level was high (.86), and for the 3 subscales was low, moderate, or high (range,.53-.89). Significant mean group differences between general and orthopedic surgery patients confirmed discriminant validity. The psychometric quality of the International Pain Outcomes questionnaire can be regarded as satisfactory. Perspective The International Pain Outcomes questionnaire provides an instrument for postoperative pain assessment and improvement of quality of care, which demonstrated good psychometric quality when translated into a variety of languages in a large European and Israeli patient population. This measure provides the basis for the first comprehensive postoperative pain registry in Europe and other countries. © 2013 by the American Pain Society.
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| 7. |
- Zaslansky, R., et al.
(författare)
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PAIN OUT : An international acute pain registry supporting clinicians in decision making and in quality improvement activities
- 2014
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 20:6, s. 1090-1098
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives Management of post-operative pain is unsatisfactory worldwide. An estimated 240 million patients undergo surgery each year. Forty to 60% of these patients report clinically significant pain. Discrepancy exists between availability of evidence-based medicine (EBM)-derived knowledge about management of perioperative pain and increased implementation of related practices versus lack of improvement in patient-reported outcomes (PROs). We aimed to assist health care providers to optimize perioperative pain management by developing and validating a medical registry that measures variability in care, identifies best pain management practices and assists clinicians in decision making. Methods PAIN OUT was established from 2009 to 2012 with funding from the European Commission. It now continues as a self-sustaining, not-for-profit project, targeting health care professionals caring for patients undergoing surgery. Results The growing registry includes data from 40 898 patients, 60 hospitals and 17 countries. Collaborators upload data (demographics, clinical, PROs) from patients undergoing surgery in their hospital/ward into an Internet-based portal. Two modules make use of the data: (1) online, immediate feedback and benchmarking compares PROs across sites while offline analysis permits in-depth analysis; and (2) the case-based clinical decision support system offers practice-based treatment recommendations for individual patients; it is available now as a prototype. The Electronic Knowledge Library provides succinct summaries on perioperative pain management, supporting knowledge transfer and application of EBM. Conclusion PAIN OUT, a large, growing international registry, allows use of 'real-life' data related to management of perioperative pain. Ultimately, comparative analysis through audit, feedback and benchmarking will improve quality of care.
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