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- Jildenstål, Pether, et al.
(author)
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Agreement between frontal and occipital regional cerebral oxygen saturation in infants during surgery and general anesthesia an observational study
- 2019
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In: Pediatric Anesthesia. - : Wiley. - 1460-9592 .- 1460-9592 .- 1155-5645. ; 29:11, s. 1122-1127
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Journal article (peer-reviewed)abstract
- Abstract Background: Advances in perioperative pediatric care have resulted in an increased number of procedures requiring anesthesia. During anesthesia and surgery, the patient is subjected to factors that affect the circulatory homeostasis, which can influence oxygenation of the brain. Near‐infrared spectroscopy (NIRS) is an easy applicable noninvasive method for monitoring of regional tissue oxygenation (rScO₂%). Alternate placements for NIRS have been investigated; however, no alternative cranial placements have been explored. Aim: To evaluate the agreement between frontal and occipital recordings of rScO₂% in infants using INVOSTM during surgery and general anesthesia. Method: A standard frontal monitoring of rScO₂% with NIRS was compared with occipital rScO₂% measurements in fifteen children at an age <1 year, ASA 1‐2, undergoing cleft lip and/or palate surgery during general anesthesia with sevoflurane. An agreement analysis was performed according to Bland and Altman. Results: Mean values of frontal and occipital rScO₂% at baseline were largely similar (70.7 ± 4.77% and 69.40 ± 5.04%, respectively). In the majority of the patients, the frontal and occipital recordings of rScO2 changed in parallel. There was a moderate positive correlation between frontal and occipital rScO₂% INVOS™ readings (rho[ρ]: 0.513, P < .01). The difference between frontal and occipital rScO₂ ranged from −31 to 28 with a mean difference (bias) of −0.15%. The 95% limit of agreement was −18.04%‐17.74%. The error between frontal and occipital rScO₂ recordings was 23%. Conclusion: The agreement between frontal and occipital recordings of brain rScO₂% in infants using INVOSTM during surgery and general anesthesia was acceptable. In surgical procedures where the frontal region of the head is not available for monitoring, occipital recordings of rScO₂% could be an option for monitoring.
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| 2. |
- Abrahamsson, A., et al.
(author)
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Perioperative COX-2 inhibitors may increase the risk of post-operative acute kidney injury
- 2017
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 61:7, s. 714-721
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Journal article (peer-reviewed)abstract
- BackgroundIn enhanced recovery protocols (ERP), a restrictive fluid regimen is proposed. Patients who undergo major surgery have an increased risk of post-operative acute kidney injury (AKI). This combination may pose difficulties when ERP is used for patients undergoing major surgery. The aim of this study was to evaluate whether patients undergoing pancreatic surgery and treated with a restrictive fluid regimen are at greater risk of post-operative AKI. Furthermore, if there was an increased risk of AKI, we aimed to identify its cause. MethodsWe reviewed the medical records of patients who underwent pancreatic surgery during 2014 (preERP, n = 58) and 2015 (ERP, n = 65). Fluid balance, the administration of cyclooxygenase-2 inhibitors, creatinine levels and mean arterial pressure were recorded. The Kidney Disease: Improving Global Outcomes criteria were used to define AKI. ResultsThe incidence of AKI was higher in the ERP group than in the PreERP group (12.5% vs. 1.8%, respectively, P = 0.035). The increased incidence of AKI could not be explained by differences in comorbidities, age, pre-operative creatinine or perioperative hypotension. Administration of coxibs was higher in the ERP group and was associated with increased incidence of post-operative AKI (P = 0.018). The combination of coxibs and restrictive fluid regimen seems particularly harmful. ConclusionPancreatic surgery with a restrictive fluid regimen carries an increased risk of post-operative AKI if patients are also treated with cyclooxygenase-2 inhibitors. It is therefore suggested that in protocols including a restrictive fluid regimen for open pancreatic surgery, the use of cyclooxygenase-2 inhibitors should be avoided.
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| 3. |
- Alvekrans, Anna-Lena, et al.
(author)
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From Knowledge to Decision - A Case Study of Sales and Operations Planning in Health Care
- 2016
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In: Production planning & control. - : Informa UK Limited. - 0953-7287 .- 1366-5871. ; 27:12, s. 1019-1026
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Journal article (peer-reviewed)abstract
- One of the most important challenges in health care management is balancing resources with fluctuating and uncertain demand. This study examines whether introducing a standardised process for Sales and Operations planning at a large university hospital improved specialty department managers’ knowledge of planning conditions and if so, whether decisions were made based on this knowledge. Using responses from a survey of 30 specialty department managers at Sahlgrenska University Hospital in Sweden, the analyses indicate that operational knowledge strengthens insights about the needs for strategic decisions, and vice versa. Moreover, knowledge is a necessary, but not sufficient, condition for making decisions at the department level. An overall planning and decision structure is required and should be implemented first at the hospital level to effectively allocate resources.
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