| 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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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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| 3. |
- 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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| 4. |
- Jildenstål, Pether, et al.
(författare)
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Swedish anaesthesiologists and nurse anaesthetists routines for evaluation and management of cognitive function : a nationwide survey
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Annan publikation (populärvet., debatt m.m.)abstract
- Introduction: In clinical practice efforts have mainly been focused on cardiovascular and pulmonary risks, there is less attention on postoperative delirium (POD) and postoperative cognitive dysfunction (POCD).Methods: An online questionnaire regarding cognitive decline after anaesthesia and surgery was sent nationwide to a total of 2 626 anaesthesiologists and nurse anaesthetists. The questionnaire consisted of 3 parts, subjective preferences, routines and practices based on four typical case scenarios i.e. POCD, POD, emergence agitation (EA) and awareness.Results: The response rate was n=417 (45%) and n=669 (55%) for anaesthesiologists and nurse anaesthetists respectively. Only 10% of the responders consider cognitive function, assessment of preoperatively and risk for cognitive side-effects postoperatively important. The concern regarding awareness was far greater (90%) than for EA, POD and POCD, 30- 45%. EEG based depth of anaesthetic monitoring (DOA) is used regularly by 10% and in 22% in patients with increased risk. Regarding treatment, investigation and follow-up routines, less than 15% had written structured protocols. Sixty percent of the respondents do not consider POCD as an important outcome. Anaesthesiologists have a better knowledge of screening methods, management and follow-up routines and drug treatment for POD, POCD and EA compared to nurse anaesthetists.Conclusions: Our nationwide survey of anaesthesiologists and nurse anaesthetists shows that there is a general lack of knowledge about assessment and management of postoperative cognitive dysfunction. They are more concerned about awareness than the much more frequent and serious problems such as POD and POCD. In general DOA monitoring is not considered necessary. This survey shows that there is a clear need for improvement regarding knowledge of cognitive function.
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| 5. |
- 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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| 6. |
- 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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| 7. |
- Moschetti, Giuseppe, 1982, et al.
(författare)
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Planar InAs/AlSb HEMTs With Ion-Implanted Isolation
- 2012
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Ingår i: IEEE Electron Device Letters. - : Institute of Electrical and Electronics Engineers (IEEE). - 0741-3106 .- 1558-0563. ; 33:4, s. 510-512
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Tidskriftsartikel (refereegranskat)abstract
- The fabrication and performance of planar InAs/AlSb high-electron-mobility transistors (HEMTs) based on ion-implantation isolation technology are reported. Ar atoms have been implanted at an energy of 100 keV and with a dose of 2 x 10(15) cm(-2) in order to induce device isolation. The InAs/AlSb HEMT exhibited a maximum drain current of 900 mA/mm, a peak transconductance of 1180 mS/mm, and an f(T)/f(max) ratio of 210 GHz/180 GHz at a low drain bias of 0.3 V. The combination of excellent stability against oxidation with the high device isolation demonstrated by the implantation technique can dramatically improve the suitability of InAs/AlSb HEMTs for high-frequency and ultralow-power MMIC applications.
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| 8. |
- Moschetti, Giuseppe, 1982, et al.
(författare)
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Source-drain scaling of ion-implanted InAs/AlSb HEMTs
- 2012
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Ingår i: Indium Phosphide and Related Materials (IPRM), 2012 International Conference on. - : IEEE. - 1092-8669. - 9781467317252 ; , s. 57-60
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Konferensbidrag (refereegranskat)abstract
- We report on the lateral scaling of true planar InAs/AlSb high electron mobility transistors (HEMTs) based on ion implantation for device isolation. When reducing the source drain distance, dsd, from 2.5 μm to 1 μm, the HEMTs showed up to 56% higher maximum drain current, 23% higher peak transconductance and T of 185 GHz (+32%). A trade-off in the lateral scaling is needed due to increased gate leakage current and pinch-off degradation for dsd below 1.5 μm. The ability to withstand oxidation of the InAs/AlSb heterostructure makes the planar technology based on ion implantation extremely promising for MMIC integration of InAs/AlSb HEMTs.
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| 9. |
- Moschetti, Giuseppe, 1982, et al.
(författare)
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True planar InAs/AlSb HEMTs with ion-implantation technique for low-power cryogenic applications
- 2013
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Ingår i: Solid-State Electronics. - : Elsevier BV. - 0038-1101 .- 1879-2405. ; 79, s. 268-273
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we report the room-temperature and cryogenic properties of true planar 110 nm InAs/AlSb HEMTs fabricated with Ar-ion isolation technology. Device isolation is generally improved and is in particular increased by four orders of magnitude at 6 K compared to 300 K. This results in improved drain current saturation, lower gate leakage current and 23% higher peak transconductance. The RF performance is significantly improved as well, with 47% higher f(T) (162 GHz) and 72% higher f(max) (155 GHz) at the low drain voltage of 0.1 V, compared to room temperature. The overall performance of the fabricated devices shows the suitability of ion implantation for the device isolation at cryogenic temperature. Furthermore, the excellent stability against oxidation and truly planar structure of these devices demonstrate great potential for highly integrated cryogenic millimeter-wave circuits in InAs/AlSb technology with ultra-low power consumption.
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