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Rawal, Narinder
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Publications (10 of 14) Show all publications
Jildenstål, P. K., Hallén, J. L., Rawal, N. & Berggren, L. (2012). Does depth of anesthesia influence postoperative cognitive dysfunction or inflammatory response following major ENT surgery?. Journal of Anesthesia & Clinical Research, 3(6), 220
Open this publication in new window or tab >>Does depth of anesthesia influence postoperative cognitive dysfunction or inflammatory response following major ENT surgery?
2012 (English)In: Journal of Anesthesia & Clinical Research, ISSN 2155-6148, Vol. 3, no 6, p. 220-Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Cognitive decline, general anesthesia, auditory evoked potential (AEP)
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-34016 (URN)10.4172/2155-6148.1000220 (DOI)2-s2.0-84880002452 (Scopus ID)
Available from: 2014-03-03 Created: 2014-03-03 Last updated: 2018-09-11Bibliographically approved
Jildenstål,, P. K., Hallén, J. L., Rawal, N., Gupta, A. & Berggren, L. (2011). Effect of auditory evoked potential-guided anaesthesia on consumption of anaesthetics and early postoperative cognitive dysfunction: a randomised controlled trial. European Journal of Anaesthesiology, 28(3), 213-219
Open this publication in new window or tab >>Effect of auditory evoked potential-guided anaesthesia on consumption of anaesthetics and early postoperative cognitive dysfunction: a randomised controlled trial
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2011 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 3, p. 213-219Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2011
Keywords
Auditory evoked potential monitoring, cognitive decline, general anaesthesia, minor surgery
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-34015 (URN)10.1097/EJA.0b013e328340dbb9 (DOI)000287439400014 ()21088592 (PubMedID)2-s2.0-79953879703 (Scopus ID)
Available from: 2014-03-03 Created: 2014-03-03 Last updated: 2018-05-05Bibliographically approved
Allvin, R., Svensson, E., Rawal, N., Ehnfors, M., Kling, A.-M. & Idvall, E. (2011). The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles. Journal of Evaluation In Clinical Practice, 17(2), 236-243
Open this publication in new window or tab >>The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles
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2011 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 2, p. 236-243Article in journal (Refereed) Published
Abstract [en]

Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.

Methods. Postoperative recovery was assessed during the period from discharge to 12 months after lower abdominal- and orthopedic surgery. Construct validity was evaluated by comparing the assessments from the PRP-questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering.

Results. A total of 158 patients were included. The result showed that 7.6 % of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge 51 % participants in the abdominal group were fully recovered, as compared with the 73%, in the orthopedic group (95% CI: 6 % to 40 %). The item variable pain appeared as top five at eight measurement occasions of eight possible in both the abdominal and the orthopedic groups. The importance of the items was emphasized.

Conclusions. The PRP questionnaire allows for evaluation of the progress of postoperative recovery, and can be useful to assess patient-reported recovery after surgical treatment. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-8083 (URN)10.1111/j.1365-2753.2010.01422.x (DOI)000288217700005 ()20846316 (PubMedID)2-s2.0-79952668667 (Scopus ID)
Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-12-13
Allvin, R., Ehnfors, M., Rawal, N., Svensson, E. & Idvall, E. (2009). Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability. Journal of Evaluation In Clinical Practice, 15(3), 411-419
Open this publication in new window or tab >>Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability
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2009 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 3, p. 411-419Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability.   The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery.

Method. The study involved four steps. 1) A conceptualisation and item definitions were based on a theoretical framework and a description of patients' postoperative recovery from the perspective of patients, registered nurses and surgeons. 2) Content validity of items was tested through expert judgements. 3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement. 4) The stability of the questionnaire was evaluated through intra-patient reliability assessment.

Results. As a result of the operationalisation process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability.

Conclusion. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing Ltd, 2009
National Category
Surgery Medical and Health Sciences
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-8081 (URN)10.1111/j.1365-2753.2008.01027.x (DOI)000266425900002 ()
Note

Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7731

Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2019-04-03Bibliographically approved
Allvin, R., Ehnfors, M., Rawal, N. & Idvall, E. (2008). Experiences of the postoperative recovery process: an interview study. The open nursing journal, 2, 1-7
Open this publication in new window or tab >>Experiences of the postoperative recovery process: an interview study
2008 (English)In: The open nursing journal, ISSN 1874-4346, Vol. 2, p. 1-7Article in journal (Refereed) Published
Abstract [en]

Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.

Place, publisher, year, edition, pages
Bussum, Netherlands: Bentham Open, 2008
Keywords
Postoperative, recovery, experience, interview, content analysis
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-41340 (URN)10.2174/1874434600802010001 (DOI)19319214 (PubMedID)
Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2017-10-17Bibliographically approved
Allvin, R., Ehnfors, M., Rawal, N. & Idvall, E. (2008). Experiences of the postoperative recovery process: an interview study. The open nursing journal, 2, 1-7
Open this publication in new window or tab >>Experiences of the postoperative recovery process: an interview study
2008 (English)In: The open nursing journal, ISSN 1874-4346, Vol. 2, p. 1-7Article in journal (Refereed) Published
Abstract [en]

Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.

Place, publisher, year, edition, pages
Bentham Science Publishers Ltd, 2008
Keywords
postoperative, recovery, experience, interview, content analysis
National Category
Surgery Medical and Health Sciences
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-8080 (URN)
Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-10-18Bibliographically approved
Axelsson, K., Gupta, A., Johanzon, E., Berg, E., Ekbäck, G., Rawal, N., . . . Nordensson, U. (2008). Intraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study. Anesthesia and Analgesia, 106(1), 328-333
Open this publication in new window or tab >>Intraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study
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2008 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 106, no 1, p. 328-333Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In this study we assessed the efficacy of intraarticular regional analgesia on postoperative pain and analgesic requirements. METHODS: Fifty-one patients undergoing shoulder surgery (Bankart) were recruited into this double-blind study. At the end of the operation, patients were randomized to three groups to receive intraarticularly via a catheter: Group 1: ropivacaine 90 mg (9 mL), morphine 4 mg (10 mL), and ketorolac 30 mg (1 mL) (total volume 20 mL); Groups 2 and 3: saline (20 mL). In addition, Groups 1 and 3 received 1 mL saline IV while Group 2 received ketorolac 30 mg (1 mL) IV. Postoperatively, Group 1 received pain relief using 10 mL 0.5% ropivacaine on demand via the intraarticular catheter while Groups 2 and 3 received 10 mL of saline intraarticularly. Group 3 was the Control group. RESULTS: Postoperative pain at rest and on movement were lower in Group 1 than in Groups 2 and 3 during the first 30 and 120 min, respectively. The time to first request for local anesthetic infusion was longer in Group 1 than in Groups 2 and 3 (P < 0.001). The median morphine consumption during the first 24 postoperative hours was less in Groups 1 and 2 than in Group 3 (P < 0.001). There was no significant difference in analgesic consumption between Group 1 and Group 2. The median satisfaction score was higher in Group 1 compared with Groups 2 (P < 0.05) and 3 (P < 0.001). CONCLUSIONS: A combination of intraarticular ropivacaine, morphine, and ketorolac followed by intermittent injections of ropivacaine as needed provided better pain relief, less morphine consumption, and improved patient satisfaction compared with the control group. The group that received IV ketorolac consumed less morphine and was more satisfied with treatment than patients in the control group.

Keywords
Adult, Amides/*administration & dosage, Analgesia; Patient-Controlled, Analgesics; Opioid/*administration & dosage, Anesthetics; Local/*administration & dosage, Cyclooxygenase Inhibitors/*administration & dosage, Double-Blind Method, Drug Therapy; Combination, Female, Humans, Infusions; Parenteral, Injections; Intra-Articular, Injections; Intravenous, Ketorolac/*administration & dosage, Male, Middle Aged, Morphine/*administration & dosage, Pain Measurement, Pain; Postoperative/*prevention & control, Patient Satisfaction, Questionnaires, Research Design, Shoulder/*surgery, Time Factors, Treatment Outcome
National Category
Anesthesiology and Intensive Care Medical and Health Sciences
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-3399 (URN)10.1213/01.ane.0000297297.79822.00 (DOI)18165599 (PubMedID)
Available from: 2008-12-04 Created: 2008-12-04 Last updated: 2017-12-14Bibliographically approved
Rawal, N. & Langford, R. M. (2007). Current practices for postoperative pain management in Europe and the potential role of the fentanyl HCl iontophoretic transdermal system. European Journal of Anaesthesiology, 24(4), 299-308
Open this publication in new window or tab >>Current practices for postoperative pain management in Europe and the potential role of the fentanyl HCl iontophoretic transdermal system
2007 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 24, no 4, p. 299-308Article in journal (Refereed) Published
Abstract [en]

Survey results continue to reveal that postoperative pain is insufficiently managed throughout Europe and the rest of the world. However, the efficient use of existing resources, as well as the introduction of novel technologies, may aid in its improvement. Use of an acute pain service has the potential to improve pain management through specialized patient care and utilization of effective analgesic techniques. Multimodal analgesic techniques, which include adjuvant non-opioids and/or regional analgesic techniques, can provide effective analgesia and reduce the amount of systemic opioids (or obviate the need) for postoperative pain management. Patient-controlled analgesia modalities may also offer improvements to pain management, as in practice they provide pain relief superior to the intermittent administration of bolus doses of opioids. A novel patient-controlled analgesia modality that has been approved by the European Medicines Evaluation Agency (EMEA) for the treatment of acute, moderate-to-severe pain is the needle-free, pre-programmed fentanyl HCl iontophoretic transdermal system. This system was shown in a recent US clinical trial to be comparable in efficacy to a standard regimen of morphine intravenous patient-controlled analgesia. Adverse events associated with the use of the fentanyl iontophoretic transdermal system are generally similar to those experienced by patients using intravenous morphine patient-controlled analgesia. Considerations regarding the selection of patients for treatment with the fentanyl iontophoretic transdermal system are similar to those with other patient-controlled analgesia modalities; sufficient upper limb mobility and alertness are required to operate the system. Utilization of the fentanyl iontophoretic transdermal system, together with the guidance of an effective acute pain service, may lead to improvements in postoperative pain management.

Place, publisher, year, edition, pages
Oxford: Blackwell Science, 2007
National Category
Anesthesiology and Intensive Care Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-11590 (URN)10.1017/S026502150600189X (DOI)17156510 (PubMedID)
Available from: 2010-08-17 Created: 2010-08-17 Last updated: 2017-12-12Bibliographically approved
Joshi, G. P., Kehlet, H. & Rawal, N. (2007). Evidence-based guidelines for postoperative pain management. Regional anesthesia and pain medicine, 32(2), 173
Open this publication in new window or tab >>Evidence-based guidelines for postoperative pain management
2007 (English)In: Regional anesthesia and pain medicine, ISSN 1098-7339, E-ISSN 1532-8651, Vol. 32, no 2, p. 173-Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Secaucus: Churchill Livingstone, 2007
National Category
Medical and Health Sciences Anesthesiology and Intensive Care
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-11561 (URN)10.1016/j.rapm.2006.11.002 (DOI)17350537 (PubMedID)
Available from: 2010-08-13 Created: 2010-08-13 Last updated: 2017-12-12Bibliographically approved
Rawal, N. (2007). Postoperative pain treatment for ambulatory surgery. Best practice & research. Clinical anaesthesiology, 21(1), 129-148
Open this publication in new window or tab >>Postoperative pain treatment for ambulatory surgery
2007 (English)In: Best practice & research. Clinical anaesthesiology, ISSN 1753-3740, Vol. 21, no 1, p. 129-148Article in journal (Refereed) Published
Abstract [en]

One of the most significant changes in surgical practice during the last two decades has been the growth of ambulatory surgery. Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery. Recent studies have shown that large numbers of patients suffer from moderate to severe pain during the first 24-48 hr. The success of fast-tracking depends to a considerable extent on effective postoperative pain management routines and the cost saving of outpatient surgery may be negated by unanticipated hospital admission for poorly treated pain. Depending on the intensity of postoperative pain current management includes the use of analgesics such as paracetamol, NSAIDs including coxibs and tramadol as single drugs or in combination as part of balanced (multimodal) analgesia. However, in the ambulatory setting many patients suffer from pain at home in spite of multimodal analgesic regimens. Sending patients home with perineural, incisional, and intra-articular catheters is a new and evolving area of postoperative pain management. Current evidence suggests that these techniques are effective, feasible and safe in the home environment if appropriate patient selection routines and organization for follow-up are in place.

Place, publisher, year, edition, pages
London: Baillière Tindall, 2007
National Category
Medical and Health Sciences Anesthesiology and Intensive Care
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-11588 (URN)10.1016/j.bpa.2006.11.005 (DOI)17489224 (PubMedID)
Available from: 2010-08-17 Created: 2010-08-17 Last updated: 2017-10-18Bibliographically approved
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