oru.sePublications
Change search
Refine search result
12345 1 - 50 of 211
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Abad-Gurumeta, A.
    et al.
    Dept Anaesthesia, Hosp Univ la Paz, Madrid, Spain.
    Ripolles-Melchor, J.
    Dept Anaesthesia, Hosp Univ Infanta Leonor, Univ Complutense Madrid, Madrid, Spain.
    Casans-Frances, R.
    Dept Anaesthesia, Hosp Clin Univ Lozano Blesa, Zaragoza, Spain.
    Espinosa, A.
    Dept Anaesthesia, Örebro University Hospital, Örebro, Sweden.
    Martinez-Hurtado, E.
    Dept Anaesthesia, Hosp Univ Infanta Leonor, Univ Complutense Madrid, Madrid, Spain.
    Fernandez-Perez, C.
    Dept Consultant Prevent Med & Publ Hlth, Univ Complutense Madrid, Madrid, Spain.
    Ramirez, J. M.
    Dept Colorectal Surg, Univ Zaragoza, Zaragoza, Spain.
    Lopez-Timoneda, F.
    Hosp Clin San Carlos, Dept Anaesthesia, Univ Complutense Madrid, Madrid, Spain.
    Calvo-Vecino, J. M.
    Hosp Univ Infanta Leonor, Dept Anaesthesia, Univ Complutense Madrid, Madrid, Spain.
    A systematic review of sugammadex vs neostigmine for reversal of neuromuscular blockade2015In: Anaesthesia, ISSN 0003-2409, E-ISSN 1365-2044, Vol. 70, no 12, p. 1441-1452Article, review/survey (Refereed)
    Abstract [en]

    We reviewed systematically sugammadex vs neostigmine for reversing neuromuscular blockade. We included 17 randomised controlled trials with 1553 participants. Sugammadex reduced all signs of residual postoperative paralysis, relative risk (95% CI) 0.46 (0.29-0.71), p=0.0004 and minor respiratory events, relative risk (95% CI) 0.51 (0.32-0.80), p=0.0034. There was no difference in critical respiratory events, relative risk (95% CI) 0.13 (0.02-1.06), p=0.06. Sugammadex reduced drug-related side-effects, relative risk (95% CI) 0.72 (0.54-0.95), p=0.02. There was no difference in the rate of postoperative nausea or the rate of postoperative vomiting, relative risk (95% CI) 0.94 (0.79-1.13), p=0.53, and 0.87 (0.65-1.17), p=0.36 respectively.

  • 2.
    Acosta, Stefan
    et al.
    Vascular Center, Malmö University Hospital, Malmö, Sweden.
    Block, Tomas
    Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Björnsson, Steinarr
    Vascular Center, Malmö University Hospital, Malmö, Sweden.
    Resch, Timothy
    Vascular Center, Malmö University Hospital, Malmö, Sweden.
    Björck, Martin
    Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Nilsson, Torbjörn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Chemistry, Örebro University Hospital, Örebro, Sweden.
    Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion2012In: Journal of Emergency Medicine, ISSN 0736-4679, E-ISSN 1090-1280, Vol. 42, no 6, p. 635-641Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted.

    OBJECTIVES: To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion.

    METHODS: Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005-2009.

    RESULTS: The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%) patients with embolic occlusion. Elevated pancreas amylase and normal plasma lactate were found in 12/45 and 13/27, respectively. A troponin I (TnI) above the clinical decision level was associated with a high frequency of referrals from the general surgeon to a specialist in internal medicine (p = 0.011) or a cardiologist (p = 0.024). The diagnosis was established after computed tomography angiography in 98% of the patients. The overall in-hospital mortality rate was 33%. Attempting intestinal revascularization (n = 43; p < 0.001), with a 95% frequency rate of completion control of the vascular procedure, was associated with a higher survival rate, whereas referral to the cardiologist was associated with a higher mortality rate (p = 0.018).

    CONCLUSION: Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion.

  • 3.
    Ahlstrand, Rebecca
    Örebro University, School of Health and Medical Sciences.
    Effects of anasthesia on esophageal sphincters2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The esophageal sphincters constitute the anatomical protection against pulmonary aspiration. The aim of this thesis was to study the esophageal sphincters and how they are affected by different components of emergency anesthesia using high-resolution solid-state manometry.

    The effect of propofol (0.3 mg/kg) was studied in young and elderly volunteers. Propofol can be given as an anxiolytic agent for manometric studies of the lower esophageal sphincter (LES) without affecting the results. However, propofol is not recommended for studies of the upper esophageal sphincter (UES).

    The effects of cricoid pressure (CP) and peripheral pain were studied in awake volunteers, with and without remifentanil infusion (5 ng/ml). Pain did not affect pressure in the LES, but CP or remifentanil induced a significant decrease in LES pressure. However, neither CP nor remifentanil affected the barrier pressure (LES-intra gastric pressure). When CP was applied during ongoing remifentanil infusion, no further decrease in LES pressure was measured. CP induced high pressures in the area of the UES independent of remifentanil infusion, indicating that CP is effective in preventing gastroesophageal regurgitation.

    Barrier pressure was also studied in anesthetized patients after rocuronium (0.6 mg/kg) administration and no decrease was measured. In addition, alfentanil (20 μ/kg) added during anesthesia induction with propofol did not decrease the barrier pressure.

    In conclusion, CP seems to be effective in preventing regurgitation and does not affect barrier pressure. Muscle relaxation with rocuronium does not risk gastro-esophageal integrity. In addition, opioids can be integrated, even during emergency anethesia, without increasing the risk for pulmonary aspiration.

    List of papers
    1. Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry
    Open this publication in new window or tab >>Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry
    2011 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 4, p. 273-278Article in journal (Refereed) Published
    Abstract [en]

    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.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2011
    National Category
    Medical and Health Sciences Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-15384 (URN)10.1097/EJA.0b013e3283413211 (DOI)000288196000009 ()21119519 (PubMedID)2-s2.0-79953874254 (Scopus ID)
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2017-12-11Bibliographically approved
    2. Effects of cricoid pressure and remifentanil on the esophageal sphincters using high-resolution solid-state manometry
    Open this publication in new window or tab >>Effects of cricoid pressure and remifentanil on the esophageal sphincters using high-resolution solid-state manometry
    2011 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 2, p. 209-215Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Cricoid pressure has been shown to decrease the pressure in the lower esophageal sphincter (LES), increasing the risk of aspiration. Whether this reaction is due to pain associated with the application of cricoid pressure has not been studied. The aim of this study was to compare the effects of cricoid pressure with those of peripheral pain on pressures in the LES, and to study whether remifentanil influences these effects. Data from the upper esophageal sphincter (UES) are also described.

    METHODS: Continuous solid-state manometry was performed in 14 healthy volunteers. Initially, the effect of remifentanil (target-controlled infusion with a plasma target concentration of 5.0 ng/ml) was studied, and thereafter, the effects of cricoid pressure and peripheral pain stimulation (cold stimulation). Finally, these two interventions were repeated under ongoing remifentanil infusion.

    RESULTS: Remifentanil decreased the LES pressure significantly [ΔP-6.5 mmHg, 95% confidence interval (95% CI) -1.7 to -11.2]. Cricoid pressure application decreased the LES pressure significantly (ΔP-3.7 mmHg, 95% CI -1.4 to 6.1), whereas peripheral pain did not (ΔP 1.2 mmHg, 95% CI -3.5 to 1.1). Under ongoing remifentanil infusion, no cricoid pressure-induced LES relaxation was observed. Cricoid pressure induced high pressures in the area of the UES, 215.7 (±91.2) mmHg without remifentanil vs. 219.4 (±74.2) mmHg with remifentanil.

    CONCLUSIONS: Remifentanil as well as cricoid pressure per se induced decreases in LES pressure. However, cricoid pressure-induced changes of the barrier pressure were not significant whether induced with or without an infusion of remifentanil.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2011
    National Category
    Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-15386 (URN)10.1111/j.1399-6576.2010.02367.x (DOI)000286208600010 ()21226863 (PubMedID)2-s2.0-78651516200 (Scopus ID)
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2018-02-20Bibliographically approved
    3. High resolution solid-state manometry of the effect of rocuronium on esophagogastric junction integrity
    Open this publication in new window or tab >>High resolution solid-state manometry of the effect of rocuronium on esophagogastric junction integrity
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The pressure in the lower esophageal sphincter (LES) is partly dependent on striated muscles derived from the crural portion of the diaphragm. The effect of neuromuscular blockade on the integrity of the esophagogastric junction is not well studied. We conducted a prospective interventional study to determine the effect of rocuronium on the pressure in the LES and the barrier pressure (LES pressure – intra gastric pressure). We also studied the effect of positive pressure ventilation on the barrier pressure after neuromuscular blockade with rocuronium.

    Methods: Fourteen patients classified as ASA I or II (aged 18-75 years) who presented for elective surgery (11 cholecystectomy, 3 inguinal hernia) participated in the study. Esophageal manometry was performed after anesthetization with propofol, fentanyl and sevoflurane. After the insertion of a laryngeal mask airway, the patients breathed spontaneously for one minute. Rocuronium was administrated and the patients observed during the onset of apnea and during one minute of apnea and complete neuromuscular blockade. Volume controlled positive pressure ventilation followed.

    Results: Muscle relaxation with rocuronium showed no significant changes in barrier pressure comparing the pressure immediately before rocuronium administration with the pressure obtained at the time point of 0% TOF. Conversion to positive pressure ventilation did not change the barrier pressure with inspiration or expiration. The greatest decrease in barrier pressure was measured after inducing anesthesia when comparing pressures during inspiration (P< 0.01)

    National Category
    Medical and Health Sciences Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-15387 (URN)
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2017-10-17Bibliographically approved
    4. Integrity of the esophagogastric junction during propofol induction with and without remifentanil: a double-blind,randomized, crossover study in volunteers
    Open this publication in new window or tab >>Integrity of the esophagogastric junction during propofol induction with and without remifentanil: a double-blind,randomized, crossover study in volunteers
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Context: Practice varies regarding the use of opioids during rapid sequence induction. Controversy exists as to whether opioids may increase the risk of pulmonary aspiration by decreasing the barrier pressure (lower oesophageal sphincter pressure – intragastric pressure).

    Objectives: To evaluate the effects of adding alfentanil during anaesthesia induction with propofol with respect to the barrier pressure in the oesophagogastric junction.

    Participants and Setting: Seventeen healthy volunteers (11 males and 6 females) participated in a double-blind, randomised, crossover trial at the University Hospital in Örebro, Sweden.

    Interventions and outcome measures: The volunteers were anaesthetised on two different occasions, randomly assigned to receive either alfentanil 20 g kg ˉ1 or an equivalent amount of saline, administered intravenously, one minute before induction with propofol 2 mg kg ˉ1. One minute after propofol administration, a cricoid pressure of 30N was applied. The primary outcome was the difference in the change in barrier pressure between the alfentanil and the placebo occasion one minute after propofol administration. The secondary outcomes were differences in the changes in barrier pressure one minute after alfentanil or placebo administration and during ongoing cricoid pressure application.

    Results: There were no statistically significant differences in barrier pressure, at any time point, between anaesthesia induction with alfentanil and propofol compared with induction with placebo and propofol. The barrier pressure never decreased to less than 2.4 mmHg in any volunteer.

    Conclusion: Our study showed no increased risk regarding the integrity of the gastrooesophageal junction when alfentanil is added during an induction with propofol in volunteers. This supports the practice of adding opioids as adjuvants during rapid sequence induction.

    National Category
    Medical and Health Sciences Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-15388 (URN)
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2017-10-17Bibliographically approved
  • 4.
    Ahlstrand, Rebecca
    et al.
    Örebro University, School of Health and Medical Sciences.
    Magnuson, Anders
    Thörn, Sven-Egron
    Dahlkvist, Anette
    Wattvil, Magnus
    Integrity of the esophagogastric junction during propofol induction with and without remifentanil: a double-blind,randomized, crossover study in volunteersManuscript (preprint) (Other academic)
    Abstract [en]

    Context: Practice varies regarding the use of opioids during rapid sequence induction. Controversy exists as to whether opioids may increase the risk of pulmonary aspiration by decreasing the barrier pressure (lower oesophageal sphincter pressure – intragastric pressure).

    Objectives: To evaluate the effects of adding alfentanil during anaesthesia induction with propofol with respect to the barrier pressure in the oesophagogastric junction.

    Participants and Setting: Seventeen healthy volunteers (11 males and 6 females) participated in a double-blind, randomised, crossover trial at the University Hospital in Örebro, Sweden.

    Interventions and outcome measures: The volunteers were anaesthetised on two different occasions, randomly assigned to receive either alfentanil 20 g kg ˉ1 or an equivalent amount of saline, administered intravenously, one minute before induction with propofol 2 mg kg ˉ1. One minute after propofol administration, a cricoid pressure of 30N was applied. The primary outcome was the difference in the change in barrier pressure between the alfentanil and the placebo occasion one minute after propofol administration. The secondary outcomes were differences in the changes in barrier pressure one minute after alfentanil or placebo administration and during ongoing cricoid pressure application.

    Results: There were no statistically significant differences in barrier pressure, at any time point, between anaesthesia induction with alfentanil and propofol compared with induction with placebo and propofol. The barrier pressure never decreased to less than 2.4 mmHg in any volunteer.

    Conclusion: Our study showed no increased risk regarding the integrity of the gastrooesophageal junction when alfentanil is added during an induction with propofol in volunteers. This supports the practice of adding opioids as adjuvants during rapid sequence induction.

  • 5.
    Ahlstrand, Rebecca
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Anesthesiology and Intensive Care.
    Savilampi, Johanna
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Thörn, Sven-Egron
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Wattwil, Magnus
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Effects of cricoid pressure and remifentanil on the esophageal sphincters using high-resolution solid-state manometry2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 2, p. 209-215Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cricoid pressure has been shown to decrease the pressure in the lower esophageal sphincter (LES), increasing the risk of aspiration. Whether this reaction is due to pain associated with the application of cricoid pressure has not been studied. The aim of this study was to compare the effects of cricoid pressure with those of peripheral pain on pressures in the LES, and to study whether remifentanil influences these effects. Data from the upper esophageal sphincter (UES) are also described.

    METHODS: Continuous solid-state manometry was performed in 14 healthy volunteers. Initially, the effect of remifentanil (target-controlled infusion with a plasma target concentration of 5.0 ng/ml) was studied, and thereafter, the effects of cricoid pressure and peripheral pain stimulation (cold stimulation). Finally, these two interventions were repeated under ongoing remifentanil infusion.

    RESULTS: Remifentanil decreased the LES pressure significantly [ΔP-6.5 mmHg, 95% confidence interval (95% CI) -1.7 to -11.2]. Cricoid pressure application decreased the LES pressure significantly (ΔP-3.7 mmHg, 95% CI -1.4 to 6.1), whereas peripheral pain did not (ΔP 1.2 mmHg, 95% CI -3.5 to 1.1). Under ongoing remifentanil infusion, no cricoid pressure-induced LES relaxation was observed. Cricoid pressure induced high pressures in the area of the UES, 215.7 (±91.2) mmHg without remifentanil vs. 219.4 (±74.2) mmHg with remifentanil.

    CONCLUSIONS: Remifentanil as well as cricoid pressure per se induced decreases in LES pressure. However, cricoid pressure-induced changes of the barrier pressure were not significant whether induced with or without an infusion of remifentanil.

  • 6.
    Ahlstrand, Rebecca
    et al.
    Örebro University, School of Health and Medical Sciences.
    Thörn, Sven-Egron
    Wattvil, Magnus
    High resolution solid-state manometry of the effect of rocuronium on esophagogastric junction integrityManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The pressure in the lower esophageal sphincter (LES) is partly dependent on striated muscles derived from the crural portion of the diaphragm. The effect of neuromuscular blockade on the integrity of the esophagogastric junction is not well studied. We conducted a prospective interventional study to determine the effect of rocuronium on the pressure in the LES and the barrier pressure (LES pressure – intra gastric pressure). We also studied the effect of positive pressure ventilation on the barrier pressure after neuromuscular blockade with rocuronium.

    Methods: Fourteen patients classified as ASA I or II (aged 18-75 years) who presented for elective surgery (11 cholecystectomy, 3 inguinal hernia) participated in the study. Esophageal manometry was performed after anesthetization with propofol, fentanyl and sevoflurane. After the insertion of a laryngeal mask airway, the patients breathed spontaneously for one minute. Rocuronium was administrated and the patients observed during the onset of apnea and during one minute of apnea and complete neuromuscular blockade. Volume controlled positive pressure ventilation followed.

    Results: Muscle relaxation with rocuronium showed no significant changes in barrier pressure comparing the pressure immediately before rocuronium administration with the pressure obtained at the time point of 0% TOF. Conversion to positive pressure ventilation did not change the barrier pressure with inspiration or expiration. The greatest decrease in barrier pressure was measured after inducing anesthesia when comparing pressures during inspiration (P< 0.01)

  • 7.
    Al Dabbagh, Z.
    et al.
    Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Jansson, K. Å.
    Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Stiller, C. O.
    Department of Medicine, Clinical Pharmacology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Weiss, R. J.
    Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Long-term pattern of opioid prescriptions after femoral shaft fractures2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 5, p. 634-641Article in journal (Refereed)
    Abstract [en]

    Background: The use of opioids in non-cancer-related pain following skeletal trauma is controversial due to the presumed risk of dose escalation and dependence. We therefore examined the pattern of opioid prescriptions, that is, those actually dispensed, in patients with femoral shaft fractures.

    Methods: We analysed data from the Swedish National Hospital Discharge Register and the Swedish Prescribed Drug Register between 2005 and 2008.

    Results: We identified 1471 patients with isolated femoral shaft fractures. The median age was 75 (16-102) years and 56% were female. In this cohort, 891 patients (61%) received dispensed opioid prescriptions during a median follow-up of 20 months (interquartile range 11-32). In the age- and sex-matched comparison cohort (7339 individuals) without fracture, 25% had opioid prescriptions dispensed during the same period. The proportions of patients receiving opioid analgesics at 6 and 12 months after the fracture were 45% (95% CI 42-49) and 36% (32-39), respectively. The median daily morphine equivalent dose (MED) was between 15 and 17 mg 1-12 months post-fracture. After 3 months, less than 5% used prescription doses higher than 20 mg MED per day. Older age (≥ 70 compared with < 70 years) was a significant predictor of earlier discontinuation of opioid use (Hazard ratio [HR] 1.9).

    Conclusion: A notable proportion of patients continued to receive dispensed prescriptions for opioids for over 6 months (45%) and more than a third of them (36%) continued treatment for at least 12 months. However, the risk of dose escalation seems to be small in opioid-naïve patients.

  • 8.
    Al Dabbagh, Zewar
    et al.
    Dept Mol Med & Surg, Sect Orthopaed & Sports Med, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden.
    Jansson, Karl-Åke
    Dept Mol Med & Surg, Sect Orthopaed & Sports Med, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden.
    Stiller, Carl-Olav
    Dept Med, Clin Pharmacol Unit, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Med, Clin Epidemiol Unit, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden; Dept Epidemiol & Publ Hlth, University College London (UCL), London, England .
    Weiss, Rudiger J.
    Dept Mol Med & Surg, Sect Orthopaed & Sports Med, Karolinska Univ Hosp, Karolinska Inst, Stockholm, Sweden.
    No signs of dose escalations of potent opioids prescribed after tibial shaft fractures: a study of Swedish National Registries2014In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, p. 4-Article in journal (Refereed)
    Abstract [en]

    Background: The pattern of opioid use after skeletal trauma is a neglected topic in pain medicine. The purpose of this study was to analyse the long-term prescriptions of potent opioids among patients with tibial shaft fractures.

    Methods: Data were extracted from the Swedish National Hospital Discharge Register, the National Pharmacy Register, and the Total Population Register, and analysed accordingly. The study period was 2005-2008.

    Results: We identified 2,571 patients with isolated tibial shaft fractures. Of these, 639 (25%) collected a prescription for opioids after the fracture. The median follow-up time was 17 (interquartile range [IQR] 7-27) months. Most patients with opioid prescriptions after fracture were male (61%) and the median age was 45 (16-97) years. The leading mechanism of injury was fall on the same level (41%). At 6 and 12 months after fracture, 21% (95% CI 17-24) and 14% (11-17) were still being treated with opioids. Multiple Cox regression-analysis (adjusted for age, sex, type of treatment, and mechanism of injury) revealed that older patients (age >50 years) were more likely to end opioid prescriptions (Hazard ratio 1.5 [95% CI 1.3-1.9]). During follow-up, the frequency of patients on moderate and high doses declined. Comparison of the daily morphine equivalent dose among individuals who both had prescriptions during the first 3 months and the 6th month indicated that the majority of these patients (11/14) did not have dose escalations.

    Conclusions: We did not see any signs in registry-data of major dose escalations over time in patients on potent opioids after tibial shaft fractures.

  • 9.
    Alm, Fredrik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hälsorisker för personal i operationsrum som yrkesexponeras för anestesigaser2011Independent thesis Advanced level (professional degree), 5 credits / 7,5 HE creditsStudent thesis
  • 10.
    Alm, Fredrik
    et al.
    Örebro University, School of Health Sciences. Department of Anaesthesia and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Stalfors, Joacim
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sheikh Khalifa Medical City, Ajman, United Arab Emirates.
    Nerfeldt, Pia
    Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden; Division of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–20162017In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 274, no 10, p. 3711-3722Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to\18 years) during 2009–2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE ± A), and 18,321 tonsillotomies with or without adenoidectomy (TT ± A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE ± A for surgical indication obstruction, TT ± A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE ± A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE ± A for infectious indications. In both indication groups, TE ± A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE ± A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE ± A caused considerably higher ratings of pain-related outcome measures, compared to TT ± A. For TE ± A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE ± A than younger ones.

  • 11.
    Anand, K J S
    et al.
    Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Anestheslogy, Neurobiology, and Pharmacology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
    Hall, R Whit
    Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
    Desai, Nirmala
    Department of Pediatrics, University of Kentucky Medical Center, Lexington, KY.
    Shephard, Barbara
    Department of Pediatrics, Tufts University School of Medicine, Boston, MA.
    Bergqvist, Lena L
    Neonatal Research Unit, Karolinska Institute, Astrid Lindgren's Children's Hospital, Stockholm, Sweden.
    Young, Thomas E
    Department of Pediatrics, University of North Carolina at Chapel Hill and Wake Medical Center, Raleigh, NC, USA.
    Boyle, Elaine M
    Simpson Memorial Maternity Pavilion, University of Edinburgh, Edinburgh, UK.
    Carbajal, Ricardo
    Service de Pédiatrie et Médecine Néonatale, Centre Hospitaller Poissy Saint Germain, Poissy, France.
    Bhutani, Vinod K
    Department of Pediatrics, University of Pennsylvania and Pennsylvania Hospital, Philadelphia, PA, USA.
    Moore, Mary Beth
    Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
    Kronsberg, Shari S
    Maryland Medical Research Institute, Baltimore, MD.
    Barton, Bruce A
    Maryland Medical Research Institute, Baltimore, MD.
    Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial2004In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 363, no 9422, p. 1673-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Opioid analgesia is commonly used during neonatal intensive care. We undertook the Neurologic Outcomes and Pre-emptive Analgesia in Neonates (NEOPAIN) trial to investigate whether pre-emptive morphine analgesia decreases the rate of a composite primary outcome of neonatal death, severe intraventricular haemorrhage (IVH), and periventricular leucomalacia (PVL) in preterm neonates.

    METHODS: Ventilated preterm neonates (n=898) from 16 centres were randomly assigned masked placebo (n=449) or morphine (n=449) infusions. After a loading dose (100 microg/kg), morphine infusions (23-26 weeks of gestation 10 microg kg(-1) h(-1); 27-29 weeks 20 microg kg(-1) h(-1); 30-32 weeks 30 microg kg(-1) h(-1)) were continued as long as clinically justified (maximum 14 days). Open-label morphine could be given on clinical judgment (placebo group 242/443 [54.6%], morphine group 202/446 [45.3%]). Analyses were by intention to treat.

    FINDINGS: Baseline variables were similar in the randomised groups. The placebo and morphine groups had similar rates of the composite outcome (105/408 [26%] vs 115/419 [27%]), neonatal death (47/449 [11%] vs 58/449 [13%]), severe IVH (46/429 [11%] vs 55/411 [13%]), and PVL (34/367 [9%] vs 27/367 [7%]). For neonates who were not given open-label morphine, rates of the composite outcome (53/225 [24%] vs 27/179 [15%], p=0.0338) and severe IVH (19/219 [9%] vs 6/189 [3%], p=0.0209) were higher in the morphine group than the placebo group. Placebo-group neonates receiving open-label morphine had worse rates of the composite outcome than those not receiving open-label morphine (78/228 [34%] vs 27/179 [15%], p<0.0001). Morphine-group neonates receiving open-label morphine were more likely to develop severe IVH (36/190 [19%] vs 19/219 [9%], p=0.0024).

    INTERPRETATION: Pre-emptive morphine infusions did not reduce the frequency of severe IVH, PVL, or death in ventilated preterm neonates, but intermittent boluses of open-label morphine were associated with an increased rate of the composite outcome. The morphine doses used in this study decrease clinical signs of pain but can cause significant adverse effects in ventilated preterm neonates.

  • 12.
    Ander, Fredrik
    et al.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Magnuson, Anders
    Berggren, Lars
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    de Leon, Alex
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Effects of Esmolol on the Esophagogastric Junction: A Double-Blind, Randomized, Crossover Study on 14 Healthy Volunteers2017In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 125, no 4, p. 1184-1190Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Passive regurgitation may occur throughout the perioperative period, increasing the risk for pulmonary aspiration and postoperative pulmonary complications. Hypnotics and opioids, especially remifentanil, that are used during anesthesia have been shown to decrease the pressure in the esophagogastric junction (EGJ), that otherwise acts as a barrier against passive regurgitation of gastric contents. Esmolol, usually used to counteract tachycardia and hypertension, has been shown to possess properties useful during general anesthesia. Like remifentanil, the beta-1-adrenoreceptor antagonist may be used to attenuate the stress reaction to tracheal intubation and to modify perioperative anesthetic requirements. It may also reduce the need for opioids in the postoperative period. Its action on the EGJ is however unknown. The aim of this trial was to compare the effects of esmolol and remifentanil on EGJ pressures in healthy volunteers, when administrated as single drugs.

    METHODS: Measurements of EGJ pressures were made in 14 healthy volunteers using high resolution solid-state manometry. Interventions were administered in a randomized sequence and consisted of esmolol that was given IV as a bolus dose of 1 mg/kg followed by an infusion of 10 mu g.kg(-1).minute(-1) over 15 minutes, and remifentanil with target-controlled infusion of 4 ng/mL over 15 minutes. Interventions were separated by a 20-minute washout period. Analyses of EGJ pressures were performed at baseline, and during drug administration at 2 (T2) and 15 minutes (T15). The primary outcome was the inspiratory EGJ augmentation, while the inspiratory and expiratory EGJ pressures were secondary outcomes.

    RESULTS: There was no effect on inspiratory EGJ augmentation when comparing remifentanil and esmolol (mean difference -4.0 mm Hg [-9.7 to 1.7]; P = .15). In contrast, remifentanil significantly decreased both inspiratory and expiratory pressures compared to esmolol (-12.2 [-18.6 to 5.7]; P = .003 and 8.0 [-13.3 to 2.8]; P = .006).

    CONCLUSIONS: Esmolol, compared with remifentanil, does not affect EGJ function. This may be an advantage regarding passive regurgitation and esmolol may thus have a role to play in anesthesia where maintenance of EGJ barrier function is of outmost importance.

  • 13.
    Ander, Fredrik
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Berggren, Lars
    Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Department of Anaesthesia and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    de Leon, Alex
    Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Time-to-intubation in obese patients: A randomized study comparing direct laryngoscopy and videolaryngoscopy in experienced anaesthetists2017In: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 83, no 9, p. 906-913Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Airway management may be difficult in obese patients. Moreover, during prolonged intubation, oxygen desaturation develops rapidly. Videolaryngoscopy improves the view of the larynx, and the Storz® C-MACTM has been shown to be superior to other videolaryngoscopes in terms of intubation time in obese patients. However, no effort has been made to compare the Storz® C-MACTM with direct laryngoscopy. The aim of the study was to evaluate if the use of Storz® C-MACTM may reduce intubation time when compared to direct laryngoscopy (classic Macintosh® blade).

    METHODS: eighty patients with body mass index > 35kg/m2 were randomized to orotracheal intubation using either Macintosh® laryngoscope, or the Storz® C-MACTM with the standard Macintosh blade. Patients had no previous history of a difficult airway. Time- to-intubation (TTI) was defined as the time from the moment anaesthetist took the laryngoscope until end-tidal carbon dioxide was detected.

    RESULTS: no significant difference in TTI could be demonstrated between the two devices tested (mean difference -1.7s (95% CI -6.9 to 3.5s). All patients in the videolaryngoscopy group were successfully intubated with the allocated device, whereas five patients in the direct laryngoscopy group required an alternative device for successful intubation. No significant difference regarding the subjective difficulty of intubation and postoperative sore throat between groups was demonstrated.

    CONCLUSION: in obese patients the airway may be secured equally fast using direct laryngoscopy (Macintosh®) and with videolaryngoscopy using the Stortz® C-MACTM. The risk for failed intubation, however, appears to be greater with direct laryngoscopy, especially in male obese patients.

  • 14.
    Ander, Fredrik
    et al.
    Örebro University, School of Medical Sciences. Department of Anaesthesia and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Magnuson, Anders
    de Leon, Alex
    Department of Anaesthesia and Intensive Care, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Does the β-receptor antagonist esmolol have analgesic effects?: A randomised placebo-controlled cross-over study on healthy volunteers undergoing the cold pressor test2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 3, p. 165-172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Esmolol may attenuate the sympathetic response to pain and reduce postoperative opioid consumption. It is not clear whether esmolol has an analgesic effect per se.

    OBJECTIVES: The aim of this study was to evaluate the analgesic effect of esmolol in the absence of anaesthetics and opioids. We tested the hypothesis that esmolol would reduce the maximum pain intensity perceived during the cold pressor test (CPT) by 2 points on a 0 to 10 numeric pain rating scale (NRS) compared to placebo.

    DESIGN: Randomised, placebo-controlled cross-over study.

    SETTING: Postoperative recovery area, Örebro University Hospital. Study period, November 2013 to February 2014.

    PARTICIPANTS: Fourteen healthy volunteers. Exclusion criteria included ongoing medication, pregnancy and breastfeeding and participation in other medical trials.

    INTERVENTIONS: At separate study sessions, participants received interventions: esmolol (0.7 mg kg bolus over 1 min followed by infusion at 10 μg kg min); 0.9% normal saline bolus then remifentanil infusion at 0.2 μg kg min and 0.9% normal saline bolus and infusion according to a random sequence. All infusions were administered over 30 min.

    MAIN OUTCOME MEASURES: Perceived maximum pain intensity score, pain tolerance and haemodynamic changes during CPT, and occurrence of side-effects to interventions compared to placebo, respectively.

    RESULTS: Esmolol did not reduce perceived pain intensity or pain tolerance during the CPT. The NRS-max score was similar for esmolol, 8.5 (±1.4) and placebo, 8.4 (±1.3). The mean difference was 0.1 [95% confidence interval (-1.2 to 1.4)], P value equal to 0.83. Remifentanil significantly reduced NRS-max scores, 5.4 (±2.1) compared to placebo, [mean difference -3.1 (95% confidence interval (-4.4 to -1.8)), P < 0.001]. Side-effects were seen with remifentanil but not with esmolol.

    CONCLUSION: No direct analgesic effect of esmolol could be demonstrated in the present study. The postoperative opioid-sparing effect demonstrated in previous studies, could therefore be secondary to other factors such as avoidance of opioid-induced hyperalgesia, synergy with coadministered opioids or altered pharmacokinetics of those drugs.

    TRIAL REGISTRATION: European clinical trials database, https://eudract.ema.europa.eu/, EudraCT no. 2011-005780-24.

  • 15.
    Andersson, Pia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Augustsson, Lena
    Preoperativa metoder som anestesisjuksköterskan kan använda sig utav för att minska den postoperativa smärtan2011Independent thesis Advanced level (professional degree), 5 credits / 7,5 HE creditsStudent thesis
  • 16.
    Ansari, Malik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Azar, Jonny
    Barn och föräldrars behov av information och förberedelser inför ett kirurgiskt ingrepp2011Independent thesis Advanced level (professional degree), 5 credits / 7,5 HE creditsStudent thesis
  • 17.
    Aronsson, Johnas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    DESATURATION I SAMBAND MED GENERELL ANESTESI: En litteraturgenomgång2009Independent thesis Advanced level (professional degree), 5 credits / 7,5 HE creditsStudent thesis
  • 18.
    Axelsson, Kjell
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences.
    Johanzon, Eva
    Berg, Elisabeth
    Ekbäck, Gustav
    Rawal, Narinder
    Enström, Peter
    Nordensson, Ulf
    Intraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study2008In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 106, no 1, p. 328-333Article in journal (Refereed)
    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.

  • 19. Axelsson, Patric
    et al.
    Thörn, Sven-Egron
    Örebro University, Department of Clinical Medicine.
    Lövqvist, Åsa
    Wattwil, Lisbeth
    Örebro University, Department of Clinical Medicine.
    Wattwil, Magnus
    Örebro University, Department of Clinical Medicine.
    Betamethasone does not prevent nausea and vomiting induced by the dopamine-agonist apomorphine2006In: Canadian Journal of Anesthesia, ISSN 0832-610X, E-ISSN 1496-8975, Vol. 53, no 4, p. 370-374Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The mechanism of the antiemetic actions of corticosteroids is not known. The purpose of this study was to evaluate if betamethasone can prevent nausea, vomiting or increase of vasopressin induced by apomorphine. Metoclopramide, a dopamine antagonist, was used as a control substance. METHODS: Ten healthy volunteers were studied on three occasions. In a randomized order they were allocated to receive pretreatment with betamethasone 8 mg iv, metoclopramide 10 mg iv, and normal saline 2 mL as placebo on the three different occasions, 15 min before the administration of apomorphine 30 microg x kg(-1) s.c.. After administration of apomorphine, episodes of vomiting were recorded, and the intensity of nausea was estimated by the subject on a visual analogue scale (VAS 0-10 cm). Blood samples for analysis of plasma concentrations of vasopressin were analyzed. RESULTS: One volunteer decided to withdraw, as he experienced akathisia after receiving metoclopramide. During the first two hours after apomorphine, eight of nine volunteers vomited both after betamethasone and placebo. One volunteer did not vomit after betamethasone and placebo but he experienced nausea. None of the volunteers vomited after metoclopramide (P < 0.01 vs betamethasone and placebo). The maximum VAS for nausea was significantly higher after betamethasone and placebo compared to metoclopramide (P < 0.01). The vasopressin levels increased after betamethasone and placebo, but there was no increase in any volunteer after pretreatment with metoclopramide. CONCLUSION: This study demonstrates that betamethasone does not prevent nausea, vomiting and increase of vasopressin induced by apomorphine, whereas metoclopramide prevents apomorphine-induced emesis. Our work suggests that betamethasone does not have dopamine-antagonistic effects.

  • 20.
    Axman Sara, Inga Lisa
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kvist, Maria
    Patienters upplevelser av att fasta inför operation2012Independent thesis Advanced level (professional degree), 5 credits / 7,5 HE creditsStudent thesis
  • 21.
    Bartha, Erzsebet
    et al.
    Karolinska University Hospital, Huddinge, Sweden.
    Bertilsson, Mathias
    Karolinska University Hospital, Huddinge, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences.
    Bell, Max
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Björne, Håkan
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Brattström, Olof
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Nilsson, Lena
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Semenas, Egidijus
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Wiklund, Andreas
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Kalman, Sigridur
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Combining functional dependency and ASA III classification for risk stratification-predictors, risk factors, and outcomes following major surgery study (NCT02626546)2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1011-1011Article in journal (Other academic)
    Abstract [en]

    Background: In elderly reclassification of ASA3 class by functional dependency improved prediction of postoperative mortality. We hypothesized that such a reclassification could improve the risk prediction of adverse outcomes also following high risk surgery.

    Method: We analyzed data collected by the PROFS study in four Swedish academic hospitals. The inclusion criteria were: adults, ASA≥3, major or xmajor/complex surgery (UK surgical severity coding). ASA 3 patients were reclassified into ASA 3a (functionally independent) and 3b (functionally dependent). The adverse outcomes were postoperative complications (yes/no) screened by Postoperative Morbidity Survey (days 3, 7, 10) and mortality (30-day). Complications graded ≥2 by Clavien-Dindo classification were considered. The predictive value of reclassification was analyzed by logistic regression models.

    Results: Between 2015 Nov2th and 2016 Feb19th 1089 patients were include; 13 were excluded (violation of inclusion criteria), 3 were lost to follow-up and 1073 were analyzed. ASA 3b (vs ASA 3a) patients had higher risk for mortality and for postoperative complications at days 7 and 10. ASA 4 (vs ASA 3) patients had higher risk of all adverse outcomes (Table 1). When age was added in the regression model ASA 3b patients still had higher risk for postoperative complications at day 10, but the significance disappeared when also urgency was added.

    Conclusion: The loss of significance by adding urgency in the model might be attributed to the dominance of urgent procedures in ASA3b and ASA4 groups. Reclassification of ASA 3 patients by dependency is recommended, as it may predict adverse outcomes and support clinical judgment.

  • 22.
    Bartha, Erzsebet
    et al.
    Karolinska University Hospital, Huddinge, Sweden.
    Helleberg, Johan
    Karolinska University Hospital, Huddinge, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Bell, Max
    Karolinska University Hospital, Solna, Sweden.
    Björne, Hakan
    Karolinska University Hospital, Solna, Sweden.
    Brattström, Olof
    Karolinska University Hospital, Solna, Sweden.
    Nilsson, Lena
    University Hospital Linköping, Linköping, Sweden.
    Semenas, Egidijus
    Uppsala University Hospital, Uppsala, Sweden.
    Wiklund, Andreas
    Karolinska University Hospital, Solna, Sweden.
    Kalman, Sigridur
    Karolinska University Hospital, Huddinge, Sweden.
    Performance of prediction models of postoperative mortality in high-risk surgical patients in swedish university hospitals: Predictors, Risk factors and Outcome Following major Surgery study (PROFS study NCT02626546)2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1056-1057Article in journal (Other academic)
    Abstract [en]

    Background: There are several progn ostic prediction models that estimate the probability of postoperative mortality. The role of these models is to support clinical decisions. Before implementation of a prediction model in routine care, it is necessary to analyze its performance in the target population. Our aim was to analyze the performance of four different prediction models of postoperative mortality in a high-risk surgical population.

    Methods: Data collected from 2015-11-01 until 2016-02-15 in a prospective consecutive observational study (PROFS study) in four university hospitals was used. The inclusion criteria were adult, ASA classification ≥3, and major/complex upper or lower gastrointestinal, urogenital or orthoped ic surgery (UK surgical severity codingA XA PPP). Four prediction models were evaluated: Surgical Outcome Risk Tool (SORT), Surgical APGAR, P-POSSUM and Surgical Risk Scale (SRS). The outcome measure was 90-day mortality. We evaluated the discrimination of the models by area under receiver operator characteristic curve (AUC ROC) before and after recalibration.

    Results: In total, 1 089 patients were included. Thirteen patients were excluded due to erroneous inclusion, and another three were lost to follow-up, so data from 1 073 was used in this analysis. The mean age was 73 years, the presence of malignancy was 41%, and 90-day mortality was 13% (n = 140). The SORT model had the best discrimination both before and after recalibration. The P-POSSUM model improved after recalibration. The SRS model overestimated, whereas the APGAR model underestimated, the risk of mortality.

    Conclusions: The original SORT model is promising and could be incorporated as decision support for high-risk surgical patients.

  • 23.
    Batchelor, Timothy J. P.
    et al.
    Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
    Rasburn, Neil J.
    Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
    Abdelnour-Berchtold, Etienne
    Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Brunelli, Alessandro
    Department of Thoracic Surgery, St. James’s University Hospital, Leeds, UK.
    Cerfolio, Robert J.
    Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA.
    Gonzalez, Michel
    Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Petersen, René H.
    Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Popescu, Wanda M.
    Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
    Slinger, Peter D.
    Department of Anesthesia, University Health Network – Toronto General Hospital, Toronto, ON, Canada.
    Naidu, Babu
    Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
    Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS)2018In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734XArticle in journal (Refereed)
    Abstract [en]

    Enhanced recovery after surgery is well established in specialties such as colorectal surgery. It is achieved through the introduction of multiple evidence-based perioperative measures that aim to diminish postoperative organ dysfunction while facilitating recovery. This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery (principally lung resection). A systematic review of meta-analyses, randomized controlled trials, large non-randomized studies and reviews was conducted for each protocol element. Smaller prospective and retrospective cohort studies were considered only when higher-level evidence was unavailable. The quality of the evidence base was graded by the authors and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society and the European Society for Thoracic Surgery. Recommendations were developed for a total of 45 enhanced recovery items covering topics related to preadmission, admission, intraoperative care and postoperative care. Most are based on good-quality studies. In some instances, good-quality data were not available, and subsequent recommendations are generic or based on data extrapolated from other specialties. In other cases, no recommendation can currently be made because either equipoise exists or there is a lack of available evidence. Recommendations are based not only on the quality of the evidence but also on the balance between desirable and undesirable effects. Key recommendations include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anaesthetics to facilitate early emergence, regional anaesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters and early mobilization after surgery. These guidelines outline recommendations for the perioperative management of patients undergoing lung surgery based on the best available evidence. As the recommendation grade for most of the elements is strong, the use of a systematic perioperative care pathway has the potential to improve outcomes after surgery.

  • 24.
    Berggren, Rickard
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    En beskrivning av preventiva åtgärder för att minska bildandet av atelektaser perioperativt2011Independent thesis Advanced level (professional degree), 5 credits / 7,5 HE creditsStudent thesis
  • 25.
    Bergström, Gunnar
    et al.
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Cecilia
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Hagberg, Jan
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Jensen, Irene
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients: Is sick leave outcome dependent on psychologically derived patient groups?2010In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 4, p. 426-433Article in journal (Refereed)
    Abstract [en]

    A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.

  • 26.
    Beverly, Anair
    et al.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston MA, USA.
    Kaye, Alan D.
    Department of Anesthesiology and Pharmacology, Anesthesiology Services, LSU School of Medicine, University Medical Center Hospital, New Orleans LA, USA.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Urman, Richard D.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston MA, USA.
    Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines2017In: Anesthesiology Clinics, ISSN 1932-2275, Vol. 35, no 2, p. e115-e143Article in journal (Refereed)
    Abstract [en]

    Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. This article outlines the evidence base forming the current multimodal analgesia recommendations made by the Enhanced Recovery After Surgery Society (ERAS). We describe current evidence and important future directions for effective perioperative multimodal analgesia in enhanced recovery pathways.

  • 27.
    Björkman, Louise
    et al.
    Örebro University, School of Medical Sciences. Department of Pediatrics, Örebro University Hospita, Örebro, Sweden.
    Hagberg, J.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Örebro University, School of Medical Sciences.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Can the use of isopropanol impregnated caps cause alcohol leakage into intravenous lines?2017Conference paper (Refereed)
  • 28.
    Bowyer, A.
    et al.
    Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville Vic, Australia.
    Jakobsson, J.
    Department for Anaesthesia and Intensive Care, Institution of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University Hospital. Department of Surgery; Institution of Molecular medicine and Surgery, Karolinska Insitutet, Stockholm, Sweden.
    Royse, C.
    Department of Surgery, The University of Melbourne, Parkville Vic, Australia.
    A review of the scope and measurement of postoperative quality of recovery2014In: Anaesthesia, ISSN 0003-2409, E-ISSN 1365-2044, Vol. 69, no 11, p. 1266-1278Article, review/survey (Refereed)
    Abstract [en]

    To date, postoperative quality of recovery lacks a universally accepted definition and assessment technique. Current quality of recovery assessment tools vary in their development, breadth of assessment, validation, use of continuous vs dichotomous outcomes and focus on individual vs group recovery. They have progressed from identifying pure restitution of physiological parameters to multidimensional assessments of postoperative function and patient-focused outcomes. This review focuses on the progression of these tools towards an as yet unreached ideal that would provide multidimensional assessment of recovery over time at the individual and group level. A literature search identified 11 unique recovery assessment tools. The Postoperative Quality of Recovery Scale assesses recovery in multiple domains, including physiological, nociceptive, emotive, activities of daily living, cognition and patient satisfaction. It addresses recovery over time and compares individual patient data with base line, thus describing resumption of capacities and is an acceptable method for identification of individual patient recovery.

  • 29.
    Braatz, Erik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tjäder, Albin
    Prevention av Perioperativ Hypotermi2010Independent thesis Advanced level (professional degree), 5 credits / 7,5 HE creditsStudent thesis
  • 30.
    Buer, Nina
    et al.
    Neurotec Department, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Department of Health Promotion for Personnel, Örebro University Hospital, Örebro, Sweden .
    Linton, Steven J
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden .
    Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population2002In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 99, no 3, p. 485-491Article in journal (Refereed)
    Abstract [en]

    Fear-avoidance beliefs and catastrophizing have been shown to be powerful cognitions in the process of developing chronic pain problems and there is a need for increased knowledge in early stages of pain.

    The objectives of this study were therefore, firstly, to examine the occurrence of fear-avoidance beliefs and catastrophizing in groups with different degrees of non-chronic spinal pain in a general population, and secondly to assess if fear-avoidance beliefs and catastrophizing were related to current ratings of pain and activities of daily living (ADL).

    The study was a part of a population based back pain project and the study sample consisted of 917 men and women, 35-45 years old, either pain-free or with non-chronic spinal pain. The results showed that fear-avoidance beliefs as well as catastrophizing occur in this general population of non-patients. The levels were moderate and in catastrophizing a 'dose-response' pattern was seen, such that more the catastrophizing was, the more was pain. The study showed two relationships, which were between fear-avoidance and ADL as well as between catastrophizing and pain intensity. Logistic regression analyses were performed with 95% confidence intervals and the odds ratio for fear-avoidance beliefs and ADL was 2.5 and for catastrophizing and pain 1.8, both with confidence interval above unity. The results suggest that fear-avoidance beliefs and catastrophizing may play an active part in the transition from acute to chronic pain and clinical implications include screening and early intervention. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

  • 31.
    Bukur, M.
    et al.
    Division of Trauma and Surgical Critical Care, Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States; Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Department of Acute Care Surgery, Los Angeles County, Los Angeles CA, United States; University of Southern California Medical Center, Los Angeles CA, United States.
    Ley, E.
    Division of Trauma and Surgical Critical Care, Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States.
    Salim, A.
    Division of Trauma and Surgical Critical Care, Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States.
    Margulies, D.
    Division of Trauma and Surgical Critical Care, Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States.
    Talving, P.
    Department of Acute Care Surgery, Los Angeles County, Los Angeles CA, United States; University of Southern California Medical Center, Los Angeles CA, United States.
    Demetriades, D.
    Department of Acute Care Surgery, Los Angeles County, Los Angeles CA, United States; University of Southern California Medical Center, Los Angeles CA, United States.
    Inaba, K.
    Department of Acute Care Surgery, Los Angeles County, Los Angeles CA, United States; University of Southern California Medical Center, Los Angeles CA, United States.
    Efficacy of beta-blockade after isolated blunt head injury: Does race matter? (vol 72, pg 1013, 2012)2012In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 72, no 6, p. 1725-1725Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several retrospective clinical studies and recent prospective animal models demonstrate improved outcomes with beta-blocker administration after isolated blunt head injury. However, no investigations to date have examined the influence of race on the potential therapeutic effectiveness of these medications. Our hypothesis was that mortality benefits associated with beta-blocker exposure after isolated blunt head injury varies based on ethnicity.

    METHODS: The trauma registry and the surgical intensive care unit (ICU) databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2009. Patients sustaining major associated extracranial injuries (Abbreviated Injury Scale [AIS] score ≥3 in any body region) were excluded. Patient demographics, injury profile, Injury Severity Score, and beta-blocker exposure were abstracted. The primary outcome evaluated was in-hospital mortality stratified by ethnicity.

    RESULTS: During the 11-year study period, 3,750 patients were admitted to the Los Angeles County + University of Southern California Medical Center trauma ICU because of blunt trauma. Of these, 65% (n = 2,446) had an “isolated” head injury. When stratified by race, most patients were Hispanics (60%), followed by Whites (21%), Asians (11%), and African Americans (8%). After adjusting for confounding variables with multivariate regression, only those of Asian and Hispanic descent demonstrated significantly improved outcomes associated with beta-blocker administration.

    CONCLUSIONS: Our results indicate that beta-blockade after traumatic brain injury may not benefit all races equally. Further prospective research is necessary to assess this discrepancy in treatment benefit and explore other possible therapeutic interventions.

    LEVEL OF EVIDENCE: III, therapeutic study; II, prognostic study.

  • 32.
    Bulow, Hans-Henrik
    et al.
    Intensive Care, Holbaek Hospital, Holbaek, Denmark.
    Sprung, Charles L.
    Department of Anesthesiology and Critical Care Medicine, Medical Center, Hadassah Hebrew University, Jerusalem, Israel.
    Baras, Mario
    Hadassah School of Public Health, Hadassah Medical Center, Hebrew University, Jerusalem, Israel.
    Carmel, Sara
    Centre for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Negev, Israel.
    Svantesson, Mia
    Örebro University Hospital. Örebro University, School of Health Sciences. Centre for Health Care Research.
    Benbenishty, Julie
    Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
    Maia, Paulo A.
    Department of Intensive Care, Centro Hospitalar, Hospital S. Antonio, Porto, Portugal.
    Beishuizen, Albertus
    Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.
    Cohen, Simon
    Intensive Care Unit, University College Hospital, London, United Kingdom.
    Nalos, Daniel
    Krajská Zdravotní A.s., ARO Masarykova Nemocnice Ústí Nad, Labem, Czech Republic.
    Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU?: The Ethicatt study2012In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 38, no 7, p. 1126-1133Article in journal (Refereed)
    Abstract [en]

    This study explored differences in end-of-life (EOL) decisions and respect for patient autonomy of religious members versus those only affiliated to that particular religion (affiliated is a member without strong religious feelings).

    In 2005 structured questionnaires regarding EOL decisions were distributed in six European countries to ICUs in 142 hospital ICUs. This sub-study of the original data analyzed answers from Protestants, Catholics and Jews.

    A total of 304 physicians, 386 nurses, 248 patients and 330 family members were included in the study. Professionals wanted less treatment (ICU admission, CPR, ventilator treatment) than patients and family members. Religious respondents wanted more treatment and were more in favor of life prolongation, and they were less likely to want active euthanasia than those affiliated. Southern nurses and doctors favored euthanasia more than their Northern colleagues. Three quarters of doctors and nurses would respect a competent patient's refusal of a potentially life-saving treatment. No differences were found between religious and affiliated professionals regarding patient's autonomy. Inter-religious differences were detected, with Protestants most likely to follow competent patients' wishes and the Jewish respondents least likely to do so, and Jewish professionals more frequently accepting patients' wishes for futile treatment. However, these findings on autonomy were due to regional differences, not religious ones.

    Health-care professionals, families and patients who are religious will frequently want more extensive treatment than affiliated individuals. Views on active euthanasia are influenced by both religion and region, whereas views on patient autonomy are apparently more influenced by region.

  • 33.
    Busch, Hillevi
    et al.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Bergström, Gunnar
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Jensen, Irene B.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Patterns of sickness absence a decade after pain-related multidisciplinary rehabilitation2011In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 152, no 8, p. 1727-1733Article in journal (Refereed)
    Abstract [en]

    Multidisciplinary programmes using a vocational approach can enhance work return in chronic pain patients, but little is known about the long-term effects of rehabilitation. The current study examined the patterns of sickness absence 10 years after participation in 3 treatment groups (physiotherapy, cognitive behavioural therapy, and vocational multidisciplinary rehabilitation) in comparison to a control group receiving treatment-as-usual. Cost-effectiveness was also assessed. Two hundred fourteen patients participated in a randomized controlled trial and were followed-up via register data 10 years after the interventions. On average, persons in multidisciplinary rehabilitation had 42.98 fewer days on sickness absence per year compared to those treated-as-usual (95% confidence interval −82.45 to −3.52, P=0.03). The corresponding reduction of sickness absence after physiotherapy and cognitive behavioural therapy was not significantly different from the control group. The effect of rehabilitation seems to be more pronounced for disability pension than for sick leave. The economic analyses showed substantial cost savings for individuals in the multidisciplinary group compared to the control group.

  • 34.
    Coccolini, Federico
    et al.
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Ansaloni, Luca
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Splenic trauma: WSES classification and guidelines for adult and pediatric patients2017In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 12, article id 40Article, review/survey (Refereed)
    Abstract [en]

    Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

  • 35.
    Coccolini, Federico
    et al.
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Stahel, Philip F.
    Department of Orthopedic Surgery, Department of Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver CO, USA.
    Montori, Giulia
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Biffl, Walter
    Acute Care Surgery, The Queen's Medical Center, Honolulu HI, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Dept. of Cardiothoracic and Vascular Surgery & Dept. Of Surgery, Örebro University Hospital, Örebro, Sweden.
    Catena, Fausto
    Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy.
    Kluger, Yoram
    Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel.
    Moore, Ernest E.
    Trauma Surgery, Denver Health, Denver CO, USA.
    Peitzman, Andrew B.
    Surgery Department, University of Pittsburgh, Pittsburgh PA, USA.
    Ivatury, Rao
    Virginia Commonwealth University, Richmond VA, USA.
    Coimbra, Raul
    Department of Surgery, UC San Diego Health System, San Diego, USA.
    Fraga, Gustavo Pereira
    Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas SP, Brazil.
    Pereira, Bruno
    Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas SP, Brazil.
    Rizoli, Sandro
    Trauma & Acute Care Service, St Michael's Hospital, Toronto ON, Canada.
    Kirkpatrick, Andrew
    General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary AB, Canada.
    Leppaniemi, Ari
    Abdominal Center, University Hospital Meilahti, Helsinki, Finland.
    Manfredi, Roberto
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Magnone, Stefano
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Chiara, Osvaldo
    Emergency and Trauma Surgery, Niguarda Hospital, Milan, Italy.
    Solaini, Leonardo
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Ceresoli, Marco
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Allievi, Niccolò
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Arvieux, Catherine
    Digestive and Emergency Surgery, UGA-Université Grenoble Alpes, Grenoble, France.
    Velmahos, George
    Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General Hospital, Boston MA, USA.
    Balogh, Zsolt
    Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle NSW, Australia.
    Naidoo, Noel
    Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
    Weber, Dieter
    Department of General Surgery, Royal Perth Hospital, Perth, Australia.
    Abu-Zidan, Fikri
    Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
    Sartelli, Massimo
    General and Emergency Surgery, Macerata Hospital, Macerata, Italy.
    Ansaloni, Luca
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Pelvic trauma: WSES classification and guidelines2017In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 12, no 5Article in journal (Refereed)
    Abstract [en]

    Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

  • 36.
    Cone, David C
    et al.
    Department of Emergency Medicine, Yale University School of Medicine, New Haven CT, USA.
    Serra, John
    Department of Emergency Medicine, University of California, San Diego CA, USA.
    Kurland, Lisa
    Department of Clinical Research and Education, Karolinska Institutet, Stockholm, Sweden.
    Comparison of the SALT and Smart triage systems using a virtual reality simulator with paramedic students2011In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 18, no 6, p. 314-321Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Virtual reality systems may allow for organized study of mass casualty triage systems by allowing investigators to replicate the same mass casualty incident, with the same victims, for a large number of rescuers. The study objectives were to develop such a virtual reality system, and use it to assess the ability of trained paramedic students to triage simulated victims using two triage systems.

    METHODS: Investigators created 25 patient scenarios for a highway bus crash in a virtual reality simulation system. Paramedic students were trained to proficiency on the new 'Sort, Assess, Life saving interventions, Treat and Transport (SALT)' triage system, and 22 students ran the simulation, applying the SALT algorithm to each victim. After a 3-month washout period, the students were retrained on the 'Smart' triage system, and each student ran the same crash simulation using the Smart system. Data inputs were recorded by the simulation software and analyzed with the paired t-tests.

    RESULTS: The students had a mean triage accuracy of 70.0% with SALT versus 93.0% with Smart (P=0.0001). Mean overtriage was 6.8% with SALT versus 1.8% with Smart (P=0.0015), and mean undertriage was 23.2% with SALT versus 5.1% with Smart (P=0.0001). The average time for a student to triage the scene was 21 min 3 s for SALT versus 11 min 59 s for Smart (P=0.0001).

    CONCLUSION: The virtual reality platform seems to be a viable research tool for examining mass casualty triage. A small sample of trained paramedic students using the virtual reality system was able to triage simulated patients faster and with greater accuracy with 'Smart' triage than with 'SALT' triage.

  • 37.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Philipsson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Hälleberg Nyman, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial2017In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1039-1046Article in journal (Refereed)
    Abstract [en]

    Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.

    Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.

    Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.

    Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.

    Clinical trial registration:NCT02492191

  • 38.
    Darvish, Bijan
    Örebro University, School of Medical Sciences.
    Post-Dural Puncture Headache in Obstetrics: Audiological, Clinical and Epidemiological studies2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Post-dural puncture headache (PDPH) is the most common complication of obstetric epidural analgesia. The characteristic positional headache, often associated with visual, vestibular or cochlear symptoms, is severe and disabling for the parturient. The diagnosis is clinical without the possibility of confirmatory objective tests. Although epidural blood patch (EBP) is considered the gold standard for treatment of PDPH, many aspects of this treatment modality remain to be explored. This thesis was performed in order to improve our current knowledge of the diagnosis and the short and long-term consequences of PDPH. We found that the incidence of accidental dural puncture in labour epidural analgesia was 1% in the Nordic countries and 90% of these patients were managed with an EBP (study I). Auditory impairment related to PDPH was prospectively investigated in 21 parturients with PDPH treated with EBP (study II). A significantly greater number of parturients suffering from PDPH had hearing loss (> 20 dB) in the low frequency range compared to controls which improved spontaneously but independent of treatment with EBP. At 4 hours, 95% of subjects had a successful EBP but headache recurred in 24% at 24 hours. In study III, we investigated residual hearing deficit several years after PDPH treated with EBP. We found statistically significant long-term impairment of hearing but this was of minor clinical relevance. In study IV, 60 women with previous PDPH and treated with EBP responded to a validated questionnaire to determine the long-term effects of EBP on headache and backache. We found that subjects who had been treated with EBP had a significantly greater incidence and severity of headache compared to controls. The incidence of mild backache was also significantly higher but of limited clinical importance. In conclusion, PDPH after labour epidural analgesia is an important clinical problem. Parturients suffering from PDPH may have audiometric deterioration in the early postpartum period that recovers spontaneously over time and some long-term effects of PDPH on hearing may be evident but these are of minor clinical relevance. Clinically important headache, but not backache, may be present several years after PDPH.

    List of papers
    1. Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey
    Open this publication in new window or tab >>Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey
    Show others...
    2011 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 1, p. 46-53Article in journal (Refereed) Published
    Abstract [en]

    Background: A major risk with epidural analgesia is accidental dural puncture (ADP), which may result in post-dural puncture headache (PDPH). This survey was conducted to explore the incidence of ADP, the policy for management of PDPH and the educational practices in epidural analgesia during labour in the Nordic countries.

    Methods: A postal questionnaire was sent to the anaesthesiologist responsible for Obstetric anaesthesia service in all maternity units (n=153) with questions relating to the year 2008.

    Results: The overall response rate was 93%. About 32% (22-47%) of parturients received epidural analgesia for labour. There were databases for registering obstetric epidural complications in 13% of Danish, 24% of Norwegian and Swedish, 43% of Finnish and 100% of hospitals in Iceland. The estimated incidence of ADP was 1% (n approximate to 900). Epidural blood patch (EBP) was performed in 86% (n approximate to 780) of the parturients. The most common time interval from diagnosis to performing EBP was 24-48 h. The success rate for EBP was > 75% in 67% (62-79%) of hospitals. The use of diagnostic CT/MRI before the first or the second EBP was exceptional. No major complication was reported. Teaching of epidurals was commonest (86%) in the non-obstetric population and 53% hospitals desired a formal training programme in obstetric analgesia.

    Conclusion: We found the incidence of ADP to be approximately 1%. EBP was the commonest method used for its management, and the success rate was high in most hospitals. Formal training in epidural analgesia was absent in most countries and trainees first performed it in the non-obstetric population.

    Place, publisher, year, edition, pages
    The Acta Anaesthesiologica Scandinavica Foundation, 2011
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-49012 (URN)10.1111/j.1399-6576.2010.02335.x (DOI)000284898500008 ()21039355 (PubMedID)2-s2.0-78650009807 (Scopus ID)
    Available from: 2016-03-07 Created: 2016-03-07 Last updated: 2018-05-07Bibliographically approved
    2. The effect of Epidural Blood Patch on Auditory Function following Accidental Dural Puncture in the Parturient: a prospective cohort study
    Open this publication in new window or tab >>The effect of Epidural Blood Patch on Auditory Function following Accidental Dural Puncture in the Parturient: a prospective cohort study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-49015 (URN)
    Available from: 2016-03-07 Created: 2016-03-07 Last updated: 2018-09-18Bibliographically approved
    3. Auditory function following post-dural puncture headache treated with epidural blood patch: a long-term follow-up
    Open this publication in new window or tab >>Auditory function following post-dural puncture headache treated with epidural blood patch: a long-term follow-up
    Show others...
    2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 10, p. 1340-1354Article in journal (Refereed) Published
    Abstract [en]

    Background: Epidural analgesia is commonly used for pain management during labor. Sometimes, accidental dural puncture (ADP) occurs causing severely debilitating headache, which may be associated with transient hearing loss. We investigated if auditory function may be impaired several years after ADP treated with epidural blood patch (EBP).

    Methods: Sixty women (ADP group) without documented hearing disability, who received EBP following ADP during labor between the years 2005-2011 were investigated in 2013 for auditory function using the following tests: otoscopic examination, tympanometry, pure tone audiometry, and transient-evoked otoacoustic emissions. Additionally, they responded to a questionnaire, the Speech, Spatial and Qualities (SSQ) of hearing, concerning perceived hearing impairment. The results were compared to a control group of 20 healthy, non-pregnant women in the same age group.

    Results: The audiometric test battery was performed 5.2 (1.9)years after delivery. No significant differences were found between the ADP and the control groups in tympanometry or otoacoustic emissions. Pure tone audiometry revealed a significant but small (<5dB) difference between the ADP and control groups (P<0.05). The ability to hear speech in noise as measured by SSQ was significantly reduced in the ADP group compared to the control group (P<0.05).

    Conclusions: A minor hearing loss was detected in the ADP group compared to the control group in pure tone audiometry in some women and during speech-in-noise component several years after accidental dural puncture treated with an epidural blood patch. This small residual hearing loss has minor clinical significance.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2015
    National Category
    Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-46393 (URN)10.1111/aas.12566 (DOI)000362589100014 ()26105531 (PubMedID)2-s2.0-84943362300 (Scopus ID)
    Available from: 2015-11-04 Created: 2015-11-04 Last updated: 2018-07-23Bibliographically approved
    4. Persistent headache and backache following accidental dural puncture in the parturient: a matched cohort study
    Open this publication in new window or tab >>Persistent headache and backache following accidental dural puncture in the parturient: a matched cohort study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-49018 (URN)
    Available from: 2016-03-07 Created: 2016-03-07 Last updated: 2017-10-17Bibliographically approved
  • 39.
    Darvish, Bijan
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
    Dahlgren, G.
    Department of Anesthesia and Intensive Care, Capio St Görans Hospital, Stockholm, Sweden.
    Irestedt, L.
    Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
    Magnuson, A.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Swedish Institute of Disability Research, Örebro University, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
    Auditory function following post-dural puncture headache treated with epidural blood patch: a long-term follow-up2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 10, p. 1340-1354Article in journal (Refereed)
    Abstract [en]

    Background: Epidural analgesia is commonly used for pain management during labor. Sometimes, accidental dural puncture (ADP) occurs causing severely debilitating headache, which may be associated with transient hearing loss. We investigated if auditory function may be impaired several years after ADP treated with epidural blood patch (EBP).

    Methods: Sixty women (ADP group) without documented hearing disability, who received EBP following ADP during labor between the years 2005-2011 were investigated in 2013 for auditory function using the following tests: otoscopic examination, tympanometry, pure tone audiometry, and transient-evoked otoacoustic emissions. Additionally, they responded to a questionnaire, the Speech, Spatial and Qualities (SSQ) of hearing, concerning perceived hearing impairment. The results were compared to a control group of 20 healthy, non-pregnant women in the same age group.

    Results: The audiometric test battery was performed 5.2 (1.9)years after delivery. No significant differences were found between the ADP and the control groups in tympanometry or otoacoustic emissions. Pure tone audiometry revealed a significant but small (<5dB) difference between the ADP and control groups (P<0.05). The ability to hear speech in noise as measured by SSQ was significantly reduced in the ADP group compared to the control group (P<0.05).

    Conclusions: A minor hearing loss was detected in the ADP group compared to the control group in pure tone audiometry in some women and during speech-in-noise component several years after accidental dural puncture treated with an epidural blood patch. This small residual hearing loss has minor clinical significance.

  • 40.
    Darvish, Bijan
    et al.
    Karolinska University Hospital Solna, Stockholm, Sweden.
    Dahlgren, Gunnar
    Capio St Görans Hospital, Stockholm, Sweden.
    Irestedt, Lars
    Karolinska University Hospital, Solna, Sweden.
    Magnuson, Anders
    Örebro university, Örebro, Sweden.
    Möller, Claes
    School Medicine & Health Sci, Örebro University, Örebro, Sweden.
    Gupta, Anil
    Karolinska University Hospital Solna, Stockholm, Sweden.
    Auditory function following post dural puncture headache treated with epidural blood patch A long-term follow-up of parturients2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, p. 24-25Article in journal (Other academic)
  • 41.
    de Leon, A.
    et al.
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Thörn, Sven-Egron
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Ottosson, J.
    Örebro University Hospital, Örebro, Sweden.
    Wattwil, Magnus
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Body positions and esophageal sphincter pressures in obese patients during anesthesia2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 4, p. 458-463Article in journal (Refereed)
    Abstract [en]

    Background: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions.

    Methods: Using high-resolution solid-state manometry, we studied 17 patients (27-63 years) with a BMI>or=35 kg/m(2) who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20 degrees) and in the Trendelenburg position (-20 degrees). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordings in the different positions were repeated.

    Results: Before anesthesia, there were no differences in UES pressure in the different positions but compared with the other positions, it increased during the reverse Trendelenburg during anesthesia. LES pressure decreased in all body positions during anesthesia. The LES pressure increased during the Trendelenburg position before but not during anesthesia. The BP remained positive in all body positions both before and during anesthesia.

    Conclusion: LES pressure increased during the Trendelenburg position before anesthesia. This effect was abolished during anesthesia. LES and BPs decreased during anesthesia but remained positive in all patients regardless of the body position.

  • 42.
    de Leon, Alex
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ahlstrand, Rebecca
    Örebro University, School of Health and Medical Sciences.
    Thörn, Sven-Egron
    Örebro University, School of Health and Medical Sciences.
    Wattwil, Magnus
    Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 4, p. 273-278Article in journal (Refereed)
    Abstract [en]

    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.

  • 43.
    de Leon, Alex
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Lundin, Stefan
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Stenqvist, Ola
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Esophageal multi-level tip manometry in morbidly obese patients during a PEEP step2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1028-1028Article in journal (Other academic)
    Abstract [en]

    Background: Esophageal pressure, a surrogate for pleural pressure, is used to determine transpulmonary pressure and to set appropriate PEEP levels. There is no consensus on the representativity of esophageal pressure for pleural pressure and how to position and inflate the catheter balloon. The aim of this retrospective study1 was to analyze esophageal pressure using multi-level tip manometry (no balloon).

    Methods: An esophageal catheter with 12 radially directed tip mano meters at 35 levels one centimeter apart, detecting pressure from pharynx to stomach was placed in 17 patients (BMI >35 kg/m2). Pressure was analyzed integrating measurements from five manometer levels at mid- and lower esophageal level and for all levels between the upper and lower esophageal sphincters at PEEP 0 cmH2O (ZEEP) and after increasing PEEP to 10 cmH2O.

    Results: End-expiratory esophageal pressure (PESEE) was 10–12 cmH2O at ZEEP and increased minimally and transiently in whole and mid esophagus when PEEP was increased. Lower esophageal pressure increased more, but started to recede after approximately 20 breaths.

    Conclusions: End-expiratory pressure is positive, 10–12 cmH2O at all esophageal levels at FRC in contrast to absolute pleural pressure, which according to established knowledge is negative. There was only a marginal, transient increase in PESEE in response to PEEP. The change in end-expiratory trans-pulmonary and respiratory system pressures in response to a PEEP increase is therefore equal, and lung elastance can be calculated as the chan ge in PEEP divided by the change in end-expiratory lung volume.

  • 44.
    de León, Alex
    Örebro University, School of Health and Medical Sciences.
    Effects of anesthesia on esophageal sphincters in obese patients2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of this thesis was to evaluate the UES, LES, esophageal (E) and barrier (Br) pressures (P) using high resolution solid state manometry (HRSM). Comparisons were made between obese and nonobese patients, before and during anesthesia induction, and in obese patients in different body positions and during different respiratory maneuvers.

    Methods: The effects of low-dose propofol (0.3 mg/kg iv) were studied in 10 young (ages 18–30 years) and 10 elderly volunteers (ages 60–87 years). The effects of anesthesia induction with remifentanil, propofol and rocuronium were studied in 14 obese patients (BMI >35 kg/m2) and compared with effects in 14 non-obese patients. The effects of different body positions on esophageal sphincters were evaluated in 17 obese patients before and during anesthesia. The effects of different respiratory maneuvers on pressures in the esophagus and esophageal sphincters were studied before and during anesthesia in 17 obese patients. HRSM was used in all studies.

    Results: The low propofol dose did not infl uence LES pressures in either young or elderly volunteers. Anesthesia induction with Remifentanil and Propofol decreased pressures in the esophageal sphincters and the BrP in both obese and non-obese patients. The pressures were signifi cantly lower in obese patients. The BrP remained positive in both obese and non-obese individuals. The LES pressure increased in the Trendelenburg position before but not during anesthesia. During spontaneous breathing the LES pressure was signifi cantly lower during end-expiration compared to end-inspiration. The LES pressure increased during the Valsalva maneuver and forced inspiration. With the patients in supine position the EP was positive during normal spontaneous breathing and during mechanical ventilation but was negative during forced inspiration. The EP increased signifi cantly during PEEP.

    Conclusion: High-resolution solid-state manometry is a valuable tool for studying esophageal function. Lower esophageal sphincter pressure and barrier pressure decreased during anesthesia induction and were signifi cantly lower in obese compared to non-obese patients. However, barrier pressure remained positive in all patients. When evaluating the risk for regurgitation, the lowest lower esophageal sphincter pressure and barrier pressure are found during end-expiration. PEEP during anesthesia increased esophageal pressures and may therefore decrease the risk for passive regurgitation.

    List of papers
    1. Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry
    Open this publication in new window or tab >>Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry
    2011 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 4, p. 273-278Article in journal (Refereed) Published
    Abstract [en]

    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.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2011
    National Category
    Medical and Health Sciences Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-15384 (URN)10.1097/EJA.0b013e3283413211 (DOI)000288196000009 ()21119519 (PubMedID)2-s2.0-79953874254 (Scopus ID)
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2017-12-11Bibliographically approved
    2. High-resolution solid-state manometry of the upper and lower esophageal sphincters during anesthesia induction: a comparison between obese and non-obese patients
    Open this publication in new window or tab >>High-resolution solid-state manometry of the upper and lower esophageal sphincters during anesthesia induction: a comparison between obese and non-obese patients
    2010 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 111, no 1, p. 149-153Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: The prevalence of obesity has increased dramatically in recent decades. The gastrointestinal changes associated with obesity have clinical significance for the anesthesiologist in the perioperative period. The lower esophageal sphincter and the upper esophageal sphincter play a central role in preventing regurgitation and aspiration. The effects of increased intra-abdominal pressure during anesthesia on the lower esophageal sphincter and the upper esophageal sphincter in obese patients are unknown. In the present study we evaluated, with high-resolution solid-state manometry, the upper esophageal sphincter, lower esophageal sphincter, and barrier pressure (BrP) (lower esophageal pressure - gastric pressure) in obese patients during anesthesia induction and compared them with pressures in non-obese patients. METHODS: We studied 28 patients, ages 18 to 72 years, 14 with a body mass index >= 35kg/m(2), who were undergoing laparoscopic gastric bypass, and 14 with a body mass index <= 30kg/m(2), who were undergoing laparoscopic cholecystectomy, using high-resolution solid-state manometry. RESULTS: Upper esophageal sphincter pressure decreased during anesthesia induction in both groups. Lower esophageal sphincter pressure decreased in both groups during anesthesia induction, and it was significantly lower in obese patients than in non-obese patients. The BrP decreased in both groups and was significantly lower in the obese group than in the non-obese group. The BrP remained positive at all times in both groups. CONCLUSION: Lower esophageal sphincter and BrPs decreased in both obese and non-obese patients during anesthesia induction, but were significantly lower in obese patients. Although the BrP was significantly lower, it remained positive in all patients. (Anesth Analg 2010;111:149-53)

    National Category
    Medical and Health Sciences Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-15389 (URN)10.1213/ANE.0b013e3181e1a71f (DOI)000279281500027 ()
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2017-12-11Bibliographically approved
    3. Body positions and esophageal sphincter pressures in obese patients during anesthesia
    Open this publication in new window or tab >>Body positions and esophageal sphincter pressures in obese patients during anesthesia
    2010 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 4, p. 458-463Article in journal (Refereed) Published
    Abstract [en]

    Background: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions.

    Methods: Using high-resolution solid-state manometry, we studied 17 patients (27-63 years) with a BMI>or=35 kg/m(2) who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20 degrees) and in the Trendelenburg position (-20 degrees). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordings in the different positions were repeated.

    Results: Before anesthesia, there were no differences in UES pressure in the different positions but compared with the other positions, it increased during the reverse Trendelenburg during anesthesia. LES pressure decreased in all body positions during anesthesia. The LES pressure increased during the Trendelenburg position before but not during anesthesia. The BP remained positive in all body positions both before and during anesthesia.

    Conclusion: LES pressure increased during the Trendelenburg position before anesthesia. This effect was abolished during anesthesia. LES and BPs decreased during anesthesia but remained positive in all patients regardless of the body position.

    Place, publisher, year, edition, pages
    Malden, USA: Wiley-Blackwell Publishing Inc., 2010
    National Category
    Medical and Health Sciences Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-11649 (URN)10.1111/j.1399-6576.2009.02158.x (DOI)000274932800012 ()19912128 (PubMedID)2-s2.0-77649215976 (Scopus ID)
    Available from: 2010-08-27 Created: 2010-08-27 Last updated: 2017-12-12Bibliographically approved
    4. Effects of different respiratory maneuvers on esophageal sphincters in obese patients before and during anesthesia
    Open this publication in new window or tab >>Effects of different respiratory maneuvers on esophageal sphincters in obese patients before and during anesthesia
    Show others...
    2010 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 10, p. 1204-1209Article in journal (Refereed) Published
    Abstract [en]

    Background: Data on esophageal sphincters in obese individuals during anesthesia are sparse. The aim of the present study was to evaluate the effects of different respiratory maneuvers on the pressures in the esophagus and esophageal sphincters before and during anesthesia in obese patients.

    Methods: Seventeen patients, aged 28-68 years, with a BMI >= 35 kg/m2, who were undergoing a laparoscopic gastric by-pass surgery, were studied, and pressures from the hypopharynx to the stomach were recorded using high-resolution solid-state manometry. Before anesthesia, recordings were performed during normal spontaneous breathing, Valsalva and forced inspiration. The effects of anesthesia induction with remifentanil and propofol were evaluated, and positive end-expiratory pressure (PEEP) 10 cmH(2)O was applied during anesthesia.

    Results: During spontaneous breathing, the lower esophageal sphincter (LES) pressure was significantly lower during end-expiration compared with end-inspiration (28.5 +/- 7.7 vs. 35.4 +/- 10.8 mmHg, P < 0.01), but barrier pressure (BrP) and intra-gastric pressure (IGP) were unchanged. LES, BrP (P < 0.05) and IGP (P < 0.01) decreased significantly during anesthesia. BrP remained positive in all patients. IGP increased during Valsalva (P < 0.01) but was unaffected by PEEP. Esophageal pressures were positive during both spontaneous breathing and mechanical ventilation. Esophageal pressures increased during PEEP from 9.4 +/- 3.8 to 11.3 +/- 3.3 mmHg (P < 0.01).

    Conclusion: During spontaneous breathing, the LES pressure was the lowest during end-expiration but there were no differences in BrP and IGP. LES, BrP and IGP decreased during anesthesia but BrP remained positive in all patients. During the application of PEEP, esophageal pressures increased and this may have a protective effect against regurgitation.

    Place, publisher, year, edition, pages
    Malden, USA: Wiley-Blackwell, 2010
    National Category
    Medical and Health Sciences Infectious Medicine
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-12872 (URN)10.1111/j.1399-6576.2010.02305.x (DOI)000282687400007 ()20840514 (PubMedID)2-s2.0-78650198233 (Scopus ID)
    Available from: 2011-01-05 Created: 2011-01-03 Last updated: 2018-04-23Bibliographically approved
  • 45.
    Djalali, Ahmadreza
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Castren, Maaret
    Department of Clinical Sciences and Education and Department of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hosseinijenab, Vahid
    Department of emergency management, Natural Disaster Research Institute, Tehran, Iran.
    Khatib, Mahmoud
    Tehran social security organization, Tehran, Iran.
    Ohlen, Gunnar
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Sciences and Education and Department of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hospital Incident Command System (HICS) performance in Iran; decision making during disasters2012In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, article id 14Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS) is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises.

    METHODS: This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as < 40%; intermediate as 41-70%; high as 71-100% of the maximum score of 192. Descriptive statistics, T-test, and Univariate Analysis of Variance were used.

    RESULTS: None of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04).

    CONCLUSIONS: The decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.

  • 46.
    Djalali, Ahmadreza
    et al.
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden.
    Khankeh, Hamidreza
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden; Nursing Department, University of Social Welfare and Rehabilitation, Tehran, Iran.
    Öhlén, Gunnar
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden.
    Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study2011In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 19, article id 30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days.

    METHODS: The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation.

    RESULTS: The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators.

    CONCLUSIONS: The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

  • 47.
    Djärv, Therese
    et al.
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institute, Stockholm, Sweden.
    Mårtenson, Linda
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Section of Emergency Medicine, Karolinska Institute, Stockholm, Sweden.
    Decreased general condition in the emergency department: high in-hospital mortality and a broad range of discharge diagnoses2015In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 22, no 4, p. 241-246Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Decreased general condition (DGC) is a frequent presenting complaint within the Adaptive Triage Process. DGC describes a nonspecific decline in health and well-being, and it is common among elderly patients in the emergency department (ED).

    AIM: The aim of this study was to compare the in-hospital mortality among patients presenting with DGC with that among patients in the corresponding triage category presenting with other complaints to an ED. The secondary aim was to describe the discharge diagnoses of patients presenting with DGC.

    METHODS: All patients admitted to Södersjukhuset from the ED in 2008 were included. The difference in the in-hospital mortality rate was stratified for triage category at the ED, between patients with DGC (n=1182) and those with all other presenting complaints (n=20 775), and assessed with sex-adjusted and age-adjusted logistic regression models. Discharge diagnoses were assessed as the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) in the medical discharge notes.

    RESULTS: A total of 1182 patients with DGC at the ED were admitted for in-hospital care, and they had a four-fold risk of suffering an in-hospital death [odds ratio 4.74 (95% confidence interval 3.88-5.78)] compared with patients presenting with other presenting complaints. The most common discharge diagnoses were diseases of the circulatory system (14%), respiratory system (14%), and genitourinary system (10%).

    INTERPRETATION: Patients presenting with DGC to an ED often receive low triage priority, frequently require admission for in-hospital care, and, because of the three-fold increased risk of in-hospital death compared with others, belong to a high-risk group.

  • 48.
    Druwé, Patrick
    et al.
    Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
    Monsieurs, Koenraad G.
    Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium.
    Piers, Ruth
    Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.
    Gagg, James
    Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom.
    Nakahara, Shinji
    Teikyo University School of Medicine, Tokyo, Japan.
    Alpert, Evan Avraham
    Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel.
    van Schuppen, Hans
    Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Élö, Gabor
    Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
    Truhlar, Anatolij
    Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic.
    Huybrechts, Sofie A.
    Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium.
    Mpotos, Nicolas
    Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium..
    Joly, Luc-Marie
    Department of Emergency Medicine, Rouen University Hospital, Rouen, France.
    Xanthos, Theodoros
    European University, Nicosia, Cyprus, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
    Roessler, Markus
    Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany.
    Paal, Peter
    Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria.
    Cocchi, Michael N.
    Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia, Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, United States.
    Björshol, Conrad
    Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Norway.
    Paulikova, Monika
    Department of Anesthesiology and Intensive Care, East Slovak Institute of Oncology, Košice, Slovakia.
    Nurmi, Jouni
    Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
    Salmeron, Pascual Pinera
    Hospital General Universitario Reina Sofia, Murcia, Spain.
    Owczuk, Radoslaw
    Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland.
    Svavarsdottir, Hildigunnur
    Akureyri Hospital and University of Akureyri, Akureyri, Iceland.
    Deasy, Conor
    Department of Emergency Medicine, Cork University Hospital, Cork, Ireland.
    Cimpoesu, Diana
    University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania.
    Ioannides, Marios
    Nicosia General Hospital, Nicosia, Cyprus.
    Aguilera Fuenzalida, Pablo
    Pontificia Universidad Católica de Chile, Santiago, Chile.
    Kurland, Lisa
    Örebro University, School of Medical Sciences. Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden.
    Raffay, Violetta
    Municipal Institute for Emergency Medicine, Novi Sad, Serbia.
    Pachys, Gal
    Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel.
    Gadeyne, Bram
    Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
    Steen, Johan
    Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
    Vansteelandt, Stijn
    Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    De Paepe, Peter
    Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium.
    Benoit, Dominique D.
    Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
    Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 132, p. 112-119Article in journal (Refereed)
    Abstract [en]

    Introduction: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome.

    Methods: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models.

    Results: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P < .0001), a non-witnessed arrest (2.68 [1.89-3.79]; P < .0001), in older patients (2.94 [2.18-3.96]; P < .0001, for patients > 79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P < .0001). In accordance, non-shockable and non-witnessed arrests were both associated with lower survival to hospital discharge (0.33 [0.26 - 0.41]; P < 0.0001 and 0.25 [0.15 - 0.41]; P < 0.0001, respectively), as were older patient age (0.25 [0.14 - 0.44]; P < 0.0001 for patients > 79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P < 0.0001).

    Conclusions: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.

  • 49.
    Dryver, Eric T
    et al.
    Emergency Department, Skane's University Hospital, Akutkliniken, Lund, Sweden; Practicum Clinical Skills Centre, Region Skåne, Lund/Malmö, Sweden.
    Eriksson, Anders
    Anesthesiology Department, Ersta Hospital, Stockholm, Sweden.
    Söderberg, Patrik
    Södersjukhus Hospital, Stockholm's County Council, Stockholm, Sweden.
    Kurland, Lisa
    Södersjukhus Hospital, Karolinska Institution, Stockholm, Sweden.
    The Swedish specialist examination in emergency medicine: form and function2017In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 24, no 1, p. 19-24Article in journal (Refereed)
    Abstract [en]

    AIM/BACKGROUND: The purpose of the Swedish specialist examination in Emergency Medicine is not only to determine whether residents have attained the level of competence of specialists, but also to guide and facilitate residency training.

    METHODS: The Swedish Society for Emergency Medicine has developed checklists that delineate criteria of consideration and action items for particular processes. These checklists are freely available and used to assess competence during the examination. They are also intended for use during teaching and clinical care, thus promoting alignment between clinical practice, teaching and assessment. The examination is carried out locally by residency program educators, thereby obviating travel expenses. It consists of a total of 24 stations and over 100 potential scenarios, thereby minimizing case specificity. Each station consists of a scenario based on a real case. The checklists allow for direct feedback to the examinee after each station.

    RESULTS AND CONCLUSION: This model may be of interest to other European countries.

  • 50.
    Ekelund, Ulf
    et al.
    Emergency Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Kurland, Lisa
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Eklund, Fredrik
    Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Torkki, Paulus
    HEMA-Institute, BIT Research Centre, Aalto University, Espoo, Finland.
    Letterstål, Anna
    Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Lindmarker, Per
    Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Sciences and Education and Section of Emergency Medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Patient throughput times and inflow patterns in Swedish emergency departments: A basis for ANSWER, A National SWedish Emergency Registry2011In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 19, article id 37Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Quality improvement initiatives in emergency medicine (EM) often suffer from a lack of benchmarking data on the quality of care. The objectives of this study were twofold: 1. To assess the feasibility of collecting benchmarking data from different Swedish emergency departments (EDs) and 2. To evaluate patient throughput times and inflow patterns.

    METHOD: We compared patient inflow patterns, total lengths of patient stay (LOS) and times to first physician at six Swedish university hospital EDs in 2009. Study data were retrieved from the hospitals' computerized information systems during single on-site visits to each participating hospital.

    RESULTS: All EDs provided throughput times and patient presentation data without significant problems. In all EDs, Monday was the busiest day and the fewest patients presented on Saturday. All EDs had a large increase in patient inflow before noon with a slow decline over the rest of the 24 h, and this peak and decline was especially pronounced in elderly patients. The average LOS was 4 h of which 2 h was spent waiting for the first physician. These throughput times showed a considerable diurnal variation in all EDs, with the longest times occurring 6-7 am and in the late afternoon.

    CONCLUSION: These results demonstrate the feasibility of collecting benchmarking data on quality of care targets within Swedish EM, and form the basis for ANSWER, A National SWedish Emergency Registry.

12345 1 - 50 of 211
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf