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Biomedical subjects

E Håkanson

Publications and source records attributed to E Håkanson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Glutamate and high-dose glucose-insulin-potassium (GIK) in the treatment of severe cardiac failure after cardiac operations.

Postischemic derangement of myocardial metabolism that is further aggravated by the systemic neuroendocrine response to surgical trauma may explain reversible myocardial dysfunction after cardiac surgical procedures. Since 1991, all patients with signs of cardiac failure after operation for ischemic heart disease (45/515 patients) were treated according to our metabolic strategy. Sixteen patients in whom we previously would have considered use of an intraaortic balloon pump were treated by prolonged unloading of the heart with cardiopulmonary bypass, by glutamate infusion, and by high-dose glucose-insulin-potassium. Rapid improvement in hemodynamic performance was seen in the first hour and almost full recovery within 6 hours in the surviving patients (12/16). None of the 3 patients requiring mechanical assist survived. Our early clinical experience suggests that metabolic support with glutamate and high-dose glucose-insulin-potassium is a safe treatment with a high success rate in reversible cardiac failure.

Aged↗
PubMed1994

[Crisis intervention and requests for organ donation--impossible to reconcile?].

A request for organ donation after a patient's death imposes a strong emotional impact both on the family and on the medical staff. How well the family copes with the loss of a close relative is subject to a variety of factors including the immediate emotional support provided by the staff. On the other hand, a donation request, if made with sensitivity, may in combination with adequate psychological support facilitate the grieving process. Health care professionals need emotional support and training to help them deal with the difficulties of caring for bereaved families, of breaking bad news, and of making organ donation requests.

Crisis Intervention↗
PubMed1990

Influence of local beta-adrenoceptor blockade on exchange of fat and glucose in the human leg after surgery.

The metabolic effects of the local administration of propranolol were determined in seven patients undergoing cholecystectomy. Measurements were carried out in the early postoperative period before and after infusion of 2 mg of intraarterial propranolol into the femoral artery of one leg using the other leg as control. Blood flow and arterio-venous concentration differences for oxygen, glucose, lactate, alanine, glycerol and total FFAs were determined. Uptake and release of FFAs were determined by using a tracer technique. The statistical analyses were based on differences between the test and the control leg in changes following the blockade. Glycerol release was significantly more suppressed in the test leg than in the control leg. No difference between the legs was seen in the uptake of oxygen, FFA and glucose or the release of lactate and alanine. The arterial concentration of propranolol was 6.07 +/- 0.72 ng ml-1 (mean +/- SEM). This study indicates that a local beta-blockade by intra-arterial propranolol infusion after surgery slightly reduces the postoperative lipolysis in leg tissues but does not influence or only marginally influences leg blood flow and oxygen uptake or the exchange of glucose, lactate and alanine after moderate surgical trauma.

Adult↗
PubMed1989

A new diagnostic approach to the patient with severe pneumonia.

36 patients with severe community-acquired pneumonia, treated in an intensive care unit (ICU), were examined in a prospective study using a comprehensive diagnostic program to establish an early etiological diagnosis. The resulting prompt and adequate antimicrobial therapy may have decreased the number of fatal cases. Special emphasis was placed on the use of a method incorporating fiberoptic bronchoscopy, together with protected brush sampling and bronchial lavage. An etiological diagnosis was established in 81% (29/36) of the cases. This etiological diagnosis was established within 48-72 h in 53% (19/36) of the patients, S. pneumoniae being the most frequent agent found (12 patients). This information, however, was poorly utilized since in only 11/19 of these patients was the antimicrobial therapy changed from a broad-spectrum antibiotic to a more specific narrow spectrum agent. The overall mortality rate was 22% (8/36). 7/8 patients who died had compromising factors. Most deaths in community-acquired pneumonia are still associated with pneumococcal infection. We conclude that fiberoptic bronchoscopy with brush samples via a plugged double lumen catheter provides the least misleading information concerning the etiological agent in pneumonia; sampling should be done as soon as possible after admission to the hospital, ideally before the need for ICU treatment; factors other than prompt antimicrobial therapy may influence the outcome of severe community-acquired pneumonia.

Adult↗
PubMed1987

Effects of graded exercise on leg exchange of energy substrates in malignant hyperthermia susceptible subjects.

It has been speculated that, in malignant hyperthermia-susceptible (MHS) individuals, an abnormality of sympathetic activity is seen during stressful situations, such as exercise. The authors investigated whether muscle metabolism in eight MHS subjects, at rest and during moderate and heavy short-term exercise, is different then that in normals. Leg exchange of energy substrates (glucose, lactate, and glycerol) was quantified by measuring leg blood flow and arterial-venous concentration differences. Muscle biopsies were also performed, and ATP, glycogen, and lactate were analyzed. Catecholamines and oxygen uptake were also measured. The study was performed at rest with subjects in the supine position and during two periods (40% and 80% of the subjects maximal oxygen uptake, respectively) on a bicycle ergometer. The principal finding of the study was that there was no major difference in oxygen uptake or leg exchange of glucose, lactate, and glycerol between MHS-subjects and previously standard normals during different grades of exercise. Furthermore, muscle metabolites and plasma catecholamines did not differ between the groups. This study indicates a normal sympathetic activity and muscle metabolism in MHS subjects during rest, as well as during moderate and severe exercise. The authors' results do not support the opinion that persons with positive in vitro tests for MH should restrict their physical activity.

Adult↗
PubMed1987

Influence of epidural blockade on postoperative plasma fibronectin concentrations.

To investigate the influence of neurogenic and hormonal stimuli during and after surgery on plasma fibronectin levels, 16 females undergoing cholecystectomy were studied. Eight patients received general anaesthesia, and eight also received a thoracic epidural block with local anaesthetic, which was maintained for 24 h postoperatively. The epidural group had significantly lower plasma levels of adrenaline and cortisol than the general anaesthesia group in the postoperative period. The previously well-documented early decrease in plasma fibronectin concentration following surgery was observed, and was essentially parallel with that of albumin, pre-albumin and thyroid hormones, with no differences between the groups. However, the restoration of the fibronectin level was slower in the epidural group, with significantly lower values as compared with controls at 48 and 72 h after surgery (p less than 0.01-0.001). It was concluded that the post-traumatic plasma fibronectin decrease is not mediated by neurogenic or adrenal stimuli. Such stimuli may, however, influence the subsequent restoration of the plasma fibronectin concentration.

Adult↗
PubMed1986

Exchange of free fatty acids and glucose in leg tissues before and immediately after surgery.

The present study was undertaken to investigate whether there is an augmented uptake of free fatty acids (FFA) in the leg tissues immediately after surgery when the energy expenditure of the leg is increased considerably. Eight patients were studied before and after cholecystectomy. Blood and plasma flow were determined in one leg, as well as arterio-venous concentration differences for oxygen, glycose, lactate and the total fraction of FFA. To determine uptake and release of FFA, 1-(14C)-oleic acid was infused intravenously and the arterio-venous differences for (14C)-FFA were determined. The mean oxygen uptake in the leg increased from 0.72+/-0.06 mmol/min to 1.78+/-0.41 mmol/min. The uptake of free fatty acids in the leg did not increase significantly after cholecystectomy when compared to before operation in spite of the marked increase in oxygen uptake. Postoperatively there was, however, a positive linear relationship between the uptake of FFA and that of oxygen in the leg. The glucose uptake, after correction for released lactate, corresponded to 7% of the oxygen uptake before surgery and 13% after surgery. The arterial FFA concentration did not change. This study indicates that the combined possible contribution of glucose and free fatty acids to the oxidative energy metabolism of the leg tissues exceeded the oxygen uptake before, but not after surgery. In the postoperative state there was a positive correlation between oxygen uptake and FFA uptake in the leg.

Journal Article↗
PubMed1986

Malignant hyperthermia: clinical course and metabolic changes in two patients.

Two cases of malignant hyperthermia (MH) are presented. One patient was treated symptomatically for the first 6 h until she was given dantrolene. Her clinical course was complicated and the catecholamine and cortisol concentrations were still elevated 24 h after start of treatment. In the second patient an early diagnosis was made and treatment promptly instituted. Only minor endocrine-metabolic changes were seen in this patient. However, in spite of the early successful treatment with dantrolene the MH reaction recurred 12 h after the initial symptoms. These two cases demonstrate the importance of early treatment including dantrolene. Successful treatment with dantrolene does not, however, preclude a recurrence of MH, and thus subsequent doses of dantrolene should be given.

Catecholamines↗
PubMed1986

Effect of adrenaline on exchange of glucose in leg tissues and splanchnic area. A comparison with the metabolic response to surgical stress.

Surgical trauma is accompanied by increased energy expenditure and raised arterial concentrations of adrenaline and glucose. In order to study the acute effects of an adrenaline infusion on glucose metabolism and oxygen uptake in the leg and splanchnic bed, adrenaline was administered at a rate giving plasma concentrations of adrenaline similar to those in connection with abdominal surgery. Seven healthy males participated in the study. Adrenaline 40 ng/(min X kg body weight) (0.22 nmol/(min X kg body weight] was infused producing a plasma concentration of 2.77 +/- 0.42 nmol/l (mean +/- SEM). Leg and splanchnic blood flows and the femoral and hepatic arterio-venous differences for oxygen, glucose, lactate and other metabolites were determined. Measurements were made before and between 30 and 40 min after the start of the adrenaline infusion. Following the infusion of adrenaline the leg blood flow increased by 140% and hepatic blood flow by 25%. The leg oxygen uptake increased by 30%, but no significant increase in splanchnic oxygen uptake was observed. The arterial glucose concentration rose by 35%. Splanchnic glucose output increased X 2.5, but no significant increase in leg glucose uptake was observed. Leg release of gluconeogenic substrates increased but only lactate and glycerol uptake increased in the splanchnic bed. Leg blood flow increased more than that usually seen after surgery, whereas leg oxygen uptake and splanchnic oxygen uptake was higher in the immediate postoperative period. Splanchnic glucose release increased more during the infusion than in connection with surgery. It is concluded that adrenaline at a plasma concentration similar to that during and immediately after surgery can induce changes in glucose metabolism which are of the same order or more pronounced than those seen in connection with abdominal surgery.

Adult↗
PubMed1986

Effect of adrenaline on exchange of free fatty acids in leg tissues and splanchnic area. A comparison with the metabolic response to surgical stress.

The present investigation was aimed at studying the acute effects of an adrenaline infusion on the exchange of free fatty acids in the leg and splanchnic bed. Seven healthy males participated in the study. Adrenaline (40 ng/(min X kg body weight)) (0.22 nmol/(min X kg body weight] was infused to produce a plasma concentration similar to that seen in connection with surgery (2.77 +/- 0.42 nmol/l). Leg and splanchnic blood flow were measured and the femoral and hepatic arterio-venous differences for the total fraction of FFA were determined. 1-14C-oleic acid was infused intravenously so as to determine uptake and release of FFA. Measurements were made before and between 30 and 40 min after the start of the adrenaline infusion. The FFA concentration rose by 140% and the FFA uptake in the leg and splanchnic region increased about three fold. For 3-hydroxybutyrate the arterial concentrations as well as leg uptake and splanchnic uptake increased about six fold, four fold and eight fold, respectively. Ketogenesis accounted for a large part of the FFA uptake in the splanchnic bed during adrenaline infusion. We conclude that adrenaline infusion results in pronounced changes in FFA and 3-hydroxybutyrate concentrations and in the exchange of these substrates in leg and splanchnic bed. The adrenaline-induced increases in FFA and 3-hydroxybutyrate metabolism were generally more marked than those seen during and immediately after surgery.

3-Hydroxybutyric Acid↗
PubMed1985

Effects of the extradural administration of morphine or bupivacaine, on the metabolic response to upper abdominal surgery.

The influence of thoracic extradural local anaesthetics (0.5% bupivacaine) or extradural morphine on the metabolic response to upper abdominal surgery was compared with the administration of morphine i.v. in the period after operation. The extradural local anaesthetic group had significantly lower blood glucose and plasma FFA concentrations and consistently, but not significantly, lower blood glycerol and lactate concentrations than both the other groups. At 4 h both extradural groups had significantly lower plasma FFA and blood 3-hydroxybutyrate concentrations than the control group. Blood alanine concentration decreased in all three groups with a minimum at 24 h. There were no differences in serum insulin concentrations between the groups. It is concluded that thoracic extradural morphine differs from thoracic extradural local anaesthetics in being much less able to suppress the metabolic response associated with upper abdominal surgery.

Adult↗
PubMed1985

Factors of importance in the hyperglycaemia induced by upper abdominal surgery.

The variation in the hyperglycaemic response, between different individuals, is large in the immediate postoperative period. In the present study, factors of possible importance in the hyperglycaemic response to standardized elective surgery (cholecystectomy) were determined by stepwise multiple linear regression analysis. The statistical analysis comprised 29 variables which included hormones (catecholamines, cortisol, insulin, thyroid hormones), blood-borne energy metabolites (glucose, lactate, free fatty acids (FFA), glycerol, 3-hydroxybutyrate, alanine) as well as anthropometric data and variables related to surgery and anaesthesia. In linear regression analysis, with one independent variable, the glucose concentration correlated significantly with: the duration of surgery, the dose of pancuronium bromide, the dose of fentanyl, the lactate, adrenaline and cortisol concentrations respectively. The variables which, when successively included in stepwise regression, significantly reduced the residual variance for glucose were, in order of introduction; the duration of surgery and the cortisol and adrenaline concentrations respectively. It is concluded that, in standardized surgical trauma the duration of surgery may influence the metabolic response to surgery. Duration of surgery has, thus, to be taken into account when interpreting results from studies where different treatments are compared. Our results confirm that there is a synergistic effect of cortisol and adrenaline in mediating the hyperglycaemic response to surgery.

Adult↗
PubMed1985

Influence of extradural blockade on serum thyroid hormone concentrations after surgery.

To study the changes in thyroid hormone metabolism after surgery, the influence of neurogenic blockade by extradural local anaesthetics, and possible hormonal interactions, 16 women undergoing cholecystectomy were randomly allocated to two groups of eight each. All patients received general anaesthesia and in addition one group received extradural blockade for 24 h. Preoperatively and at 2, 4, 6, 12 and 24 h after skin incision arterial serum concentrations of thyroid hormones (T3, free T3, rT3, T4, free T4 and TSH), catecholamines (adrenaline and noradrenaline), cortisol and serum proteins (albumin, prealbumin and TBG) were determined. In both groups total T3, free T3, total T4 and TSH decreased significantly whereas free T4 was unchanged and rT3 increased. No differences between the extradural group and the controls regarding thyroid hormones were observed, in spite of suppressed catecholamine and cortisol concentrations in the extradural group as compared to the control group. All serum thyroid hormone binding proteins decreased significantly in both groups. Changes in thyroid hormone metabolism after surgery seem independent of neurogenic blockade by extradural local anaesthetics, and of plasma catecholamine and cortisol concentrations.

Adult↗
PubMed1984

Effects of the extradural administration of morphine, or bupivacaine, on the endocrine response to upper abdominal surgery.

The endocrine response, and the relief of pain, following the extradural administration of morphine or a local anaesthetic agent bupivacaine (0.5%) were studied for 24h after abdominal surgery and compared with a control group given conventional i.v. morphine after operation. Samples were taken before and at 2, 4, 6, 12 and 24 h after skin incision. Pain relief in both extradural groups was significantly better when compared with the control group. In all three groups, the plasma concentration of cortisol was increased immediately after surgery. Thereafter, significantly lower values were seen in the extradural groups. Plasma adrenaline concentration was lower immediately after surgery only in the group given the extradural local anaesthetic. Plasma noradrenaline concentration remained unchanged after extradural local anaesthesia while an intermediate increase occurred after extradural morphine. Plasma noradrenaline concentration was significantly greater in the controls compared with both extradural groups. Our results indicate that extradural analgesia with a local anaesthetic drug can suppress the increases in the plasma concentrations of the catecholamines and cortisol after surgery. In contrast to extradural local anaesthetic extradural morphine cannot suppress the endocrine response immediately after surgery. However, later in the postoperative period, extradural morphine can suppress the endocrine response, thus indicating that postoperative pain is a factor involved in the stress response following surgery.

Adult↗
PubMed1984

Endocrine and metabolic responses after standardized moderate surgical trauma: influence of age and sex.

The endocrine and metabolic responses to elective cholecystectomy and the influence of age and sex on this stress response were investigated in 21 patients, eight men and 13 women. The patients were divided into two groups, older (n=10) and younger (n=11) than 55 years respectively. Arterial plasma concentrations of catecholamines, cortisol and free fatty acids as well as serum insulin and arterial blood concentrations of glucose, lactate, glycerol, alanine and 3-hydroxybutyrate were measured preoperatively and 2, 24, 48, 72 and 96 h after the start of surgery. Oxygen uptake and CO2 production were measured and respiratory quotient (RQ) was calculated. All hormones and metabolites except insulin and alanine were significantly elevated immediately after surgery. At 24 h plasma noradrenaline and blood glucose were still significantly increased. Serum insulin was increased at 24 and 48 h. Oxygen uptake and plasma cortisol were significantly elevated throughout the period studied and blood alanine was decreased from 2 to 72 h after surgery. The older group showed a significantly higher increase in noradrenaline and lactate, whereas women preoperatively as well as postoperatively had higher glycerol levels. At the end of the period studied women had higher FFA-levels. We conclude that cholecystectomy evokes a significant endocrine and metabolic response and that some of the variables studied are still significantly altered up to 4 days postoperatively. The influence of age and sex on this stress response is of minor importance.

Adult↗