Biomedical subjects

J Jakobsson

Publications and source records attributed to J Jakobsson.

At least 19 recordsLinked to original sources

PubMed1998

[Dosage of anesthetics--a tricky question].

The optimal dosage of anaesthetic agents may be difficult. Not only does the intensity of surgical stimuli vary during a surgical procedure, but drug sensitivity varies between subjects exposed to comparable stimuli. Moreover, clinically monitored body reactions do not always reflect the balance between central nervous system effects of the surgical stimuli and of the anaesthetic agent. Therefore, the specialist in anaesthesiology requires access to additional methods of monitoring to enable dosage to be optimised for each patient, minute by minute, thus improving the chances of maintaining an appropriate depth of anaesthesia. Two electro-encephalographic techniques are presented in the article, and aspects of under- and over-dosage of anaesthetic agents are discussed.

Anesthetics, General↗

PubMed1997

Anaesthesia during laparoscopic gynaecological surgery: a comparison between desflurane and isoflurane.

Desflurane is a new inhalation anaesthetic with a low blood/gas solubility which should allow a fast emergence from anaesthesia. In a prospective open randomized study, desflurane was compared with isoflurane paying special attention to recovery and the quality of the post-operative period. The occurrence of pain and post-operative nausea and vomiting (PONV) was recorded during the first 20 post-operative hours. Seventy women ASA Grade I-II scheduled for elective gynaecological laparoscopic procedures were studied. Patients receiving desflurane were extubated earlier than patients receiving isoflurane, 5 +/- 1 and 9 +/- 1 min respectively (P < 0.05) and the patients anaesthetized with desflurane were able to tell their name and date on average 5 min earlier than those who had received isoflurane; however, time in the recovery room was the same for both groups of patients. Twenty-two of 35 patients receiving desflurane, and 18 of 35 receiving isoflurane required analgesia. PONV was recorded in 18 patients anaesthetized with desflurane and 12 patients anaesthetized with isoflurane. In both groups PONV was more frequently observed in patients after leaving the recovery room. PONV in the recovery room was associated with a delayed discharge, 139 vs. 114 min respectively. Desflurane seems to be an useful alternative to isoflurane for laparoscopic procedures.

Adult↗

PubMed1997

Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section.

UNLABELLED: We compared the effects of intrathecal sufentanil 2.5 and 5 microg, fentanyl 10 microg, and placebo when administered together with hyperbaric bupivacaine 0.5% 12.5 mg for cesarean section. The study was performed in a randomized, double-blind fashion in 80 (20 per group) healthy, full-term parturients presenting for elective cesarean section. Postoperative pain was assessed using the visual analog scale (VAS). Duration of complete analgesia was defined as the time from the intrathecal injection to VAS score > 0. Duration of effective analgesia was defined as the time to VAS score > or = 4. No patient experienced intraoperative pain. Complete analgesia was prolonged in all groups receiving opioids. Effective analgesia was prolonged and the 0- to 6-h intravenous opioid requirements were lower in the groups receiving sufentanil compared with those receiving fentanyl and placebo. The need for intraoperative antiemetic medication was greater in the placebo group. Pruritus was a frequent and dose-related side effect in the groups receiving sufentanil. There were no differences in umbilical cord blood gases or neonatal Apgar scores and neurological and adaptive capacity scores among the groups. In conclusion, the addition of sufentanil or fentanyl improved the quality of subarachnoid block compared with placebo. The duration of action was longer for sufentanil than fentanyl. IMPLICATIONS: Small doses of fentanyl or sufentanil (synthetic opioids) added to bupivacaine (local anesthetic) for spinal anesthesia for cesarean section reduce the need for intraoperative antiemetic medication and increase the duration of analgesia in the early postoperative period compared with placebo.

Adult↗

PubMed1997

Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts. A prospective, randomized and blinded study.

BACKGROUND: Postoperative nausea and vomiting (PONV) after general anesthesia and surgery may have an incidence as high as 70% irrespective of antiemetic drug therapy. The use of preoperative hypnosis and mental preparation by means of an audio tape was investigated in the prophylaxis of nausea and vomiting before elective breast reduction surgery. Similar interventions have not been found in the literature. METHODS: Fifty women were randomized to a control group or a hypnosis group; the latter listened to an audio tape daily 4-6 days prior to surgery. A hypnotic induction was followed by suggestions as to how to relax and experience states incompatible with nausea and vomiting postoperatively (e.g. thirst and hunger). There was a training part on the tape where the patients were asked to rehearse their own model for stress reduction. Premedication and anesthetic procedures were standardized. RESULTS: Patients in the hypnosis group had significantly less vomiting, 39% compared to 68% in the control group, less nausea and less need of analgesics postoperatively. CONCLUSIONS: Preoperative relaxation and/or hypnotic techniques in breast surgery contribute to a reduction of both PONV and postoperative analgesic requirements.

Adult↗

PubMed1996

Nitrous oxide: a valuable alternative for pain relief and sedation during routine colonoscopy.

BACKGROUND AND STUDY AIMS: Patient-administered nitrous oxide in 50% oxygen has lately come into use as an alternative to combined opioid and benzodiazepine medication for colonoscopic procedures. A randomized study was carried out comparing intramuscular pethidine hydrochloride 1 mg/kg with inhalation of Medimix (a mixture of nitrous oxide in oxygen 50%) for relief of pain and anxiety during colonoscopy. PATIENTS AND METHODS: Thirty-eight patients (19 in the pethidine group and 19 in the nitrous oxide group) were studied. The following parameters were measured: blood pressure, pulse rate, and arterial oxygen saturation. At the end of the colonoscopy and before the patients left the ward, pain, nausea, and general well-being were evaluated by the patients using a visual analogue scale. The colonoscopy time, investigation conditions and the total length of hospital stay were registered. RESULTS: Colonoscopy time and the colonoscopists' opinions concerning the investigation conditions did not differ between the groups. Pain relief and patient evaluation of the total procedure were also equal between the patient groups. However, there was less nausea among the Medimix patients. Three patients in the pethidine group had oxygen saturations below 92%. There was no desaturation during and five minutes after colonoscopy in the Medimix group. Patients in the Medimix group left the hospital on average 34 minutes earlier than patients in the pethidine group. CONCLUSIONS: We conclude that the use of nitrous oxide (Medimix) as an analgesic is as good as pethidine for colonoscopy. Medimix has clear advantages compared to pethidine in terms of reducing nausea and shortening the hospital stay.

Adult↗

PubMed1996

Intramuscular NSAIDS reduce post-operative pain after minor outpatient anaesthesia.

Two hundred healthy patients scheduled for elective minor gynaecological surgery under general anaesthesia were randomly allocated to one of four groups who received either diclofenac 75 mg intramuscularly (i.m.), ketorolac 30 mg i.m., diclofenac 50 mg orally, or 2 mL NaCl i.m. The drugs were administered 10-20 min prior to a standard anaesthetic. All surgery was uneventful. The patients were discharged after a mean of 110 +/- 30 min with no differences between the groups. Complaints about pain and need for post-operative analgesics were significantly less frequent in the two groups of patients receiving an intramuscular non-steroidal anti-inflammatory drug (NSAID), as compared to placebo. The patients who received 50 mg diclofenac orally, administered shortly before the procedure, had the same pain course as the placebo patients.

Administration, Oral↗

PubMed1995

Contribution from upper and lower airways to exhaled endogenous nitric oxide in humans.

Endogenous nitric oxide (NO) is thought to regulate many biological functions, including pulmonary circulation and bronchomotion, and it has been found in exhaled air. Our aim was to study the excretion of NO in different parts of the respiratory system. Exhaled concentrations of NO were measured by chemiluminescence in chronic tracheostomy outpatients (group 1), in patients admitted for minor abdominal surgery (group 2), and in patients with acute respiratory failure (ARF) during mechanical ventilation (group 3). In awake volunteers (group 4), 0.57 L/min gas was aspirated through the nasal cavity into the chemiluminescence device. In group 1 (tracheostomy, n = 5) we detected 16 +/- 2 (mean +/- s.e. mean) parts per billion (ppb) NO when exhaling through the mouth, and a lower (P < 0.05) value of 4.6 +/- 0.8 ppb NO when exhaling through the tracheostomy. Before anaesthesia, group 2 (n = 11) exhibited 18 +/- 2.4 ppb NO in orally exhaled gas, increasing considerably during exhalation through the nose. Upon endotracheal intubation exhaled NO concentration dropped to 1.3 +/- 0.2 ppb (P < 0.05). In group 3 (ARF, n = 7) tracheal NO concentrations were 0.8 +/- 0.2 ppb. In group 4 (volunteers, n = 6) 394 +/- 23 ppb NO was recorded in air from the nasal cavity. In both healthy subjects and patients with respiratory failure a significant NO excretion occurs in the lower airways and lungs. The upper airways, especially the nose, contribute the largest amount of NO (> 90%) to exhaled air. The physiological implications of an upper airway source of NO remain to be defined.

Adolescent↗

PubMed1995

Implicit processing and therapeutic suggestion during balanced anaesthesia.

The effect of therapeutic suggestion--implicit processing during balanced anaesthesia was studied in 70 female patients scheduled for elective breast surgery. The patients were randomly allocated to listen to a message with reassuring information focused on minimising postoperative nausea and vomiting, or just a blank tape during surgery. Occurrence of nausea and vomiting was studied during the postoperative period. No patient recalled any explicit memories during the peroperative period. No major differences were observed in the number of patients who experienced nausea or vomiting during the 24 hour observation period. The patients exposed to positive suggestion did, however, have a lower frequency of recall for nausea and vomiting compared to those just listening to the blank tape. We did not observe any major effect of peroperative suggestion for postoperative nausea and vomiting. However, we cannot rule out some implicit processing during balanced anaesthesia.

Adult↗

PubMed1995

Oral premedication one hour before minor gynaecological surgery--does it have any effect? A comparison between ketobemidone, lorazepam, propranolol and placebo.

The purpose of the present study was to compare the effects of oral premedication with ketobemidone 5 mg, lorazepam 1 mg, propranolol 40 mg or placebo, given about an hour prior to anaesthesia, in a prospective randomized double-blind fashion. One hundred and twenty ASA I female patients scheduled for elective laparoscopy were randomly prescribed one of the study drugs. Patient evaluation of anxiety, nurse evaluation of premedication, induction and postoperative course were studied. Ninety-three of the 120 patients (78%) experienced no change or a decrease in anxiety, regardless of type of active drug or placebo administered. Eighty-eight of the patients (73%) were considered adequately premedicated by the nurse observer, with no differences between the groups. Pre induction pulse rate, blood pressure and amount of induction agent needed was also similar between the four groups of patients. No major differences could be seen during the postoperative course. We found no major effects of any of the active drugs studied compared to placebo. Routine use of small doses of oral premedication one hour before elective surgery among low anxiety patients could probably be omitted.

Administration, Oral↗

PubMed1995

Anaesthesia for short outpatient procedures. A comparison between thiopentone and propofol in combination with fentanyl or alfentanil.

We studied supplementation of propofol or thiopentone anaesthesia with 0.5 or 1.0 mg alfentanil or 0.05 or 0.1 mg fentanyl for minor gynaecological outpatient procedures. Four hundred patients scheduled for elective termination of pregnancy were randomly allocated to one of eight groups. Induction agent doses, peroperative complications, complaints about pain and emesis during the postoperative period, and time to discharge were studied. Propofol compared to thiopentone was associated with a shorter time to discharge, 103 +/- 28 and 115 +/- 33 minutes respectively (P < 0.05) and anxiety during recovery was more frequent in the thiopentone group (P < 0.05). The need for postoperative reserve analgesics was less in the alfentanil group (P < 0.05). We found, however, no major differences between the supplementations tested regarding the total dose of induction agent, emesis or time to discharge. Supplementation with 1.0 mg of alfentanil to propofol was found to be the best combination tested for short outpatient procedures.

Abortion, Induced↗

PubMed1994

Postoperative nausea and vomiting. A comparison between intravenous and inhalation anaesthesia in breast surgery.

Nausea and vomiting during the first 24 postoperative hours after breast surgery were studied. Ninety patients scheduled for elective breast surgery were randomly assigned to one of three anaesthetic methods: total intravenous anaesthesia with propofol, or propofol or thiopental for induction followed by isoflurane anaesthesia. All three groups received fentanyl for peroperative analgesia. A total of 46 (51%) patients experienced emetic sequelae: 19 (21%) complained about nausea and another 27 (30%) vomited once or more during the postoperative course. More than 50% of the patients with nausea and 70% with vomiting first suffered from these symptoms in the surgical wards after leaving the postoperative unit. Nausea and vomiting were seen in 18 (60%), 13 (43%) and 15 (50%) for the groups propofol-propofol, propofol-isoflurane and thiopental-isoflurane, respectively. In conclusion, every second patient experienced nausea or vomiting after breast surgery, the majority of these emetic symptoms occurring after leaving the postoperative unit. Propofol for induction or as a main anaesthetic did not make any major difference with regard to postoperative nausea or vomiting.

Aged↗

PubMed1993

Patient evaluation of four different combinations of intravenous anaesthetics for short outpatient procedures.

We studied 200 female patients (ASA group 1) scheduled for termination of pregnancy under general anaesthesia. The patients were randomly allocated to receive one of four anaesthetic combinations; (1) propofol in combination with ketamine 20 mg, (2) propofol in combination with fentanyl 0.1 mg, (3) thiopentone in combination with fentanyl 0.1 mg, (4) methohexitone in combination with fentanyl 0.1 mg. All patients were breathing oxygen in nitrous oxide 1:2. Patients' self assessments of per- and postoperative course and time to discharge were compared. No patient's response suggested light anaesthesia, but dreams were frequently experienced during anaesthesia especially among the propofol-ketamine combination (29 out of 50). Time to discharge was shortest for the groups of patients given propofol; the mean time was 93 and 96 min for the ketamine and fentanyl groups respectively. During the recovery period significantly more patients experienced pain in the ketamine-propofol group. Complaints of nausea were seen in only 15 patients, and seven patients noted psycho-mimetic side effects during recovery, without any differences between the groups. All four combinations tested offered good conditions for short outpatient procedures. However, the propofol-fentanyl combination was found to offer the best quality of anaesthesia as assessed by the patients themselves.

Abortion, Induced↗

PubMed1993

Recall of music: a comparison between anaesthesia with propofol and isoflurane.

Sixty patients undergoing laparoscopy were randomly assigned to receive total intravenous anaesthesia with propofol or inhalation anaesthesia with isoflurane. Patients in these two groups were also randomly assigned to three subgroups listening to soft music, hard rock music or no music at all. Twenty-four hours after surgery all patients were interviewed and asked if they had heard music during the operation. A tape with seven different pieces of music was also played for the patients. The music they heard during surgery was one of these. No patient had any memories or experiences from the operation. Four patients had dreams, three from the total intravenous anaesthesia group and one from the inhalation anaesthesia group. Twelve patients believed they had heard music, ten from the total intravenous anaesthesia group and two from the inhalation anaesthesia group (P < 0.05). Two patients, one from each group, picked the right melody. In conclusion, there was no difference between the two groups with respect to recall during anaesthesia. Patients in the TIVA group were significantly more inclined to state that they had been exposed to music.

Adult↗

PubMed1992

Effect of antithrombin concentrate on haemostatic variables in critically ill patients.

In a controlled pilot study of 32 critically ill patients, we have attempted prospectively to identify laboratory variables which can be used to select and monitor patients on antithrombin (AT) therapy. Patients with plasma AT levels less than 70% of normal were randomized to receive (AT group) or not to receive AT concentrate (non-AT group). The groups did not differ in median age, sex, median APACHE II and TISS scores, number of days spent in the Intensive Care Unit or mortality rate. At the time of inclusion all patients had activated coagulation and fibrinolysis demonstrated as high levels of soluble fibrin, thrombin-antithrombin complexes and fibrin-D-dimers (twice, four and ten times the upper reference range, respectively). In the AT group these levels decreased faster and the prothrombin complex concentration increased more rapidly to normal (i.e. the prothrombin time decreased). The level of C-reactive protein which was high in both groups on inclusion (139 and 98 mg/l, respectively) decreased by 40% in the AT group but did not change in the control group. Our study indicates that laboratory variables normalize faster in seriously ill patients who have activated coagulation and fibrinolysis when they receive AT concentrate and that the variables mentioned above seem to be useful for monitoring the treatment.

Aged↗

PubMed1992

Core temperature measured in the auricular canal: comparison between four different tympanic thermometers.

Four different tympanic thermometers, absorbing infra-red radiation, (FirstTemp, Diatek, Ivac and Genius) were studied. Variations from repeated measurements and reliability of tympanic temperature compared to oesophageal, rectal and pulmonary artery temperature were studied. Core temperature measured by the "FirstTemp" and the "Genius" thermometers showed slightly higher values than core temperature measured by oesophageal, rectal and pulmonary artery thermistors. Compared to oesophageal temperature "FirstTemp" showed 0.56 degrees C and "Genius" 0.28 degrees C higher values, while the "Diatek" and the "Ivac" gave slightly lower values (-0.5 degrees C and -0.28 degrees C). All four thermometers were found accurate for repeated measurement both in terms of standard deviation and coefficient of variance. All four tympanic thermometers showed good accuracy for changes in core temperatures compared to the reference thermistors (r2 values 0.96 for "FirstTemp", 0.88 for "Diatek", 0.96 for "IVAC" and 0.95 for "Genius"). The tympanic thermometer was found to be a valuable alternative for measuring core temperature in most clinical settings.

Body Temperature↗

PubMed1992

Vibro-acoustic stimulation in high-risk pregnancies; maternal perception of fetal movements, fetal heart rate and fetal outcome.

Maternal perception of fetal movement in response to vibro-acoustic stimulation was compared with antenatal fetal heart rate monitoring as a test of fetal well-being in a population of gravidae with high-risk pregnancies (n = 517), admitted to the high-risk ward at Danderyd Hospital, Karolinska Institutet; a total of 2,015 tests were performed. The sensitivity and the specificity of the test compared to the fetal heart rate tracing was 81% and 89% respectively. If the test was performed within 24 hours of delivery, its predictive value for fetal asphyxia (i.e. a 5-minute Apgar score < 7) was 14% (7/49). Ten per cent of the patients felt no fetal movement in response to stimulation (irrespective of gestational age). In five cases where fetal heart rate tracings were pathological, stimulation nonetheless produced fetal movement and fetal outcome was good. Pathological heart rate tracings and no fetal movement in response to stimulation were present in 30 cases (out of 251 with no fetal movements at stimulation), in seven of which the infants had 5-minute Apgar scores < 7. Although many patients underwent repeated vibro-acoustic stimulation, there was no evidence of fetal habituation to the test. On 24 occasions (i.e. 1.2%), the patient denied vibro-acoustic stimulation, mostly because of previous discomfort due to vigorous fetal response. Where resources are limited, maternal perception of fetal movements in response to vibro-acoustic stimulation might be a useful alternative for preliminary screening of high-risk pregnancies.

Acoustic Stimulation↗

PubMed1991

Premedication before elective breast surgery, a comparison between ketobemidone and midazolam.

One hundred female patients scheduled for elective breast surgery (mean age 60 +/- 11 years were randomly assigned to receive one of two premedications: ketobemidone (Ketogan) 1-1.5 ml or midazolam 4-5 mg, intramuscularly. The effects on preoperative anxiety and postoperative emetic sequelae were studied. All patients were anaesthetised with thiopentone, fentanyl and atracurium, and ventilated with a mixture of nitrous oxide in oxygen with supplementary isoflurane. Sixty-nine percent of the midazolam- and 50% of the ketobemidone-premedicated patients experienced a reduction in anxiety. Midazolam was found to be more effective than ketobemidone in reducing anxiety among more tense patients--those with a VAS grading before premedication of 2 or more (P less than 0.05). Midazolam-premedicated patients were also assessed by observers as being more relaxed (P less than 0.05). No difference was seen in the frequency of emetic sequelae: 20 patients in the midazolam group and 14 patients in the ketobemidone group vomited once or more during the 24-h observation period. There was no difference between the two groups in time until an analgetic was required. In conclusion, midazolam seemed more effective in reducing preoperative anxiety than ketobemidone without any negative effects on postoperative emesis or time until an analgetic was required.

Aged↗

PubMed1991

Opioid supplementation to propofol anaesthesia for outpatient abortion: a comparison between alfentanil, fentanyl and placebo.

One hundred and sixty-four patients scheduled for elective termination of pregnancy under general anaesthesia were randomly assigned to receive one of three different supplements to propofol and oxygen in nitrous oxide anaesthesia: 0.1 mg fentanyl, 0.5 mg alfentanil or placebo. Postoperative pain and nausea, as well as complications during anaesthesia were studied. There were no differences in complications or complaints by surgeons during anaesthesia, and no patient in any group reacted unsatisfactorily to surgery. The patients in the placebo group consumed significantly more propofol during the procedure (P less than 0.001). No differences were seen in time until hospital discharge between the three groups. Complaints about postoperative pain were significantly less frequent among patients receiving fentanyl (P less than 0.01). The number of patients requesting postoperative analgetics, however, did not differ. There was no difference in the frequency of nausea or vomiting, but postoperative pain was found significantly to increase complaints of nausea (P less than 0.01) and also time until hospital discharge (P less than 0.01). In conclusion, opioid supplementation lowered the amount of propofol needed for anaesthesia. Alfentanil 0.5 mg did not improve the postoperative course. Fentanyl 0.1 mg decreased the frequency of postoperative pain without increasing the time to hospital discharge.

Abortion, Induced↗