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Biomedical subjects

Lars S Rasmussen

Publications and source records attributed to Lars S Rasmussen.

16 recordsLinked to original sources
PubMed2007

Hemodynamic differences between propofol-remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants.

BACKGROUND: Propofol-remifentanil anesthesia is widely used in adults but few studies are available in infants. We aimed at comparing the hemodynamic effects of propofol-remifentanil vs sevoflurane-fentanyl anesthesia. In addition, we sought to investigate recovery and whether remifentanil induced acute opioid tolerance. METHODS: In total, 39 infants 4-6 months old were prospectively enrolled and randomized to receive either a combination of remifentanil and propofol (n = 17) or a sevoflurane-fentanyl anesthesia (n = 22) for surgical repair of cleft lip and palate. In both groups, sevoflurane was used for induction of anesthesia and fentanyl was administered before tracheal extubation. Mean arterial blood pressure and heart rate were recorded every 5 min after induction. We also recorded time from termination of surgery to tracheal extubation, postoperative behavior and the need for analgesia for the first 24 h after surgery. Postoperative observations were blinded. RESULTS: In the remifentanil-propofol group, the mean arterial blood pressure was higher [58 (51-65) vs 51 (45-55), P = 0.02] and the mean heart rate was lower [111 (108-113) vs 128 (122-143), P < 0.0001]. There were no differences in recovery time or behavior after surgery. In the remifentanil group, a median fentanyl dose of 4 microg x kg(-1) was required to insure a smooth recovery, but there was no difference in morphine consumption during the first 24 h after surgery. CONCLUSIONS: A high-dose remifentanil-propofol infusion was associated with a higher blood pressure and lower heart rate than sevoflurane-fentanyl anesthesia in infants. Postoperative morphine consumption, recovery time and quality were similar.

Anesthesia Recovery Period↗
PubMed2006

Long-term prognosis after out-of-hospital cardiac arrest.

OBJECTIVE: In this study we aimed to report survival beyond 6 months, including quality of life, for patients after out-of-hospital cardiac arrest (OHCA) with a physician-based EMS in an urban area. METHODS: We collected data related to OHCA prospectively during a 2-year period. Long-term survival was determined by cross-referencing our database with two Danish national registries. Patients older than 18 years who had survived for more than 6 months after OHCA were contacted, and after informed written consent was obtained, an interview was conducted in their home and a questionnaire on quality of life (SF-36) and the mini mental state examination (MMSE) were administered. RESULTS: We had data on 984 cases of OHCA. In 512 cases CPR was attempted and at 6 months, a total of 63 patients were alive corresponding to 12.3% [95% CI: 9.7-15.5%] of all who were treated. Of the 33 patients examined, the median MMSE was 29 (16-30) and two patients, corresponding to 6%, [95% CI: 0.7-20.6%] had an MMSE below 24. Two out of eight aspects of the SF-36 were significantly worse than national norms at the same age, but none of the summary scores differed significantly. CONCLUSION: Survival beyond 6 months was found in 12.3% OHCA in a physician-based EMS. Summary scores of quality of life were not significantly different from the national norm but 2 out of 8 subscores were lower. Signs of dementia were uncommon as only 6% had an MMSE score below 24.

Adolescent↗
PubMed2006

[Cognitive functions in elderly high-risk patients after off-pump coronary artery bypass grafting versus conventional bypass grafting - a randomised study - Secondary publication].

It has been suggested that the risk of cerebral dysfunction is less with off-pump coronary artery bypass grafting (OPCAB) than with conventional coronary artery bypass grafting (CCAB). The study is a part of the Best Bypass Surgery Trial. A total of 120 elderly patients underwent psychometric testing with a neuropsychological test battery before as well as 3 months after surgery. Cognitive dysfunction was identified in 7.4% of the patients in the OPCAB group and 9.8% in the CCAB group. We found no significant difference after either OPCAB or CCAB.

English Abstract↗
PubMed2006

Health-related quality of life following off-pump versus on-pump coronary artery bypass grafting in elderly moderate to high-risk patients: a randomized trial.

OBJECTIVE: Previous trials comparing coronary artery bypass grafting (CABG) with or without extracorporeal circulation have mainly enrolled selected patients at younger age and low risk. Patient-reported health-related quality of life has not been significantly different. We compared health-related quality of life in elderly moderate to high-risk patients randomized to either off-pump or on-pump surgery. METHODS: The study is a sub-study of the randomized Best Bypass Surgery Trial that compares off-pump to on-pump treatment, with respect to peri- and postoperative mortality and morbidity in patients with a moderate to high-predicted preoperative risk. After randomization and before heart surgery, 120 consecutive patients were asked to fill in the Medical Outcomes Study Short Form 36 (SF-36) and Major Depression Inventory (MDI) diagnostic scale for self-report of health-related quality of life. Three months after surgery, the same questionnaires were mailed to the patients. RESULTS: The response rate was 96.5%. At baseline, the groups were comparable except for a difference in educational level. Both groups improved in all eight SF-36 domains from baseline to 3 months. No statistical differences were seen between the groups except for changes in mean difference of role limitation due to emotional problems, which was significantly (P=.04) improved in favour of the on-pump group. Depression scores remained unchanged within and between the two surgical groups. CONCLUSIONS: Both on-pump and off-pump patients improved in health-related quality of life scores after CABG surgery. No clinically relevant difference between the groups could be demonstrated.

Activities of Daily Living↗
PubMed2006

Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting: a randomized trial.

BACKGROUND: It has been suggested that the risk of cerebral dysfunction is less with off-pump coronary artery bypass grafting (OPCAB) than with conventional coronary artery bypass grafting (CCAB). However, evidence for this statement is preliminary, and additional insight is needed. METHODS AND RESULTS: The study was a substudy of the randomized Best Bypass Surgery trial that compared OPCAB with CCAB treatment with respect to intraoperative and postoperative mortality and morbidity in patients with a moderate to high level of predicted preoperative risk. The outcome was cognitive function. A total of 120 elderly patients (mean age 76 years, SD 4.5 years) underwent psychometric testing before surgery and at a mean of 103 (SD 15) days postoperatively with a neuropsychological test battery that included 7 parameters from 4 tests. Cognitive dysfunction was defined as the occurrence of at least 2 of the 7 possible deficits. Secondary analysis was performed on the basis of the definition of a 20% decline in cognitive scores compared with baseline, and with z score analysis. Cognitive dysfunction was identified in 4 of the 54 patients (7.4%, 95% confidence interval [CI] 2.1% to 17.9%) in the OPCAB group and 5 of the 51 patients (9.8%, 95% CI 3.3% to 21.4%) in the CCAB group. We found no difference in incidence of cognitive dysfunction between the groups regardless of the definition applied. CONCLUSIONS: In elderly high-risk patients, no significant difference was found in the incidence of cognitive dysfunction 3 months after either OPCAB or CCAB.

Aged↗
PubMed2006

Postoperative cognitive dysfunction: incidence and prevention.

Postoperative cognitive dysfunction (POCD) is a decline in cognitive function for weeks or months after surgery. Due to its subtle nature, neuropsychological testing is necessary for its detection. The interpretation of literature on POCD is difficult because of numerous methodological limitations, particularly the different definitions of POCD and the lack of data from control groups. POCD is common after cardiac surgery, and recent studies have now verified that POCD also exists after major non-cardiac surgery, although at a lower incidence. The risk of POCD increases with age, and the type of surgery is also important because there is a very low incidence associated with minor surgery. Regional anaesthesia does not seem to reduce the incidence of POCD, and cognitive function does not seem to improve after carotid surgery as has previously been suggested.

Aged↗
PubMed2006

Long-term prognosis for patients with COPD treated in the prehospital setting: Is it influenced by hospital admission?

STUDY OBJECTIVES: Our aim was to assess long-term prognosis for patients with an exacerbation of COPD who were treated by the anesthesiologists of the Mobile Emergency Care Unit (MECU) of Copenhagen. We specifically sought to examine whether mortality was different among patients released before hospital admission and those admitted to the hospital. DESIGN: An observational cohort study with 5-year follow-up. SETTING: Prehospital and university hospital. PATIENTS: Patients with exacerbation of COPD treated by the MECU. MEASUREMENTS: We included all patients treated from 2000 to 2001. In September 2005, we conducted a search to find out whether these patients were still alive, and we analyzed survival using Kaplan-Meier statistics and log-rank test. Patients admitted to the hospital (primarily or secondarily) were compared to patients treated and released before hospital admission. RESULTS: In total, 573 patients with COPD had 995 episodes of exacerbation treated by the MECU in the 2-year period. On September 1, 2005, only 155 patients (27%) were alive. In 245 of the exacerbation episodes (25%) among 163 patients, hospital admission was not necessary primarily, but in 42 of these exacerbations (17%), secondary admission occurred within 48 h. Mortality was significantly higher (p = 0.02) in patients admitted to the hospital either primarily or secondarily, compared to patients treated and released before admission to the hospital. CONCLUSIONS: Mortality was high among COPD patients. Less than one fifth of patients treated at home and released are admitted to hospital secondarily. Mortality was significantly higher among admitted patients. A set of criteria selecting the patient prone to secondary admission is desirable.

Aged↗
PubMed2005

Tetranectin in cerebrospinal fluid: biochemical characterisation and evidence of intrathecal synthesis or selective uptake into CSF.

BACKGROUND: Tetranectin (TN) is a 67 kDa glycoprotein thought to play a prominent role in the regulation of proteolytic processes via its binding to plasminogen and indirect activation of plasminogen. The TN concentration in serum is approximately 10 mg/l and is reduced in patients with several cancers. The TN concentration in the normal CSF has not been examined. METHODS: The TN concentration in the serum and CSF of 47 normal subjects without neurological disorders was established using a polyclonal sandwich ELISA. RESULTS: The median TN concentration (quartile range) was 10.8 mg/l (9.0-12.1) in serum and 0.43 mg/l (0.3-0.53) in CSF. The TN index median (quartile range), defined as (TN CSF concentration/TN serum concentration)/(Albumin CSF concentration/Albumin serum concentration), was found to be 5.5 (4.7-7.6), suggesting intrathecal synthesis or selective uptake of TN in CNS. Immunohistochemistry showed TN immunoreactivity in neurons and dendrites, but no staining in glial cells in the cerebrum and cerebellum. In plexus choroideus, the ependymal cells exhibited strong immunoreactivity. TN in serum and CSF were immunochemically identical and of similar size. CONCLUSION: TN is present in normal brain and CSF, and the TN index is very high, but further studies are necessary to decide whether TN is synthesised in the CNS or selectively transported over the blood-brain barrier.

Cerebrospinal Fluid↗
PubMed2005

Using a nasopharyngeal airway during fiberoptic intubation in small children with a difficult airway.

BACKGROUND: Induction of anesthesia and tracheal intubation in small children with a difficult airway is a challenging task. We report the experience with a procedure based on sevoflurane inhalation via a nasopharyngeal airway inserted early during induction before airway obstruction occurs. A pediatric fiberscope is used to perform a nasotracheal intubation via the opposite nostril. METHODS: All small children with suspected or known difficult airway needing tracheal intubation were scheduled for a fiberoptic intubation following the described protocol. RESULTS: In 3 years, we performed 27 successful fiberoptic guided tracheal intubations in 19 children, median age 8.2 months (1.0-39.1 months) and median weight 7.6 kg (3.0-15.0 kg). The optimal depth for placement of the nasopharyngeal airway was found to be 8.0 cm (7.0-8.5 cm) from the nostril in the first year of life and 8.5 cm (8.0-10 cm) in the second year. Oxygenation was sufficient during the entire procedure in all cases except one child who had short-lasting laryngeal spasm caused by instillation of lidocaine during light anesthesia. The duration of fiberoptic intubation was significantly shorter when performed by an experienced anesthesiologist (55 s vs. 120 s), but there was no significant correlation between the duration of fiberoscopy and oxygen saturation during fiberoscopy or endtidal CO(2) after intubation. CONCLUSION: The combination of nasopharyngeal airway and fiberoptic guided tracheal intubation seems to be a reliable and safe procedure for managing the difficult airway in small children.

Airway Obstruction↗
PubMed2004

Outcome of out-of-hospital cardiac arrest--why do physicians withhold resuscitation attempts?

OBJECTIVE: To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts. METHODS: Prospective collection of data during 12 months by the anaesthesiologists from the Advanced Life Support unit (ALS) of the Emergency Medical Service (EMS) according to the Utstein template. RESULTS: In total, 499 OHCA were analysed and 266 patients received cardiopulmonary resuscitation (CPR) by the ALS unit. Initial rhythm was ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) in 35%, asystole in 38%, and other rhythm in 27%. Of the 266 treated patients, 83 (31%) patients had a spontaneous circulation on admission to hospital. Survival to discharge from hospital was 6.2% for all cases of OHCA, 11.7% for all 266 treated patients, and 20.5% for patients with witnessed cardiac arrest and presumed cardiac aetiology in VF. On arrival, the physician decided in 233 cases to withhold or discontinue CPR. The explanation for this was prolonged anoxia (74%), terminal cancer (8%), and severe trauma (7%). The most common incident locations were the patient's home and nursing homes. These locations were more common in the group where resuscitation was not attempted and these patients were older and the proportions of females and asystole were significantly higher. Bystander CPR was provided in 82 (16%) overall, but only in 8 (3%) in the group where resuscitation was not attempted. CONCLUSION: Survival to discharge from hospital in all cases of OHCA was 6.2% but 20.5% in witnessed, presumed cardiac aetiology in VF. The decision to withhold resuscitation was based upon presumed prolonged anoxia in the majority of cases.

Adolescent↗
PubMed2004

Apolipoprotein E genotype and cognitive dysfunction after noncardiac surgery.

BACKGROUND: Apolipoprotein E is important in recovery after neuronal damage. The epsilon4 allele of the apolipoprotein E gene has been shown as a risk factor for Alzheimer disease, poor outcome after cerebral injury, and accelerated cognitive decline with normal aging. The authors hypothesized that patients with the epsilon4 allele would have an increased risk of postoperative cognitive dysfunction (POCD) after noncardiac surgery. METHODS: In a multicenter study, a total of 976 patients aged 40 yr and older undergoing noncardiac surgery were tested preoperatively and 1 week and 3 months after surgery with a neuropsychological test battery comprising seven subtests. POCD was defined as a decline in test performance of more than 2 SD from the expected. Apolipoprotein E genotypes were determined by blood sample analysis at a central laboratory. Multivariate logistic regression analysis with POCD as the dependent variable assessed presence of the epsilon4 allele (yes/no) and other possible risk factors. RESULTS: The epsilon4 allele was found in 272 patients. One week after surgery, the incidence of POCD was 11.7% in patients with the epsilon4 allele and 9.9% in patients without the epsilon4 allele (P = 0.41). Three months later, POCD was found in 10.3% of patients with the epsilon4 allele and in 8.4% of patients without the epsilon4 allele (P = 0.40). Multivariate logistic regression analysis did not identify the epsilon4 allele as a risk factor at 1 week (P = 0.33) or 3 months (P = 0.57). CONCLUSIONS: The authors were unable to show a significant association between apolipoprotein E genotype and POCD, but statistical power was limited because of a lower incidence of POCD than expected.

Adult↗
PubMed2002

Cerebral blood flow and cognitive dysfunction after coronary surgery.

BACKGROUND: Postoperative cognitive dysfunction after cardiac surgery has been attributed both to embolic events and periods with reduced cerebral perfusion. We investigated whether cognitive dysfunction after coronary surgery is associated with changes in regional cerebral blood flow (CBF) using single photon emission computed tomography. METHODS: Before surgery and at discharge, 15 coronary surgery patients were studied. Global and regional CBF were measured using a brain-dedicated single photon emission computed tomography scanner, and neuropsychological testing with seven subtests was performed. Postoperative cognitive dysfunction was defined as a Z score above 2. Normative single photon emission computed tomography data were available from 26 healthy age-matched controls. RESULTS: Preoperative global CBF was significantly lower in patients compared with controls (53.7 versus 46.1 mL/100 g/min, p = 0.006). After surgery, global CBF significantly decreased in the patient group (46.1 versus 38.6 mL/100 g/min, p = 0.0001). No significant differences were detected in regional CBF. Cognitive dysfunction was identified in 4 of the 15 patients (26.7%, 95% CI 7.8% to 55.1%). No correlation was found between the neuropsychological Z score and global or regional CBF. CONCLUSIONS: The significant decrease in CBF after coronary surgery was uniformly distributed and was not correlated to postoperative cognitive dysfunction.

Aged↗
PubMed2002

Neuron loss after coronary artery bypass detected by SPECT estimation of benzodiazepine receptors.

BACKGROUND: Cerebral dysfunction is common after cardiac surgery and probably related to embolic phenomena, but the etiological mechanisms have not been elucidated. The aim of this study was to assess whether a possible neuron loss could be detected by single photon emission computer tomography (SPECT) estimation of benzodiazepine receptor density. In addition, we correlated the findings with neuropsychological test results. METHODS: We included 15 elderly patients undergoing coronary artery bypass surgery. Neuropsychological testing was performed before surgery and postoperatively at discharge from hospital and after 3 months using a neuropsychological test battery. SPECT was performed before surgery and after 3 months using the iomazenil bolus/infusion technique, and the benzodiazepine receptor density was calculated for the frontal, parietal, temporal, and occipital cortex. RESULTS: Cognitive dysfunction was found in 46.7% at discharge from hospital and in 6.7% after 3 months. A significant decrease in the estimated density of neurons was found in the frontal cortex, but no significant correlation was found between cognitive dysfunction and SPECT findings. CONCLUSIONS: Neuron loss was detectable in the frontal cortex, but the decrease did not correlate with neuropsychological test results.

Aged↗
PubMed2002

Postoperative cognitive dysfunction in middle-aged patients.

BACKGROUND: Postoperative cognitive dysfunction (POCD) after noncardiac surgery is strongly associated with increasing age in elderly patients; middle-aged patients (aged 40-60 yr) may be expected to have a lower incidence, although subjective complaints are frequent. METHODS: The authors compared the changes in neuropsychological test results at 1 week and 3 months in patients aged 40-60 yr, using a battery of neuropsychological tests, with those of age-matched control subjects using Z-score analysis. They assessed risk factors and associations of POCD with measures of subjective cognitive function, depression, and activities of daily living. RESULTS: At 7 days, cognitive dysfunction as defined was present in 19.2% (confidence interval [CI], 15.7-23.1) of the patients and in 4.0% (CI, 1.6-8.0) of control subjects (P < 0.001). After 3 months, the incidence was 6.2% (CI, 4.1-8.9) in patients and 4.1% (CI, 1.7-8.4) in control subjects (not significant). POCD at 7 days was associated with supplementary epidural analgesia and reported avoidance of alcohol consumption. At 3 months, 29% of patients had subjective symptoms of POCD, and this finding was associated with depression. Early POCD was associated with reports of lower activity scores at 3 months. CONCLUSIONS: Postoperative cognitive dysfunction occurs frequently but resolves by 3 months after surgery. It may be associated with decreased activity during this period. Subjective report overestimates the incidence of POCD. Patients may be helped by recognition that the problem is genuine and reassured that it is likely to be transient.

Adult↗