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  • 1. Andersson, L.
    et al.
    Lagerstrand, L.
    Thorne, A.
    Sollevi, A.
    Brodin, Lars-Åke
    Odeberg-Wernerman, S.
    Effect of CO2 pneumoperitoneum on ventilation-perfusion relationships during laparoscopic cholecystectomy2002In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 46, no 5, p. 552-560Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have shown that pneumoperitoneum transiently reduces venous admixture as assessed by a calculation based on the shunt formula, and increases arterial oxygen tension (PaO2) in patients without heart or lung disease. The aim of the present study was to further explore the relationship between ventilation-perfusion ((V) over dot (A)/(Q) over dot) before and during pneumoperitoneum by using the multiple inert gas technique. Methods: Nine patients without heart or lung disease (ASA I), with a mean age of 42 years, scheduled for laparoscopic cholecystectomy were included. After premedication and induction of anaesthesia, radial artery and pulmonary artery catheters were introduced percutaneously. The (V) over dot (A)/(Q) over dot relationships were evaluated by the multiple inert gas elimination technique before and during pneurnoperitoneum to obtain a direct measure of the pulmonary shunt. Results: Induction of pneumoperitoneum decreased the pulmonary shunt from 5.8 (4.5) to 4.1 (3.2)% (P<0.05) and increased PaO2 from 21.7 (5.9) to 24.7 (4.8) kPa (P<0.01). During surgery, the shunt increased from 3.2 (2.8) to 5.2 (3.4)% to the same level as before pneumoperitoneum induction. No area with low (V) over dot (A)/(Q) over dot was seen. Dead space ventilation amounted to 20.0 (1.2)% in the supine position and did not change during the investigation. Conclusions: In patients without heart or lung disease, pneumoperitoneum at an intra-abdominal pressure level of 11-13 mmHg- causes a transient reduction of the pulmonary shunt. The mechanisms underlying the present finding remain to be elucidated.

  • 2.
    Eiken, Ola
    et al.
    Karolinska Institutet.
    Tesch, P. A.
    Mejkavic, I. B.
    Effect of nitrous oxide on human skeletal muscle function1996In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 40, no 4, p. 486-488Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nitrous oxide (N2O) is commonly administered in conjunction with parturition, which requires the performance of repeated high-force voluntary muscle actions. Therefore, we examined the effect of a subanesthetic dose of N2O on the force-velocity relationship of the quadriceps femoris muscle.

    METHODS: Nine healthy subjects performed maximal voluntary muscle actions once while breathing air and once while breathing a normoxic gas mixture containing 35% (N2O). Peak torque of the knee extensors was measured during concentric muscle contractions at different angular velocities (30, 60, 90, 150 and 210 degrees s-1), and eccentric (30, 60, 90, and 150 degrees s-1) and isometric (knee-joint angle approximately equal to 60 degrees) muscle actions. Maximal angular velocity was determined during unloaded knee extensions.

    RESULTS: N2O decreased peak torque at any given angular velocity. The overall decrease in peak averaged 4.8 +/- 2.2% (P < 0.0001). Likewise, N2O decreased maximal angular velocity by 5.7 +/- 4.3% (P < 0.01). Thus, the impairment in muscle function induced by a 35% N2O is only minute and hence most likely of little significance in clinical practice.

  • 3.
    Fuchs, Gabriel
    et al.
    Sundsvall Reg Hosp, Sundsvall, Sweden..
    Berg, Niclas
    KTH, School of Engineering Sciences (SCI), Mechanics. KTH, School of Engineering Sciences (SCI), Centres, Linné Flow Center, FLOW.
    Broman, Mikael
    Karolinska Hosp, ECMO Ctr, Stockholm, Sweden..
    Prahl Wittberg, Lisa
    KTH, School of Engineering Sciences (SCI), Mechanics. KTH, School of Engineering Sciences (SCI), Centres, Linné Flow Center, FLOW.
    Blood clots in the ECMO-system - a theoretical platelet activation study2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 964-965Article in journal (Other academic)
  • 4.
    Fuchs, Gabriel
    et al.
    Sundsvall Reg Hosp, Sundsvall, Sweden..
    Broman, Mikael
    Karolinska Univ Hosp, ECMO Ctr, Stockholm, Sweden..
    Wittberg, Lisa Prahl
    KTH, School of Engineering Sciences (SCI), Mechanics. KTH, School of Engineering Sciences (SCI), Centres, Linné Flow Center, FLOW.
    Non-invasive detection of pump-associated blood clots in the ECMO-system2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 964-964Article in journal (Other academic)
  • 5. Gunther, A. C.
    et al.
    Schandl, A. R.
    Berhardsson, J.
    Bjärtå, A.
    Wållgren, M.
    Sundin, O.
    Alvarsson, Jesper
    KTH, School of Engineering Sciences (SCI), Aeronautical and Vehicle Engineering, Marcus Wallenberg Laboratory MWL.
    Bottai, M.
    Martling, C. -R
    Sackey, P. V.
    Pain rather than induced emotions and ICU sound increases skin conductance variability in healthy volunteers2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 8, p. 1111-1120Article in journal (Refereed)
    Abstract [en]

    BackgroundAssessing pain in critically ill patients is difficult. Skin conductance variability (SCV), induced by the sympathetic response to pain, has been suggested as a method to identify pain in poorly communicating patients. However, SCV, a derivate of conventional skin conductance, could potentially also be sensitive to emotional stress. The purpose of the study was to investigate if pain and emotional stress can be distinguished with SCV. MethodsIn a series of twelve 1-min sessions with SCV recording, 18 healthy volunteers were exposed to standardized electric pain stimulation during blocks of positive, negative, or neutral emotion, induced with pictures from the International Affective PictureSystem (IAPS). Additionally, authentic intensive care unit (ICU) sound was included in half of the sessions. All possible combinations of pain and sound occurred in each block of emotion, and blocks were presented in randomized order. ResultsPain stimulation resulted in increases in the number of skin conductance fluctuations (NSCF) in all but one participant. During pain-free baseline sessions, the median NSCF was 0.068 (interquartile range 0.013-0.089) and during pain stimulation median NSCF increased to 0.225 (interquartile range 0.146-0.3175). Only small increases in NSCF were found during negative emotions. Pain, assessed with the numeric rating scale, during the sessions with pain stimulation was not altered significantly by other ongoing sensory input. ConclusionIn healthy volunteers, NSCF appears to reflect ongoing autonomous reactions mainly to pain and to a lesser extent, reactions to emotion induced with IAPS pictures or ICU sound.

  • 6. Li, Y.
    et al.
    Tesselaar, E.
    Borges, J. B.
    Böhm, S. H.
    Sjöberg, F.
    Janerot-Sjöberg, Birgitta
    KTH, School of Technology and Health (STH).
    Hyperoxia affects the regional pulmonary ventilation/perfusion ratio: an electrical impedance tomography study2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 6, p. 716-725Article in journal (Refereed)
    Abstract [en]

    Background The way in which hyperoxia affects pulmonary ventilation and perfusion is not fully understood. We investigated how an increase in oxygen partial pressure in healthy young volunteers affects pulmonary ventilation and perfusion measured by thoracic electrical impedance tomography (EIT). Methods Twelve semi-supine healthy male volunteers aged 21-36 years were studied while breathing room air and air-oxygen mixtures (FiO2) that resulted in predetermined transcutaneous oxygen partial pressures (tcPO2) of 20, 40 and 60kPa. The magnitude of ventilation (Zv) and perfusion (ZQ)-related changes in cyclic impedance variations, were determined using an EIT prototype equipped with 32 electrodes around the thorax. Regional changes in ventral and dorsal right lung ventilation (V) and perfusion (Q) were estimated, and V/Q ratios calculated. Results There were no significant changes in Zv with increasing tcPO2 levels. ZQ in the dorsal lung increased with increasing tcPO2 (P=0.01), whereas no such change was seen in the ventral lung. There was a simultaneous decrease in V/Q ratio in the dorsal region during hyperoxia (P=0.04). Two subjects did not reach a tcPO2 of 60kPa despite breathing 100% oxygen. Conclusion These results indicate that breathing increased concentrations of oxygen induces pulmonary vasodilatation in the dorsal lung even at small increases in FiO2. Ventilation remains unchanged. Local mismatch of ventilation and perfusion occurs in young healthy men, and the change in ventilation/perfusion ratio can be determined non-invasively by EIT.

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