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Background Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. Aim In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2−6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation. Methods In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2−6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively. Results Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group. Conclusions In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.
Åsa Bromfalk; Tomi Myrberg; Jakob Walldén; Åsa Engström; Magnus Hultin. Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine. Pediatric Anesthesia 2021, 1 .
AMA StyleÅsa Bromfalk, Tomi Myrberg, Jakob Walldén, Åsa Engström, Magnus Hultin. Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine. Pediatric Anesthesia. 2021; ():1.
Chicago/Turabian StyleÅsa Bromfalk; Tomi Myrberg; Jakob Walldén; Åsa Engström; Magnus Hultin. 2021. "Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine." Pediatric Anesthesia , no. : 1.
Background The overall risk of postoperative nausea and vomiting (PONV) after general anaesthesia is reportedly 20%-40%. The first episode of PONV may occur early in the post-anaesthesia care unit (PACU), or later at the ward or after discharge at home in an ambulatory setting. This study aimed to investigate and describe the risk of early PONV in a PACU and we hypothesised that patients- and perioperative factors were associated with early PONV. Methods This single-centre retrospective observational study was conducted in a Swedish county hospital from January to June 2017 and included adult patients who underwent surgical procedures under general anaesthesia. Perioperative data were obtained by reviewing the local registry for surgical procedures, medical records, and anaesthesia and postoperative charts. Early PONV was defined as PONV occurring up to four hours postoperatively at the PACU. Any notification in the medical records, perioperative charts, or the registry regarding nausea, vomiting, or PONV treatment was regarded as PONV. Uni- and multivariate analyses were performed for factors associated with early PONV. Results 2030 patients were included in the study, of which 9.6 % (n=194) experienced early PONV. Factors associated with a high risk of early PONV were suboptimal PONV prophylaxis, need for opioids, female sex, body mass index > 35 kg/m2, and major surgery and anaesthesia time ≥ 60 minutes. Conclusion We found that every tenth patient under general anaesthesia experienced early PONV. Suboptimal PONV prophylaxis and previously acknowledged risk factors for PONV were associated with early PONV.
Emma Johansson; Magnus Hultin; Tomi Myrberg; Jakob Walldén. Early post‐operative nausea and vomiting: A retrospective observational study of 2030 patients. Acta Anaesthesiologica Scandinavica 2021, 1 .
AMA StyleEmma Johansson, Magnus Hultin, Tomi Myrberg, Jakob Walldén. Early post‐operative nausea and vomiting: A retrospective observational study of 2030 patients. Acta Anaesthesiologica Scandinavica. 2021; ():1.
Chicago/Turabian StyleEmma Johansson; Magnus Hultin; Tomi Myrberg; Jakob Walldén. 2021. "Early post‐operative nausea and vomiting: A retrospective observational study of 2030 patients." Acta Anaesthesiologica Scandinavica , no. : 1.
Background When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes. Method Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2. Results Education in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist. Conclusions This intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs. Trial registration This randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.
Karin Jonsson; Christine Brulin; Maria Härgestam; Marie Lindkvist; Magnus Hultin. Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2021, 29, 1 -11.
AMA StyleKarin Jonsson, Christine Brulin, Maria Härgestam, Marie Lindkvist, Magnus Hultin. Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2021; 29 (1):1-11.
Chicago/Turabian StyleKarin Jonsson; Christine Brulin; Maria Härgestam; Marie Lindkvist; Magnus Hultin. 2021. "Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams." Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 29, no. 1: 1-11.
ObjectiveIdentify factors of preparedness for peer first response to underground mining emergencies with injured victims.DesignCross-sectional questionnaire study of Swedish underground mineworkers.SettingSeven out of nine Swedish underground mines.ParticipantsA total of 741 mineworkers out of 1022 (73%) participated in this study.InterventionsNone.Outcome measuresLevel of preparedness for emergencies with injuries in underground mines.ResultsThree factors influenced the preparedness of mineworkers for a peer first response: (1) familiarity with rescue procedures during emergencies with injuries; (2) risk perception of emergencies with injuries and (3) experience of using self-protective and first aid equipment. Mineworkers who believed that they knew how to handle emergencies with injuries (OR 1.30, 95% CI 1.22 to 1.38) and those who were trained in the use of self-protective and first aid equipment (OR 1.19, 95% CI 1.07 to 1.32) considered themselves to be better prepared for a peer first response than those who were unfamiliar with the rescue procedures or who had not used self-protective and first aid equipment. However, mineworkers who rated the risk for emergencies with injuries as high considered themselves to be less prepared than those who rated the risk as low (OR 0.95, 95% CI 0.91 to 0.98).ConclusionThis study identified three factors that were important for the peer-support preparedness of underground mineworkers. More research is needed to adapt and contextualise first aid courses to the needs of underground peer responders.
Sofia Karlsson; Britt-Inger Saveman; Magnus Hultin; Ulf Björnstig; Lina Gyllencreutz. Preparedness for peer first response to mining emergencies resulting in injuries: a cross-sectional study. BMJ Open 2020, 10, e036094 .
AMA StyleSofia Karlsson, Britt-Inger Saveman, Magnus Hultin, Ulf Björnstig, Lina Gyllencreutz. Preparedness for peer first response to mining emergencies resulting in injuries: a cross-sectional study. BMJ Open. 2020; 10 (11):e036094.
Chicago/Turabian StyleSofia Karlsson; Britt-Inger Saveman; Magnus Hultin; Ulf Björnstig; Lina Gyllencreutz. 2020. "Preparedness for peer first response to mining emergencies resulting in injuries: a cross-sectional study." BMJ Open 10, no. 11: e036094.
Background The overall risk of postoperative nausea and vomiting after general anaesthesia is approximately 30% even with prophylactic medications. Studies exploring the risk after regional anaesthesia including intrathecal morphine are limited but indicate that intrathecal morphine is highly emetogenic and is additive to the PONV risk associated with other forms of anaesthesia. The aim of this observational study was to investigate the risk of PONV after spinal blockade combined with intrathecal morphine and to explore associations with patient and perioperative factors, including given PONV-prophylaxis. We hypothesized that a large number of patients in a clinical setting receive less prophylaxis than the recommendations in guidelines (suboptimal prophylaxis), leading to a higher risk for PONV compared to those receiving adequate PONV prophylaxis. Methods The study was conducted as a prospective observational cohort study regarding PONV in patients undergoing hip/knee replacement under spinal anaesthesia including intrathecal morphine. Patients were included at a county hospital in Sweden during April–November 2013 (n = 59) and September 2014–June 2015 (n = 40). One hundred eight patients entered the study with 99 patients analysed in the final cohort. Patients were followed the first three postoperative days with a questionnaire regarding PONV and peri- and postoperative data was collected. PONV risk is presented as the proportion of patients (%) with PONV and was related to the level of perioperative PONV-prophylaxis (suboptimal/optimal). Univariate analysis was used to analyse factors associated with PONV. Results Forty-six patients (46%) experienced PONV during the 3-day study period whereof 36 patients (36%) until noon the first day after the procedure. 19/27 patients (70%) that received suboptimal PONV-prophylaxis experienced PONV compared to 27/72 (38%) that received optimal PONV-prophylaxis (p = 0.015). Further, female gender and/or a history of motion sickness were associated with an increased PONV-risk. Conclusions There was a high risk for PONV after spinal anaesthesia including morphine. PONV risk was associated with the level of prophylaxis and with known risk factors for PONV. Our findings suggest that a more liberal use of PONV prophylaxis might be motivated.
Antonio Moraitis; Magnus Hultin; Jakob Walldén. Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine. BMC Anesthesiology 2020, 20, 1 -9.
AMA StyleAntonio Moraitis, Magnus Hultin, Jakob Walldén. Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine. BMC Anesthesiology. 2020; 20 (1):1-9.
Chicago/Turabian StyleAntonio Moraitis; Magnus Hultin; Jakob Walldén. 2020. "Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine." BMC Anesthesiology 20, no. 1: 1-9.
A major fire incident in a Swedish underground mine made the personnel from the mining company and the rescue service realize their limited preparedness. It was the beginning of a collaboration project that included the development of a new exercise model for a more effective joint rescue operation practice. The aim of this study was to explore the collaborative learning process of exercise organizers from the rescue service, mining companies, the emergency medical service, a training company, and academia. The analysis was performed through the application of the theory cycle of expansive learning to the material consisting of documents from 16 collaboration meetings and 11 full-scale exercises. The learning process started by the participants questioning the present practice of the rescue operation and analyzing it by creating a flow chart. An essential part of the process was to model new tools in order to increase the potential for collaboration. The tools were examined and tested during collaboration meetings and implemented during full-scale exercises. The exercise organizers reflected that the process led to organizational development and a better understanding of the other organizations’ perspectives. Consequently, a tentative model for developing the learning process of exercise organizers was developed.
Sofia Karlsson; Britt-Inger Saveman; Magnus Hultin; Annika Eklund; Lina Gyllencreutz. Expansive Learning Process of Exercise Organizers: The Case of Major Fire Incident Exercises in Underground Mines. Sustainability 2020, 12, 5790 .
AMA StyleSofia Karlsson, Britt-Inger Saveman, Magnus Hultin, Annika Eklund, Lina Gyllencreutz. Expansive Learning Process of Exercise Organizers: The Case of Major Fire Incident Exercises in Underground Mines. Sustainability. 2020; 12 (14):5790.
Chicago/Turabian StyleSofia Karlsson; Britt-Inger Saveman; Magnus Hultin; Annika Eklund; Lina Gyllencreutz. 2020. "Expansive Learning Process of Exercise Organizers: The Case of Major Fire Incident Exercises in Underground Mines." Sustainability 12, no. 14: 5790.
Introduction Healthcare teams and their performance in a complex environment such as that of intensive care units (ICUs) are influenced by several factors. This study investigates the relationship between team background characteristics and team as well as task performance. Methods This study included 105 professionals (26 teams), working at the ICUs of 2 hospitals in Northern Sweden. The team-based simulation training sessions were video recorded, and thereafter, team performance and task performance were analyzed based on ratings of the TEAM instrument and the ABCDE checklist. Results The final analyses showed that a higher age was significantly associated with better total team performance (β = 0.35, P = 0.04), teamwork (β = 0.04, P = 0.04), and task management (β = 0.04, P = 0.05) and with a higher overall rating for global team performance (β = 0.09, P = 0.02). The same pattern was found for the association between age and task performance (β = 0.02, P = 0.04). In addition, prior team training without video-facilitated reflection was significantly associated with better task performance (β = 0.35, P = 0.04). On the other hand, prior team training in communication was significantly associated with worse (β = −1.30, P = 0.02) leadership performance. Conclusions This study reveals that a higher age is important for better team performance when caring for a severely ill patient in a simulation setting in the ICU. In addition, prior team training had a positive impact on task performance. Therefore, on a team level, this study indicates that age and, to some extent, prior team training without video-facilitated reflection have an impact on team performance in the care of critically ill patients.
Karin Jonsson; Magnus Hultin; Maria Härgestam; Marie Lindkvist; Christine Brulin. Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 2020, 16, 29 -36.
AMA StyleKarin Jonsson, Magnus Hultin, Maria Härgestam, Marie Lindkvist, Christine Brulin. Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2020; 16 (1):29-36.
Chicago/Turabian StyleKarin Jonsson; Magnus Hultin; Maria Härgestam; Marie Lindkvist; Christine Brulin. 2020. "Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario." Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 16, no. 1: 29-36.
Background Cardiac disease and aberrations in central volume statusare risk factors for perioperative complications,and should be identified prior to surgery. This study investigatedthe benefit of transthoracic echocardiography for preoperative identification of cardiac disease andhypovolemia in ambulatory surgery. Methods Ninety‐six patients, with a mean age of 63.5±12.2 years and body mass index of 27.0±4.3 kg/m2, scheduled for ambulatorysurgery (breast, thyroid, minor gastrointestinal), were consecutively enrolled in this prospective observational study. Preoperative comprehensive transthoracic echocardiographywas performed in order to assess heart failure, asymptomatic left ventricular dysfunction, valvular disease and aberrations incentral volume status. Results Preoperative transthoracic echocardiography identified a total of 28 cases of heart failure; thirteen cases of heart failure with reduced, or moderately reduced, ejection fraction and fifteen cases of heart failure with preserved ejection fraction. Furthermore, forty‐six cases of asymptomatic left ventricular dysfunction were identified. 44/96 patients were hypovolemic, 16 of whom in severe hypovolemia.Seven cases of previously unknown obstructive valvular or myocardial diseaseand six cases of right ventricular systolic dysfunction were identified.A total of 24% (23/96) were classified as potential critical hemodynamic findings. The number needed to treat for preoperative TTE in order to find one critical finding was 4.2. Conclusion In this ambulatory surgical cohort, a high prevalence of preoperative LV dysfunction and aberrations in volume status was observed. The results demonstrate that preoperative TTE contributed valuable hemodynamic information. The standard preoperative assessment for this cohort might need to be revised.
Ylva Stenberg; Linnea Lindelöf; Magnus Hultin; Tomi Myrberg. Pre‐operative transthoracic echocardiography in ambulatory surgery—A cross‐sectional study. Acta Anaesthesiologica Scandinavica 2020, 64, 1055 -1062.
AMA StyleYlva Stenberg, Linnea Lindelöf, Magnus Hultin, Tomi Myrberg. Pre‐operative transthoracic echocardiography in ambulatory surgery—A cross‐sectional study. Acta Anaesthesiologica Scandinavica. 2020; 64 (8):1055-1062.
Chicago/Turabian StyleYlva Stenberg; Linnea Lindelöf; Magnus Hultin; Tomi Myrberg. 2020. "Pre‐operative transthoracic echocardiography in ambulatory surgery—A cross‐sectional study." Acta Anaesthesiologica Scandinavica 64, no. 8: 1055-1062.
PurposeInformation is scarce on healthcare managers' understanding of simulation educators' impact on clinical work. Therefore, the aim of this study was to explore healthcare managers' perceptions of the significance of clinically active simulation educators for the organisation.Design/methodology/approachHealthcare managers were invited to be interviewed in a semi-structured manner. Inductive thematic analysis was used to identify and analyse patterns of notions describing the managers' perceptions of simulation educators' impact as co-workers on their healthcare organisations.FindingsThe identified relevant themes for the healthcare unit were: (1) value for the manager, (2) value for the community and (3) boundaries. Simulation educators were perceived to be valuable gatekeepers of evidence-based knowledge and partners in leadership for educational issues. Their most prominent value for the community was establishing a reflective climate, facilitating open communication and thereby improving the efficacy of teamwork. Local tradition, economy, logistics and staffing of the unit during simulation training were suggested to have possible negative impacts on simulation educators' work.Practical implicationsThe findings might have implications for the implementation and support of simulation training programs.Social implicationsHealthcare managers appreciated both the personal value of simulation educators and the effect of their work for their own unit. Local values were prioritised versus global. Simulation training was valued as an educational tool for continual professional development, although during the interviews, the managers did not indicate the importance of employment of pedagogically competent and experienced staff.Originality/valueThe study provided new insights about how simulation educators as team members affect clinical practice.
Éva Tamás; Marie-Louise Södersved Källestedt; Håkan Hult; Liisa Carlzon; Klas Karlgren; Magnus Berndtzon; Magnus Hultin; Italo Masiello; Renée Allvin. Simulation educators in clinical work: the manager's perspective. Journal of Health Organization and Management 2020, 34, 181 -191.
AMA StyleÉva Tamás, Marie-Louise Södersved Källestedt, Håkan Hult, Liisa Carlzon, Klas Karlgren, Magnus Berndtzon, Magnus Hultin, Italo Masiello, Renée Allvin. Simulation educators in clinical work: the manager's perspective. Journal of Health Organization and Management. 2020; 34 (2):181-191.
Chicago/Turabian StyleÉva Tamás; Marie-Louise Södersved Källestedt; Håkan Hult; Liisa Carlzon; Klas Karlgren; Magnus Berndtzon; Magnus Hultin; Italo Masiello; Renée Allvin. 2020. "Simulation educators in clinical work: the manager's perspective." Journal of Health Organization and Management 34, no. 2: 181-191.
ObjectivesThe assessment of situation awareness (SA), team performance and task performance in a simulation training session requires reliable and feasible measurement techniques. The objectives of this study were to test the Airways–Breathing–Circulation–Disability–Exposure (ABCDE) checklist and the Team Emergency Assessment Measure (TEAM) for inter-rater reliability, as well as the application of Situation Awareness Global Assessment Technique (SAGAT) for feasibility and internal consistency.DesignMethodological approach.SettingData collection during team training using full-scale simulation at a university clinical training centre. The video-recorded scenarios were rated independently by four raters.Participants55 medical students aged 22–40 years in their fourth year of medical studies, during the clerkship in anaesthesiology and critical care medicine, formed 23 different teams. All students answered the SAGAT questionnaires, and of these students, 24 answered the follow-up postsimulation questionnaire (PSQ). TEAM and ABCDE were scored by four professionals.MeasuresThe ABCDE and TEAM were tested for inter-rater reliability. The feasibility of SAGAT was tested using PSQ. SAGAT was tested for internal consistency both at an individual level (SAGAT) and a team level (Team Situation Awareness Global Assessment Technique (TSAGAT)).ResultsThe intraclass correlation was 0.54/0.83 (single/average measurements) for TEAM and 0.55/0.83 for ABCDE. According to the PSQ, the items in SAGAT were rated as relevant to the scenario by 96% of the participants. Cronbach’s alpha for SAGAT/TSAGAT for the two scenarios was 0.80/0.83 vs 0.62/0.76, and normed χ² was 1.72 vs 1.62.ConclusionTask performance, team performance and SA could be purposefully measured, and the reliability of the measurements was good.
Magnus Hultin; Karin Jonsson; Maria Härgestam; Marie Lindkvist; Christine Brulin. Reliability of instruments that measure situation awareness, team performance and task performance in a simulation setting with medical students. BMJ Open 2019, 9, e029412 .
AMA StyleMagnus Hultin, Karin Jonsson, Maria Härgestam, Marie Lindkvist, Christine Brulin. Reliability of instruments that measure situation awareness, team performance and task performance in a simulation setting with medical students. BMJ Open. 2019; 9 (9):e029412.
Chicago/Turabian StyleMagnus Hultin; Karin Jonsson; Maria Härgestam; Marie Lindkvist; Christine Brulin. 2019. "Reliability of instruments that measure situation awareness, team performance and task performance in a simulation setting with medical students." BMJ Open 9, no. 9: e029412.
Heparin-binding protein (HBP) is released by neutrophils upon activation, and elevated plasma levels are seen in inflammatory states like sepsis, shock, cardiac arrest, and burns. However, little is known about the elimination of HBP. We wanted to study renal clearance of HBP in healthy individuals and in burn patients in intensive care units (ICUs). We also wished to examine the levels of HBP in the effluent of renal replacement circuits in ICU patients undergoing continuous renal replacement therapy (CRRT). We measured plasma and urine levels of HBP and urine flow rate in 8 healthy individuals and 20 patients in a burn ICU. In 32 patients on CRRT, we measured levels of HBP in plasma and in the effluent of the CRRT circuit. Renal clearance of HBP (median (IQR) ml/min) was 0.19 (0.08–0.33) in healthy individuals and 0.30 (0.01–1.04) in burn ICU patients. In ICU patients with cystatin C levels exceeding 1.44 mg/l, clearance was 0.45 (0.15–2.81), and in patients with cystatin C below 1.44 mg/l clearance was lower 0.28 (0.14–0.55) (p = 0.04). Starting CRRT did not significantly alter plasma levels of HBP (p = 0.14), and the median HBP level in the effluent on CRRT was 9.1 ng/ml (IQR 7.8–14.4 ng/ml). In healthy individuals and critically ill burn patients, renal clearance of HBP is low. It is increased when renal function is impaired. Starting CRRT in critically ill patients does not alter plasma levels of HBP significantly, but HBP can be found in the effluent. It seems unlikely that impaired kidney function needs to be considered when interpreting concentrations of HBP in previous studies. Starting CRRT does not appear to be an effective way of reducing HBP concentrations.
Line Samuelsson; Jonas Tydén; Heiko Herwald; Magnus Hultin; Jakob Walldén; Ingrid Steinvall; Folke Sjöberg; Joakim Johansson. Renal clearance of heparin-binding protein and elimination during renal replacement therapy: Studies in ICU patients and healthy volunteers. PLOS ONE 2019, 14, e0221813 .
AMA StyleLine Samuelsson, Jonas Tydén, Heiko Herwald, Magnus Hultin, Jakob Walldén, Ingrid Steinvall, Folke Sjöberg, Joakim Johansson. Renal clearance of heparin-binding protein and elimination during renal replacement therapy: Studies in ICU patients and healthy volunteers. PLOS ONE. 2019; 14 (8):e0221813.
Chicago/Turabian StyleLine Samuelsson; Jonas Tydén; Heiko Herwald; Magnus Hultin; Jakob Walldén; Ingrid Steinvall; Folke Sjöberg; Joakim Johansson. 2019. "Renal clearance of heparin-binding protein and elimination during renal replacement therapy: Studies in ICU patients and healthy volunteers." PLOS ONE 14, no. 8: e0221813.
Background Preserving perfusion pressure during anesthesia induction is crucial. Standardized anesthesia methods, alert fluid therapy and vasoactive drugs may help maintain adequate hemodynamic conditions throughout the induction procedure. In this randomized study, we hypothesized that a pre‐operative volume bolus based on lean body weight would decrease the incidence of significant blood pressure drops (BPD) after induction with target‐controlled infusion (TCI) or rapid sequence induction (RSI). Methods Eighty individuals scheduled for non‐cardiac surgery were randomized to either a pre‐operative colloid fluid bolus of 6 ml kg−1 lean body weight or no bolus, and then anesthetized by means of TCI or RSI. The main outcome measure was blood pressure drops below the mean arterial pressure 65 mm Hg during the first 20 minutes after anesthesia induction. ClinicalTrials.com Identifier: NCT03394833. Results Pre‐operative fluid therapy decreased the incidence of BPDs fivefold, from 23 of 40 (57.5%) individuals without fluids to 5 of 40 (12.5%) with fluid management, P < .001. The mean BPD was greater in the groups without pre‐operative fluids compared to the groups with fluid management; 53 ± 18 mm Hg vs 43 ± 14 mm Hg, P = .007. The overall mean volume of pre‐operative fluid bolus infused was 387 ± 52 ml. There was no difference in hemodynamic stability between TCI and RSI. No correlation was shown between incidence of BPDs and increasing age, medication, hypertension, diabetes, renal failure, or low physical capacity. Conclusions Pre‐operative fluid bolus decreased the incidence of significant blood pressure drops during TCI and RSI induction of general anesthesia.
Tomi Myrberg; Linnea Lindelöf; Magnus Hultin. Effect of preoperative fluid therapy on hemodynamic stability during anesthesia induction, a randomized study. Acta Anaesthesiologica Scandinavica 2019, 63, 1129 -1136.
AMA StyleTomi Myrberg, Linnea Lindelöf, Magnus Hultin. Effect of preoperative fluid therapy on hemodynamic stability during anesthesia induction, a randomized study. Acta Anaesthesiologica Scandinavica. 2019; 63 (9):1129-1136.
Chicago/Turabian StyleTomi Myrberg; Linnea Lindelöf; Magnus Hultin. 2019. "Effect of preoperative fluid therapy on hemodynamic stability during anesthesia induction, a randomized study." Acta Anaesthesiologica Scandinavica 63, no. 9: 1129-1136.
Intranasal dexmedetomidine administered as premedication before anesthesia and cardioversion appears to have the potential to facilitate the return of sinus rhythm. Two children, 3.5 and 1.5 years old, with recurrent supraventricular tachycardia in need of cardioversion have now on several occasions spontaneously returned to sinus rhythm within 20–40 minutes after intranasal administration of dexmedetomidine (4 μg/kg) with a mucosal atomization device. Both children were observed on all occasions at the pediatric outpatient clinic and could return home within 2 hours of cardioversion. For children with supraventricular tachycardia, a selective α2-agonist might be a valuable alternative to cardioversion with adenosine.
Magnus Hultin; Erik Sundberg. Spontaneous Conversions of Supraventricular Tachycardia to Sinus Rhythm in Children After Premedication With Intranasal Dexmedetomidine: A Case Report. A&A Practice 2018, 11, 219 -220.
AMA StyleMagnus Hultin, Erik Sundberg. Spontaneous Conversions of Supraventricular Tachycardia to Sinus Rhythm in Children After Premedication With Intranasal Dexmedetomidine: A Case Report. A&A Practice. 2018; 11 (8):219-220.
Chicago/Turabian StyleMagnus Hultin; Erik Sundberg. 2018. "Spontaneous Conversions of Supraventricular Tachycardia to Sinus Rhythm in Children After Premedication With Intranasal Dexmedetomidine: A Case Report." A&A Practice 11, no. 8: 219-220.
Although mechanical ventilation is often lifesaving, it can also cause injury to the lungs. The lung injury is caused by not only high pressure and mechanical forces but also by inflammatory processes that are not fully understood. Heparin-binding protein (HBP), released by activated granulocytes, has been indicated as a possible mediator of increased vascular permeability in the lung injury associated with trauma and sepsis. We investigated if HBP levels were increased in the bronchoalveolar lavage fluid (BALF) or plasma in a pig model of ventilator-induced lung injury (VILI). We also investigated if HBP was present in BALF from healthy volunteers and in intubated patients in the intensive care unit (ICU). Anaesthetized pigs were randomized to receive ventilation with either tidal volumes of 8 ml/kg (controls, n = 6) or 20 ml/kg (VILI group, n = 6). Plasma and BALF samples were taken at 0, 1, 2, 4, and 6 h. In humans, HBP levels in BALF were sampled from 16 healthy volunteers and from 10 intubated patients being cared for in the ICU. Plasma levels of HBP did not differ between pigs in the control and VILI groups. The median HBP levels in BALF were higher in the VILI group after 6 h of ventilation compared to those in the controls (1144 ng/ml (IQR 359-1636 ng/ml) versus 89 ng/ml (IQR 33-191 ng/ml) ng/ml, respectively, p = 0.02). The median HBP level in BALF from healthy volunteers was 0.90 ng/ml (IQR 0.79-1.01 ng/ml) as compared to 1959 ng/ml (IQR 612-3306 ng/ml) from intubated ICU patients (p < 0.001). In a model of VILI in pigs, levels of HBP in BALF increased over time compared to controls, while plasma levels did not differ between the two groups. HBP in BALF was high in intubated ICU patients in spite of the seemingly non-harmful ventilation, suggesting that inflammation from other causes might increase HBP levels.
Jonas Tydén; N. Larsson; S. Lehtipalo; H. Herwald; M. Hultin; J. Walldén; A. F. Behndig; J. Johansson. Heparin-binding protein in ventilator-induced lung injury. Intensive Care Medicine Experimental 2018, 6, 33 .
AMA StyleJonas Tydén, N. Larsson, S. Lehtipalo, H. Herwald, M. Hultin, J. Walldén, A. F. Behndig, J. Johansson. Heparin-binding protein in ventilator-induced lung injury. Intensive Care Medicine Experimental. 2018; 6 (1):33.
Chicago/Turabian StyleJonas Tydén; N. Larsson; S. Lehtipalo; H. Herwald; M. Hultin; J. Walldén; A. F. Behndig; J. Johansson. 2018. "Heparin-binding protein in ventilator-induced lung injury." Intensive Care Medicine Experimental 6, no. 1: 33.
J. Wallden; T. A. Halliday; Magnus Hultin. Reply to: Sorbello et al., PONV in bariatric surgery: time for opioid-free anaesthesia. Acta Anaesthesiologica Scandinavica 2017, 61, 858 -858.
AMA StyleJ. Wallden, T. A. Halliday, Magnus Hultin. Reply to: Sorbello et al., PONV in bariatric surgery: time for opioid-free anaesthesia. Acta Anaesthesiologica Scandinavica. 2017; 61 (7):858-858.
Chicago/Turabian StyleJ. Wallden; T. A. Halliday; Magnus Hultin. 2017. "Reply to: Sorbello et al., PONV in bariatric surgery: time for opioid-free anaesthesia." Acta Anaesthesiologica Scandinavica 61, no. 7: 858-858.
There is no biomarker with high sensitivity and specificity for the development of acute kidney injury (AKI) in a mixed intensive care unit (ICU) population. Heparin-binding protein (HBP) is released from granulocytes and causes increased vascular permeability which plays a role in the development of AKI in sepsis and ischemia. The aim of this study was to investigate whether plasma levels of HBP on admission can predict the development of AKI in a mixed ICU population and in the subgroup with sepsis. Longitudinal observational study with plasma HBP levels from 245 patients taken on admission to ICU. Presence and severity of AKI was scored daily for 1 week. Mean (95% CI) plasma concentrations of log HBP (ng/ml) in the groups developing different stages of AKI were: stage 0 (n = 175), 3.5 (3.4–3.7); stage 1 (n = 33), 3.7 (3.5–4.0), stage 2 (n = 20), 4.4 (3.5–4.8); and stage 3 (n = 17), 4.6 (3.8–5.2). HBP levels were significantly higher in patients developing AKI stage 3 (P < 0.01) compared to AKI stage 0 and 1. The area under the curve (AUC) for HBP to discriminate the group developing AKI stage 2–3 was 0.70 (CI: 0.58–0.82) and in the subgroup with severe sepsis 0.88 (CI: 0.77–0.99). Heparin-binding protein levels on admission to ICU are associated with the development of severe kidney injury. The relationship between HBP and AKI needs to be further validated in larger studies.
J. Tydén; H. Herwald; Magnus Hultin; J. Walldén; J. Johansson. Heparin-binding protein as a biomarker of acute kidney injury in critical illness. Acta Anaesthesiologica Scandinavica 2017, 61, 797 -803.
AMA StyleJ. Tydén, H. Herwald, Magnus Hultin, J. Walldén, J. Johansson. Heparin-binding protein as a biomarker of acute kidney injury in critical illness. Acta Anaesthesiologica Scandinavica. 2017; 61 (7):797-803.
Chicago/Turabian StyleJ. Tydén; H. Herwald; Magnus Hultin; J. Walldén; J. Johansson. 2017. "Heparin-binding protein as a biomarker of acute kidney injury in critical illness." Acta Anaesthesiologica Scandinavica 61, no. 7: 797-803.
The risk of post-operative nausea and vomiting (PONV) in patients undergoing bariatric surgery is unclear. The aim of the study was to investigate the risk of PONV and the use and effectiveness of PONV prophylaxis. This prospective observational study included 74 patients undergoing bariatric surgery with total intravenous anaesthesia. Patients were given PONV prophylaxis based on published guidelines and a simplified PONV risk score. Perioperative data were collected and a questionnaire was used at 2, 4, 6, 24, 48 and 72 h after the operation to evaluate PONV. Data are presented as risk (%) with the 95% confidence interval. Sixty five per cent (54–75) of the patients experienced PONV in the first 24 post-operative hours and the risk increased with the number of risk factors for PONV. PONV occurred in 78% (66–87) of women and 26% (12–49) of men during the first 24 h. In relation to the guidelines, one patient received suboptimal PONV prophylaxis, 23% received optimal prophylaxis and 76% supra-optimal prophylaxis. The risk of PONV was 82% (59–94) with optimal prophylaxis and 59% (46–71) with supra-optimal prophylaxis. Of all patients, 34% (24–45) experienced severe PONV in the first 24 h that limited their activity. The incidence of PONV in bariatric surgery patients was high despite a PONV prophylaxis regime following current guidelines. These results cast doubt as to the effectiveness of the usual PONV prophylaxis in this patient group and point to the need for further investigation of PONV prophylaxis and treatment in bariatric surgery patients.
T. A. Halliday; J. Sundqvist; M. Hultin; J. Walldén. Post‐operative nausea and vomiting in bariatric surgery patients: an observational study. Acta Anaesthesiologica Scandinavica 2017, 61, 471 -479.
AMA StyleT. A. Halliday, J. Sundqvist, M. Hultin, J. Walldén. Post‐operative nausea and vomiting in bariatric surgery patients: an observational study. Acta Anaesthesiologica Scandinavica. 2017; 61 (5):471-479.
Chicago/Turabian StyleT. A. Halliday; J. Sundqvist; M. Hultin; J. Walldén. 2017. "Post‐operative nausea and vomiting in bariatric surgery patients: an observational study." Acta Anaesthesiologica Scandinavica 61, no. 5: 471-479.
Confident but not theoretically grounded â
Renée Allvin; Magnus Berndtzon; Liisa Carlzon; Samuel Edelbring; Håkan Hult; Magnus Hultin; Klas Karlgren; Italo Masiello; Marie-Louise Södersved Källestedt; Éva Tamás. Confident but not theoretically grounded – experienced simulation educators’ perceptions of their own professional development. Advances in Medical Education and Practice 2017, ume 8, 99 -108.
AMA StyleRenée Allvin, Magnus Berndtzon, Liisa Carlzon, Samuel Edelbring, Håkan Hult, Magnus Hultin, Klas Karlgren, Italo Masiello, Marie-Louise Södersved Källestedt, Éva Tamás. Confident but not theoretically grounded – experienced simulation educators’ perceptions of their own professional development. Advances in Medical Education and Practice. 2017; ume 8 ():99-108.
Chicago/Turabian StyleRenée Allvin; Magnus Berndtzon; Liisa Carlzon; Samuel Edelbring; Håkan Hult; Magnus Hultin; Klas Karlgren; Italo Masiello; Marie-Louise Södersved Källestedt; Éva Tamás. 2017. "Confident but not theoretically grounded – experienced simulation educators’ perceptions of their own professional development." Advances in Medical Education and Practice ume 8, no. : 99-108.
In ambulatory surgery, post-discharge nausea and vomiting (PDNV) has been identified as a significant problem occurring in more than one-third of patients. To validate a simplified PDNV score in a Swedish population. Prospective observational study. Two county hospitals in Sweden: Sundsvall from June 2012 to May 2013 and Sunderbyn from January to October 2014. Adult patients undergoing ambulatory surgery under general anaesthesia. Postoperative outcomes with a focus on nausea and vomiting were collected at 2, 4, and 6 h after surgery and on the first three postoperative days. The simplified PDNV score, calculated before discharge, included the factors: female sex, age less than 50 years, history of postoperative nausea and vomiting, postoperative nausea and opioids given postoperatively. The prediction performance of the simplified PDNV score was evaluated in terms of discrimination (area under receiver-operating characteristics curve) and calibration plots and was compared with that of the original development study. A total of 559 patients were asked to participate, of which 431 were included in the final study cohort. The overall risk of postoperative nausea and vomiting and PDNV were 18.8 [95% confidence interval (CI), 15.4–22.8]% and 28.1 (95% CI, 24.0–32.5)%, respectively. The discrimination capacity of the simplified PDNV score in our study was similar to that of the original dataset [area under the curve 0.693 (95% CI, 0.638–0.748) vs. 0.706 (0.681–0.731), absolute difference 0.013]. The slope of the calibration curve was 0.893, with a constant of 0.021 (R-square 0.884). In a Swedish cohort of patients, the simplified PDNV score performs well in discriminating between patients who will experience post-discharge nausea and/or vomiting after ambulatory surgery. Our results indicate that the simplified PDNV score is as valid in other cohorts as it was in the original development cohort.
Jakob Walldén; Jesper Flodin; Magnus Hultin. Validation of a prediction model for post-discharge nausea and vomiting after general anaesthesia in a cohort of Swedish ambulatory surgery patients. European Journal of Anaesthesiology 2016, 33, 743 -749.
AMA StyleJakob Walldén, Jesper Flodin, Magnus Hultin. Validation of a prediction model for post-discharge nausea and vomiting after general anaesthesia in a cohort of Swedish ambulatory surgery patients. European Journal of Anaesthesiology. 2016; 33 (10):743-749.
Chicago/Turabian StyleJakob Walldén; Jesper Flodin; Magnus Hultin. 2016. "Validation of a prediction model for post-discharge nausea and vomiting after general anaesthesia in a cohort of Swedish ambulatory surgery patients." European Journal of Anaesthesiology 33, no. 10: 743-749.
Magnus Hultin; Maritha Jacobsson; Christine Brulin; Maria Härgestam. Kunskap och kommunikation är en ledares plattform - Tvärvetenskaplig studie av traumateamövningar visar betydelsen av verbal och icke-verbal kommunikation. Lakartidningen 2016, 113, 1 .
AMA StyleMagnus Hultin, Maritha Jacobsson, Christine Brulin, Maria Härgestam. Kunskap och kommunikation är en ledares plattform - Tvärvetenskaplig studie av traumateamövningar visar betydelsen av verbal och icke-verbal kommunikation. Lakartidningen. 2016; 113 ():1.
Chicago/Turabian StyleMagnus Hultin; Maritha Jacobsson; Christine Brulin; Maria Härgestam. 2016. "Kunskap och kommunikation är en ledares plattform - Tvärvetenskaplig studie av traumateamövningar visar betydelsen av verbal och icke-verbal kommunikation." Lakartidningen 113, no. : 1.