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Biomedical subjects

G Dahlgren

Publications and source records attributed to G Dahlgren.

At least 19 recordsLinked to original sources
PubMed2005

Colloid vs. crystalloid preloading to prevent maternal hypotension during spinal anesthesia for elective cesarean section.

BACKGROUND: Hypotension associated with spinal anesthesia for cesarean section is still a clinical problem. Colloid solutions seem preferable to crystalloid solutions for preloading. In most studies the overall rate of hypotension is reported. Few studies have, however, investigated the maternal and neonatal consequences of different levels of maternal hypotension. METHODS: In this randomized, double-blinded study 110 patients presenting for elective cesarean section received either 1000 ml acetated Ringer's solution or 1000 ml 3% dextran 60 solution immediately before spinal anesthesia. The effect on overall hypotension, clinically significant hypotension (hypotension associated with maternal discomfort defined as nausea, retching/vomiting, dizziness or chest symptoms) and severe hypotension (systolic arterial pressure <80 mmHg) was studied. RESULTS: Dextran reduced the incidence of overall hypotension from 85 to 66% (P=0.03), reduced the incidence of clinically significant hypotension from 60 to 30% (P=0.002) and reduced the incidence of severe hypotension from 23 to 3.6% (P=0.004) compared to Ringer's solution. There were neither differences in neonatal outcome between treatment groups nor between neonates grouped after severity of maternal hypotension. CONCLUSION: Clinically significant hypotension seems to be a more suitable outcome variable than overall hypotension. The protective effect of the colloid solution increased with increased severity of hypotension.

Adult↗
PubMed2004

Four cases of the ex utero intrapartum treatment (EXIT) procedure: anesthetic implications.

The ex utero intrapartum treatment (EXIT) procedure is a method of maintaining utero-placental circulation during cesarean section to gain time to secure a potentially obstructed fetal airway. Four cases of the EXIT procedure are described with special reference to the maternal anesthetic technique. Deep volatile anesthesia (approximately 2 MAC) with isoflurane or sevoflurane for a prolonged period of time, in three cases in combination with an intravenous nitroglycerin infusion, was used to ensure a fully relaxed uterus during the procedure. All mothers were maintained hemodynamically stable with preserved utero-placentary perfusion. It was possible to intubate the tracheas of two fetuses, whereas in the other two tracheostomies had to be performed. Fetal gas exchange was not negatively affected during the EXIT procedure as evidenced by normal blood gas values in the umbilical artery at the time of delivery. After reducing the concentration of volatile anesthetic, delivery of the neonate and administration of oxytocin, uterine contractility was promptly re-established and there were no signs of uterine atony in the postoperative period. All four neonates survived the procedure without complications.

Adult↗
PubMed2001

Development of a national injury prevention/safe community programme in Vietnam.

The aim of this study is to describe the initiation of a national programme on injury prevention/safe community (IP/SC). Market economy, Doi Moi, was introduced in Vietnam in 1986, and since then the injury pattern has been reported to have changed. The number of traffic injury deaths has increased three-fold from 1980 to 1996 and traffic injuries more than four-fold. Injuries are now the leading cause of mortality in hospitals. There are difficulties in obtaining a comprehensive picture of the injury pattern from official statistics and, in conjunction with the work initiated by the Ministry of Health, a number of local reporting systems have already been developed. Remarkable results have been achieved within the IP/SC in a very short time, based on 20 years of experience. An organizational construction system has been built from province to local community areas. Management is based on administrative and legislative documents. IP/SC implementation is considered the duty of the whole community, local authorities and people committees, and should be incorporated into local action plans. The programme is a significant contribution towards creating a safe environment in which everybody may live and work, allowing the stability for society to develop. Implementation of the programme in schools is a special characteristic. The programme will be developed in 800 schools with a large number of pupils (25% of the population). This model for safer schools is considerably concerned and is a good experience to disseminate. The recommendations are that more pilot models of IP/SC should be conducted in other localities and that the programme should be expanded to a national scale. Furthermore, co-operation between sectors and mass organizations should be encouraged and professional skills of key SC members at all levels should be raised.

Accidents, Traffic↗
PubMed2000

Neurological complications in obstetric regional anaesthesia.

Neurological complications after obstetric central neural blocks are rare events. Although central neural blockade does cause neurological complications, there must be awareness that neurological deficits may either develop spontaneously (e.g. epidural abscess/haematoma) or as a result of the labour and delivery process (maternal obstetric palsies). We have attempted to review as completely as possible the published survey and case reports in the English literature on neurological complications of obstetric regional blockade obtained from Medline spanning the period 1966 to November 1998. We also performed cross-checking of our references to find important missing articles, e.g. papers published in journals not included in Index Medicus at the time of publication, such as the International Journal of Obstetric Anesthesia. We wish to provide some insight to the incidences, pathophysiology, clinical features, investigations, treatment and prognosis of these complications. Maternal obstetric palsies and case reports of spontaneous epidural abscess/haematoma are also discussed. It is often difficult, if not impossible, to determine the exact aetiology, but unfortunately for the anaesthetists, regional blockade is usually incriminated till proven otherwise. Although we cannot eliminate the occurrence of neurological complications completely, preventive measures can still be taken to decrease their incidence (e.g. aseptic technique). There must also be regular monitoring after neural blockade for the development of neurological complications. Early diagnosis and prompt appropriate treatment will usually lead to complete resolution of the neurological deficit even in cases of epidural haematoma/abscess.

Journal Article↗
PubMed2000

Successful EXIT (ex utero intrapartum treatment) procedure in a fetus diagnosed prenatally with congenital high-airway obstruction syndrome due to laryngeal atresia.

Congenital high-airway obstruction syndrome (CHAOS) is due to rare malformations and has been reported previously in only few cases. If the diagnosis can be made prenatally, the ex utero intrapartum treatment (EXIT) procedure may be life-saving. A healthy 28-year old nulli-para was referred because of isolated ascites found at gestational week 16 during routine ultrasound scan. Repeated scans showed overdistended hyperechogenic lungs with inverted diaphragm and a dilated trachea, which was interpreted as a CHAOS resulting from laryngeal atresia. The ascites eventually disappeared. An EXIT procedure was performed at 35 weeks of gestation. Anesthesia of the mother was induced with thiopental, succinylcholine and fentanyl followed by intubation, and maintained with isoflurane and nitrous oxide. A low abdominal midline incision was performed followed by a low transverse incision of the uterus. The fetal head, right arm and shoulder were delivered and intramuscular anesthesia was administered to the fetus. Immediate laryngoscopy confirmed the diagnosis and a tracheostomy was therefore performed. Surfactant was given after a few minutes of ventilation. Compliance improved and when the fetus was easy to ventilate, it was delivered. The baby is developing normally at 18 months of age. Surgical correction of the malformation will be performed after two years of age. It is concluded that some fetuses with a prenatal diagnosis of CHAOS can benefit from the EXIT procedure at delivery. This necessitates a multidisciplinary management team.

Adult↗
PubMed1999

Nausea and vomiting after laparoscopic gynecologic surgery: a study of the incidence and the effects of tropisetron prophylaxis.

We have studied the incidence of postoperative nausea and vomiting (PONV) and the effect of prophylactic tropisetron, a 5-HT3 antagonist, during the first 24 hr after elective gynecologic laparoscopic surgery. Thirty-two of 68 patients (47%) experienced nausea or vomiting some time during the observation period. Sixteen of these patients (50%) had their first emetic symptoms after discharge from the recovery room. We could see no difference in the frequency of PONV in the patients who were given prophylactic tropisetron 5 mg orally before anesthesia.

Adolescent↗
PubMed1999

Nausea and vomiting after laparoscopic gynecological surgery: a study of the incidence and the effects of tropisetron prophylaxis.

The authors studied the incidence of postoperative nausea and vomiting (PONV) and the effect of prophylactic tropisetron, a 5-HT3 antagonist, during the first 24 h following elective gynecologic laparoscopic surgery. Thirty-two of 68 (47%) of the patients experienced nausea or vomiting some time during the observation period. Sixteen of the 32 PONV patients (50%) had their first emetic symptoms after discharge from the recovery room. We could see no difference in the frequency of PONV in the patients who were given prophylactic tropisetron 5 mg orally before anesthesia.

Adolescent↗
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↗
PubMed1993

Changes in left ventricular diameter during intravenous induction of anesthesia.

Transthoracic two-dimensional echocardiography was used to measure left ventricular diameter in end-systole and end-diastole during anesthetic induction in 11 patients before coronary artery bypass grafting. Midazolam, 0.1 mg/kg, and fentanyl, 6 to 10 micrograms/kg, were used followed by pancuronium, 0.1 mg/kg. Lidocaine, 1.5 mg/kg, was given topically in the airways before intubation. During induction of anesthesia there was a gradual decrease in diastolic diameter (preload) and in systolic diameter and pressure (afterload). The decrease in end-diastolic diameter from 4.6 cm to 3.9 cm indicated a decrease in preload, defined as end-diastolic volume, by approximately 34%. These results are in agreement with earlier findings using calculated ventricular volumes, based on the determination of either ejection fraction with radionuclide cardiography or stroke volume with thermodilution, during induction of anesthesia with thiopental, diazepam, fentanyl, and pancuronium.

Aged↗
PubMed1993

Influence of glucose-insulin-potassium on left ventricular function during coronary artery bypass grafting.

To evaluate the hemodynamic effect of glucose-insulin-potassium administered during cardiopulmonary bypass grafting (CABG), i.v. infusion of glucose 0.5 g, insulin 1.35 IU and potassium 0.25 mmol/kg b.w/hour was begun after induction of anesthesia and continued until aortic cross-clamping in seven patients. Seven controls underwent CABG without such infusion. The left ventricular ejection fraction was measured after i.v. injection of Tc-99m-HSA before and at termination of cardiopulmonary bypass (CPB), in conjunction with invasive measurements to obtain left ventricular pressure-volume indices at end-systole and end-diastole. Three-step transfusion from the oxygenator was given before and after CPB in order to assess left ventricular contractility during volume-load, using the end-systolic pressure-volume index. Left ventricular contractility remained unchanged after CPB in the patients given glucose-insulin-potassium but decreased significantly in the controls. The left ventricular passive diastolic properties were unchanged after the ischemic period in both groups. The arterial glucose concentration rose markedly in the infused group (7.3-18.5 mmol/l) and moderately (6.4-8.2) in the controls. Glucose-insulin-potassium infusion thus favorably influenced left ventricular function during CABG by preventing decrease in contractility after CPB.

Cardioplegic Solutions↗
PubMed1991

Left ventricular end-systolic pressure estimated from measurements in a peripheral artery.

Aortic and radial arterial pressure measurements were compared after cannulation and before cardiopulmonary bypass in 26 patients scheduled for coronary artery bypass grafting. The radial artery blood pressure range was 89 to 147 mm Hg systolic and 44 to 75 mm Hg diastolic. A difference was found between the central and peripheral dicrotic notch pressures, the former being 7.9 +/- 2.7 (SD) mm Hg higher than the latter. When 8 mm Hg was added to the notch pressure measured in the radial artery to construct a calculated end-systolic pressure, there was good agreement with the centrally measured notch pressure. The mean difference was -0.15 mm Hg with a 95% confidence interval of -1.2 to 0.9 mm Hg. It was not possible to calculate peak systolic aortic pressure with the same accuracy from the systolic and diastolic pressure measurements in the radial artery. It is concluded that left ventricular end-systolic pressure measured as the aortic dicrotic notch pressure can be calculated from the dicrotic notch pressure in the radial artery with reasonable accuracy.

Aorta↗