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Biomedical subjects

J Jakobsson

Publications and source records attributed to J Jakobsson.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1990

Measurement of extravascular lung water by thermal-dye dilution technique: mechanisms of cardiac output dependence.

The extent to which extravascular lung water (EVLW) is dependent on cardiac output was analysed in anaesthetized and mechanically ventilated pigs. EVLW was measured by thermal-dye dilution technique, by a fibreoptic thermistor catheter system (system 1), and by a thermistor catheter-external optical cuvette system (system 2). During baseline conditions, at which cardiac output was 3.65 l/min, and EVLW was 11.7 and 7.7 ml/kg b.w. with systems 1 and 2 respectively. A reduction of cardiac output to a mean of 1.90 l/min by the addition of halothane to the inspired gas did not significantly affect EVLW with system 1 (-5%) but increased EVLW by 39% (p less than 0.05) with system 2. An increase of cardiac output to a mean of 4.78 l/min by intravenous infusion of isoproterenol caused a small increase in EVLW with system 1 (14%; p less than 0.05) and a decrease with system 2 (10%; p less than 0.05). The dependence on cardiac output was the same whether the catheters were positioned centrally (aortic root) or peripherally (abdominal aorta). With system 1 the CO dependence was due to different time constants in thermistor and optical systems, and with appropriate phasing the dependence could be eliminated. With system 2 a large overestimation of the mean transit time difference between the two indicators was seen when cardiac output was low, resulting in overestimation of EVLW. It is concluded that the dependence of EVLW volume on cardiac output is an artefact due to technical problems in the design of the recording equipment rather than a reflection of pulmonary or vascular effects.

Animals↗
PubMed1990

Clinical experience with three different defibrillators for resuscitation of out of hospital cardiac arrest.

Three defibrillators, one manual and two different semiautomatic, were prospectively compared during a one year period for out-of-hospital use by ordinary ambulance personnel with short additional training. Eighty-three cardiac arrest patients were treated with one of two different semiautomatic defibrillators and 26 by an ordinary manual defibrillator. Twenty-nine were found in ventricular fibrillation. Five of these patients were successfully resuscitated and admitted for further hospital care, two survived to be discharged home. The semiautomatic defibrillators were found to be accurate in ECG interpretation, sensitivity and specificity was 100%, respectively, and both were equally effective in defibrillation. There were no differences in conversion rate or in the clinical outcome between the three defibrillators tested. Both semiautomatic defibrillators tested seemed to be safe, reliable and cost-effective. The low survival rate found is most certainly due to a long ambulance delay.

Adult↗
PubMed1990

Comparison of two different electrodes for the delivery of dc-shocks.

Twenty-six consecutive patients with atrial fibrillation, planned for elective cardioversion were randomised to cardioversion with ordinary or self-adhesive electrodes. The two types of electrodes were found equally efficient for conversion to sinus rhythm. With the self-adhesive electrodes there was a tendency towards the need for a lesser number of DC-shocks and a lower cumulated energy. The post-cardioversion maximal serum creatine kinase activity adjusted for number of shocks was significantly lower when the self-adhesive electrodes were used, indicating a lesser degree of skeletal muscle damage.

Adhesives↗
PubMed1990

Enzyme release after elective cardioversion.

Electrical cardioversion is reported to be associated with some degree of skeletal muscle and myocardial damage. In the present study, total creatine kinase (S-CK) and the activity of the subunit S-CK-B activity have been measured in serum after elective cardioversion in 30 patients. The enzyme activity peaked during a 28-h observation period. S-CK increased from 72 +/- 6 (mean +/- SEM) Ul-1 (1.2 +/- 0.1 ukat l-1) to a maximal value of 990 +/- 258 u l-1 (16.5 +/- 4.3 ukat l-1) and S-CK-B (analysed as a measure of S-CK-MB) increased from 3.0 +/- 0.6 U l-1 (0.05 +/- 0.01 ukat l-1) to a maximum of 10.2 +/- 1.8 U l-1 (0.17 +/- 0.03 ukat l-1), with seven patients reaching a S-CK-B value above the discrimination limit for myocardial infarction. The relationship between S-CK and S-CK-B values, however, indicated a skeletal muscle origin of the enzyme release. The maximal activity of both S-CK (r = 0.79; P less than 0.001) and S-CK-B (r = 0.70; P less than 0.001) correlated positively to the cumulative delivered energy. Thus, the release of S-CK and S-CK-B after elective cardioversion is correlated to the cumulative energy delivered, indicating increased skeletal muscle damage with greater energy. If the S-CK activity curve is interpreted without access to the S-CK-B activity this might interfere with the diagnosis of myocardial infarction.

Atrial Fibrillation↗
PubMed1990

Resuscitation of hospitalized patients.

Effects of in-hospital resuscitations performed by a trained resuscitation team were studied over a 20-month period during which 1653 deaths were registered. Resuscitative attempts were made in 61 patients with a mean age of 71 years (range 0-86 years). The underlying disease was ischaemic heart disease in 38 cases and most arrests occurred in general wards. Twenty-one patients were initially resuscitated; 12, however, died after an average of 3.2 days while still in hospital. Nine patients were discharged and seven are still alive after two and a half years.

Coronary Disease↗
PubMed1990

Fetal responses to different intensity levels of vibroacoustic stimulation.

The fetal responses to three different intensity levels of vibroacoustic stimulation (mean 92, 103, and 109 dB) were investigated in 275 pregnant women between 32-42 weeks of gestation. A 103-dB and a 109-dB stimulation aroused fetal movements, perceived by the mother, significantly more often than did a 92-dB stimulation (P less than .05 and P less than .01, respectively). Fetal heart rate (FHR) accelerations occurred slightly more often at a 109-dB stimulation than at a 92-dB level, but the difference was not significant. In the second part of the study, the three modes of stimulation were compared under standardized conditions in ten normal patients. The immediate reaction concerning fetal body movements as measured by the mother or the observer and FHR accelerations were the same as described earlier. There was a significant delayed increase of fetal gross body movements after 8 minutes at the 103- and 109-dB stimulation levels. Thus, the fetal response to vibroacoustic stimulation changes with different intensity levels.

Acoustic Stimulation↗
PubMed1989

Energy requirement for early defibrillation.

The appropriate energy requirement for defibrillation of out-of-hospital ventricular fibrillation has been a matter of discussion. We analysed the effects of 360 J, 200 J or a combination of 200 and 360 J DC shocks given by ordinary manual defibrillators or semiautomatic defibrillators. 120 of 127 ventricular fibrillation episodes were converted by three or less 360 J DC shocks delivered by a manual defibrillator. All 28 ventricular fibrillation episodes were converted by an average of 1.9 DC shocks when 360 J were delivered by a semiautomatic defibrillator. 139 of 152 ventricular fibrillation episodes were converted by three or fewer 200 J DC shocks and 52 of 53 by 2 x 200 J followed, if needed, by 1 x 360 J DC shock delivered by the same semiautomatic defibrillator. Three or fewer 360 J DC shocks seems completely adequate for conversion of most episodes of out-of-hospital ventricular fibrillation. There is no difference in the result of defibrillation by manual and semiautomatic defibrillators.

Bioelectric Energy Sources↗
PubMed1989

One year's experience of early defibrillation in Stockholm.

The effects of resuscitation on patients who died suddenly out of hospital were evaluated after the introduction of early defibrillation performed by ambulance personnel using semi-automatic defibrillators. Resuscitation attempts were initiated in 548 patients during the 1-year study period. Mean ambulance delay was 7.5 min, 22% of the cardiac arrest patients had received bystander cardiopulmonary resuscitation (CPR). Sensitivity and specificity for the semi-automatic defibrillator in the interpretation of ventricular fibrillation was found to be 97 and 100% respectively. Only 28 (14%) of the 206 defibrillated patients regained circulation and were admitted for further hospital care. Only three survived to be discharged. Among the 342 patients in whom defibrillation was not indicated, 16 (5%) regained circulation and were admitted for further hospital care and one (0.3%) survived to be discharged. Semi-automatic defibrillators seem reliable, safe and inexpensive; however, the isolated addition of defibrillation to basal ambulance service seems to be inadequate in Stockholm. We need to evaluate what further resources are of importance to guarantee a successful outcome.

Ambulances↗
PubMed1989

Computerised evaluation of the electrocardiogram during and for a short period after gall bladder surgery.

Long-term ECG recording on tape (LTER) was performed in 32 consecutive patients undergoing cholecystectomy. Twenty-two of the patients recorded showed ST-segment changes during the per- and early post-operative period. ST-segment depression was the most common change seen in 17 patients; however, 12 patients showed ST-segment elevation. In only nine patients were the ST-segment changes seen to be associated with major changes in pulse or blood pressure. ST-segment changes were seen as frequently in patients with, as without, known cardiovascular disease. All patients had an uncomplicated postoperative course and no case of myocardial infarction was seen. ST-segment changes during elective surgery seem to be a common phenomenon. The etiology of the observed changes is not clear and its value in the detection of per- or postoperative myocardial ischemia needs to be further evaluated.

Aged↗
PubMed1987

Effects of early defibrillation of out-of-hospital cardiac arrest patients by ambulance personnel.

During the year of this study, the specially trained ambulance personnel initiated cardiopulmonary resuscitation in 307 out of hospital cardiac arrest patients. All arrests, regardless of aetiology, age or other circumstances, were studied. The mean age for the arrest patients was 66 years. The majority of arrests occurred in elderly patients at home. Although as many as 70% of the arrests were witnessed, cardiopulmonary resuscitation had been initiated in only 15% of patients before the arrival of the ambulance. One hundred and forty patients had rapid ventricular tachycardia or ventricular fibrillation when the ambulance arrived (mean delay of 7.8 +/- 3.7 min). The effects of defibrillation could be fully evaluated in 135 patients. QRS complexes, with a rate between 20 and 110 min-1, were seen after defibrillation in 94 patients, persistent asystole in 26 patients and persistent ventricular fibrillation, despite one or more 360 J DC shocks, in 15 patients. Nineteen of the 94 patients who had a return of QRS complexes also had a return of pulse shortly after defibrillation without further advanced life support measures, while another six patients had a return of pulse after further life support therapy. Six of the 32 ventricular fibrillation patients (19%) reached within 4 min and three of the 63 ventricular fibrillation patients (5%) reached between 4-8 min survived. An estimated 4.2 lives per 100,000 inhabitants a year were saved when early defibrillation was used as the only addition to the basic life support provided by the present ambulance service.

Adolescent↗
PubMed1987

Concise education of ambulance personnel in ECG interpretation and out of hospital defibrillation.

We describe an 8 hour training program for ambulance personnel in the management of cardiac arrest due to ventricular fibrillation or ventricular tachycardia. The effect of the program over a one year period is evaluated using ECG recordings and case records from the event. Emergency medical technicians manning three hospital-based ambulances were given an 8 hour theoretical and practical course followed by an examination. Fifty-nine emergency medical technicians went through the training; 52 passed the examination at the first attempt and 6 at the second (88% and 98%, respectively). The medical technicians started resuscitative procedures in 277 out of hospital cardiac arrest patients. 127 showed ventricular fibrillation at initiation of resuscitation and of these, 125 were given direct current cardioversion (DC shock) (98%). In 19 cases ventricular fibrillation persisted following defibrillation. In 9 cases no further defibrillation was attempted following our standard instructions; in the remaining 10 the ECG findings could not be interpreted by the technicians. Cardioversion was carried out in three cases, despite absence of ventricular fibrillation, one in desperation and two following misinterpretation of the ECG. A short training program for ambulance personnel seems to be sufficient with regard to the management of patients found in ventricular fibrillation and may be used by other ambulance services.

Allied Health Personnel↗
PubMed1987

Cardiac arrest in Stockholm with special reference to the ambulance organization.

During a one-year period all patients with cardiac arrest (CA) taken care of by three ambulances were studied. An incidence of 110 cardiac arrests/100,000 inhabitants/year was found. The majority of CAs affected the elderly and occurred during the day in their homes. The majority of CAs were witnessed but cardiopulmonary resuscitation (CPR) had been initiated by bystanders in only a few cases. The ambulance arrived within a mean time of 7.7 +/- 4.0 min. Forty-eight per cent of the CA patients showed ventricular tachycardia or ventricular fibrillation (VT/VF) on ambulance arrival. Patients with a prolonged ambulance delay showed a lower incidence of VT/VF than patients with a short delay. Patients in whom CPR had been initiated by bystanders showed a significantly higher incidence of VT/VF (67%) than unattended patients (45%). Bystander CPR was furthermore associated with an increased incidence of VT/VF in patients with prolonged ambulance delay. VT/VF was present at the time when the ambulance arrived in 86% of the CA patients who had received CPR from a bystander and were reached within 8 min by the ambulance.

Aged↗
PubMed1987

Prognosis and clinical follow-up of patients resuscitated from out-of hospital cardiac arrest.

A new organization has been formed in which ambulance personnel have been trained to recognize ventricular tachycardia and ventricular fibrillation (VF) and to defibrillate. Cardiac arrest (CA) occurred in 307 patients and 140 were defibrillated. Twenty-eight patients were resuscitated and admitted for further hospital care. A previous history of ischaemic heart disease was found in 24 patients. Twenty-two of the patients admitted were found to have VF, two asystole and four other rhythms. All 11 survivors regained circulation at the site of the CA. At the time of admission all but one of the patients were unconscious and one long-time survivor remained unconscious until the 5th day following admission. Seventeen patients died while still in hospital. In 16 cases a diagnosis of acute myocardial infarction was established, a further six had VF without evidence of acute myocardial infarction and six had other diagnoses. Ten out of the 11 survivors were still alive six months after discharge. Only one case of recurrent VF was seen during a median follow-up period of 16 months. Prolonged coma, especially in combination with convulsions, was associated with a poor prognosis, while early return of circulation was significantly more common among survivors. Ongoing medication with beta-blockers, a high QRS rate on admission and VF without proof of any acute myocardial infarction were also found to be more common in survivors.

Adult↗
PubMed1987

Cost of a saved life following out-of-hospital cardiac arrest resuscitated by specially trained ambulance personnel.

During a 1-year-study period three emergency ambulances manned by specially trained emergency medical technicians (EMTs) were successful in the resuscitation of 28 out-of-hospital cardiac arrest patients, who were admitted to hospital for further treatment. Nineteen patients died in hospital while nine were discharged to their homes, a survival rate corresponding to 3.5 saved lives per 100,000 inhabitants per year. The extra pre-hospital costs and the estimated costs for hospital treatment of the admitted patients amounted to 929,600 Swedish kronor (SEK). The program cost of the early defibrillation by trained EMTs accounted for only 12% of this amount, or 113,600 SEK. The cost of hospital treatment accounted for the remaining 88%, or 816,000 SEK. Intensive care accounted for 53% of the hospital costs, coronary care 4%, treatment in a general ward 33% and in a ward for rehabilitation or long-term care 10%. Non-survivors accounted for 58% of the hospital expenditure. The marginal prehospital cost (program cost) for each survivor was 12,622 SEK or approximately 1800 US dollars. The total cost per life saved was 103,000 SEK or approximately 14,700 US dollars. The estimated cost to each taxpayer of providing this extra emergency resource would be approximately 0.5 SEK a year.

Allied Health Personnel↗