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Pölkki A, Pekkarinen PT, Lahtinen P, Koponen T, Reinikainen M. Vasoactive Inotropic Score compared to the sequential organ failure assessment cardiovascular score in intensive care. Acta Anaesthesiol Scand 2023; 67:1219-1228. [PMID: 37278095 DOI: 10.1111/aas.14287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The cardiovascular component of the sequential organ failure assessment (cvSOFA) score may be outdated because of changes in intensive care. Vasoactive Inotropic Score (VIS) represents the weighted sum of vasoactive and inotropic drugs. We investigated the association of VIS with mortality in the general intensive care unit (ICU) population and studied whether replacing cvSOFA with a VIS-based score improves the accuracy of the SOFA score as a predictor of mortality. METHODS We studied the association of VIS during the first 24 h after ICU admission with 30-day mortality in a retrospective study on adult medical and non-cardiac emergency surgical patients admitted to Kuopio University Hospital ICU, Finland, in 2013-2019. We determined the area under the receiver operating characteristic curve (AUROC) for the original SOFA and for SOFAVISmax , where cvSOFA was replaced with maximum VIS (VISmax ) categories. RESULTS Of 8079 patients, 1107 (13%) died within 30 days. Mortality increased with increasing VISmax . AUROC was 0.813 (95% confidence interval [CI], 0.800-0.825) for original SOFA and 0.822 (95% CI: 0.810-0.834) for SOFAVISmax , p < .001. CONCLUSION Mortality increased consistently with increasing VISmax . Replacing cvSOFA with VISmax improved the predictive accuracy of the SOFA score.
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Affiliation(s)
- Anssi Pölkki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Pirkka T Pekkarinen
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pasi Lahtinen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koponen
- Department of Anaesthesiology and Intensive Care, North Karelia Central Hospital, Joensuu, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Adamski J, Weigl W, Musialowicz T, Lahtinen P, Reinikainen M. Predictors of treatment limitations in Finnish intensive care units. Acta Anaesthesiol Scand 2022; 66:526-538. [PMID: 35118641 DOI: 10.1111/aas.14035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies have examined the factors that predict the limitations of life-sustaining treatment (LST) to patients in intensive care units (ICUs). We aimed to identify variables associated with the decision of withholding of life support (WHLS) at admission, WHLS during ICU stay and the withdrawal of ongoing life support (WDLS). METHODS This retrospective observational study comprised 17,772 adult ICU patients who were included in the nationwide Finnish ICU Registry in 2016. Factors associated with LST limitations were identified using hierarchical logistic regression. RESULTS The decision of WHLS at admission was made for 822 (4.6%) patients, WHLS during ICU stay for 949 (5.3%) patients, and WDLS for 669 (3.8%) patients. Factors strongly predicting WHLS at admission included old age (adjusted odds ratio [OR] for patients aged 90 years or older in reference to those younger than 40 years was 95.6; 95% confidence interval [CI], 47.2-193.5), dependence on help for activities of daily living (OR, 3.55; 95% CI, 3.01-4.2), and metastatic cancer (OR, 4.34; 95% CI, 3.16-5.95). A high severity of illness predicted later decisions to limit LST. Diagnoses strongly associated with WHLS at admission were cardiac arrest, hepatic failure and chronic obstructive pulmonary disease. Later decisions were strongly associated with cardiac arrest, hepatic failure, non-traumatic intracranial hemorrhage, head trauma and stroke. CONCLUSION Early decisions to limit LST were typically associated with old age and chronic poor health whereas later decisions were related to the severity of illness. Limitations are common for certain diagnoses, particularly cardiac arrest and hepatic failure.
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Affiliation(s)
- Jan Adamski
- Department of Anaesthesiology and Intensive Care Faculty of Medical Sciences University of Warmia and Mazury in Olsztyn Olsztyn Poland
| | - Wojciech Weigl
- Anaesthesiology and Intensive Care Department of Surgical Sciences Akademiska Hospital Uppsala University Uppsala Sweden
| | - Tadeusz Musialowicz
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
| | - Pasi Lahtinen
- Anaesthesiology and Intensive Care Department Central Hospital of South Ostrobothnia Seinäjoki Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
- Faculty of Health Sciences School of Medicine Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
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Koponen T, Musialowicz T, Lahtinen P. Gelatin and the risk of acute kidney injury after cardiac surgery. Acta Anaesthesiol Scand 2022; 66:215-222. [PMID: 34811729 DOI: 10.1111/aas.14004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gelatin has been used as a plasma volume expander because of its ability to preserve intravascular volume more effectively than crystalloids. However, gelatin may have detrimental effects on kidney function and increase the risk of acute kidney injury (AKI). METHOD We investigated by retrospective analysis of prospectively collected data whether the administration of 4% succinyl gelatin is associated with an increased risk of AKI after cardiac surgery. We compared two propensity score-matched groups of 1,187 patients (crystalloid group and gelatin group). RESULTS The incidence of AKI was similar in both groups (gelatin 21% and crystalloid 20%) (p = 0.414). The incidence of moderate AKI (8% vs. 6%) was higher in the gelatin group, but there was no difference in mild or severe AKI. Postoperative serum creatine on the first (70 vs. 70 μmol L-1 , p = 0.689) or fourth (71 vs. 70, p = 0.313) postoperative day was similar between groups and there was no difference in the need for new renal replacement therapy (p = 0.999). Patients in the gelatin group received less crystalloids (2080 ml vs. 4130 ml, p = 0.001) and total fluids (3760 ml vs. 4180 ml, p = 0.001), their fluid balance was less positive (p = 0.001) and they required less vasoactive and inotropic medication (p = 0.001). Gelatin was not associated with increased mortality compared to the crystalloid group. CONCLUSION Gelatin was not associated with AKI after cardiac surgery.
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Affiliation(s)
- Timo Koponen
- Department of Anaesthesia and Intensive Care Medicine North Karelia Central Hospital Joensuu Finland
| | - Tadeusz Musialowicz
- Department of Anaesthesia and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
| | - Pasi Lahtinen
- Anesthesiology and Intensive Care Department Central Hospital of South Ostrobothnia Seinäjoki Finland
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Koponen T, Musialowicz T, Lahtinen P. Gelatin and the risk of bleeding after cardiac surgery. Acta Anaesthesiol Scand 2020; 64:1438-1445. [PMID: 32735701 DOI: 10.1111/aas.13677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gelatins has been used in cardiac surgery because of their ability to preserve intravascular volume better than crystalloids. Unfortunately, gelatin has been associated with impaired coagulation and hemostasis, that may cause increased bleeding. We investigated whether the administration of gelatin increases postoperative bleeding after cardiac surgery. METHODS Retrospective, observational single-center cohort study in the intensive care unit of a tertiary teaching hospital. Postoperative bleeding, chest tube drainage volume and consumption of blood products were compared between groups. RESULTS Cohort included 3067 consecutive patients who underwent cardiac surgery. First 1698 patients received gelatin (gelatin group), and 1369 patients did not (crystalloid group). The characteristics of the patients in the gelatin and crystalloid groups were comparable. Postoperative chest tube drainage was 18% (95% CI 11%-20%) greater during the first 12 hours (P < .001) and 15% (95% CI 7%-17%) greater during the first 24 hours (P < .001) in the gelatin group compared to the crystalloid group. Severe and massive postoperative bleeding was more common in the gelatin group compared to the crystalloid group (21% vs 16%, P < .001). Patients in the gelatin group received red blood cells (40% vs 20%, P < .001) and platelets (12% vs 8%, P < .001) more frequently than patients in the crystalloid group. However, the number of administered fresh-frozen plasma transfusions did not differ between the groups. CONCLUSION Gelatin may increase postoperative bleeding and the need for blood product transfusions after cardiac surgery.
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Affiliation(s)
- Timo Koponen
- Department of Anesthesia and Intensive Care Medicine North Karelia Central Hospital Joensuu Finland
| | - Tadeusz Musialowicz
- Department of Anesthesia and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
| | - Pasi Lahtinen
- Department of Anesthesia and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
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Adamski J, Weigl W, Lahtinen P, Reinikainen M, Kaminski T, Pietiläinen L, Musialowicz T. Intensive care patient survival after limiting life-sustaining treatment-The FINNEOL* national cohort study. Acta Anaesthesiol Scand 2020; 64:1144-1153. [PMID: 32329052 DOI: 10.1111/aas.13612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/11/2020] [Accepted: 04/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have examined survival in intensive care unit (ICU) patients after the restriction of life-sustaining treatment (LST). We aimed to analyse independent factors associated with hospital and 12-month survival rates in ICU patients after treatment restrictions. METHODS This retrospective observational study examined all patients treated in adult ICUs from 1 January 2016 until 31 December 2016 included in the Finnish ICU Registry. Multivariable logistic regression analysis was performed to explain the effect on survival. RESULTS Decisions to limit LST were made for 2444 patients (13.7%; 95% CI 13.2-14.2). ICU, hospital, and 12-month survival rates were 71% (95% CI 69-73), 49% (95% CI 47-51), and 24% (95% CI 22-26), respectively. In patients for whom life support was withheld, increased 12-month survival rates were associated with admission from the operating theatre (OR 1.9, 95% CI 1.1-3.4), good pre-hospital physical fitness (OR 4.7, 95% Cl 1.2-16.8) and being housed at home (OR 2.0, 95% Cl 1.4-2.8). Decreased survival rates were associated with admission from a hospital ward (OR 0.67, 95% Cl 0.5-0.9), higher comorbidity (OR 0.6, 95% Cl 0.4-0.9), cancer (OR 0.4, 95%CI 0.2-0.9), greater illness severity (SAPS II; OR 0.98, 95% Cl 0.98-0.99), and higher care intensity (TISS-76; OR 0.93, 95% Cl 0.92-0.95). CONCLUSION Survival among ICU patients with limited treatment was higher than expected. Advanced age was not associated with higher mortality, potentially because treatment restrictions may be set more easily for older patients.
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Affiliation(s)
- Jan Adamski
- Department of Intensive Care Medicine Satakunta Central Hospital Pori Finland
| | - Wojciech Weigl
- Anaesthesiology and Intensive Care Department of Surgical Sciences Uppsala University Hospital Uppsala Sweden
| | - Pasi Lahtinen
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
- Faculty of Health Sciences School of Medicine Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
| | - Tadeusz Kaminski
- Department of Intensive Care Medicine Central Hospital of Middle Ostrobothnia Kokkola Finland
| | - Laura Pietiläinen
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
| | - Tadeusz Musialowicz
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
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Valtola A, Morse JD, Florkiewicz P, Hautajärvi H, Lahtinen P, Musialowicz T, Anderson BJ, Ranta VP, Kokki H. Bioavailability of oxycodone by mouth in coronary artery bypass surgery patients - a randomized trial. J Drug Assess 2020; 9:117-128. [PMID: 32939317 PMCID: PMC7470105 DOI: 10.1080/21556660.2020.1797753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective Pain after coronary artery by-pass (CAB) surgery is severe. Analgesic administration by mouth is unreliable until after gastrointestinal function has recovered. We evaluated the bioavailability of oxycodone co-administered with naloxone by mouth in patients after CAB surgery using either a conventional extracorporeal circulation (CECC) or off-pump surgery (OPCAB). Methods Twenty-four patients, 50–73 years, 12 with CECC and 12 with OPCAB, were administered a 10/5 mg oxycodone-naloxone controlled-release tablet by mouth on the preoperative day and for the first seven postoperative days (PODs) thereafter. Blood samples were collected up to 24 h after the preoperative administration, and then randomly either on POD1 and POD3 or on POD2 and POD4. The oxycodone concentration in plasma was analyzed using liquid chromatography-mass spectrometry. Results On POD1 oxycodone absorption was markedly delayed in five of six patients after CECC and in all six patients after OPCAB surgery; median of tmax after CECC 630 [range 270–1420] minutes and after OPCAB 1020 [720–1410] minutes, compared to median of 120–315 min preoperatively and on POD2-POD4. The carry-over corrected AUC0–24 values on the PODs did not differ from the preoperative values, but were higher on POD3 compared with POD1 in both CECC and OPCAB groups. The rate and extent of oxycodone absorption equaled preoperative values on POD2 and onwards in patients with CAB surgery. Conclusions Bioavailability of oxycodone by mouth was similar after CAB surgery via CECC or having OPCAB. Data indicate that POD2 is an appropriate time to start oxycodone administration by mouth after CAB surgery.
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Affiliation(s)
- Antti Valtola
- Heart Centre, Kuopio University Hospital, Kuopio, Finland
| | - James D Morse
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Pawel Florkiewicz
- Department of Anesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
| | | | - Pasi Lahtinen
- Department of Anesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tadeusz Musialowicz
- Department of Anesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Brian J Anderson
- Department of Anesthesia, University of Auckland, Auckland, New Zealand
| | - Veli-Pekka Ranta
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Hannu Kokki
- School of Medicine, University of Eastern Finland, Kuopio, Finland
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Ellam S, Pitkänen O, Lahtinen P, Musialowicz T, Hippeläinen M, Hartikainen J, Halonen J. Impact of minimal invasive extracorporeal circulation on the need of red blood cell transfusion. Perfusion 2019; 34:605-612. [PMID: 31027452 DOI: 10.1177/0267659119842811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Minimal invasive extracorporeal circulation may decrease the need of packed red blood cell transfusions and reduce hemodilution during cardiopulmonary bypass. However, more data are needed on the effects of minimal invasive extracorporeal circulation in more complex cardiac procedures. We compared minimal invasive extracorporeal circulation and conventional extracorporeal circulation methods of cardiopulmonary bypass. METHODS A total of 424 patients in the minimal invasive extracorporeal circulation group and 844 patients in the conventional extracorporeal circulation group undergoing coronary artery bypass grafting and more complex cardiac surgery were evaluated. Age, sex, type of surgery, and duration of perfusion were used as matching criteria. Hemoglobin <80 g/L was used as red blood cell transfusion trigger. The primary endpoint was the use of red blood cells during the day of operation and the five postoperative days. Secondary endpoints were hemodilution (hemoglobin drop after the onset of perfusion) and postoperative bleeding from the chest tubes during the first 12 hours after the operation. RESULTS Red blood cell transfusions were needed less often in the minimal invasive extracorporeal circulation group compared to the conventional extracorporeal circulation group (26.4% vs. 33.4%, p = 0.011, odds ratio 0.72, 95% confidence interval 0.55-0.93), especially in coronary artery bypass grafting subgroup (21.3% vs. 35.1%, p < 0.001, odds ratio 0.50, 95% confidence interval 0.35-0.73). Hemoglobin drop after onset of perfusion was also lower in the minimal invasive extracorporeal circulation group than in the conventional extracorporeal circulation group (24.2 ± 8.5% vs. 32.6 ± 12.6%, p < 0.001). Postoperative bleeding from the chest tube did not differ between the groups (p = 0.808). CONCLUSION Minimal invasive extracorporeal circulation reduced the need of red blood cell transfusions and hemoglobin drop when compared to the conventional extracorporeal circulation group. This may have implications when choosing the perfusion method in cardiac surgery.
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Affiliation(s)
- Sten Ellam
- Department of Anesthesia and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Otto Pitkänen
- Department of Anesthesia and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Pasi Lahtinen
- Department of Anesthesia and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Tadeusz Musialowicz
- Department of Anesthesia and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Hippeläinen
- Heart Center, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari Halonen
- Heart Center, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
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Florkiewicz P, Musialowicz T, Hippeläinen M, Lahtinen P. Continuous Ropivacaine Infusion Offers No Benefit in Treating Postoperative Pain After Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:378-384. [DOI: 10.1053/j.jvca.2018.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 12/11/2022]
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Musialowicz T, Florkiewicz P, Hippeläinen M, Lahtinen P. Abstract PR320. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492717.43357.6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Florkiewicz P, Musialowicz T, Pitkänen O, Lahtinen P. The effect of two different doses of remifentanil on postoperative pain and opioid consumption after cardiac surgery--a randomized controlled trial. Acta Anaesthesiol Scand 2015; 59:999-1008. [PMID: 25900227 DOI: 10.1111/aas.12536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Remifentanil, an ultra-short-acting opioid, provides intensive analgesia without prolonged respiratory depression and is widely used in cardiac surgery. Diminished dosing may also offer stable hemodynamics, even during sternotomy and sternal retraction. However, increased postoperative pain and induced opioid tolerance after remifentanil dosing during abdominal surgery was reported. We tested whether remifentanil 0.3 μg/kg/min infusion increased postoperative opioid consumption and pain compared to 0.1 μg/kg/min dosing. METHODS Ninety coronary artery bypass grafting or heart valve surgery patients were randomized to remifentanil 0.1 μg/kg/min or 0.3 μg/kg/min infusions during surgery. All patients received oxycodone bolus 0.15 μg/kg postoperatively, and patient-controlled analgesia (PCA) with oxycodone thereafter. Postoperative pain was estimated thrice daily by visual analogue scale, and 48-h opioid consumption was recorded from the PCA-device. RESULTS Total remifentanil dosing was 64 μg/kg in the higher and 22 μg/kg in the lower dosing group during the 3-h cardiac operations. Mean postoperative opioid consumption was 107 (SD 36) mg in the lower and 104 (SD 33) mg in the higher dose remifentanil groups. Postoperative pain did not differ between groups, at rest or during deep breathing, at any time (P = 0.110 and 0.941, respectively). CONCLUSIONS Remifentanil 0.3 μg/kg/min infusion did not increase postoperative pain or opioid consumption after cardiac surgery compared to the 0.1 μg/kg/min infusion. Remifentanil infusion 0.1-0.3 μg/kg/min during cardiac surgery was safe, with no exaggerated postoperative pain or opioid consumption.
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Affiliation(s)
- P. Florkiewicz
- Department of Anesthesiology; Kuopio University Hospital; Kuopio Finland
| | - T. Musialowicz
- Department of Anesthesiology; Kuopio University Hospital; Kuopio Finland
| | - O. Pitkänen
- Department of Anesthesiology; Kuopio University Hospital; Kuopio Finland
| | - P. Lahtinen
- Department of Anesthesiology; Kuopio University Hospital; Kuopio Finland
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Lahtinen P, Pitkänen O, Musialowicz T. Levosimendan Increases Bleeding Risk After Heart Valve Surgery: A Retrospective Analysis of a Randomized Trial. J Cardiothorac Vasc Anesth 2014; 28:1238-42. [DOI: 10.1053/j.jvca.2014.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Indexed: 11/11/2022]
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Abstract
The production of nanopapers from nanocellulose suspensions by a papermaking-process and their utilization as organic solvent nanofiltration membranes is demonstrated.
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Affiliation(s)
- A. Mautner
- Department of Chemical Engineering
- Polymer & Composite Engineering (PaCE) Group
- Imperial College London
- SW7 2AZ London, UK
| | - K.-Y. Lee
- Department of Chemical Engineering
- University College London
- WC1E 7JE London, UK
- Polymer & Composite Engineering (PaCE) group
- Institute for Materials Chemistry and Research
| | - P. Lahtinen
- VTT Technical Research Centre of Finland
- FL-02044 Espoo, Finland
| | - M. Hakalahti
- VTT Technical Research Centre of Finland
- FL-02044 Espoo, Finland
| | - T. Tammelin
- VTT Technical Research Centre of Finland
- FL-02044 Espoo, Finland
| | - K. Li
- Department of Chemical Engineering
- Imperial College London
- SW7 2AZ London, UK
| | - A. Bismarck
- Department of Chemical Engineering
- Polymer & Composite Engineering (PaCE) Group
- Imperial College London
- SW7 2AZ London, UK
- Polymer & Composite Engineering (PaCE) group
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Hayrinen M, Mikkola T, Honkanen P, Lahtinen P, Paananen A, Blomqvist M. Biomechanical analysis of the jump serve in men's volleyball. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084558.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hayrinen M, Lehto H, Mikkola T, Honkanen P, Lahtinen P, Paananen A, Blomqvist M. Time analysis of men's and youth boy's top-level volleyball. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084558.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lahtinen P, Musialowicz T, Hyppölä H, Kiviniemi V, Kurola J. Reply to Letter: External jugular vein cannulation is irreplaceable in many situations. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lahtinen P, Musialowicz T, Hyppölä H, Kiviniemi V, Kurola J. Is external jugular vein cannulation feasible in emergency care? A randomised study in open heart surgery patients. Resuscitation 2009; 80:1361-4. [DOI: 10.1016/j.resuscitation.2009.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 08/24/2009] [Indexed: 11/25/2022]
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Lahtinen P, Kokki H, Hynynen M. Remifentanil Infusion Does Not Induce Opioid Tolerance After Cardiac Surgery. J Cardiothorac Vasc Anesth 2008; 22:225-9. [DOI: 10.1053/j.jvca.2007.07.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Indexed: 11/11/2022]
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Abstract
Background
Persistent chest pain may originate from cardiac surgery. Conflicting results have been reported on the incidence of persistent poststernotomy pain with considerable discrepancies between the retrospective reports and the one prospective study conducted to assess this pain. Therefore, the authors conducted a follow-up survey for the first 12 months after cardiac surgery in 213 patients who had a sternotomy.
Methods
The authors performed a prospective inquiry of acute and chronic poststernotomy pain both before and after cardiac surgery. Two hundred thirteen coronary artery bypass patients received a questionnaire preoperatively, 4 days postoperatively, and 1, 3, 6, and 12 months postoperatively. All patients were asked about their expectations, their preferences, and the location and intensity of postoperative pain.
Results
The return rates for the postal questionnaires were 203 (95%) and 186 (87%) after 1 and 12 months, respectively. Patients experienced more pain postoperatively at rest than they had expected to preoperatively. At rest, the worst actual postoperative pain was 6 (0-10), and the worst expected pain as assessed preoperatively was 5 (0-10) (P = 0.013). The worst reported postoperative pain was severe (numeric rating scale score 7-10) in 49% at rest, in 78% during coughing, and in 62% of patients on movement. One year after the operation, 26 patients (14%) reported mild chronic poststernotomy pain at rest, 1 patient (1%) had moderate pain, and 3 patients (2%) had severe pain. Upon movement, persistent pain was even more common: 45 patients (24%) had mild, 5 patients (3%) had moderate, and 7 patients (4%) had severe pain. Patients who experienced moderate to severe acute postoperative pain also reported any chronic poststernotomy pain (numeric rating scale score 1-10) more frequently.
Conclusions
Although common, the incidence of persistent pain after sternotomy was lower than previously reported. Also, reassuringly, 1 year after surgery this pain was mostly mild in nature both at rest and on movement.
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Affiliation(s)
- Pasi Lahtinen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, 70210 Kuopio, Finland.
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20
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Abstract
There are no studies evaluating S(+)-ketamine for pain management after sternotomy. In this prospective, randomized, double-blind, placebo-controlled clinical trial, we evaluated the efficacy and feasibility of S(+)-ketamine as an adjunctive analgesic after cardiac surgery. Ninety patients scheduled for elective coronary artery bypass grafting (CABG) were randomized to receive either a 75 microg/kg bolus of S(+)-ketamine followed by a continuous infusion of 1.25 microg . kg(-1) . min(-1) for 48 h (n = 44) or placebo (normal saline bolus and infusion) (n = 46). From the time of tracheal extubation, patients could access an opioid (oxycodone) via a patient-controlled analgesia device, and the cumulative oxycodone doses were measured over 48 h. Pain was evaluated on a visual analog scale three times daily. The quality of recovery, patient satisfaction with pain management, and adverse effects were recorded. The cumulative oxycodone consumption during the first 48 postoperative hours was less in the S(+)-ketamine group (103 +/- 44 mg) than in the placebo group (125 +/- 45 mg; mean difference, 22 mg; 95% confidence interval for the difference, 3-40 mg; P = 0.023). Pain scores did not differ between the groups at rest (P = 0.17) or during a deep breath (P = 0.23). Patient satisfaction was superior in S(+)-ketamine-treated patients: 26 (60%) of 44 in the S(+)-ketamine group compared with 16 (35%) of 46 in the placebo group were very satisfied with the analgesic management (P = 0.032). Nausea and vomiting were the most common adverse events, with similar frequencies in both groups. Four patients in the S(+)-ketamine group developed transient hallucinations during the infusion, versus none in the placebo group. In conclusion, small-dose S(+)-ketamine decreased opioid consumption in CABG patients during the first 48 h after surgery.
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Affiliation(s)
- Pasi Lahtinen
- Departments of *Anesthesiology and Intensive Care and ‡Surgery, Kuopio University Hospital, Kuopio, Finland; †Department of Pharmacology and Toxicology, Clinical Pharmacology, University of Kuopio, Kuopio, Finland; and §Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland
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21
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22
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Abstract
UNLABELLED Postoperative pain management after cardiac surgery has been mainly based on parenteral opioids. However, because opioids have numerous side effects, coadministration of non-opioid analgesics has been introduced as a method of reducing opioid dose. In this prospective, randomized, double-blinded study, we evaluated the efficacy of propacetamol, an IV administered prodrug of acetaminophen (paracetamol), as an adjunctive analgesic after cardiac surgery. Seventy-nine patients scheduled for elective coronary artery bypass grafting were randomized to receive either propacetamol 2 g (n = 40) or placebo (n = 39) IV in 6-h intervals for 72 h. From the time of extubation, patients had access to an opioid (oxycodone) via a patient-controlled analgesia device. Pain was evaluated on a visual analog scale four times daily, whereas respiratory function tests (forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and arterial blood gas measurements) were performed once a day. The prespecified primary efficacy variable (cumulative oxycodone consumption at the end of the 72-h postoperative period) was 123.5 mg (51.3 mg) (mean [SD]) in the propacetamol group and 141.8 mg (57.5 mg) in the placebo group (difference in mean, 18.3 mg = 13%; 95% confidence interval, 6.1-42.7 mg; P = 0.15). Pain scores did not differ between the groups at rest (P = 0.65) or during a deep breath (P = 0.72). The groups were also similar in terms of pulmonary function tests, postoperative bleeding, and hepatic function tests, and no significant differences were noted in the incidences of adverse effects. After completion of the study, apost hoc analysis was also performed analyzing the first 24 h as split into 6-h intervals. This analysis showed a significantly (P = 0.036) smaller consumption of oxycodone in the propacetamol group at 24 h (47.1 mg [20.7 mg] versus 57.9 mg [23.9 mg]; difference in mean, 10.8 mg; 95% confidence interval, 0.7-20.9 mg). In conclusion, propacetamol did not enhance opioid-based analgesia in coronary artery bypass grafting patients, nor did it decrease cumulative opioid consumption or reduce adverse effects within 3 days after surgery. However, post hoc analysis showed that oxycodone requirement was reduced within the first 24 h in the propacetamol group. IMPLICATIONS This is the first placebo-controlled study to investigate the efficacy of propacetamol as a complementary analgesic to opioids after cardiac surgery. Propacetamol did not enhance analgesia, nor did it decrease cumulative opioid consumption or reduce adverse effects in a dose of 2 g given every sixth hour for 3 days after surgery.
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Affiliation(s)
- Pasi Lahtinen
- Department of Anesthesia and Intensive Care and Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
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23
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Abstract
Gastric mucosal and arterial blood PCO2 must be known to assess mucosal perfusion by means of gastric tonometry. As end-tidal PCO2 (PE'CO2) is a function of arterial PCO2, the gradient between PE'CO2 and gastric mucosal PCO2 may reflect mucosal perfusion. We studied the agreement between two methods to monitor gut perfusion. We measured the difference between gastric mucosal PCO2 (air tonometry) and PE'CO2 (= DPCO2gas) and the difference between gastric mucosal PCO2 (saline tonometry) and arterial blood PCO2 (= DPCO2sal) in 20 patients with or without lung injury. DPCO2gas was greater than DPCO2sal but changes in DPCO2gas reflected changes in DPCO2sal. The bias between DPCO2gas and DPCO2sal was 0.85 kPa and precision 1.25 kPa. The disagreement between DPCO2gas and DPCO2sal increased with increasing dead space. We propose that the disagreement between the two methods studied may not be clinically important and that DPCO2gas may be a method for continuous estimation of splanchnic perfusion.
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Affiliation(s)
- A Uusaro
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland
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24
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Hendolin HI, Pääkönen ME, Alhava EM, Tarvainen R, Kemppinen T, Lahtinen P. Laparoscopic or open cholecystectomy: a prospective randomised trial to compare postoperative pain, pulmonary function, and stress response. Eur J Surg 2000; 166:394-9. [PMID: 10881952 DOI: 10.1080/110241500750008961] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Open cholecystectomy (OC) has been superseded by laparoscopic cholecystectomy (LC) for the treatment of cholelithiasis, although this fashion has not been validated by prospective studies. Our aim was to compare the two techniques. DESIGN Prospective, randomised, open study. SETTING University hospital, Finland. PATIENTS 49 patients who required cholecystectomy for cholelithiasis confirmed by ultrasound. INTERVENTIONS 49 patients were randomly allocated to LC (n = 27) or OC (n = 22): 25 and 22, respectively, eventually had the operation. LC was done using a four-trocar technique, and OC through a transverse right subcostal incision, as short as possible. MAIN OUTCOME MEASURES Length of hospital stay and the duration of the sick leave were the primary outcome measures. Secondary outcome measures were: postoperative pain evaluated by visual analogue scale (VAS) and the need for opioids; pulmonary function measured by forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak flow velocity (PEFV), and arterial oxygen tension (PaO2), and endocrine stress measured by plasma catecholamines, cortisol and glucose concentrations. RESULTS The median (range) hospital stay was significantly shorter after LC than OC, being 2.0 (1-15) compared with 4.5 (2-19) days p < 0.01. The duration of sick leave was also significantly shorter after LC than OC, being 14 (7-17) compared with 29 (4-34), p < 0.01. Patients had significantly less postoperative pain after LC than OC as reflected by the need for opioids. Pulmonary function and arterial oxygen tension deteriorated significantly less after LC than OC. The stress response was equal. There were three documented complications, one pneumonia after LC and two wound infections after OC. CONCLUSIONS LC gives significantly better results in terms of less postoperative pain, better pulmonary function, better arterial oxygenation, and shorter hospital stay and duration of sick leave.
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Affiliation(s)
- H I Hendolin
- Department of Anaesthesia, Kuopio University Hospital, Finland
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25
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Lehtinen M, Koivisto V, Lahtinen P, Lehtinen T, Aaran RK, Leinikki P. Phospholipase A2 activity is copurified together with herpes simplex virus-specified Fc receptor proteins. Intervirology 1988; 29:50-6. [PMID: 2838429 DOI: 10.1159/000150028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We purified Fc-binding proteins from herpes simplex virus (HSV)-infected Vero cells by using an inverse immunoaffinity column chromatography. Polyacrylamide gel electrophoresis analysis revealed a single, virus-specific 65-kd polypeptide both in HSV type 1- and HSV type 2-infected cell-derived preparations. A Ca2+-dependent phospholipase A2 activity was demonstrated to be associated with the viral Fc-binding proteins.
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Affiliation(s)
- M Lehtinen
- Institute of Biomedical Sciences, University of Tampere, Finland
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