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Winsö, Ola
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Publications (10 of 55) Show all publications
Talsi, O., Berggren, R. K., Johansson, G. & Winsö, O. (2019). A national survey on routines regarding sedation in Swedish intensive care units. Upsala Journal of Medical Sciences, 37(23), 3088-3096
Open this publication in new window or tab >>A national survey on routines regarding sedation in Swedish intensive care units
2019 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 37, no 23, p. 3088-3096Article in journal (Refereed) Published
Abstract [en]

Background: Previous studies concerning sedation in Swedish intensive care units (ICU) have shown variability in drug choices and strategies. Currently, there are no national guidelines on this topic. As an update to a Nordic survey from 2004, and as a follow-up to a recently introduced quality indicator from the Swedish Intensive Care Registry, we performed a national survey.

Methods: A digital survey was sent to the ICUs in Sweden, asking for sedation routines regarding hypnosedatives, analgosedatives, protocols, sedation scales, etc.

Results: Fifty out of 80 ICUs responded to the survey. All units used sedation scales, and 88% used the RASS scale; 80% used written guidelines for sedation. Propofol and dexmedetomidine were the preferred short-term hypnosedatives. Propofol, dexmedetomidine, and midazolam were preferred for long-term hypnosedation. Remifentanil, morphine, and fentanyl were the most frequently used agents for analgosedation.

Conclusions: All ICUs used a sedation scale, an increase compared with previous studies. Concerning the choice of hypno- and analgosedatives, the use of dexmedetomidine, clonidine, and remifentanil has increased, and the use of benzodiazepines has decreased since the Nordic survey in 2004.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Analgesics, intensive care, mechanical ventilation, sedation scale, sedatives
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-160299 (URN)10.1080/03009734.2019.1616339 (DOI)000469543300001 ()31119971 (PubMedID)
Available from: 2019-06-17 Created: 2019-06-17 Last updated: 2019-06-17Bibliographically approved
Kroger Dahlin, B.-I., Thurm, M., Winsö, O. & Ljungberg, B. (2019). Patient's QoL after open kidney surgery in a randomized study of spinal versus epidural analgesia in patients with renal cell carcinoma. Scandinavian journal of urology, 53, 17-17
Open this publication in new window or tab >>Patient's QoL after open kidney surgery in a randomized study of spinal versus epidural analgesia in patients with renal cell carcinoma
2019 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, p. 17-17Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Objective: This study was aimed to evaluate the patients perspectives, before and one month after surgery in patients treated with open surgery for renal cell carcinoma (RCC). Can effective perioperative analgesia be part of a multimodal approach to minimize morbidity and improve postoperative management [1].

Material and Methods: A total of 135 patients with RCC in all stages 2012-2015, were randomized to receive either spinal analgesia with clonidine, or epidural analgesia in addition to the general anesthesia: The patients were stratified according to surgical technique. Inclusion criteria: ASA score I-III, age >18 years, no chronic pain medication or cognitive disorders. The patients survey used was based on the EORTC QLQ-C30. Wilcoxon Signed Rank test and Mann-Whitney-U tests were used for statistical evaluation.

Results: A majority of the patients (117 of 135, 86%) responded to the survey. Patients groups treated with partial nephrectomy or radical nephrectomy, had significantly reduced physical and social functioning while emotional functioning improved postoperatively compared with preoperatively. In both surgical groups the patients reported significant negative financial difficulties postoperatively. Similar results was achieved for patients treated with either spinal or epidural anesthesia. The epidural group of patients experienced more negative social functioning but had an improved global health. When comparing the surgical procedures there was no significant difference in the quality of life parameters. However when comparing the analgesic groups, spinal anesthesia had significantly better physical and social functioning after surgery while the patients in the epidural group reported better global health.

Conclusion: Patients randomized to be treated with spinal analgesia with clonidine, had better physical and social functioning postoperatively than patients randomized to be treated with epidural analgesia.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-161601 (URN)10.1080/21681805.2019.1619285 (DOI)000472734500034 ()
Note

Supplement: 221

Special Issue: SI

Meeting Abstract: NO2-02

Available from: 2019-07-18 Created: 2019-07-18 Last updated: 2019-07-18Bibliographically approved
Winsö, O., Kral, J., Wang, W., Kralova, I., Abrahamsson, P., Johansson, G. & Blind, P.-J. (2018). Thoracic epidural anaesthesia reduces insulin resistance and inflammatory response in experimental acute pancreatitis. Upsala Journal of Medical Sciences, 123(4), 207-215
Open this publication in new window or tab >>Thoracic epidural anaesthesia reduces insulin resistance and inflammatory response in experimental acute pancreatitis
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2018 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 4, p. 207-215Article in journal (Refereed) Published
Abstract [en]

AIMS: The activity of the sympathetic nervous system (SNS) is crucial at an early stage in the development of an inflammatory reaction. A study of metabolic events globally and locally in the early phase of acute pancreatitis (AP), implying hampered SNS activity, is lacking. We hypothesized that thoracic epidural anaesthesia (TEA) modulates the inflammatory response and alleviates the severity of AP in pigs.

MATERIAL AND METHODS: The taurocholate (TC) group (n = 8) had only TC AP. The TC + TEA group (n = 8) had AP and TEA. A control group (n = 8) underwent all the preparations, without having AP or TEA. Metabolic changes in the pancreas were evaluated by microdialysis and by histopathological examination.

RESULTS: The relative increase in serum lipase concentrations was more pronounced in the TC group than in TC + TEA and control groups. A decrease in relative tissue oxygen tension (PtiO2) levels occurred one hour later in the TC + TEA group than in the TC group. The maintenance of normoglycaemia in the TC group required a higher glucose infusion rate than in the TC + TEA group. The relative decrease in serum insulin concentrations was most pronounced in the TC + TEA group.

CONCLUSION: TEA attenuates the development of AP, as indicated by changes observed in haemodynamic parameters and by the easier maintenance of glucose homeostasis. Further, TEA was associated with attenuated insulin resistance and fewer local pathophysiological events.

Place, publisher, year, edition, pages
Abingdon: Taylor & Francis, 2018
Keywords
Acute pancreatitis, epidural anaesthesia, insulin, microdialysis, sodium-taurocholic acid, sympathetic nervous system
National Category
Anesthesiology and Intensive Care Surgery
Identifiers
urn:nbn:se:umu:diva-153672 (URN)10.1080/03009734.2018.1539054 (DOI)000455702800003 ()30468105 (PubMedID)
Available from: 2018-11-26 Created: 2018-11-26 Last updated: 2019-02-25Bibliographically approved
Ljungberg, B., Thurm, M., Kröger Dahlin, B.-I. & Winsö, O. (2017). A randomized controlled study of spinal analgesia show improved surgical outcome after open nephrectomy for renal cell carcinoma as compared with epidural analgesia. Scandinavian journal of urology, 51, 47-47
Open this publication in new window or tab >>A randomized controlled study of spinal analgesia show improved surgical outcome after open nephrectomy for renal cell carcinoma as compared with epidural analgesia
2017 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, p. 47-47Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Surgical Therapy & New Technology
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-137998 (URN)000404615000057 ()
Note

Supplement: 220, Special Issue: SI, Meeting Abstract: 55

Available from: 2017-07-31 Created: 2017-07-31 Last updated: 2018-06-09Bibliographically approved
Jacobsson, S., Larsson, P., Johansson, G., Norberg, M., Wadell, G., Hallmans, G., . . . Söderberg, S. (2017). Leptin independently predicts development of sepsis and its outcome. Journal of Inflammation, 14, Article ID 19.
Open this publication in new window or tab >>Leptin independently predicts development of sepsis and its outcome
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2017 (English)In: Journal of Inflammation, ISSN 1476-9255, E-ISSN 1476-9255, Vol. 14, article id 19Article in journal (Refereed) Published
Abstract [en]

Background: Sepsis is a life-threatening condition and obesity is related to the clinical outcome. The underlying reasons are incompletely understood, but the adipocyte derived hormones leptin and adiponectin may be involved.

Methods: Patients aged 18 years or more with documented first time sepsis events were included in a nested case-referent study if they had participated in previous health surveys. Two matched referents free of known sepsis were identified. Circulating levels of leptin and adiponectin were determined in stored plasma, and their impact on a future sepsis event and its outcome was evaluated.

Results: We identified 152 patients (62% women) with a sepsis event and a previous participation in a health survey. Eighty-three % had also blood samples from the acute event. Hyperleptinemia at health survey associated with a future sepsis event (OR 1.77, 95% CI 1.04-3.00) and with hospital death. After adjustment for BMI leptin remained associated with sepsis in men, but not in women. High levels in the acute phase associated with increased risk for in hospital death in women (OR 4.18, 95% CI 1.17-15.00), while being protective in men (OR 0.05, 95% CI 0.01-0.48). Furthermore, leptin increased more from baseline to the acute phase in men than in women. Adiponectin did not predict sepsis and did not relate to outcome.

Conclusions: Hyperleptinemia independently predicted the development of sepsis and an unfavourable outcome in men, and inertia in the acute response related to worse outcome.

Place, publisher, year, edition, pages
London: BioMed Central, 2017
Keywords
Sepsis, Leptin, Adiponectin, Obesity, Case-referent study, Sex
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-140039 (URN)10.1186/s12950-017-0167-2 (DOI)000410649100001 ()28919840 (PubMedID)
Available from: 2017-10-05 Created: 2017-10-05 Last updated: 2019-05-23Bibliographically approved
Zickerman, C., Hult, A.-C., Hedlund, L. & Winsö, O. (2017). Midazolam is better than clonidine in preventing negative postoperative behaviour in children age 2-4. Acta Anaesthesiologica Scandinavica, 61(8), 976-977
Open this publication in new window or tab >>Midazolam is better than clonidine in preventing negative postoperative behaviour in children age 2-4
2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 976-977Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-138575 (URN)10.1111/aas.12941 (DOI)000407231100033 ()
Available from: 2017-09-29 Created: 2017-09-29 Last updated: 2018-06-09
Brändström, H., Sundelin, A., Hoseason, D., Sundström, N., Birgander, R., Johansson, G., . . . Haney, M. (2017). Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 25, Article ID 50.
Open this publication in new window or tab >>Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation
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2017 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, article id 50Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures. METHODS: A cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations. RESULTS: Approximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during 'flight' would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop 'inflight' related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile. DISCUSSION: These findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport. CONCLUSIONS: Very small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Air ambulance, Intracranial pressure, Pneumocephalus
National Category
Anesthesiology and Intensive Care Neurosciences Surgery Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-134974 (URN)10.1186/s13049-017-0394-9 (DOI)000401225800001 ()28499454 (PubMedID)
Available from: 2017-05-15 Created: 2017-05-15 Last updated: 2018-06-09Bibliographically approved
Thurm, M., Kröger Dahlin, B. I., Winsö, O. & Ljungberg, B. (2017). Spinal analgesia improves surgical outcome after open nephrectomy for renal cell carcinoma: a randomized controlled study. Scandinavian journal of urology, 51(4), 277-281
Open this publication in new window or tab >>Spinal analgesia improves surgical outcome after open nephrectomy for renal cell carcinoma: a randomized controlled study
2017 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, no 4, p. 277-281Article in journal (Refereed) Published
Abstract [en]

Objective: This study evaluated whether more effective perioperative analgesia can be part of a multimodal approach to minimizing morbidity and improving postoperative management after the open surgical approaches frequently used in the treatment of renal cell carcinoma (RCC). The aim of the study was to determine whether spinal anesthesia with clonidine can enhance postoperative analgesia, speed up mobilization and reduce the length of hospital stay (LOS).

Materials and methods: Between 2012 and 2015, 135 patients with RCC were randomized, in addition to general anesthesia, to receive either spinal analgesia with clonidine or epidural analgesia, stratified to surgical technique. Inclusion criteria were American Society of Anesthesiologists (ASA) score of III or less, age over 18 years and no chronic pain medication or cognitive disorders.

Results: The median LOS was 4 days for patients in the spinal group and 6 days in the epidural group (p = 0.001). There were no differences regarding duration of surgery, blood loss, RENAL score, tumor size or complications between the given analgesia methods. A limitation was that different anesthesiologists were responsible for administering spinal or epidural anesthesia, as in a real-world clinical situation.

Conclusions: In this randomized controlled study, spinal analgesia with clonidine was superior to continuous epidural analgesia in patients operated on with open nephrectomy, based on shorter LOS. A shorter LOS in the study group indicates faster mobilization and improved analgesia. Spinal analgesia did not carry more complications than epidural analgesia.

Keywords
Clonidine, epidural anesthesia, length of stay, nephrectomy, renal cell carcinoma, spinal anesthesia
National Category
Anesthesiology and Intensive Care Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-136672 (URN)10.1080/21681805.2017.1318300 (DOI)000405483400008 ()
Available from: 2017-06-21 Created: 2017-06-21 Last updated: 2018-06-09Bibliographically approved
Abrahamsson, P., Johansson, G., Åberg, A.-M., Winsö, O. & Blind, P. J. (2016). Outcome of microdialysis sampling on liver surface and parenchyma. Journal of Surgical Research, 200(2), 480-487
Open this publication in new window or tab >>Outcome of microdialysis sampling on liver surface and parenchyma
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2016 (English)In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 200, no 2, p. 480-487Article in journal (Refereed) Published
Abstract [en]

Background: To investigate whether surface microdialysis (μD) sampling in probes covered by a plastic film, as compared to noncovered and to intraparenchymatous probes, would increase the technique's sensitivity for pathophysiologic events occurring in a liver ischemia-reperfusion model. Placement of μD probes in the parenchyma of an organ, as is conventionally done, may cause adverse effects, e.g., bleeding, possibly influencing outcome.

Methods: A transient ischemia-reperfusion model of the liver was used in six anesthetized normoventilated pigs. μD probes were placed in the parenchyma and on the liver surface. Surface probes were either left uncovered or were covered by plastic film.

Results: Lactate and glucose levels were significantly higher in plastic film covered probes than in uncovered surface probes throughout the ischemic period. Glycerol levels were significantly higher in plastic film covered probes than in uncovered surface probes at 30 and 45 min into ischemia.

Conclusions: Covering the μD probe increases the sensibility of the μD–technique in monitoring an ischemic insult and reperfusion in the liver. These findings confirm that the principle of surface μD works, possibly replacing need of intraparenchymatous placement of μD probes. Surface μD seemingly allows, noninvasively from an organ's surface, via the extracellular compartment, assessment of intracellular metabolic events. The finding that covered surface μD probes allows detection of local metabolic changes earlier than do intraparenchymatous probes, merit further investigation focusing on μD probe design.

Keywords
Microdialysis, Liver, Ischemia, Reperfusion, Surface probe, Metabolism
National Category
Physiology Biomedical Laboratory Science/Technology Surgery
Identifiers
urn:nbn:se:umu:diva-112153 (URN)10.1016/j.jss.2015.09.009 (DOI)000366841500010 ()26505659 (PubMedID)
Available from: 2015-12-03 Created: 2015-12-03 Last updated: 2018-06-07Bibliographically approved
Sehlin, M., Winsö, O., Wadell, K. & Öhberg, F. (2015). Inspiratory Capacity as an Indirect Measure of Immediate Effects of Positive Expiratory Pressure and CPAP Breathing on Functional Residual Capacity in Healthy Subjects. Respiratory care, 60(10), 1486-1494
Open this publication in new window or tab >>Inspiratory Capacity as an Indirect Measure of Immediate Effects of Positive Expiratory Pressure and CPAP Breathing on Functional Residual Capacity in Healthy Subjects
2015 (English)In: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 60, no 10, p. 1486-1494Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Positive expiratory pressure (PEP) and CPAP are used to enhance breathing parameters such as functional residual capacity (FRC) in patients. Studies comparing effects of PEP and CPAP on FRC are few and variable. One reason for this may be that sophisticated equipment, not suitable in the clinical setting, is required. Because total lung capacity (TLC) consists of inspiratory capacity (IC) and FRC, a change in IC should result in a corresponding change in FRC given constant TLC. We aimed to evaluate the effects of different PEP and CPAP devices on IC as an indirect measure of induced changes in FRC from these devices in healthy subjects. METHODS: Twenty healthy subjects breathed with 2 PEP devices, a PEP mask (flow resistor) and a PEP bottle (threshold resistor), and 2 CPAP devices, a flow resistor and a threshold resistor, in a randomized order. The measurement sequence consisted of 30 breaths with an IC measurement performed before and immediately after the 30th breath while the subjects were still connected to the breathing device. Perceived exertion of the 30 breaths was measured with the Borg category ratio 10 scale. RESULTS: Three of the 4 breathing devices, the PEP mask and the 2 CPAP devices, significantly decreased IC (P <.001). Median perceived exertion was quite low for all 4 breathing devices, but the difference in perceived exertion among the different breathing devices was large. CONCLUSIONS: Provided that TLC is constant, we found that measurements of changes in IC could be used as an indirect measure of changes in FRC in healthy subjects. All investigated breathing devices except the PEP bottle decreased IC, as an indirect measure of increased FRC.

Place, publisher, year, edition, pages
Daedalus Enterprises, 2015
Keywords
Borg CR10 scale, Cpap, Pep, flow resistor, inspiratory capacity, threshold resistor
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-107028 (URN)10.4187/respcare.03872 (DOI)000362268600019 ()26152469 (PubMedID)
Available from: 2015-08-17 Created: 2015-08-17 Last updated: 2018-06-07Bibliographically approved
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