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Publications (10 of 25) Show all publications
Bromfalk, Å., Hultin, M., Walldén, J., Myrberg, T. & Engström, Å. (2024). Perioperative staff’s experiences of premedication for children. Journal of Perianesthesia Nursing
Open this publication in new window or tab >>Perioperative staff’s experiences of premedication for children
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2024 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473Article in journal (Refereed) Accepted
National Category
Anesthesiology and Intensive Care Pediatrics
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:umu:diva-224419 (URN)
Available from: 2024-05-16 Created: 2024-05-16 Last updated: 2024-05-17
Bromfalk, Å., Hultin, M., Wallden, J. & Myrberg, T. (2023). Cardiorespiratory response to sedative premedication in preschool children: a randomized controlled trial comparing midazolam, clonidine, and dexmedetomidine. Journal of Perianesthesia Nursing, 38(3), 454-460
Open this publication in new window or tab >>Cardiorespiratory response to sedative premedication in preschool children: a randomized controlled trial comparing midazolam, clonidine, and dexmedetomidine
2023 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 38, no 3, p. 454-460Article in journal (Refereed) Published
Abstract [en]

Purpose: Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia.

Design: A single-center randomized controlled trial.

Methods: This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period.

Findings: The final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min–1, CLO 20.6±2.6 min–1, DEX 20.2±1.7 min–1; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min–1; CLO, 87.4±9.6 min–1; DEX, 87.6±7.9 min–1; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group.

Conclusions: When used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
cardiorespiratory, clonidine, dexmedetomidine, midazolam, pediatric anesthesia, premedication, sedation
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-203567 (URN)10.1016/j.jopan.2022.08.009 (DOI)001001763500001 ()36604221 (PubMedID)2-s2.0-85145714015 (Scopus ID)
Available from: 2023-01-19 Created: 2023-01-19 Last updated: 2024-05-16Bibliographically approved
Moraitis, A., Myrberg, T., Hultin, M., Nyström, H. & Walldén, J. (2023). Palonosetron as prophylaxis for post-discharge nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery. British Journal of Anaesthesia
Open this publication in new window or tab >>Palonosetron as prophylaxis for post-discharge nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery
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2023 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771Article in journal (Refereed) In press
Abstract [en]

BACKGROUND: Approximately 25% of ambulatory surgery patients experience post-discharge nausea and vomiting (PDNV). We aimed to investigate whether palonosetron, a long-acting anti-emetic, decreases the incidence of PDNV in high-risk patients.

METHODS: In this prospective, randomised, double-blind, placebo-controlled trial, 170 male and female patients undergoing ambulatory surgery under general anaesthesia, with a high predicted risk for PDNV, were randomised to receive either palonosetron 75 μg i.v. (n=84) or normal saline (n=86) before discharge. During the first 3 postoperative days (PODs), we measured outcomes using a patient questionanaire. The primary outcome was the incidence of a complete response (no nausea, vomiting, or use of rescue medication) until POD 2. Secondary outcomes included the incidence of PDNV each day until POD 3.

RESULTS: The incidence of a complete response until POD 2 was 48% (n=32) in the palonosetron group and 36% (n=25) in the placebo group (odds ratio 1.69 [95% confidence interval: 0.85-3.37]; P=0.131). No significant difference in the incidence of PDNV was observed between the two groups on the day of surgery (47% vs 56%; P=0.31). Significant differences in the incidence of PDNV were found on POD 1 (18% vs 34%; P=0.033) and POD 2 (9% vs 27%; P=0.007). No differences were observed on POD 3 (15% vs 13%; P=0.700).

CONCLUSIONS: Compared with placebo, palonosetron did not reduce the overall incidence of PDNV up to POD 2. The lower incidence of PDNV on POD 1 and POD 2 in the palonosetron group requires further investigation.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
5HT-3 antagonist, PDNV, PONV, ambulatory surgery, day-care surgery, palonosetron, post-discharge nausea and vomiting, prophylaxis
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-209021 (URN)10.1016/j.bja.2023.04.034 (DOI)37246062 (PubMedID)2-s2.0-85160219043 (Scopus ID)
Funder
Region VästernorrlandVisare Norr
Available from: 2023-06-02 Created: 2023-06-02 Last updated: 2023-06-07
Bromfalk, Å., Hultin, M., Myrberg, T., Engström, Å. & Walldén, J. (2023). Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine. Pediatric Anaesthesia, 33(11), 962-972
Open this publication in new window or tab >>Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine
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2023 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 33, no 11, p. 962-972Article in journal (Refereed) Published
Abstract [en]

Background: Preoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2–6 years.

Methods: In this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured.

Results: After excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups.

Conclusions: No statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2-agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.

Place, publisher, year, edition, pages
Wiley, 2023
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:umu:diva-212532 (URN)10.1111/pan.14740 (DOI)37528645 (PubMedID)2-s2.0-85166673433 (Scopus ID)
Funder
Region Västerbotten, RV-940554Region Västerbotten, RV-865681Norrbotten County Council, NLL-485451Norrbotten County Council, NLL-486841Norrbotten County Council, RN-785981
Available from: 2023-08-02 Created: 2023-08-02 Last updated: 2024-05-16Bibliographically approved
Lurati Buse, G. A., Mauermann, E., Ionescu, D., Szczeklik, W., De Hert, S., Filipovic, M., . . . MET: Reevaluation for Perioperative Cardiac Risk investigators, J. (2023). Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study. British Journal of Anaesthesia, 130(6), 655-665
Open this publication in new window or tab >>Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study
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2023 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 130, no 6, p. 655-665Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort tolerance improves prediction of major adverse cardiovascular events (MACEs) after noncardiac surgery.

METHODS: This is an international prospective cohort study (June 2017 to April 2020) in patients undergoing elective noncardiac surgery at elevated cardiovascular risk. Exposures were (i) questionnaire-estimated effort tolerance in metabolic equivalents (METs), (ii) number of floors climbed without resting, (iii) self-perceived cardiopulmonary fitness compared with peers, and (iv) level of regularly performed physical activity. The primary endpoint was in-hospital MACE consisting of cardiovascular mortality, non-fatal cardiac arrest, acute myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care or resulting in a prolongation of stay on ICU/intermediate care (≥24 h). Mixed-effects logistic regression models were calculated.

RESULTS: In this study, 274 (1.8%) of 15 406 patients experienced MACE. Loss of follow-up was 2%. All self-reported functional capacity measures were independently associated with MACE but did not improve discrimination (area under the curve of receiver operating characteristic [ROC AUC]) over an internal clinical risk model (ROC AUCbaseline 0.74 [0.71-0.77], ROC AUCbaseline+4METs 0.74 [0.71-0.77], ROC AUCbaseline+floors climbed 0.75 [0.71-0.78], AUCbaseline+fitnessvspeers 0.74 [0.71-0.77], and AUCbaseline+physical activity 0.75 [0.72-0.78]).

CONCLUSIONS: Assessment of self-reported functional capacity expressed in METs or using the other measures assessed here did not improve prognostic accuracy compared with clinical risk factors. Caution is needed in the use of self-reported functional capacity to guide clinical decisions resulting from risk assessment in patients undergoing noncardiac surgery.

CLINICAL TRIAL REGISTRATION: NCT03016936.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
cohort study, effort tolerance, functional capacity, major adverse cardiovascular events, noncardiac surgery, perioperative, postoperative complications, preoperative period, risk assessment
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-209019 (URN)10.1016/j.bja.2023.02.030 (DOI)37012173 (PubMedID)2-s2.0-85151415473 (Scopus ID)
Available from: 2023-06-02 Created: 2023-06-02 Last updated: 2023-06-02Bibliographically approved
Stenberg, Y., Rhodin, Y., Lindberg, A., Aroch, R., Hultin, M., Wallden, J. & Myrberg, T. (2022). Pre-operative point-of-care assessment of left ventricular diastolic dysfunction, an observational study. BMC Anesthesiology, 22(1), Article ID 96.
Open this publication in new window or tab >>Pre-operative point-of-care assessment of left ventricular diastolic dysfunction, an observational study
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2022 (English)In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 22, no 1, article id 96Article in journal (Refereed) Published
Abstract [en]

Background: Left ventricular (LV) diastolic dysfunction is an acknowledged peri-operative risk factor that should be identified before surgery. This study aimed to evaluate a simplified echocardiographic method using e’ and E/e’ for identification and grading of diastolic dysfunction pre-operatively.

Methods: Ninety six ambulatory surgical patients were consecutively included to this prospective observational study. Pre-operative transthoracic echocardiography was conducted prior to surgery, and diagnosis of LV diastolic dysfunction was established by comprehensive and simplified assessment, and the results were compared. The accuracy of e’-velocities in order to discriminate patients with diastolic dysfunction was established by calculating accuracy, efficiency, positive (PPV) and negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC).

Results: Comprehensive assessment established diastolic dysfunction in 77% (74/96) of patients. Of these, 22/74 was categorized as mild dysfunction, 43/74 as moderate dysfunction and 9/74 as severe dysfunction. Using the simplified method with e’ and E/e’, diastolic dysfunction was established in 70.8% (68/96) of patients. Of these, 8/68 was categorized as mild dysfunction, 36/68 as moderate dysfunction and 24/68 as severe dysfunction. To discriminate diastolic dysfunction of any grade, e’-velocities (mean < 9 cm s− 1) had an AUROC of 0.901 (95%CI 0.840–0.962), with a PPV of 55.2%, a NPV of 90.9% and a test efficiency of 0.78.

Conclusions: The results of this study indicate that a simplified approach with tissue Doppler e’-velocities may be used to rule out patients with diastolic dysfunction pre-operatively, but together with E/e’ ratio the severity of diastolic dysfunction may be overestimated.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Diastole, Left ventricular dysfunction, Point-of-care ultrasound, Prospective studies, Risk assessment, Tissue Doppler, Transthoracic echocardiography
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-194280 (URN)10.1186/s12871-022-01642-4 (DOI)000778706100003 ()35382761 (PubMedID)2-s2.0-85127625909 (Scopus ID)
Funder
Norrbotten County Council, NLL-733291
Available from: 2022-04-29 Created: 2022-04-29 Last updated: 2022-04-29Bibliographically approved
Johansson-Jänkänpää, E., Hultin, M., Myrberg, T. & Wallden, J. (2021). Early post-operative nausea and vomiting: A retrospective observational study of 2030 patients. Acta Anaesthesiologica Scandinavica, 65(9), 1229-1239
Open this publication in new window or tab >>Early post-operative nausea and vomiting: A retrospective observational study of 2030 patients
2021 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 65, no 9, p. 1229-1239Article in journal (Refereed) Published
Abstract [en]

Background: The overall risk of post-operative nausea and vomiting (PONV) after general anaesthesia is reportedly 20%–40%. The first episode of PONV may occur early in the post-anaesthesia care unit (PACU) or later at the ward or after discharge at home in an ambulatory setting. This study aimed to investigate and describe the risk of early PONV in a PACU, and we hypothesised that patients and perioperative factors were associated with early PONV.

Methods: This single-centre retrospective observational study was conducted in a Swedish county hospital from January to June 2017 and included adult patients who underwent surgical procedures under general anaesthesia. Perioperative data were obtained by reviewing the local registry for surgical procedures, medical records and anaesthesia and post-operative charts. Early PONV was defined as PONV occurring up to 4 hours post-operatively at the PACU. Any notification in the medical records, perioperative charts or the registry regarding nausea, vomiting or PONV treatment was regarded as PONV. Univariate and multivariate analyses were performed for factors associated with early PONV.

Results: A total of 2030 patients were included in the study, of which 9.6% (n = 194) experienced early PONV. Factors associated with a high risk of early PONV were suboptimal PONV prophylaxis, need for opioids, female sex, body mass index >35 kg m−2 and major surgery and anaesthesia time ≥60 minutes.

Conclusion: We found that every 10th patient under general anaesthesia experienced early PONV. Suboptimal PONV prophylaxis and previously acknowledged risk factors for PONV were associated with early PONV.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
observational study, post-anaesthesia care unit, post-operative nausea and vomiting
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-185907 (URN)10.1111/aas.13936 (DOI)000669405100001 ()34086350 (PubMedID)2-s2.0-85109093353 (Scopus ID)
Available from: 2021-07-12 Created: 2021-07-12 Last updated: 2023-03-24Bibliographically approved
Svensk, E., Tydén, J. & Wallden, J. (2021). Limitations of care and comorbidities are associated with increased mortality in patients treated with non-invasive ventilation: a retrospective observational study in a single-center ICU. F1000 Research, 10, Article ID 865.
Open this publication in new window or tab >>Limitations of care and comorbidities are associated with increased mortality in patients treated with non-invasive ventilation: a retrospective observational study in a single-center ICU
2021 (English)In: F1000 Research, E-ISSN 2046-1402, Vol. 10, article id 865Article in journal (Refereed) Published
Abstract [en]

Background: Non-invasive ventilation (NIV) is a common treatment for acute respiratory failure in intensive care units (ICU). While there is increasing data on outcomes after NIV treatment, there are large variations in staffing and monitoring where NIV is provided, making results hard to generalize. The aim of this study was to characterize patients treated with NIV, describe outcomes, and identify factors associated with outcome in an ICU at a Swedish county hospital.

Methods: A single-centre retrospective observational study during 2018 of patients treated with NIV in a six-bed ICU at a Swedish county hospital. Patient characteristics, including comorbidities, details of ICU stay, simplified acute physiology score (SAPS-3), details of NIV treatment and 30-day mortality were collected, and the Charlson co-morbidity index (CCI) was calculated. Primary outcomes were 30-day mortality and associated factors.

Results: 92 patients with mean age (71,3, SD 12,1) were treated with NIV during the study period. 42 (46%) were women. Median CCI was 3 (25th-75th percentiles 1.4)) and median SAPS-3 score was 66 (25th-75th percentiles 58). The 30-day mortality was 37% and in the univariate analysis, SAPS-3 score >66, Charlson comorbidity index, CCI>=3, pCO2 <5.5 and limitation of care were factors associated with increased 30-day mortality. pH <7.35 and pO2<8 at admission showed no associations with 30-day mortality.

Conclusions: We found that patients treated with NIV in ICU were a diverse population where comorbidities and presence of limitations of care might be considered as better predictors of 30-day mortality, rather than physiological parameters.

Place, publisher, year, edition, pages
F1000 Research Ltd, 2021
Keywords
Critical Care, Mortality, Noninvasive Ventilation, Withholding treatment
National Category
Anesthesiology and Intensive Care Neurology
Identifiers
urn:nbn:se:umu:diva-208054 (URN)10.12688/f1000research.53841.1 (DOI)2-s2.0-85153085559 (Scopus ID)
Available from: 2023-05-30 Created: 2023-05-30 Last updated: 2023-11-23Bibliographically approved
Bromfalk, Å., Myrberg, T., Walldén, J., Engström, Å. & Hultin, M. (2021). Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine. Pediatric Anaesthesia, 31(11), 1225-1233
Open this publication in new window or tab >>Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine
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2021 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 31, no 11, p. 1225-1233Article in journal (Refereed) Published
Abstract [en]

Introduction: Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2-6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation.

Patients and methods: In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2-6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively.

Results: Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group.

Conclusions: In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
anesthesiology, children, clinical trials, clonidine, dexmedetomidine, midazolam, premedication
National Category
Anesthesiology and Intensive Care Nursing Pediatrics
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-186941 (URN)10.1111/pan.14279 (DOI)000688432500001 ()34403548 (PubMedID)2-s2.0-85113382900 (Scopus ID)
Funder
Norrbotten County Council, NLL‐485451Norrbotten County Council, NLL‐486841Region Västerbotten, RV-865681Region Västerbotten, RV-932836Region Västerbotten, RV-940554
Available from: 2021-08-26 Created: 2021-08-26 Last updated: 2024-05-16Bibliographically approved
Stenberg, Y., Wallinder, L., Lindberg, A., Walldén, J., Hultin, M. & Myrberg, T. (2021). Preoperative Point-of-Care Assessment of Left Ventricular Systolic Dysfunction With Transthoracic Echocardiography. Anesthesia and Analgesia, 132(3), 717-725
Open this publication in new window or tab >>Preoperative Point-of-Care Assessment of Left Ventricular Systolic Dysfunction With Transthoracic Echocardiography
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2021 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 132, no 3, p. 717-725Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Left ventricular (LV) systolic dysfunction is an acknowledged perioperative risk factor and should be identified before surgery. Conventional echocardiographic assessment of LV ejection fraction (LVEF) obtained by biplane LV volumes is the gold standard to detect LV systolic dysfunction. However, this modality needs extensive training and is time consuming. Hence, a feasible point-of-care screening method for this purpose is warranted. The aim of this study was to evaluate 3 point-of-care echocardiographic methods for identification of LV systolic dysfunction in comparison with biplane LVEF.

METHODS: One hundred elective surgical patients, with a mean age of 63 ± 12 years and body mass index of 27 ± 4 kg/m, were consecutively enrolled in this prospective observational study. Transthoracic echocardiography was conducted 1-2 hours before surgery. LVEF was obtained by automatic two-dimensional (2D) biplane ejection fraction (EF) software. We evaluated if Tissue Doppler Imaging peak systolic myocardial velocities (TDISm), anatomic M-mode E-point septal separation (EPSS), and conventional M-mode mitral annular plane systolic excursion (MAPSE) could discriminate LV systolic dysfunction (LVEF <50%) by calculating accuracy, efficiency, correlation, positive (PPV) respective negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC) for each point-of-care method.

RESULTS: LVEF<50% was identified in 22% (21 of 94) of patients. To discriminate an LVEF <50%, AUROC for TDISm (mean <8 cm/s) was 0.73 (95% confidence interval [CI], 0.62-0.84; P < .001), with a PPV of 47% and an NPV of 90%. EPSS with a cutoff value of >6 mm had an AUROC 0.89 (95% CI, 0.80-0.98; P < .001), with a PPV of 67% and an NPV of 96%. MAPSE (mean <12 mm) had an AUROC 0.80 (95% CI, 0.70-0.90; P < 0.001) with a PPV of 57% and an NPV of 98%.

CONCLUSIONS: All 3 point-of-care methods performed reasonably well to discriminate patients with LVEF <50%. The clinician may choose the most suitable method according to praxis and observer experience.

Place, publisher, year, edition, pages
International Anesthesia Research Society, 2021
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-176730 (URN)10.1213/ANE.0000000000005263 (DOI)000639310500031 ()33177328 (PubMedID)2-s2.0-85102153271 (Scopus ID)
Available from: 2020-11-16 Created: 2020-11-16 Last updated: 2023-09-05Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-8171-5184

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