Carl-johan Jakobsen | Aarhus University (original) (raw)
Papers by Carl-johan Jakobsen
Colloids in cardiac surgery – friend or foe
Journal of Cardiothoracic and Vascular Anesthesia, 2017
Is Knowledge of Hemodynamics Really Dangerous?
Journal of Cardiothoracic and Vascular Anesthesia, 2016
Storage time of intraoperative transfused allogeneic red blood cells is not associated with new-onset postoperative atrial fibrillation in cardiac surgery
PloS one, 2017
Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atri... more Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC is associated with development of POAF. Pre-, per- and postoperative data were retrieved from the Western Denmark Heart Registry and local blood banks regarding patients who underwent coronary artery bypass surgery, valve surgery or combined procedures in Aalborg or Aarhus University Hospital during 2010-2014. Multiple logistic regression was used to determine the risk of POAF according to transfusion of RBC on the day of surgery. Furthermore, we determined trend in storage time of RBC according to risk of POAF using restricted cubic splines. Patients with a history of preoperative atrial fibrillation, patients who received transfusions preoperative and patients who died at the day of surgery were among exclude...
Early, dedicated follow-up and treatment of pleural effusions enhance the recovery rate after open cardiac surgery: results from a randomized, clinical trial
European Journal of Cardio-Thoracic Surgery, 2016
Recent studies conclude that cardiac surgery patients are prone to both mortality and morbidity i... more Recent studies conclude that cardiac surgery patients are prone to both mortality and morbidity in the weeks after discharge. Complications such as pleural and pericardial effusions may influence physical recovery due to symptoms such as dyspnoea, chest pain and fatigue. Dedicated follow-up and timely treatment of postoperative complications are suggested. A randomized, controlled intervention trial including 76 patients, in the ratio of 1 : 1. Patients scheduled for elective on-pump coronary artery bypass grafting and/or aortic valve replacement were eligible for inclusion. Patients were randomized to either standard postoperative care or complementary follow-up visits with clinical examinations, focused chest sonography and protocol-driven thoracentesis if applicable. Primary outcomes were the mean change in walking distance, peak expiratory flow and EuroQOL from baseline to 30 days after surgery. The mean difference in walking distance after 30 days was 15% (65 ± 22 m) between groups, P = 0.017. No differences were found in the peak expiratory flow or EuroQOL. In patients with pleural effusion, walking distance improved by 22% after thoracentesis (81 ± 42 m), P < 0.0001, and peak expiratory flow improved by 26% (1.1 ± 1.2 l/min), P < 0.001. Supplemental dedicated follow-up and treatment of postoperative effusions enhance recovery by 15% compared with standard care, measured by improvement in the walking distance 1 month after cardiac surgery. https://clinicaltrials.gov/ct2/show/NCT02045641. NCT02045641.
Remifentanil does not enhance fast-track possibilities compared to sufentanil in cardiac surgery – a randomized study☆
Journal of Cardiothoracic and Vascular Anesthesia, 2015
Progressive cost containment has resulted in a growing interest for fast-track cardiac surgery. V... more Progressive cost containment has resulted in a growing interest for fast-track cardiac surgery. Ventilation time and length of stay (LOS) in the intensive care unit (ICU) are important factors in patient turnover, a more efficient use of resources, and early patient mobilization. However, LOS in ICU is not an objective measure because, in addition to medical factors, patient discharge may be guided by logistics and policy, and thus more objective measures are warranted. The authors hypothesized that remifentanil compared with sufentanil would reduce ventilation time and LOS in the ICU and that remifentanil would have beneficial effects on the overall quality of recovery. A randomized, prospective study. Sixty patients scheduled for elective coronary artery bypass grafting with or without aortic valve replacement. A university hospital. Patients were assigned randomly to receive either remifentanil or sufentanil combined with propofol. Patients with ejection fraction<0.3, myocardial infarction within the last 4 weeks, diabetes, and severe pulmonary or arterial hypertension were excluded. The primary outcome variables were ventilation time and time to eligibility of discharge from the cardiac recovery unit. Secondary outcomes were actual LOS in the cardiac recovery unit and quality of recovery. The groups were comparable in selected demographics and perioperative parameters. There were no differences in ventilation time or eligible ICU discharge time between the groups. Remifentanil patients received more morphine than did the sufentanil patients during recovery (20 mg v 10 mg; p = 0.040). No difference was found in pharmacologic support or use of a pacemaker. In a fast-track protocol, remifentanil did not seem to be superior to a standard moderate- to high-dose sufentanil regimen.
The association between platelet transfusion and adverse outcomes after coronary artery bypass surgery
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2015
Previous research suggests that platelet transfusion is associated with adverse events after coro... more Previous research suggests that platelet transfusion is associated with adverse events after coronary artery bypass grafting (CABG). The aim of the current analysis was to verify this hypothesis. Data from 6745 consecutive patients undergoing CABG from 2006 through 2012 were collected. Patients receiving platelet transfusions intraoperatively or postoperatively in the intensive care unit were compared with control patients. To adjust for possible confounders, propensity score matching and conditional regression analyses were performed. Short-term outcomes were 30-day mortality, in-hospital myocardial infarction and stroke. Mid-term outcomes were 6-month mortality, and need for coronary angiography or repeat coronary revascularization within 6 months after surgery. Data were retrieved from the Western Denmark Heart Registry. Using propensity scores, 982 patients exposed to platelets were matched with 982 control patients. Platelet transfusion was associated with a higher rate of post...
Kronisk tromboembolisk pulmonal hypertension
Ugeskrift for laeger
Kontinuerlig måling af hjertets minutvolumen i den perioperative periode
Ugeskrift for laeger
[Atrial fibrillation after coronary artery bypass surgery. The significance of preoperative vagus modulation and ectopic atrial activity]
Ugeskrift for laeger
To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the r... more To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-hour Holter monitoring was analyzed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR-interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07/year (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or= 10 ectopic supraventricular beats/24 hour, relative risk 3.03 (1.05-8.72), and one or more event of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated preoperative cardiac vagal modulation, ectopic supraventr...
Low vagal tone and supreventricular ectopic activity predicts atrial fibrillation after coronary artery bypass grafting
European Heart Journal
Statin initiation and acute kidney injury following elective cardiovascular surgery: a population cohort study in Denmark
European Journal of Cardio-Thoracic Surgery, 2015
Acute kidney injury (AKI) is a serious complication of cardiac surgery. Statins may prevent post-... more Acute kidney injury (AKI) is a serious complication of cardiac surgery. Statins may prevent post-surgical AKI, yet methodological concerns about existing studies raise questions about the magnitude of a protective effect. We sought to determine the effect of initiating a statin prior to elective cardiac surgery on post-surgical AKI in a regional Danish surgical cohort. We identified adults who underwent cardiac surgery during 2006-11 using the Western Denmark Heart Registry. Presurgical medication use, pre- and post-surgical serum creatinine (sCr) measures, and other patient characteristics were obtained from Danish population-based registries. Post-surgical AKI was assessed using sCr measures within 5 days of surgery. The adjusted risk ratio (RR) of AKI and 95% confidence interval (CI) were estimated for patients who initiated a statin within 100 days prior to surgery compared with patients without prior statin use; long-term statin users were excluded to reduce healthy-user bias. Subanalyses were stratified by surgery type: coronary artery bypass grafting (CABG) and non-CABG surgeries. We identified 1929 CABG and 1775 non-CABG patients. AKI occurred in 25% of CABG and 28% of non-CABG surgeries, and in 29% of the non-users and 21% of the statin initiators. Half of CABG patients and 9% of non-CABG patients initiated a statin prior to surgery. The adjusted RRs for the effect of statin initiation on AKI were as follows: all surgeries combined, RR = 0.86 (95% CI: 0.74, 0.98); CABG, RR = 0.88 (0.74, 1.05); non-CABG RR = 0.87 (0.68, 1.11). Presurgical statin initiation is associated with a reduction in AKI risk after cardiac surgery.
30-DAY Mortality After Coronary Artery Bypass Grafting and Valve Surgery Has Greatly Improved Over the Last Decade, but the 1-YEAR Mortality Remains Constant
Annals of cardiac anaesthesia
European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control o... more European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was carried out to investigate whether the continued fall in short-term mortality reflects an actual improvement in late mortality, and subsequently, to investigate EuroSCORE as predictor of 1-year mortality. A population-based cohort study of 25,602 patients from a 12-year period from three public university hospitals undergoing coronary artery bypass grafting (CABG) or valve surgery. Analysis was carried out based on EuroSCORE, age and co-morbidity factors (residual EuroSCORE). During the period the average age increased from 65.1 ± 10.0 years to 68.9 ± 10.7 years (P < 0.001, one-way ANOVA), and the number of females increased from 26.0% to 28.2% (P = 0.0012, Chi-square test). The total EuroSCORE increased from 4.67 to 5.68 while the residual Euro...
[Cesarean section in severe double valvular disease]
Ugeskrift for laeger, Jan 29, 1996
During pregnancy haemodynamic changes are a stress to the cardiovascular system. Women with previ... more During pregnancy haemodynamic changes are a stress to the cardiovascular system. Women with previously asymptomatic cardiovascular disease may develop life-threatening cardiac failure because of the extra demands of pregnancy. Early diagnosis, close control and treatment during pregnancy, delivery and the postpartum period are essential. We report a case where a woman with a mitral stenosis and insufficiency of the mitral and aortic valves gave birth to a child by caesarian section.
[Loop formation of central venous catheters]
Ugeskrift for laeger, Jan 28, 1985
Effects of levosimendan in patients with left ventricular hypertrophy undergoing aortic valve replacement
Acta anaesthesiologica Scandinavica, 2015
Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac... more Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac surgery. This may be facilitated by an increased oxygen demand and diastolic dysfunction. Levosimendan augments haemodynamics without further oxygen consumption and improves echocardiographic indices of diastolic dysfunction. This study aimed to describe the haemodynamic effects of short-term pre- and intra-operative levosimendan infusion including advanced echocardiographic measures of diastolic and systolic heart function. The study was randomised, double-blinded and placebo-controlled performed at a single-centre university hospital. Patients with left ventricular hypertrophy and ejection fraction > 45% scheduled for single procedure aortic valve replacement were included and randomised to infusion of either levosimendan 0.1 μg/kg/min or placebo from 4 h before anaesthesia to the end of surgery. Outcome measures were echocardiographic indices of left ventricular diastolic function...
High thoracic epidural in cardiac anesthesia: a review
Seminars in cardiothoracic and vascular anesthesia, 2015
High thoracic epidural analgesia (HTEA) offers a distinctive opportunity to enhance postoperative... more High thoracic epidural analgesia (HTEA) offers a distinctive opportunity to enhance postoperative recovery for the thoracic surgery patient. In the modern hospital setting with day of admission surgery, the logistics of insertion of the epidural catheter has become increasingly difficult. The greatest limitation to its use might be the believed increased risk of epidural hematoma associated with anticoagulation during cardiopulmonary bypass. The aim of this review is to give an overview of complications and effect on outcomes with focus on cardiac performance and postoperative glycemic control and kidney function. Patients with epidurals may have improved postoperative pulmonary function and shorter ventilation time, while impact on length of stay in the intensive care unit and hospital is not as evident. HTEA is effective in pain management, attenuates perioperative stress and seems to improve postoperative blood glucose control. Whether HTEA improves recovery and facilitates fast-...
[Transesophageal echocardiography for registration of hemodynamics. A new tool in anesthesiology]
Ugeskrift for laeger, Jan 6, 1993
During the last ten years, transesophageal echocardiography has become an important tool for card... more During the last ten years, transesophageal echocardiography has become an important tool for cardiac monitoring. In other countries it is widely applied, especially in cardiac surgery, but the areas of application are still expanding. Transesophageal echocardiography is a non-invasive technique in contrast to most other methods available for monitoring central haemodynamics. The complication frequency is extremely low. However, correct therapeutic decisions depend on profound experience with the equipment and image interpretation. The scope of transoesophageal echocardiography as a new tool in haemodynamic monitoring is described in this paper together with preliminary results.
[Preoperative adrenergic beta receptor blockade and anesthesia. Effect on catecholamines, cardiovascular response and hemorrhage in hysterectomy]
Ugeskrift for laeger, Jan 22, 1993
The effects of a preoperative beta-adrenoceptor antagonist, metoprolol, on peroperative anxiety, ... more The effects of a preoperative beta-adrenoceptor antagonist, metoprolol, on peroperative anxiety, relaxation, general feeling, blood pressures and heart rate, were studied in patients undergoing orthopaedic surgery during epidural anesthesia. The study was double-blind and placebo controlled. Twenty non-consecutive patients were randomized to receive either metoprolol 100 mg or placebo orally 1-2 hours before anaesthesia. Patients receiving metoprolol scored statistically significantly better on anxiety, and general feeling. The average height of the epidural block was ThVIII. The average blood pressure was reduced by 5% during the first 45 minutes in both groups. The average maximum falls in mean blood pressure from preanaesthetic to the lowest measured after the epidural were 14% (metoprolol) and 7% (placebo). The heart rates were significantly lower after metoprolol. In conclusion, the patients felt subjectively better after metoprolol and no significant differences were found in blood pressure after metoprolol compared to placebo.
Low vagal tone and supraventricular ectopic activity predict atrial fibrillation and flutter after coronary artery bypass grafting
European heart journal, 1995
To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the r... more To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-h Holter monitoring was analysed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07.year-1 (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or = 10 ectopic supraventricular beats . 24 h-1, relative risk 3.03 (1.05-8.72), and one or more events of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated pre-operative cardiac vagal modulation, ectopic suprave...
[Massive gastrointestinal hemorrhage caused by metastases from a malignant melanoma]
Ugeskrift for laeger, Jan 10, 1983
Colloids in cardiac surgery – friend or foe
Journal of Cardiothoracic and Vascular Anesthesia, 2017
Is Knowledge of Hemodynamics Really Dangerous?
Journal of Cardiothoracic and Vascular Anesthesia, 2016
Storage time of intraoperative transfused allogeneic red blood cells is not associated with new-onset postoperative atrial fibrillation in cardiac surgery
PloS one, 2017
Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atri... more Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC is associated with development of POAF. Pre-, per- and postoperative data were retrieved from the Western Denmark Heart Registry and local blood banks regarding patients who underwent coronary artery bypass surgery, valve surgery or combined procedures in Aalborg or Aarhus University Hospital during 2010-2014. Multiple logistic regression was used to determine the risk of POAF according to transfusion of RBC on the day of surgery. Furthermore, we determined trend in storage time of RBC according to risk of POAF using restricted cubic splines. Patients with a history of preoperative atrial fibrillation, patients who received transfusions preoperative and patients who died at the day of surgery were among exclude...
Early, dedicated follow-up and treatment of pleural effusions enhance the recovery rate after open cardiac surgery: results from a randomized, clinical trial
European Journal of Cardio-Thoracic Surgery, 2016
Recent studies conclude that cardiac surgery patients are prone to both mortality and morbidity i... more Recent studies conclude that cardiac surgery patients are prone to both mortality and morbidity in the weeks after discharge. Complications such as pleural and pericardial effusions may influence physical recovery due to symptoms such as dyspnoea, chest pain and fatigue. Dedicated follow-up and timely treatment of postoperative complications are suggested. A randomized, controlled intervention trial including 76 patients, in the ratio of 1 : 1. Patients scheduled for elective on-pump coronary artery bypass grafting and/or aortic valve replacement were eligible for inclusion. Patients were randomized to either standard postoperative care or complementary follow-up visits with clinical examinations, focused chest sonography and protocol-driven thoracentesis if applicable. Primary outcomes were the mean change in walking distance, peak expiratory flow and EuroQOL from baseline to 30 days after surgery. The mean difference in walking distance after 30 days was 15% (65 ± 22 m) between groups, P = 0.017. No differences were found in the peak expiratory flow or EuroQOL. In patients with pleural effusion, walking distance improved by 22% after thoracentesis (81 ± 42 m), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001, and peak expiratory flow improved by 26% (1.1 ± 1.2 l/min), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001. Supplemental dedicated follow-up and treatment of postoperative effusions enhance recovery by 15% compared with standard care, measured by improvement in the walking distance 1 month after cardiac surgery. https://clinicaltrials.gov/ct2/show/NCT02045641. NCT02045641.
Remifentanil does not enhance fast-track possibilities compared to sufentanil in cardiac surgery – a randomized study☆
Journal of Cardiothoracic and Vascular Anesthesia, 2015
Progressive cost containment has resulted in a growing interest for fast-track cardiac surgery. V... more Progressive cost containment has resulted in a growing interest for fast-track cardiac surgery. Ventilation time and length of stay (LOS) in the intensive care unit (ICU) are important factors in patient turnover, a more efficient use of resources, and early patient mobilization. However, LOS in ICU is not an objective measure because, in addition to medical factors, patient discharge may be guided by logistics and policy, and thus more objective measures are warranted. The authors hypothesized that remifentanil compared with sufentanil would reduce ventilation time and LOS in the ICU and that remifentanil would have beneficial effects on the overall quality of recovery. A randomized, prospective study. Sixty patients scheduled for elective coronary artery bypass grafting with or without aortic valve replacement. A university hospital. Patients were assigned randomly to receive either remifentanil or sufentanil combined with propofol. Patients with ejection fraction&amp;amp;amp;lt;0.3, myocardial infarction within the last 4 weeks, diabetes, and severe pulmonary or arterial hypertension were excluded. The primary outcome variables were ventilation time and time to eligibility of discharge from the cardiac recovery unit. Secondary outcomes were actual LOS in the cardiac recovery unit and quality of recovery. The groups were comparable in selected demographics and perioperative parameters. There were no differences in ventilation time or eligible ICU discharge time between the groups. Remifentanil patients received more morphine than did the sufentanil patients during recovery (20 mg v 10 mg; p = 0.040). No difference was found in pharmacologic support or use of a pacemaker. In a fast-track protocol, remifentanil did not seem to be superior to a standard moderate- to high-dose sufentanil regimen.
The association between platelet transfusion and adverse outcomes after coronary artery bypass surgery
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2015
Previous research suggests that platelet transfusion is associated with adverse events after coro... more Previous research suggests that platelet transfusion is associated with adverse events after coronary artery bypass grafting (CABG). The aim of the current analysis was to verify this hypothesis. Data from 6745 consecutive patients undergoing CABG from 2006 through 2012 were collected. Patients receiving platelet transfusions intraoperatively or postoperatively in the intensive care unit were compared with control patients. To adjust for possible confounders, propensity score matching and conditional regression analyses were performed. Short-term outcomes were 30-day mortality, in-hospital myocardial infarction and stroke. Mid-term outcomes were 6-month mortality, and need for coronary angiography or repeat coronary revascularization within 6 months after surgery. Data were retrieved from the Western Denmark Heart Registry. Using propensity scores, 982 patients exposed to platelets were matched with 982 control patients. Platelet transfusion was associated with a higher rate of post...
Kronisk tromboembolisk pulmonal hypertension
Ugeskrift for laeger
Kontinuerlig måling af hjertets minutvolumen i den perioperative periode
Ugeskrift for laeger
[Atrial fibrillation after coronary artery bypass surgery. The significance of preoperative vagus modulation and ectopic atrial activity]
Ugeskrift for laeger
To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the r... more To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-hour Holter monitoring was analyzed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR-interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07/year (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or= 10 ectopic supraventricular beats/24 hour, relative risk 3.03 (1.05-8.72), and one or more event of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated preoperative cardiac vagal modulation, ectopic supraventr...
Low vagal tone and supreventricular ectopic activity predicts atrial fibrillation after coronary artery bypass grafting
European Heart Journal
Statin initiation and acute kidney injury following elective cardiovascular surgery: a population cohort study in Denmark
European Journal of Cardio-Thoracic Surgery, 2015
Acute kidney injury (AKI) is a serious complication of cardiac surgery. Statins may prevent post-... more Acute kidney injury (AKI) is a serious complication of cardiac surgery. Statins may prevent post-surgical AKI, yet methodological concerns about existing studies raise questions about the magnitude of a protective effect. We sought to determine the effect of initiating a statin prior to elective cardiac surgery on post-surgical AKI in a regional Danish surgical cohort. We identified adults who underwent cardiac surgery during 2006-11 using the Western Denmark Heart Registry. Presurgical medication use, pre- and post-surgical serum creatinine (sCr) measures, and other patient characteristics were obtained from Danish population-based registries. Post-surgical AKI was assessed using sCr measures within 5 days of surgery. The adjusted risk ratio (RR) of AKI and 95% confidence interval (CI) were estimated for patients who initiated a statin within 100 days prior to surgery compared with patients without prior statin use; long-term statin users were excluded to reduce healthy-user bias. Subanalyses were stratified by surgery type: coronary artery bypass grafting (CABG) and non-CABG surgeries. We identified 1929 CABG and 1775 non-CABG patients. AKI occurred in 25% of CABG and 28% of non-CABG surgeries, and in 29% of the non-users and 21% of the statin initiators. Half of CABG patients and 9% of non-CABG patients initiated a statin prior to surgery. The adjusted RRs for the effect of statin initiation on AKI were as follows: all surgeries combined, RR = 0.86 (95% CI: 0.74, 0.98); CABG, RR = 0.88 (0.74, 1.05); non-CABG RR = 0.87 (0.68, 1.11). Presurgical statin initiation is associated with a reduction in AKI risk after cardiac surgery.
30-DAY Mortality After Coronary Artery Bypass Grafting and Valve Surgery Has Greatly Improved Over the Last Decade, but the 1-YEAR Mortality Remains Constant
Annals of cardiac anaesthesia
European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control o... more European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was carried out to investigate whether the continued fall in short-term mortality reflects an actual improvement in late mortality, and subsequently, to investigate EuroSCORE as predictor of 1-year mortality. A population-based cohort study of 25,602 patients from a 12-year period from three public university hospitals undergoing coronary artery bypass grafting (CABG) or valve surgery. Analysis was carried out based on EuroSCORE, age and co-morbidity factors (residual EuroSCORE). During the period the average age increased from 65.1 ± 10.0 years to 68.9 ± 10.7 years (P < 0.001, one-way ANOVA), and the number of females increased from 26.0% to 28.2% (P = 0.0012, Chi-square test). The total EuroSCORE increased from 4.67 to 5.68 while the residual Euro...
[Cesarean section in severe double valvular disease]
Ugeskrift for laeger, Jan 29, 1996
During pregnancy haemodynamic changes are a stress to the cardiovascular system. Women with previ... more During pregnancy haemodynamic changes are a stress to the cardiovascular system. Women with previously asymptomatic cardiovascular disease may develop life-threatening cardiac failure because of the extra demands of pregnancy. Early diagnosis, close control and treatment during pregnancy, delivery and the postpartum period are essential. We report a case where a woman with a mitral stenosis and insufficiency of the mitral and aortic valves gave birth to a child by caesarian section.
[Loop formation of central venous catheters]
Ugeskrift for laeger, Jan 28, 1985
Effects of levosimendan in patients with left ventricular hypertrophy undergoing aortic valve replacement
Acta anaesthesiologica Scandinavica, 2015
Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac... more Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac surgery. This may be facilitated by an increased oxygen demand and diastolic dysfunction. Levosimendan augments haemodynamics without further oxygen consumption and improves echocardiographic indices of diastolic dysfunction. This study aimed to describe the haemodynamic effects of short-term pre- and intra-operative levosimendan infusion including advanced echocardiographic measures of diastolic and systolic heart function. The study was randomised, double-blinded and placebo-controlled performed at a single-centre university hospital. Patients with left ventricular hypertrophy and ejection fraction > 45% scheduled for single procedure aortic valve replacement were included and randomised to infusion of either levosimendan 0.1 μg/kg/min or placebo from 4 h before anaesthesia to the end of surgery. Outcome measures were echocardiographic indices of left ventricular diastolic function...
High thoracic epidural in cardiac anesthesia: a review
Seminars in cardiothoracic and vascular anesthesia, 2015
High thoracic epidural analgesia (HTEA) offers a distinctive opportunity to enhance postoperative... more High thoracic epidural analgesia (HTEA) offers a distinctive opportunity to enhance postoperative recovery for the thoracic surgery patient. In the modern hospital setting with day of admission surgery, the logistics of insertion of the epidural catheter has become increasingly difficult. The greatest limitation to its use might be the believed increased risk of epidural hematoma associated with anticoagulation during cardiopulmonary bypass. The aim of this review is to give an overview of complications and effect on outcomes with focus on cardiac performance and postoperative glycemic control and kidney function. Patients with epidurals may have improved postoperative pulmonary function and shorter ventilation time, while impact on length of stay in the intensive care unit and hospital is not as evident. HTEA is effective in pain management, attenuates perioperative stress and seems to improve postoperative blood glucose control. Whether HTEA improves recovery and facilitates fast-...
[Transesophageal echocardiography for registration of hemodynamics. A new tool in anesthesiology]
Ugeskrift for laeger, Jan 6, 1993
During the last ten years, transesophageal echocardiography has become an important tool for card... more During the last ten years, transesophageal echocardiography has become an important tool for cardiac monitoring. In other countries it is widely applied, especially in cardiac surgery, but the areas of application are still expanding. Transesophageal echocardiography is a non-invasive technique in contrast to most other methods available for monitoring central haemodynamics. The complication frequency is extremely low. However, correct therapeutic decisions depend on profound experience with the equipment and image interpretation. The scope of transoesophageal echocardiography as a new tool in haemodynamic monitoring is described in this paper together with preliminary results.
[Preoperative adrenergic beta receptor blockade and anesthesia. Effect on catecholamines, cardiovascular response and hemorrhage in hysterectomy]
Ugeskrift for laeger, Jan 22, 1993
The effects of a preoperative beta-adrenoceptor antagonist, metoprolol, on peroperative anxiety, ... more The effects of a preoperative beta-adrenoceptor antagonist, metoprolol, on peroperative anxiety, relaxation, general feeling, blood pressures and heart rate, were studied in patients undergoing orthopaedic surgery during epidural anesthesia. The study was double-blind and placebo controlled. Twenty non-consecutive patients were randomized to receive either metoprolol 100 mg or placebo orally 1-2 hours before anaesthesia. Patients receiving metoprolol scored statistically significantly better on anxiety, and general feeling. The average height of the epidural block was ThVIII. The average blood pressure was reduced by 5% during the first 45 minutes in both groups. The average maximum falls in mean blood pressure from preanaesthetic to the lowest measured after the epidural were 14% (metoprolol) and 7% (placebo). The heart rates were significantly lower after metoprolol. In conclusion, the patients felt subjectively better after metoprolol and no significant differences were found in blood pressure after metoprolol compared to placebo.
Low vagal tone and supraventricular ectopic activity predict atrial fibrillation and flutter after coronary artery bypass grafting
European heart journal, 1995
To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the r... more To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-h Holter monitoring was analysed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07.year-1 (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or = 10 ectopic supraventricular beats . 24 h-1, relative risk 3.03 (1.05-8.72), and one or more events of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated pre-operative cardiac vagal modulation, ectopic suprave...
[Massive gastrointestinal hemorrhage caused by metastases from a malignant melanoma]
Ugeskrift for laeger, Jan 10, 1983