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Research paper thumbnail of Monitoring of cerebral blood flow autoregulation in adults undergoing sevoflurane anesthesia: a prospective cohort study of two age groups

Journal of clinical monitoring and computing, Jan 19, 2015

Autoregulation of blood flow is a key feature of the human cerebral vascular system to assure ade... more Autoregulation of blood flow is a key feature of the human cerebral vascular system to assure adequate oxygenation and metabolism of the brain under changing physiological conditions. The impact of advanced age and anesthesia on cerebral autoregulation remains unclear. The primary objective of this study was to determine the effect of sevoflurane anesthesia on cerebral autoregulation in two different age groups. This is a follow-up analysis of data acquired in a prospective observational cohort study. One hundred thirty-three patients aged 18-40 and ≥65 years scheduled for major noncardiac surgery under general anesthesia were included. Cerebral autoregulation indices, limits, and ranges were compared in young and elderly patient groups. Forty-nine patients (37 %) aged 18-40 years and 84 patients (63 %) aged ≥65 years were included in the study. Age-adjusted minimum alveolar concentrations of sevoflurane were 0.89 ± 0.07 in young and 0.99 ± 0.14 in older subjects (P < 0.001). Eff...

Research paper thumbnail of Faculty of 1000 evaluation for Markers of cerebral damage during delirium in elderly patients with hip fracture

F1000 - Post-publication peer review of the biomedical literature, 2009

Research paper thumbnail of Faculty of 1000 evaluation for Strokes after cardiac surgery and relationship to carotid stenosis

F1000 - Post-publication peer review of the biomedical literature, 2009

Research paper thumbnail of Faculty of 1000 evaluation for Association between the apolipoprotein E4 and postoperative cognitive dysfunction in elderly patients undergoing intravenous anesthesia and inhalation anesthesia

F1000 - Post-publication peer review of the biomedical literature, 2012

Research paper thumbnail of Faculty of 1000 evaluation for Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial

F1000 - Post-publication peer review of the biomedical literature, 2011

Research paper thumbnail of Faculty of 1000 evaluation for Increased oxygen administration improves cerebral oxygenation in patients undergoing awake carotid surgery

F1000 - Post-publication peer review of the biomedical literature, 2008

Research paper thumbnail of Faculty of 1000 evaluation for Continuous measurement of autoregulation by spontaneous fluctuations in cerebral perfusion pressure: comparison of 3 methods

F1000 - Post-publication peer review of the biomedical literature, 2008

Research paper thumbnail of Faculty of 1000 evaluation for Dexmedetomidine weakens dynamic cerebral autoregulation as assessed by transfer function analysis and the thigh cuff method

F1000 - Post-publication peer review of the biomedical literature, 2008

Research paper thumbnail of Faculty of 1000 evaluation for The effect of bispectral index monitoring on long-term survival in the B-aware trial

F1000 - Post-publication peer review of the biomedical literature, 2010

Research paper thumbnail of Faculty of 1000 evaluation for Pharmacological perioperative brain neuroprotection: a qualitative review of randomized clinical trials

F1000 - Post-publication peer review of the biomedical literature, 2013

Research paper thumbnail of Faculty of 1000 evaluation for Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial

F1000 - Post-publication peer review of the biomedical literature, 2008

Research paper thumbnail of Faculty of 1000 evaluation for Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study

F1000 - Post-publication peer review of the biomedical literature, 2009

Research paper thumbnail of Delirium auf der Intensivstation

Therapeutische Umschau, Apr 12, 2013

Research paper thumbnail of Variability in the duration of action of Succinylcholine

European Journal of Anaesthesiology, 2005

Research paper thumbnail of The Predictive Ability of Pre-Operative B-Type Natriuretic Peptide in Vascular Patients for Major Adverse Cardiac Events

Journal of the American College of Cardiology, 2011

The aims of this study were to perform an individual patient data meta-analysis of studies using ... more The aims of this study were to perform an individual patient data meta-analysis of studies using B-type natriuretic peptides (BNPs) to predict the primary composite endpoint of cardiac death and nonfatal myocardial infarction (MI) within 30 days of vascular surgery and to determine: 1) the cut points for a natriuretic peptide (NP) diagnostic, optimal, and screening test; and 2) if pre-operative NPs improve the predictive accuracy of the revised cardiac risk index (RCRI).

Research paper thumbnail of The influence of clinical risk factors on pre-operative B-type natriuretic peptide risk stratification of vascular surgical patients

Anaesthesia, 2012

The role of the revised cardiac risk index in risk stratification has recently been challenged by... more The role of the revised cardiac risk index in risk stratification has recently been challenged by studies reporting on the superior predictive ability of pre-operative B-type natriuretic peptides. We found that in 850 vascular surgical patients initially risk stratified using B-type natriuretic peptides, reclassification with the number of revised cardiac risk index risk factors worsened risk stratification (p < 0.05 for > 0, > 2, > 3 and > 4 risk factors, and p = 0.23 for > 1 risk factor). When evaluated with preoperative B-type natriuretic peptides, none of the revised cardiac risk index risk factors were independent predictors of major adverse cardiac events in vascular patients. The only independent predictor was B-type natriuretic peptide stratification (OR 5.1, 95% CI 1.8-15 for the intermediate class, and OR 25, 95% CI 8.7-70 for the high-risk class). The clinical risk factors in the revised cardiac risk index cannot improve a risk stratification model based on B-type natriuretic peptides.

Research paper thumbnail of Predictors of the variability in neuromuscular block duration following succinylcholine

European Journal of Anaesthesiology, 2015

BACKGROUND The duration of neuromuscular block (NMB) following succinylcholine administration is ... more BACKGROUND The duration of neuromuscular block (NMB) following succinylcholine administration is characterised by a high interindividual variability. However, this has not yet been quantified in a large sample of surgical patients. The significance of underlying clinical factors is unknown.

Research paper thumbnail of Altered Mental Status in Neurosurgical Critical Care

Essentials of Neurosurgical Anesthesia & Critical Care, 2011

Research paper thumbnail of Can postoperative cognitive dysfunction be avoided?

Hospital practice (1995), 2012

Postoperative cognitive dysfunction (POCD) refers to a postoperative decline in cognitive functio... more Postoperative cognitive dysfunction (POCD) refers to a postoperative decline in cognitive function compared with preoperative cognitive function. Diagnosis requires pre- and postoperative testing, the latter of which is usually performed both 7 days and 3 months postoperatively. Although several risk factors for POCD have been described, age is the only consistently reported risk factor. Postoperative cognitive dysfunction is often transient. It may last several months, and is associated with leaving the labor market prematurely and increased mortality. As the pathophysiology of POCD is still a matter of debate and is likely to be multifactorial, there are no widely accepted prophylactic and therapeutic interventions. In this article, we discuss POCD's definition, risk factors, long-term significance, and pathophysiology. We also present data on prophylactic interventions that have been investigated in clinical trials.

Research paper thumbnail of The Predictive Ability of Pre-Operative B-Type Natriuretic Peptide in Vascular Patients for Major Adverse Cardiac Events

Journal of the American College of Cardiology, 2011

The aims of this study were to perform an individual patient data meta-analysis of studies using ... more The aims of this study were to perform an individual patient data meta-analysis of studies using B-type natriuretic peptides (BNPs) to predict the primary composite endpoint of cardiac death and nonfatal myocardial infarction (MI) within 30 days of vascular surgery and to determine: 1) the cut points for a natriuretic peptide (NP) diagnostic, optimal, and screening test; and 2) if pre-operative NPs improve the predictive accuracy of the revised cardiac risk index (RCRI).

Research paper thumbnail of Monitoring of cerebral blood flow autoregulation in adults undergoing sevoflurane anesthesia: a prospective cohort study of two age groups

Journal of clinical monitoring and computing, Jan 19, 2015

Autoregulation of blood flow is a key feature of the human cerebral vascular system to assure ade... more Autoregulation of blood flow is a key feature of the human cerebral vascular system to assure adequate oxygenation and metabolism of the brain under changing physiological conditions. The impact of advanced age and anesthesia on cerebral autoregulation remains unclear. The primary objective of this study was to determine the effect of sevoflurane anesthesia on cerebral autoregulation in two different age groups. This is a follow-up analysis of data acquired in a prospective observational cohort study. One hundred thirty-three patients aged 18-40 and ≥65 years scheduled for major noncardiac surgery under general anesthesia were included. Cerebral autoregulation indices, limits, and ranges were compared in young and elderly patient groups. Forty-nine patients (37 %) aged 18-40 years and 84 patients (63 %) aged ≥65 years were included in the study. Age-adjusted minimum alveolar concentrations of sevoflurane were 0.89 ± 0.07 in young and 0.99 ± 0.14 in older subjects (P < 0.001). Eff...

Research paper thumbnail of Faculty of 1000 evaluation for Markers of cerebral damage during delirium in elderly patients with hip fracture

F1000 - Post-publication peer review of the biomedical literature, 2009

Research paper thumbnail of Faculty of 1000 evaluation for Strokes after cardiac surgery and relationship to carotid stenosis

F1000 - Post-publication peer review of the biomedical literature, 2009

Research paper thumbnail of Faculty of 1000 evaluation for Association between the apolipoprotein E4 and postoperative cognitive dysfunction in elderly patients undergoing intravenous anesthesia and inhalation anesthesia

F1000 - Post-publication peer review of the biomedical literature, 2012

Research paper thumbnail of Faculty of 1000 evaluation for Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial

F1000 - Post-publication peer review of the biomedical literature, 2011

Research paper thumbnail of Faculty of 1000 evaluation for Increased oxygen administration improves cerebral oxygenation in patients undergoing awake carotid surgery

F1000 - Post-publication peer review of the biomedical literature, 2008

Research paper thumbnail of Faculty of 1000 evaluation for Continuous measurement of autoregulation by spontaneous fluctuations in cerebral perfusion pressure: comparison of 3 methods

F1000 - Post-publication peer review of the biomedical literature, 2008

Research paper thumbnail of Faculty of 1000 evaluation for Dexmedetomidine weakens dynamic cerebral autoregulation as assessed by transfer function analysis and the thigh cuff method

F1000 - Post-publication peer review of the biomedical literature, 2008

Research paper thumbnail of Faculty of 1000 evaluation for The effect of bispectral index monitoring on long-term survival in the B-aware trial

F1000 - Post-publication peer review of the biomedical literature, 2010

Research paper thumbnail of Faculty of 1000 evaluation for Pharmacological perioperative brain neuroprotection: a qualitative review of randomized clinical trials

F1000 - Post-publication peer review of the biomedical literature, 2013

Research paper thumbnail of Faculty of 1000 evaluation for Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial

F1000 - Post-publication peer review of the biomedical literature, 2008

Research paper thumbnail of Faculty of 1000 evaluation for Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study

F1000 - Post-publication peer review of the biomedical literature, 2009

Research paper thumbnail of Delirium auf der Intensivstation

Therapeutische Umschau, Apr 12, 2013

Research paper thumbnail of Variability in the duration of action of Succinylcholine

European Journal of Anaesthesiology, 2005

Research paper thumbnail of The Predictive Ability of Pre-Operative B-Type Natriuretic Peptide in Vascular Patients for Major Adverse Cardiac Events

Journal of the American College of Cardiology, 2011

The aims of this study were to perform an individual patient data meta-analysis of studies using ... more The aims of this study were to perform an individual patient data meta-analysis of studies using B-type natriuretic peptides (BNPs) to predict the primary composite endpoint of cardiac death and nonfatal myocardial infarction (MI) within 30 days of vascular surgery and to determine: 1) the cut points for a natriuretic peptide (NP) diagnostic, optimal, and screening test; and 2) if pre-operative NPs improve the predictive accuracy of the revised cardiac risk index (RCRI).

Research paper thumbnail of The influence of clinical risk factors on pre-operative B-type natriuretic peptide risk stratification of vascular surgical patients

Anaesthesia, 2012

The role of the revised cardiac risk index in risk stratification has recently been challenged by... more The role of the revised cardiac risk index in risk stratification has recently been challenged by studies reporting on the superior predictive ability of pre-operative B-type natriuretic peptides. We found that in 850 vascular surgical patients initially risk stratified using B-type natriuretic peptides, reclassification with the number of revised cardiac risk index risk factors worsened risk stratification (p < 0.05 for > 0, > 2, > 3 and > 4 risk factors, and p = 0.23 for > 1 risk factor). When evaluated with preoperative B-type natriuretic peptides, none of the revised cardiac risk index risk factors were independent predictors of major adverse cardiac events in vascular patients. The only independent predictor was B-type natriuretic peptide stratification (OR 5.1, 95% CI 1.8-15 for the intermediate class, and OR 25, 95% CI 8.7-70 for the high-risk class). The clinical risk factors in the revised cardiac risk index cannot improve a risk stratification model based on B-type natriuretic peptides.

Research paper thumbnail of Predictors of the variability in neuromuscular block duration following succinylcholine

European Journal of Anaesthesiology, 2015

BACKGROUND The duration of neuromuscular block (NMB) following succinylcholine administration is ... more BACKGROUND The duration of neuromuscular block (NMB) following succinylcholine administration is characterised by a high interindividual variability. However, this has not yet been quantified in a large sample of surgical patients. The significance of underlying clinical factors is unknown.

Research paper thumbnail of Altered Mental Status in Neurosurgical Critical Care

Essentials of Neurosurgical Anesthesia & Critical Care, 2011

Research paper thumbnail of Can postoperative cognitive dysfunction be avoided?

Hospital practice (1995), 2012

Postoperative cognitive dysfunction (POCD) refers to a postoperative decline in cognitive functio... more Postoperative cognitive dysfunction (POCD) refers to a postoperative decline in cognitive function compared with preoperative cognitive function. Diagnosis requires pre- and postoperative testing, the latter of which is usually performed both 7 days and 3 months postoperatively. Although several risk factors for POCD have been described, age is the only consistently reported risk factor. Postoperative cognitive dysfunction is often transient. It may last several months, and is associated with leaving the labor market prematurely and increased mortality. As the pathophysiology of POCD is still a matter of debate and is likely to be multifactorial, there are no widely accepted prophylactic and therapeutic interventions. In this article, we discuss POCD's definition, risk factors, long-term significance, and pathophysiology. We also present data on prophylactic interventions that have been investigated in clinical trials.

Research paper thumbnail of The Predictive Ability of Pre-Operative B-Type Natriuretic Peptide in Vascular Patients for Major Adverse Cardiac Events

Journal of the American College of Cardiology, 2011

The aims of this study were to perform an individual patient data meta-analysis of studies using ... more The aims of this study were to perform an individual patient data meta-analysis of studies using B-type natriuretic peptides (BNPs) to predict the primary composite endpoint of cardiac death and nonfatal myocardial infarction (MI) within 30 days of vascular surgery and to determine: 1) the cut points for a natriuretic peptide (NP) diagnostic, optimal, and screening test; and 2) if pre-operative NPs improve the predictive accuracy of the revised cardiac risk index (RCRI).