Peter Frykholm - Academia.edu (original) (raw)

Papers by Peter Frykholm

Research paper thumbnail of Preoxygenation with high-flow nasal cannula versus face mask in morbidly obese patients

BJA: British Journal of Anaesthesia, Jul 1, 2020

Research paper thumbnail of Practical and societal implications of the potential anaesthesia-induced neurotoxicity: The Safetots perspective

Best Practice & Research Clinical Anaesthesiology, Mar 1, 2023

Research paper thumbnail of Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care

European Journal of Anaesthesiology, 2022

Current paediatric anaesthetic fasting guidelines have recommended conservative fasting regimes f... more Current paediatric anaesthetic fasting guidelines have recommended conservative fasting regimes for many years and have not altered much in the last decades. Recent publications have employed more liberal fasting regimes with no evidence of increased aspiration or regurgitation rates. In this first solely paediatric European Society of Anaesthesiology and Intensive Care (ESAIC) pre-operative fasting guideline, we aim to present aggregated and evidence-based summary recommendations to assist clinicians, healthcare providers, patients and parents. We identified six main topics for the literature search: studies comparing liberal with conservative regimens; impact of food composition; impact of comorbidity; the use of gastric ultrasound as a clinical tool; validation of gastric ultrasound for gastric content and gastric emptying studies; and early postoperative feeding. The literature search was performed by a professional librarian in collaboration with the ESAIC task force. Recommendations for reducing clear fluid fasting to 1 h, reducing breast milk fasting to 3 h, and allowing early postoperative feeding were the main results, with GRADE 1C or 1B evidence. The available evidence suggests that gastric ultrasound may be useful for clinical decision-making, and that allowing a 'light breakfast' may be well tolerated if the intake is well controlled. More research is needed in these areas as well as evaluation of how specific patient or treatment-related factors influence gastric emptying.

Research paper thumbnail of Preoperative weight loss, hypoglycaemia and ketosis in elective paediatric patients, preliminary results from a prospective observational study

BackgroundNew paediatric fasting guidelines allow free clear fluids up until one hour prior to su... more BackgroundNew paediatric fasting guidelines allow free clear fluids up until one hour prior to surgery. At the paediatric anaesthesia department of Uppsala University Hospital, children are fasted ...

Research paper thumbnail of Vascular access - guidance for success

Anaesthesia, Feb 25, 2016

Research paper thumbnail of Ephedrine to treat intraoperative hypotension in infants: what is the target?

BJA: British Journal of Anaesthesia, May 1, 2023

Research paper thumbnail of Effect of high‐flow nasal oxygen on postoperative oxygenation in obese patients: A randomized controlled trial

Health science reports, Apr 18, 2022

Research paper thumbnail of Can oxygen delivered into the nose (rather than through a face mask) improve oxygen levels at the start of anesthesia in obese patients undergoing surgery?

http://isrctn.com/, Oct 23, 2018

Research paper thumbnail of High‐flow nasal cannula versus face mask for preoxygenation in obese patients: A randomised controlled trial

Acta Anaesthesiologica Scandinavica, Aug 12, 2021

Preoxygenation efficacy with high‐flow nasal cannula (HFNC) in obese patients is not clearly esta... more Preoxygenation efficacy with high‐flow nasal cannula (HFNC) in obese patients is not clearly established. The primary aim of this study was to compare heated, humidified, high‐flow nasal cannula with face mask for preoxygenation in this population.

Research paper thumbnail of Preoperative fasting in children: review of existing guidelines and recent developments

BJA: British Journal of Anaesthesia, Mar 1, 2018

Research paper thumbnail of The Aura-Gain laryngeal mask for airway management in neonatal inguinal hernia surgery. A feasibility study

Upsala Journal of Medical Sciences, Mar 1, 2023

Research paper thumbnail of Gastric content assessed with gastric ultrasound in paediatric patients prescribed a light breakfast prior to general anaesthesia: A prospective observational study

Pediatric Anesthesia, Nov 2, 2019

Research paper thumbnail of Low flow and temperature

Pediatric Anesthesia, Jun 1, 2006

Research paper thumbnail of Letter to the Editor in response to “Find the real responders and improve the outcome of awake prone positioning”

Critical Care, Aug 4, 2021

Research paper thumbnail of An evaluation of the mixed pediatric unit for blood loss replacement in pediatric craniofacial surgery

Pediatric Anesthesia, Apr 23, 2017

Research paper thumbnail of Pro-Con Debate: 1- vs 2-Hour Fast for Clear Liquids Before Anesthesia in Children

Anesthesia & Analgesia, Aug 16, 2021

Perioperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gas... more Perioperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gastrointestinal contents. The current recommendations from the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC) are for a minimum 2-hour fast after ingestion of clear liquids before general anesthesia, regional anesthesia, or procedural sedation and analgesia. Nonetheless, in children, fasting guidelines also have consequences as regards to child and parent satisfaction, hemodynamic stability, the ability to achieve vascular access, and perioperative energy balance. Despite the fact that current guidelines recommend a relatively short fasting time for clear fluids of 2 hours, the actual duration of fasting time can be significantly longer. This may be the result of deficiencies in communication regarding the duration of the ongoing fasting interval as the schedule changes in a busy operating room as well as to poor parent and patient adherence to the 2-hour guidelines. Prolonged fasting can result in children arriving in the operating room for an elective procedure being thirsty, hungry, and generally in an uncomfortable state. Furthermore, prolonged fasting may adversely affect hemodynamic stability and can result in parental dissatisfaction with the perioperative experience. In this PRO and CON presentation, the authors debate the premise that reducing the nominal minimum fasting time from 2 hours to 1 hour can reduce the incidence of prolonged fasting and provide significant benefits to children, with no increased risks.

Research paper thumbnail of Introducing the 6-4-0 fasting regimen and the incidence of prolonged preoperative fasting in children

Pediatric Anesthesia, Nov 23, 2017

Research paper thumbnail of Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite

Pediatric Anesthesia, May 4, 2015

Research paper thumbnail of Awake Prone Positioning in Patients with Hypoxemic Respiratory Failure Due to COVID-19: The PROFLO Multicenter Randomized Clinical Trial

Research Square (Research Square), Apr 19, 2021

Research paper thumbnail of The application of forced oscillation technique and self-mixing laser interferometers during anesthesia and mechanical ventilation

Mechanical ventilation saves lives, but it is an intervention fraught with the potential for seri... more Mechanical ventilation saves lives, but it is an intervention fraught with the potential for serious complications. Prevention of these complications has become the focus of research and critical care in the last twenty years. This thesis presents the first use, or the application under new conditions, of three technologies that could contribute to optimization of mechanical ventilation.Optoelectronic plethysmography was used in Papers I and II for continuous assessment of changes in chest wall volume, configuration, and motion in the perioperative period. A forced oscillation technique (FOT) was used in Paper III to evaluate a novel positive end-expiratory pressure (PEEP) optimization strategy. Finally, in Paper IV, FOT in conjunction with an optical sensor based on a self-mixing laser interferometer (LIR) was used to study the oscillatory mechanics of the respiratory system and to measure the chest wall displacement.In Paper I, propofol anesthesia decreased end-expiratory chest wall volume (VeeCW) during induction, with a more pronounced effect on the abdominal compartment than on the rib cage. The main novel findings were an increased relative contribution of the rib cage to ventilation after induction of anesthesia, and the fact that the rib cage initiates post-apneic ventilation. In Paper II, a combination of recruitment maneuvers, PEEP, and reduced fraction of inspired oxygen, was found to preserve lung volume during and after anesthesia. Furthermore, the decrease in VeeCW during emergence from anesthesia, associated with activation of the expiratory muscles, suggested that active expiration may contribute to decreased functional residual capacity, during emergence from anesthesia.In the lavage model of lung injury studied in Paper III, a PEEP optimization strategy based on maximizing oscillatory reactance measured by FOT resulted in improved lung mechanics, increased oxygenation, and reduced histopathologic evidence of ventilator-induced lung injury.Paper IV showed that it is possible to apply both FOT and LIR simultaneously in various conditions ranging from awake quiet breathing to general anesthesia with controlled mechanical ventilation. In the case of LIR, an impedance map representing different regions of the chest wall showed reproducible changes during the different stages that suggested a high sensitivity of the LIR-based measurements.

Research paper thumbnail of Preoxygenation with high-flow nasal cannula versus face mask in morbidly obese patients

BJA: British Journal of Anaesthesia, Jul 1, 2020

Research paper thumbnail of Practical and societal implications of the potential anaesthesia-induced neurotoxicity: The Safetots perspective

Best Practice & Research Clinical Anaesthesiology, Mar 1, 2023

Research paper thumbnail of Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care

European Journal of Anaesthesiology, 2022

Current paediatric anaesthetic fasting guidelines have recommended conservative fasting regimes f... more Current paediatric anaesthetic fasting guidelines have recommended conservative fasting regimes for many years and have not altered much in the last decades. Recent publications have employed more liberal fasting regimes with no evidence of increased aspiration or regurgitation rates. In this first solely paediatric European Society of Anaesthesiology and Intensive Care (ESAIC) pre-operative fasting guideline, we aim to present aggregated and evidence-based summary recommendations to assist clinicians, healthcare providers, patients and parents. We identified six main topics for the literature search: studies comparing liberal with conservative regimens; impact of food composition; impact of comorbidity; the use of gastric ultrasound as a clinical tool; validation of gastric ultrasound for gastric content and gastric emptying studies; and early postoperative feeding. The literature search was performed by a professional librarian in collaboration with the ESAIC task force. Recommendations for reducing clear fluid fasting to 1 h, reducing breast milk fasting to 3 h, and allowing early postoperative feeding were the main results, with GRADE 1C or 1B evidence. The available evidence suggests that gastric ultrasound may be useful for clinical decision-making, and that allowing a 'light breakfast' may be well tolerated if the intake is well controlled. More research is needed in these areas as well as evaluation of how specific patient or treatment-related factors influence gastric emptying.

Research paper thumbnail of Preoperative weight loss, hypoglycaemia and ketosis in elective paediatric patients, preliminary results from a prospective observational study

BackgroundNew paediatric fasting guidelines allow free clear fluids up until one hour prior to su... more BackgroundNew paediatric fasting guidelines allow free clear fluids up until one hour prior to surgery. At the paediatric anaesthesia department of Uppsala University Hospital, children are fasted ...

Research paper thumbnail of Vascular access - guidance for success

Anaesthesia, Feb 25, 2016

Research paper thumbnail of Ephedrine to treat intraoperative hypotension in infants: what is the target?

BJA: British Journal of Anaesthesia, May 1, 2023

Research paper thumbnail of Effect of high‐flow nasal oxygen on postoperative oxygenation in obese patients: A randomized controlled trial

Health science reports, Apr 18, 2022

Research paper thumbnail of Can oxygen delivered into the nose (rather than through a face mask) improve oxygen levels at the start of anesthesia in obese patients undergoing surgery?

http://isrctn.com/, Oct 23, 2018

Research paper thumbnail of High‐flow nasal cannula versus face mask for preoxygenation in obese patients: A randomised controlled trial

Acta Anaesthesiologica Scandinavica, Aug 12, 2021

Preoxygenation efficacy with high‐flow nasal cannula (HFNC) in obese patients is not clearly esta... more Preoxygenation efficacy with high‐flow nasal cannula (HFNC) in obese patients is not clearly established. The primary aim of this study was to compare heated, humidified, high‐flow nasal cannula with face mask for preoxygenation in this population.

Research paper thumbnail of Preoperative fasting in children: review of existing guidelines and recent developments

BJA: British Journal of Anaesthesia, Mar 1, 2018

Research paper thumbnail of The Aura-Gain laryngeal mask for airway management in neonatal inguinal hernia surgery. A feasibility study

Upsala Journal of Medical Sciences, Mar 1, 2023

Research paper thumbnail of Gastric content assessed with gastric ultrasound in paediatric patients prescribed a light breakfast prior to general anaesthesia: A prospective observational study

Pediatric Anesthesia, Nov 2, 2019

Research paper thumbnail of Low flow and temperature

Pediatric Anesthesia, Jun 1, 2006

Research paper thumbnail of Letter to the Editor in response to “Find the real responders and improve the outcome of awake prone positioning”

Critical Care, Aug 4, 2021

Research paper thumbnail of An evaluation of the mixed pediatric unit for blood loss replacement in pediatric craniofacial surgery

Pediatric Anesthesia, Apr 23, 2017

Research paper thumbnail of Pro-Con Debate: 1- vs 2-Hour Fast for Clear Liquids Before Anesthesia in Children

Anesthesia & Analgesia, Aug 16, 2021

Perioperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gas... more Perioperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gastrointestinal contents. The current recommendations from the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC) are for a minimum 2-hour fast after ingestion of clear liquids before general anesthesia, regional anesthesia, or procedural sedation and analgesia. Nonetheless, in children, fasting guidelines also have consequences as regards to child and parent satisfaction, hemodynamic stability, the ability to achieve vascular access, and perioperative energy balance. Despite the fact that current guidelines recommend a relatively short fasting time for clear fluids of 2 hours, the actual duration of fasting time can be significantly longer. This may be the result of deficiencies in communication regarding the duration of the ongoing fasting interval as the schedule changes in a busy operating room as well as to poor parent and patient adherence to the 2-hour guidelines. Prolonged fasting can result in children arriving in the operating room for an elective procedure being thirsty, hungry, and generally in an uncomfortable state. Furthermore, prolonged fasting may adversely affect hemodynamic stability and can result in parental dissatisfaction with the perioperative experience. In this PRO and CON presentation, the authors debate the premise that reducing the nominal minimum fasting time from 2 hours to 1 hour can reduce the incidence of prolonged fasting and provide significant benefits to children, with no increased risks.

Research paper thumbnail of Introducing the 6-4-0 fasting regimen and the incidence of prolonged preoperative fasting in children

Pediatric Anesthesia, Nov 23, 2017

Research paper thumbnail of Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite

Pediatric Anesthesia, May 4, 2015

Research paper thumbnail of Awake Prone Positioning in Patients with Hypoxemic Respiratory Failure Due to COVID-19: The PROFLO Multicenter Randomized Clinical Trial

Research Square (Research Square), Apr 19, 2021

Research paper thumbnail of The application of forced oscillation technique and self-mixing laser interferometers during anesthesia and mechanical ventilation

Mechanical ventilation saves lives, but it is an intervention fraught with the potential for seri... more Mechanical ventilation saves lives, but it is an intervention fraught with the potential for serious complications. Prevention of these complications has become the focus of research and critical care in the last twenty years. This thesis presents the first use, or the application under new conditions, of three technologies that could contribute to optimization of mechanical ventilation.Optoelectronic plethysmography was used in Papers I and II for continuous assessment of changes in chest wall volume, configuration, and motion in the perioperative period. A forced oscillation technique (FOT) was used in Paper III to evaluate a novel positive end-expiratory pressure (PEEP) optimization strategy. Finally, in Paper IV, FOT in conjunction with an optical sensor based on a self-mixing laser interferometer (LIR) was used to study the oscillatory mechanics of the respiratory system and to measure the chest wall displacement.In Paper I, propofol anesthesia decreased end-expiratory chest wall volume (VeeCW) during induction, with a more pronounced effect on the abdominal compartment than on the rib cage. The main novel findings were an increased relative contribution of the rib cage to ventilation after induction of anesthesia, and the fact that the rib cage initiates post-apneic ventilation. In Paper II, a combination of recruitment maneuvers, PEEP, and reduced fraction of inspired oxygen, was found to preserve lung volume during and after anesthesia. Furthermore, the decrease in VeeCW during emergence from anesthesia, associated with activation of the expiratory muscles, suggested that active expiration may contribute to decreased functional residual capacity, during emergence from anesthesia.In the lavage model of lung injury studied in Paper III, a PEEP optimization strategy based on maximizing oscillatory reactance measured by FOT resulted in improved lung mechanics, increased oxygenation, and reduced histopathologic evidence of ventilator-induced lung injury.Paper IV showed that it is possible to apply both FOT and LIR simultaneously in various conditions ranging from awake quiet breathing to general anesthesia with controlled mechanical ventilation. In the case of LIR, an impedance map representing different regions of the chest wall showed reproducible changes during the different stages that suggested a high sensitivity of the LIR-based measurements.