Årsmøde 2013
14.-16. november
DASA IMs
Program
Udsigt fra Radisson Blu Scandinavia Hotel
Kongreshotel
Hotellet ligger på Islands Brygge, København, på Ny Tøjhusgrunden lige uden for Københavns volde først på Amager på adressen; Amager Boulevard 70, København (tlf. +45 3396 5000).
Nærmeste metrostation er Islands Brygge, der ligger ca. 5 minutters gang fra hotellet.
Udendørs parkering, sikret med elektronisk port.
Priser:
kl. 06:00 - 18:00 - 21,- DKK/time kl. 18:00 - 06:00 - 12,- DKK/time 24 timer - 190,- DKK
Kongresområde
Velkommen til DASAIMs Årsmøde 2013
Vi byder jer velkommen til DASAIMs Årsmøde 2013, der er det 12. i rækken i aktuelle udform ning. En stor tak til alle, der gennem årene har bidraget til at gøre mødet til en succes!
Som tidligere forløber mødet over 3 dage med forelæsninger, parallelsessioner, posterpræsentationer og foredragskonkurrence. DASAIMs bestyrelse og udvalg har sammen med organisationskomitéen sam- mensat programmet, der udover faglig opdatering også giver mulighed for diskussion i pauserne.
Vi vil gerne takke de mange, der stiller op som foredragsholdere og moderatorer, men også sponsorer og udstillere, hvis støtte giver et solidt økonomisk fundament for dette arrangement.
Acta Anaesthesiologica Scandinavica sponsorerer 1., 2. og 3. præmien til foredragskonkurrencen. Der- ud over har vi en publikumspris samt en pris for bedste poster. De heldige modtagere af præmier og priser vil være at finde blandt det store antal indsendte abstracts, nemlig 58.
Vi glæder os til at se jer!
Steen Møiniche, Vibeke Lind Jørgensen og Tina Calundann
Tak til vores hovedsponsorer
11.30 Indledning
v. moderator overlæge Marianne Kjær Jensen, Intensiv afdeling VITA, OUH
11.35 "Sleep in critically ill patients"
v. Professor Dimitris Georgopoulos, Department of Intensive Care Medicine, University Hospital of Heraklion, Grækenland
11.55 Kan man forbedre comfort for ITA patienterne
- kliniske erfaringer med dexdor® v. overlæge Dorthe Bülow Keld,
Hjertecentret, Århus Universitets Hospital, Skejby
12.10 Opsummering og diskussion
Fokus på ITA patientens komfort - I dag findes flere alternativer
Fr o k o st sy m p o si u m
Ambu A/S afholder workshop torsdag d. 14. november 2013 Workshop i fleksibel optisk intubation og bronkoskopi
En kombination af teoretisk gennemgang samt “hands on”-workshop
Undervisere:
Lars Konge, thoraxkirurg, overlæge, ph.d., klinisk lektor og Michael Friis Tvede, anæstesiolog, afdelingslæge
Program:
Fleksibel optisk intubation. Uundværlig del af anæstesiologens ”værktøjskasse”
v/ Michael Friis Tvede
Fleksibel bronkoskopi. Optimal prøvetagning og komplet rensugning v/ Lars Konge
Praktiske øvelser på fantomer med aScope 3 v/ Michael Friis Tvede og Lars Konge
For at optimere udbyttet for deltagerne vil der være et max. antal deltager pr. session på 16 personer.
Der bliver afviklet 3 sessioner á ca. 1½ times varighed: kl. 10.00-11.30, kl. 12.00-13.30 og 14.00-15.30
Workshoppen afholdes på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde 2013.
Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig ( www.dasaim.dk )
Denmark Room Casino Ballroom
Torsdag d. 14. november 2013
08.00 - Registrering
09.00 - 10.00 Sweden-Finland Room
Den 3. Ruben-forelæsning: Klinisk forskning er livsnødvendig v/ Anders Perner
Moderator: Susanne Wammen 10.00 - 10.30 Udstilling - kaffe
10.00 - 15.00 Casino Ballroom Workshop - Ambu (3 x 1½ time med start kl. 10, kl. 12 og kl. 14) 10.30 - 11.30 Norway Room
Clinical consequence of long term opioid use v/ Anthony Dickenson og Per Sjøgren Moderator: Eske Aasvang
Sweden Room
An update on AKI and RRT in the critically ill patient v/ H. Oudermans van Straaten
Moderator: Katrin Thormar og Morten Bestle Iceland Room
Optimering af kritisk syge børn før overflytning. Nyfødte og større børn før over - flytning til børneintensiv afdeling
v/ Ole Pedersen
Moderator: Mona Tarpgaard Finland Room
Terapeutisk hypotermi. Indikationer, outcome, TTM-studiet - Target temperature management after OHCA - rationale og evidens v/ Niklas Nielsen
- Advanced postresuscitation and survival after OHCA v/ Jesper Kjærgaard Moderatorer: Michael Wanscher og Jan Bonde
11.30 - 12.15 Denmark Room Frokostsymposium - Orion Pharma 11.30 - 12.30 Udstilling - sandwich og vand i udstillingsområdet
11.30 - 12.30 Bag posteren. Se den nye danske forskning og mød forskeren bag posteren 12.30 - 13.30 Sweden Room
Præhospital behandling af hovedtraumer v/ Vagn Eskesen
Moderator: Kim Garde Iceland Room
Kliniske etiske komitéer i Danmark v/ Mogens Skadborg
Moderator: Asger Petersen Norway Room
Why pain is not just pain - an insight to the workings of neuronal networks - et foredrag om modulering af smerte fra periferi til bevidsthed
v/ Anthony Dickenson Moderator: Eske Aasvang
... torsdag d. 14. november 2013
12.30 - 13.30 Finland Room
(fortsat) Miljø og kulturs betydning for speciallægers efteruddannelse set i lyset af ledelsernes krav om øget produktion
v/ Erik Jylling og Mette Krogh Christensen Moderator: Kirsten Bested og Karen Skjelsager 13.30 - 14.00 Udstilling - kaffe og frugt
14.00 - 15.30 Chairmans Room Posterdiskussion I
Moderatorer: Karsten Skovgaard Olsen og Erika F. Christensen abstract nr.
6 Præoperativ luftvejsvurdering i Danmark. Er der national konsensus?
v/ Anders Kehlet Nørskov
25 A pig model for monitoring intense neuromuscular blockade v/ Matias Vested Madsen
13 Failed Intubation in obstetric anaesthesia. A cohort study of patients registered in the Danish Anesthesia Database v/ Mette Gøttge Madsen 17 Klinisk praksis i brugen af oxytocin ved sectio i Danmark
v/ Bjarne Nordstrøm Kjær
24 Influence of neuromuscular blockade on surgical conditions during laparotomy. A pig model v/ Matias Vested Madsen
12 Routine preoperative focused ultrasonography in patients scheduled for acute surgery - a prospective cohort study
v/ Morten T. Bøtker
29 Patientoplevet paralyse ved anæstesiafslutning kan forhindres med neuromuskulær monitorering v/ Jakob Louis Thomsen
P Importance of adequate neuromuscular monitoring to avoid residual neuromuscular blockade v/ Jannike Cassel
Denmark Room Posterdiskussion II
Moderatorer: Jørgen B. Dahl og Ole Mathiesen abstract nr.
K Smerteperception ved systemisk inflammation hos veltrænede og utrænede raske forsøgspersoner v/ Susanne Janum
18 Cutaneous sensory block area after ultrasound-guided Transversus Abdominis Plane block in volunteers v/ Kion Bo Støving
30 Ultrasound-guided BD-TAP block for laparoscopic surgery due to acute appendicitis - the first prospective randomizedand double-blind study v/ Katrine Tanggaard
31 Ultrasound-duided block of the suprascapular nerve: A volunteer study of a new approach v/ Christian Rothe
32 Smerter og selvvurderet helbred hos danske soldater såret i Afghanistan v/ Jonas Duffy
36 Does hyperbaric oxygen therapy attenuate secondary hyperalgesia areas induced by a heat injury in humans?
v/ Vibe Maria Rasmussen
C Lidocaine patch (5%) in treatment of persistent inguinal
postherniorrhaphy pain: A randomized, double-blind, placebo-control- led, crossover trial v/ Joakim M. Bischoff
14.00 - 15.30 U Ultralydsvejledt Transmuskulær Quadratus Lumborum blokade efter (fortsat) elektiv laparoskopisk cholecystektomi. En randomiseret, dobbeltblindet
klinisk undersøgelse v/ Jonas Binzer Iceland Room
Posterdiskussion III
Moderatorer: Jacob Steinmetz og Ann Møller abstract nr.
16 Is paediatric trauma severity overestimated at field triage?
An observational follow-up study v/ Hien Quoc Do
23 Incidence of cardiac arrest before and after Rapid Response Team implementation - an observational study v/ Rikke Hein-Rasmussen 34 First hour quintet 1-1-2 callers and comorbidity
v/ Mikkel S. Andersen
G High trauma overtriage at regional hospital - 4-year retrospective study v/ L. Andreas H. Burén
S A biological Bayesian network for prediction of adverse outcome in a population of acutely ill patients triaged in the emergency department v/ Charlotte Barfod
14 Effect of Hydroxyethyl Starch 130/0.4 on renal function, blood pressure and vasoactive-hormones during hip replacement surgery.
A randomised controlled trial v/ Anne Sophie Pinholt Kancir
O Knowledge about treatment of anaphylaxis among Danish health care workers - a pilot study v/ Sandra Rosemarie Viggers
35 Use of blood samples from intraosseous access in the care of critically ill seems promising but lacks investigation: A systematic review v/ Tobias Stenbjerg Lyngeraa
Sweden Room Posterdiskussion IV
Moderatorer: Else Tønnesen og Palle Toft abstract nr.
3 Postoperative care pathways following emergency gastrointestinal surgery in 2,904 patients: A population-based cohort study v/ Morten Vester-Andersen
4 Outcomes in Type-2 diabetics after fast-track hip and knee arthroplasty v/ Christoffer C Jørgensen
7 Time of admission influences intrahospital delay and mortality in subarachnoid hemorrhage v/ Peter Martin Hansen
8 Den individuelle 30 dages overlevelse efter anæstesi og operation for akut hoftefraktur v/ Jens Jacob Krintel
I The association of perioperative dexamethasone, smoking, and alcohol abuse with wound complications after laparotomy - A post hoc analysis of a randomized clinical trial v/ Rikke M. Dahl
R Predicting a difficult central neuraxial block - an exercise of limited clinical value? A cohort study of 73,579 patients from the Danish Anaesthesia Database v/ Line Stendell
10 Effect of adductor canal block on pain after revision knee arthroplasty:
a randomized, double-blind, placebo-controlled study v/ Pia Jæger A Alcoholic delirium tremens treated with propofol infusion
v/ Kristian Lorentzen
... torsdag d. 14. november 2013
14.00 - 15.30 Norway Room (fortsat) Posterdiskussion V
Moderatorer: Morten Bestle og Anders Perner abstract nr.
1 Dynamic cerebral autoregulation is enhanced with no adverse effects of acute isocapnic hypoxia after lipopolysaccharide infusion in healthy volunteers v/ Ronan M. G. Berg
11 Fluid responsiveness is predicted by analysis of ventricular extra systoles v/ Simon Tilma Vistisen
15 Significance of preadmission quality of life for mortality in the ICU:
a prospective cohort study v/ Ramin I. Bukan
19 Transplantation efter ex vivo lunge perfusion. Erfaringer det første år i Danmark v/ Ian Sune I. Henriksen
20 Dextran-70 effect on kidney function and mortality in patients with septic shock v/ Rasmus Peter Jakobsen
26 Brain death causes release of histones followed by hypercoagulation and discordant loss of clot stability. Solulin partially corrects the hemostatic abnormalities v/ Christine Lodberg Hvas
27 Transcompartmental inflammatory responses in humans: intravenous versus endobronchial administration of endotoxin v/ Ronni R. Plovsing 33 Thrombelastography and mortality in severe sepsis
v/ Nicolai Haase Finland Room
Posterdiskussion VI
Moderatorer: Kirsten Møller og Hans Kirkegaard abstract nr.
37 Dobutamine does not offer sustained contractility in a piglet model of right ventricular failure v/ Janus Adler Hyldebrandt
E Muscle wasting in the ICU can be reliably monitored using ultrasound v/ Helene Korvenius Jørgensen
F Beneficial effects of treatment with ALM in a porcine endotoxemic model v/ Asger Granfeldt
H Intensiv overlevelse relateret til BMI v/ Ditte Gry Strange J Temperaturstigning ved systemisk inflammation hos utrænede og
veltrænede raske forsøgspersoner v/ Susanne Janum
M Serum and plasma neutrophil gelatinase associated lipocalin (NGAL) levels are not equivalent in patients admitted to intensive care v/ Theis Skovsgaard Itenov
N Inflammatory effects of remote ischaemic conditioning in a porcine kidney transplantation model v/ Niels Secher
Q Kvalitetssikringsprojekt: Ernæring hos neurointensive patienter v/ Marie Winther-Olesen
15.30 - 16.00 Udstilling - kaffe og kage 16.00 - 17.30 Norway Room
FYA-symposium Finland Room
DAO generalforsamling
... torsdag d. 14. november 2013
16.00 - 17.30 Iceland Room (fortsat) Forskningsinitiativet
Moderatorer: Nicolai Haase og Asger Granfeldt
- Sian Robinson. Forebyggelse af blodpropper hos patienter med akut nyresvigt på intensivafdeling (F.B.I.)
- Mohammad Sohail Ashgar. Måling af BOLD respons ved pin prick stimulation i sekundært hyperalgetisk område efter varmeskade. Et 3-Tesla MRI studie hos raske frivillige forsøgspersoner
- Susanne Janum. Det autonome nervesystems betydning ved systematisk inflamma- tion hos veltrænede og utrænede raske forsøgspersoner
- Niels Secher. Neurologisk dysfunktion efter hjertestop - et rottestudie
- Sisse A. Thomassen. Er der en sammenhæng mellem muskelvævs saturation vur- deret med near infrared spectroscopy og den regionale perfusion vurderet med PET- CT under forskellige blodflow ved brug af kardiopulmonal bypass?
- Signe Tellerup Nielsen. GLP-1 hos kritisk syge patienter indlagt på intensiv afdeling:
lykæmisk, metabolisk, hormonel og antiflammatorisk betydning Sweden Room
DADv/ Kristian Antonsen Moderator: Kim Garde 17.30 - 19.00 Casino Ballroom Middag
19.00 - 22.30 Norway Room DASAIMs generalforsamling
... torsdag d. 14. november 2013
Octapharma afholder frokostsymposium fredag d. 15. november 2013 Octaplex® - where and how to use a PCC product
Chaired by professor Pär Johansson, Denmark
Program:
The Danish guideline from DSKI, how to treat at massive bleeding v/ professor Pär Johansson, Denmark Usage of PCC, also in relation with the NOAC’s (European guidelines) v/ professor Pierre Sié, France Clinical experience in use of PCCs v/ professor James O’donnell, Ireland
Frokostsymposiet afholdes på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde 2014.
Der vil være frokost i tilknytning til symposiet. Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig (www.dasaim.dk).
Denmark Room
07.30 Registrering 08.00 - 08.30 Norway Room
Perioperativ væskebehandling af børn v/ Jens Aage Kølsen Petersen Moderator: Jane Andersen Sweden Room
Sedation af kritisk syge patienter - en opdatering på sidste nye studier og præsentation af nyt multicenterstudie
v/ Palle Toft
Moderator: Thomas Strøm Denmark Room
Smertebehandling ved praktiserende anæstesiologer v/ Gitte Handberg
Moderator: Stephan Alpiger Iceland Room
Etiske overvejelser i forbindelse med arbejdet på RCØ v/ Michael Laub
Moderator: Asger Bendtsen 08.30 - 09.00 Udstilling - kaffe
09.00 - 09.30 Denmark Room
Gravide og fødende i AK-behandling, hvad så?
v/ Thomas Bergholt
Moderator: Mette Gøttge Madsen Norway Room
Nye skandinaviske retningslinjer for behandling af lette og moderate hovedtraumer
v/ Vagn Eskesen Moderator: Niels Juul Iceland Room
Orientering om ny målbeskrivelse v/ Kirsten Bested
Moderator: Karen Skjelsager Sweden Room
Er brug af halskrave præhospitalt til nogen nytte?
v/ Helge Asbjørnsen Moderator: Charlotte Barfod 09.30 - 10.00 Udstilling - kaffe
10.00 - 12.00 Finland-Sweden-Iceland Room
ACTA foredragskonkurrence - sponseret af SSAI
Bedømmere: Else Tønnesen, Palle Toft, Bodil Steen Rasmussen og Ann Møller
Fredag d. 15. november 2013
... fredag d. 15. november 2013
10.00 - 12.00 Moderator: Hans Kirkegaard (fortsat) abstract nr.
2 Effect of systematic local infiltration analgesia in vaginal hysterectomy v/ Ana-Marija Hristovska
28 Low level of procoagulant platelet microparticles is associated with impaired coagulation and high transfusion requirements in trauma patients v/ Nis Agerlin Windeløv
22 Ultrasound-guided selective blocks of the saphenous and obturator (posterior branch) nerves for postoperative analgesia after ambulatory knee arthroscopy – a prospective, randomized, double-blind study v/ Bo Westergaard
5 Organ failures with hydroxyethyl starch 130/0.42 in severe sepsis - post-hoc analyses of a randomised trial v/ Rasmus G Müller 21 Secondary hyperalgesia phenotypes exhibit different brain activation
patterns during noxious stimulation v/ Manuel Pereira
9 Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study
v/ Pia Jæger
12.00 - 12.45 Udstilling - sandwich og vand i udstillingsområdet 12.00 - 12.45 Denmark Room Frokostsymposium - Octapharma 12.45 - 14.15 Finland Room
Behandlingsmuligheder ved livstruende præhospital blødning v/ Annemarie Bondegaard Thomsen
Moderator: Jakob Stensballe Iceland Room
Kritisk syge børn - resultater fra arbejdsgruppe under SSAI: UL-vejledt CVK, sedation og ventilation
v/ Luana Jensen, Jakob Gjedsted og Mona Tarpgaard Moderator: Torsten Lauritsen
Norway Room
Intraoperative fluid infusion, which fluid and how much? Del 1 v/ Marhus Rehm og Jakob Steensballe
Moderator: Jens Aage Kølsen Petersen Sweden Room
Organisering af den akutte smertebehandling på tre universitetshospitaler, status og fremtid
v/ Ole Mathiesen, Erik Jylling og Lone Nikolajsen Moderator: Carsten Tollund
14.15 - 14.40 Udstilling - kaffe 14.40 - 15.10 Norway Room
Why do infused fluids leak? Why care? Del 2 v/ Markus Rehm
Moderator: Frank Pott
14.40 - 15.10 Finland Room
(fortsat) Cerebral monitorering ved hjertekirurgi v/ Bodil Rasmussen
Moderator: Lisbeth Bredahl Sweden Room
Infiltration af kirurgiske cikatricer - kan vi tillade os at lade være?
v/ Billy Bjarne Kristensen Moderator: Carsten Tollund Iceland Room
Anæstesi til expræmature småbørn v/ Tom G Hansen
Moderator: Søren Walther-Larsen 15.10 - 15.15 Kort pause
15.15 - 15.45 Finland Room Shivering v/ Sven Felsby
Moderator: Birgitte Ruhnau Norway Room
Multidisciplinær stuegang på ITA - er det det, vi skal?
v/ Nikolaj Wesche og Christian von Plessen Moderator: Mette Østergaard
Sweden Room
Præoperativ FATE - giver det mening?
v/ Morten Bøtker
Moderator: Anne Tøttrup Klith Iceland Room
Gravide med hjertesygdomme og anæstesi til disse v/ Vibeke Hornbak
Moderator: Lars Folkersen 15.45 - 18.00 PAUSE
18.00 - 19.00 Norway Room
Den 44. Husfeldt-forelæsning Hyperbar medicin
v/ Erik C Jansen
Moderator: Susanne Wammen 19.00 - 02.00 Scandinavian Ballroom
Middag og prisoverrækkelser
... fredag d. 15. november 2013
08.45 Registrering 09.00 - 09.45 Norway Room
Guidelines for anæstesi til kranietraumepatienter ved ekstrakraniel kirurgi v/ Klaus Koch
Moderator: Niels Juul Finland Room
Jura på intensiv. Hvad må vi og hvad skal vi - relation til patienter, presse og politi.
Casebaseret v/ Anne Murphy Moderator: Nanna Reiter 09.45 - 10.00 Kaffe
10.00 - 11.30 Finland Room
Nye gadgets, devices og behandlingsmodi på ITA. Introduktion af nye behandlingsmodi generelt
v/ Jacob Raben Greisen og Gunhild Holmaas Moderatorer: Susanne Ilkjær og Susanne Iversen Norway Room
Dogmer i anæstesien
- Relaxationsfri intubation v/ Martin Kryspin Sørensen - Perioperativ NSAID: Går det? v/ Susanne Janum
- Larynxmaske; udvidede indikationer - adipøse/bugleje v/ Louise Rovsing Moderatorer: Karsten Skovgaard og Mette Hyllested
11.30 - 12.15 Frokost 12.15 - 13.15 Norway Room
Den hæmatologiske patient på intensiv. Indikation, outcome, mortalitet, økonomiske begrænsninger
v/ Lars Kjeldsen
Moderator: Jens Schierbeck Finland Room
Prognosticering af cerebralt udkomme hos patienter med manglende opvågning efter hjertestop
v/ Anette Fedder Moderator: Niels Juul 13.15 - 14.00 Norway Room
Politisk emne v/ T.B.A Moderator: T.B.A
Lørdag d. 16. november 2013
• Alpiger, Stephan, praktiserende speciallæge, ph.d., Syddansk Smerteklinik Haderslev
• Andersen, Jane, overlæge, anæstesi- og intensivafd., V, Odense Universitetshospital
• Antonsen, Kristian, vicedirektør, Bispebjerg Hospital
• Asbjørnsen, Helge, overlæge, akuttmedisinsk seksjon - KSK, Haukeland Universitetssjukehus
• Astvad, Mads, anæstesi- og intensivafd., V, Odense Universitetshospital
• Bendtsen, Asger, overlæge, operations- og anæstesiafd., Glostrup Hospital
• *Bergholt, Thomas, klin.forskningslektor, overlæge, ph.d., gynækologisk-obstetrisk afd., Nordsjæl- lands Hospital, Hillerød
• Bested, Kirsten, overlæge, anæstesiafd., Sygehus Lillebælt Vejle
• Bestle, Morten, overlæge, ph.d., anæstesiafd., Nordsjællands Hospital, Hillerød
• Bonde, Jan, klinikchef, dr.med., ITA, ABD, Rigshospitalet
• Bredahl, Lisbeth, overlæge, thoraxanæstesiologisk afd., HJE, Rigshospitalet
• Bøtker, Morten, læge, anæstesiafd., Regionshospitalet, Randers
• Christensen, Erika F., lægelig chef, Præhospitalet, Region Midt
• Christensen, Mette Krogh, forskningsleder, Københavns Universitet
• Dahl, Jørgen B., professor, overlæge, dr.med., anæstesi, Rigshospitalet
• *Dickenson, Anthony, professor of neuropharmacology, dept., of neuroscience, physiology and pharmacology, University College, London, UK
• Eskesen, Vagn, overlæge, dr.med., neurokirurgisk klinik, NEU, Rigshospitalet
• Fedder, Anette, afd.læge, anæstesi- og intensivafd., Århus universitetshospital, Skejby
• Felsby, Sven, overlæge, dagkirurgi, Århus Universitetshospital, Skejby
• Folkersen, Lars, overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Garde, Kim, klinikchef, neuroanæstesiologisk klinik, NEU, Rigshospitalet
• Gjedsted, Jakob, afdelingslæge, ph.d., anæstesi- og intensivafd., Århus universitetshospital, Skejby
• Granfeldt, Asger, læge, ph.d, anæstesiafd., Århus Universitetshospital
• Greisen, Jacob Raben, overlæge, ph.d., anæstesi- og intensivafd., Århus universitetshospital, Skejby
• Handberg, Gitte, overlæge, smertecenter, Odense Universitetshospital
• Hansen, Tom G., overlæge, anæstesi- og intensivafd., V, Odense Universitetshospital
• Holmaas, Gunhild, overlæge, intensivmedisinsk seksjon, Haukeland Universitetssjukehus
• Hornbak, Vibeke, overlæge, thoraxanæstesiologisk klinik, HJE, Rigshospitalet
• Hyllested, Mette, overlæge, anæstesiafd., Bispebjerg Hospital
• Haase, Nicolai, klinisk asst., ITA, Rigshospitalet
• Ilkjær, Susanne, overlæge, ph.d., anæstesi- og intensivafd., Århus universitetshospital, Skejby
• Iversen, Susanne, overlæge, anæstesi- og intensivafd., Slagelse Sygehus
• Jansen, Erik, overlæge, dr.med., anæstesi- og operationsklinikken, trykkammeret, HOC, Rigs- hospitalet
• Janum, Susanne, klin.asst., epidemiklinikken, forskningslab., FIN, Rigshospitalet
• Jensen, Luana, L., overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Juul, Niels, overlæge, anæstesiafd., Hoved-Neuro-Centret, Aarhus Universitetshospital
• Jylling, Erik, ledende overlæge, anæstesi- og intensivafd., V, Odense Universitetshospital
• Kirkegaard, Hans, professor, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitets- hospital
• Kjeldsen, Lars, klinikchef, dr.med., hæmatologisk afd., FIN, Rigshospitalet
• Kjærgaard, Jesper, overlæge, dr.med., hjertemedicinsk klinik, HJE, Rigshospitalet
• Klith, Anne Tøttrup, overlæge, Regionshospitalet, Randers
• *Koch, Klaus, afdelingslæge, anæstesiafd., Hoved-Neuro-Centret, Århus Universitetshospital
• Kristensen, Billy Bjarne, ledende overlæge, dagkirurgisk afd., Hvidovre Hospital
• Laub, Michael, overlæge, Respirationscenter Øst
• Lauritsen, Torsten, overlæge, anæstesi- og operationsklinikken, JMC, Rigshospitalet
Foredragsholdere og moderatorer
... foredragsholdere og moderatorer
• Madsen, Mette Gøttge, overlæge, anæstesiafd., Nordsjællands Hospital, Hillerød
• Mathiesen, Ole, overlæge, ph.d., enhed for akut smertebehandling (EAS), Rigshospitalet
• Murphy, Anne, cand.jur., Sundhedsstyrelsen
• Møller, Ann, overlæge, dr.med., anæstesiafd., Herlev Hospital
• Møller, Kirsten, overlæge, dr.med., neuranæstesiologisk afd., NEU, Rigshospitalet
• Nielsen, Niklas, MD, ph.d., dept. of anaesthesiology and intensive care medicine, Helsingborg Hospital
• Nikolajsen, Lone, forskningsoverlæge, dr.med., anæstesiafd., ABD, Århus Universitetshospital
• Olsen, Karsten Skovgaard, overlæge, dr.med., operations- og anæstesiafd., Glostrup Hospital
• Oudemans-van Straaten, Heleen, professor, dr., dept. of intensive care medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, Holland
• Pedersen, Ole, overlæge, anæstesi- og intensivafd., V, Odense Universitetshospital
• Perner, Anders, professor, overlæge, ph.d., ITA, ABD, Rigshospitalet
• Petersen, Asger, overlæge, anæstesiafd., Bispebjerg Hospital
• Petersen, Jens Aage Kølsen, overlæge, ph.d., anæstsiafd., Århus Universitetshospital
• Plessen, Christian von, overlæge, Nordsjællands Hospital Hillerød, Lunge- og Infektionsmed. afd.
• Pott, Frank, overlæge, dr.med., anæstesiafd., Z, Bisbebjerg Hospital
• Rasmussen, Bodil Steen, overlæge, professor, ph.d., intensivafd., klin.anæst., Aalborg Universi- tets hospital Syd
• *Rehm, Markus, professor, Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität, München
• Reiter, Nanna, afdelingslæge, ITA, ABD, Rigshospitalet
• Rovsing, Louise, overlæge, operations- og anæstesiafd., Glostrup Hospital
• Ruhnau, Birgitte, klinikchef, anæstesi- og operationsklinikken, ABD, Rigshospitalet
• Schierbeck, Jens, overlæge, anæstesi- og intensivafd., V, Odense Universitetshospital
• *Sjøgren, Per, professor, overlæge, dr.med., palliativt afsnit, onkologisk klinik, FIN, Rigshospitalet
• Skadborg, Mogens, overlæge, exam.art.phil., MEVO, Aarhus Universitetshospital, Skejby, Respira- tionscenter Vest, Hjertecentret
• Skjelsager, Karen, uddannelsesansvarlig overlæge, MHPE, anæstesiafd., Næstved Sygehus
• Steinmetz, Jacob, traumemanager, overlæge, ph.d., anæstesi- og operationsklinikken, HOC, Rigs- hospitalet
• Strøm, Thomas, overlæge, ph.d., anæstesi- og intensivafd., V, Odense Universitetshospital
• Sørensen, Martin Kryspin, læge, ph.d., Nordsjællands Hospital Hillerød
• Tarpgaard, Mona, afdelingslæge, anæstesiafd., Hoved-Neuro-Centret, Århus Universitetshospital
• Thomsen, Annemarie Bondegaard, overlæge, ph.d., anæstesi- og operationsklinikken, HOC, Rigs- hospitalet
• Thormar, Katrin, overlæge, anæstesiafd., Bispebjerg Hospital
• Toft, Palle, professor, overlæge, dr.med., anæstesi- og intensivafd., V, Odense Universitetshospital
• Tollund, Carsten, overlæge, anæstesi- og operationsklinikken, ABD, Rigshospitalet
• Tønnesen, Else, professor, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitets- hospital
• Walther-Larsen, Søren, overlæge, anæstesi- og operationsklinikken, JMC, Rigshospitalet
• Wammen, Susanne, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Wanscher, Michael, overlæge, ph.d., thoraxanæstesiologisk klinik, HJE, Rigshospitalet
• Wesche, Nikolaj, overlæge, anæstesiafd., Nordsjællands Hospital, Hillerød
• Østergaard, Mette, overlæge, anæstesiafd., Nordsjællands Hospital Hillerød
• Aasvang, Eske, post.doc., dr.med., enhed for kirurgisk patofysiologi, JMC, Rigshospitalet
* Se præsentation af foredragsholder på side 17 og 18
* Professor Per Sjøgren (DK)
Per Sjøgren har siden den medicinske embedseksamen i 1983 dedikeret sig til behandlingen af og forskningen i cancerrelaterede smerter. Således begyndte han som klinisk assistent på Cancersmerteklinikken ved Finseninstituttet i 1986, blev speciallæge i anæstesi i 1997 og kort derefter grundlagde og ledte han i 2001 den palliative enhed på Bispebjerg Hospital. Siden 2012 har han været professor i palliativ medicin ved Rigshospitalet, Københavns Universitet.
Per Sjøgren opnåede den medicinske doktorgrad i 2006, er medforfatter på ca.
170 peer-reviewede artikler og bogkapitler, har holdt mere end 250 foredrag nationalt og internationalt og er vicepræsident i European Association for Palliative Care (EAPC). Per Sjøgren er en international anerkendt ekspert især indenfor palliation, kognitiv funktion hos patienter med cancer, samt effekter af langtidsforbrug af opioider. Hans foredrag på årsmødet vil netop omhandle betydningen og konsekvenserne af langvarig opioidbehandling. En behandling der gives til 3-5% af befolkningen, med velkendte bivirkninger i form af kvalme, sedation, kognitive forstyrrelser, kløe, etc., men også fysisk afhængighed, misbrug, suppression af immunsystemet, opioidinduceret hyperalgesi etc.
Foredraget vil sætte konsekvenserne af et langvarigt opioidforbrug i en klinisk kontekst med relevans for anæstesilæger. Professor Per Sjøgren holder sit foredrag sammen med professor Anthony Dickenson, der vil beskrive de basale patofysiologiske konsekvenser af langvarige smerter og medicinsk behandling.
Smerteudvalget
* Professor Anthony Dickenson (UK)
Anthony Dickenson er en international anerkendt topforsker indenfor basale smertemekanismer. Han er uddannet i basal videnskab i London og har arbej- det i Paris, Californien og Frankrig. Han er Professor of Neuropharmacology ved Department of Neuroscience, Physiology and Pharmacology ved Univer- sity college London, hvor han har arbejdet siden 1983. Anthony Dickenson er forfatter til mere end 275 peer-reviewed artikler og er en efterspurgt fore- dragsholder ved kongresser, men også på TV (BBC), hvilket man forstår når man har oplevet ham gøre foredrag om tilsyneladende komplicerede emner tilgængelige og fascinerende. Størstedelen af hans forskning er indenfor smer- temekanismer i centralnervesystemet, herunder hvordan smerte kan kontrol- leres både under normale og patologiske tilstande, og især hvordan hjernens inhiberende signaler modulerer smertesignaler før de når til bevidstheden.
På årsmødet vil Anthony Dickinson holde foredrag sammen med Per Sjøgren om, hvilke ændringer der opstår i det nociceptive system, når man udsættes for langvarig smerte og får langvarig smertebehandling. Anthony Dicken- sons anden forelæsning på årsmødet handler om, hvordan smerte ændrer neurofysiologien og hvad kroppen gør for at modulere smertesignaler, således at disse enten hæmmes eller forstærkes. Foredraget vil strække sig over en gennemgang af basale mekanismer til hvordan det kan påvirke den kliniske virkelighed patienten er i.
Vi glæder os over at kunne præsentere disse to internationalt anerkendte eksperter, og deres viden om smertemekanismer og konsekvenserne af opioid- behandling. Foredragene vil ruste enhver anæstesiolog til en bedre forståelse
Præsentation af foredragsholdere
for, og behandling af patienterne, uanset hvilken af anæstesiologiens søjler man tilhører.
Smerteudvalget
* Professor Markus Rehm
Alle anæstesilæger kender det: Patient har lavt blodtryk, arteriekurven gynger og patienten er allerede 2 liter i overskud. Skal man give mere væske? Hvilken væske skal man vælge? Hvorfor siver væske egentlig ud af karbanen efter infusion? Betyder det noget? Hvor meget krystalloid/kolloid skal der til for at erstatte blodtab? Det er spørgsmål mange anæstesilæger hyppigt stiller selv. Anæstesiudvalget vil på DASAIM’s årsmøde forsøge at besvare disse spørgsmål i 2 sessioner om væskebehandling.
I “Intraoperativ Fluid Infusion. Which Fluid and How Much?” vil professor Markus Rehm, Ludwig Maximilian Universität, München, komme med sit bud.
Professor Rehm er én af Europas førende eksperter på området med en stor og pågående forskningsaktivitet inden for emnet. Efter professor Rehms indlæg, bliver arbejdet med en dansk vejledning for intraoperativ væskebehandling præsenteret af Jakob Stensballe, afdelingslæge og ph.d., anæstesi- og opera- tionsklinikken, HOC, Rigshospitalet. Der vil til sidst blive tid til diskussion.
I “Why do Infused Fluid Leak? Why Care?” vil professor Rehm præsentere den nyeste viden om kapillærmembranen. Hvad sker der når kapillærerne bliver utætte og hvad betyder det for væskestrategien under anæstesi og kirurgi?”
Anæstesiudvalget
* Afdelingslæge Klaus Koch
Klaus Koch, afdelingslæge, Aarhus. Arbejder til dagligt på neuroanæstesiolo- gisk afsnit og har således hånden nede i substansen hver dag. Vil præsentere de nye retningslinjer for anæstesi til patienter med kranietraume, der skal have foretaget ekstrakraniel kirurgi, fra den teoretiske og praktiske synsvinkel.
Neuroanæstesiudvalget
* Overlæge Thomas Bergholt
Overlæge Thomas Bergholt, obstetriker, Hillerød Hospital, er forskningslektor, klinisk lektor, forskningsansvarlig og er vejleder for flere ph.d-studerende. Han har skrevet ph.d. om kejsersnit og er ved at færdiggøre en master of evidence- based healthcare.
Obstetrisk anæstesiudvalg
... præsentation af foredragsholdere
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Abstracts - ACTA Foredragskonkurrence Abstract 2
Korresponderende forfatter:
Ana-Marija Hristovska
Email: anamarijahristovska@gmail.com Afdeling: Anæstesi
Hospital/sygehus: Næstved
Medforfattere: Ana-Marija Hristovska (M.D.), Billy B Kristensen (M.D.), Marianne A. Rasmus- sen (nurse), Yvonne H. Rasmussen (M.D.), Lisbeth B. Elving (M.D.), Christian V. Nielsen (M.D.), Henrik Kehlet (M.D.)
Effect of systematic local infi ltration analgesia in vaginal hysterectomy Objective: To assess the effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy, and describe the technique in detail.
Design: A randomized, double-blind, placebo- controlled study following the CONSORT criteria.
Setting: A university hospital.
Patients: 37 patients undergoing vaginal hys- terectomy
Methods: Patients received high-volume (50 ml) ropivacaine 0.75 % (n=20) or saline (n=17) infil- tration using a systematic technique ensuring uniform delivery to all tissues incised, handled or instrumented during the procedure.
Main outcome measures: Pain, nausea, vomit- ing and opioid requirements were assessed for 32 hours as well as time spent in the post- anesthesia care unit (PACU) and time to first mobilization.
Results: Pain at rest was significantly reduced after 1, 4 and 8 hours in the ropivacaine group (p≤ 0.001 – 0.01). Pain during coughing was significantly reduced after 1 and 4 hours (p≤
0.001 and p≤ 0.003) while pain during move- ment was significantly reduced after 4 hours (p≤ 0.02). Opioid requirements and time spent in the PACU were significantly reduced in the ropivacaine group (p<0.001 and p<0.001, re- spectively) as well as the time to first mobiliza- tion (p<0.001).
Conclusion: Intraoperative systematic local infil- tration analgesia reduces postoperative pain in patients undergoing vaginal hysterectomy and improves early recovery.
Keywords: Vaginal hysterectomy surgery, local infiltration analgesia, ropivacaine, multimodal analgesia, postoperative pain treatment.
Abbreviations: PACU, post- anesthesia care unit; VAS, visual analogue scale; LIA, local infiltration analgesia;
ASA, American Society of Anesthesiologists physical status
Table 1 Patient characteristics
Ropivacaine (n=20) Placebo (n=17)
Age, years 43 (36-55) 48 (32-67)
Weight, kg 74 (51-127) 79 (55-107)
Height, cm 168 (150-178) 167 (158-176)
ASA I / II 13 / 7 7 / 10
Uterus weight 174,8 (68-381) 134,0 (57-478)
Duration of surgery 01:05:42 01:05:32
Indication for surgery
Gynecological bleeding 12 5
Dysplasia 2 5
Uterin fibroid 5 3
Pain 1 3
Uterine prolaps 0 1
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... abstracts - ACTA Foredragskonkurrence Abstract 28
Korresponderende forfatter: Nis Agerlin Windeløv
Email: nis.windelov@gmail.com
Afdeling: Anæstesi- og operationsklinikken, HovedOrtoCentret
Hospital/sygehus: Rigshospitalet
Medforfattere: Pär Ingemar Johansson, Anne Marie Sørensen, Anders Perner, Michael Wan- scher, Claus Falck Larsen, Sisse Rye Ostrowski og Lars Simon Rasmussen
Low level of procoagulant platelet microparticles is associated with impaired coagulation and high transfusion requirements in trauma patients.
Introduction: Platelets microparticles (PMPs) are small (0.1-1µm) circulating procoagulant vesicles that enhance thrombin generation at sites of injury [1]. Despite their haemostatic potential, their role in haemorrhage and coagul- opathy following trauma remains elusive. We aimed to investigate the associations between levels of PMPs and coagulation status, transfu- sion requirements and injury severity in trauma patients.
Methods: A prospective observational study of 210 trauma patients admitted directly to a level 1 trauma centre. Levels and characteristics of PMPs were determined by flow cytometry, exposure of the procoagulant phosphatidyl- serine was identified by binding of Annexin V (AnV+). Coagulation capacity was assessed on admission in whole blood by rotational throm- belastometry (ROTEM) using the EXTEM and the platelet deactivated FIBTEM assays, and in plasma by international normalized ratio (INR).
Transfusion requirement was assessed by units of red blood cells (RBC) transfused within 24h of admission. Injury severity was determined by the injury severity score (ISS).
Results: The majority of patients suffered from severe injuries as indentified by a median ISS of 17 (9-26), and blood samples were obtai- ned median 65 (49-85) min following injury. A low level of AnV+PMPs was associated with impaired whole blood and plasma coagulation evidenced by increased EXTEM clotting time (p=0.01), reduced EXTEM α-angle (p<0.01) and FIBTEM maximal clot firmness (p=0.02), increased INR (p=0.04), with high number of RBC transfused (p<0.001), also when corrected for risk factors, including platelet counts and ISS. Levels of AnV+PMPs corrected for platelet counts correlated negatively with ISS (r=-0.14, p=0.04).
Conclusion: Low levels of procoagulant PMPs on trauma centre admission was associated with impaired coagulation status and high 24h RBC transfusion requirements.
[1] Suades R, Padró T, Vilahur G, Badimon L. Thromb Haemost. 2012 Dec;108(6):1208–19.
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... abstracts - ACTA Foredragskonkurrence Abstract 22
Korresponderende forfatter: Bo Westergaard, MD Email: bowester@hotmail.com
Afdeling: Anæstesiologisk afdeling Hospital/sygehus: Bispebjerg Hospital
Medforfattere: Kenneth Jensen, MD, BBA, Katja Lenz, MD, Mojgan Vazin, MD, Katrine Tanggaard, Bjarne Worm, MD, Michael Krogsgaard, MD, DMSc, Jens Børglum, MD, PhD
Ultrasound-guided selective blocks of the saphenous and obturator (posterior branch) nerves for postoperative analgesia after ambulatory knee arthroscopy – a prospective, randomized, double-blind study
Introduction: Ambulatory knee arthroscopy is a very common procedure. Although it is generally regarded as a minor and relatively painless procedure, a significant number of patients experience considerable postopera- tive pain. Excessive postoperative pain may delay discharge and impair patient ambulation.
Selective blocks of the saphenous nerve (SN) and obturator nerve (posterior branch, ONP) should theoretically provide partial analgesia of the knee joint with minimal motor dysfunction.
We hypothesized that this block combination in addition to a standard analgesic regimen of acetaminophen and opioids would significantly reduce pain on mobilization during the first 24 hours postoperatively.
Methods: The Committees on Biomedical Re- search Ethics for the Capital Region of Denmark approved the study (H-2-2011-029). Patients scheduled for ambulatory knee arthroscopy under general anesthesia were randomized to ultrasound-guided NS and ONP blocks (Figure 1) with 7.5 mL each of either Ropivacaine or placebo (isotonic saline).
Postoperative pain scores (on a numerical rating scale of 0-10) were registered on knee flexion and at rest at 0, ½, 1, 2, 3, 4, 6, 8, 12 and 24 hours postoperatively, in addition to opioid consumption, nau- sea, length of stay (LOS) in the post-anesthetic care unit (PACU) and function levels.
After discharge, patients were instructed to per- form this registration themselves. Pain scores were reconstructed for area-under-the-curve (AUC) analysis and compared using the Mann- Whitney U-test for independent samples.
Results: 60 patients were included and 54 completed the study. Pain scores on flexion of the knee (Figure 2) were significantly reduced in the Ropivacaine group compared with the placebo group (median AUC 35 (interquartile range 22.5-74) vs. 72 (40-107.5), P=0.032) for 24 hours postoperatively. Pain score AUC was also significantly reduced during the most closely monitored period 12 hours postoperatively (P=0.011). No significant difference in pain at rest, opioid consumption, nausea, PACU LOS or change in function level was recorded.
Discussion: Although significant, the overall effect size was smaller than expected. In part, this may be due to the addition of a standard, multimodal analgesic regimen which reduces baseline pain levels. Also, the extensive variety of arthroscopic procedures performed may have involved parts of the knee joint insufficiently cov- ered by the partial analgesia provided by the SN and ONP blocks. A post-hoc analysis suggested that this block combination may be especially beneficial for patients with high preoperative pain levels or long durations of surgery.
Conclusions: Selective ultrasound-guided blocks of the SN and ONP significantly reduced pain after ambulatory knee arthroscopy. This block combination may be valuable as part of a multimodal analgesic regimen, though further studies may be required for the individualiza- tion of treatments according to patient factors and the surgical procedure.
21
... abstracts - ACTA Foredragskonkurrence Abstract 5
Korresponderende forfatter: Rasmus G Müller Email: rasmusgmuller@gmail.com
Afdeling: Intensiv Terapiklinik, 4131 Hospital/sygehus: Rigshospitalet
Medforfattere: Nicolai Haase, Jørn Wetterslev, Anders Perner
Organ failures with hydroxyethyl starch 130/0.42 in severe sepsis – post-hoc analyses of a randomised trial
Introduction: Resuscitation with hydroxyethyl starch (HES) 130/0.42 increased mortality and the use of renal replacement therapy (RRT) in the Scandinavian Starch for Severe Sepsis/Sep- tic Shock (6S) randomised, blinded trial [1,2].
However, the harmful mechanisms are still not fully elucidated. We intended to evaluate if resuscitation with HES vs. Ringer’s acetate increased organ failures within the first 5 days after randomisation.
Methods: Post-hoc analyses of organ failures in the 6S trial cohort. Organ failures were ana- lysed as area under the curve (AUC) for daily Sequential Organ Failure Assessment (SOFA) score and any new specific organ failures as SOFA score > 2. Furthermore the rate of RRT day 1 to 5 was evaluated in the intervention groups.
Results: All 798 patients were included; me- dian age was 66 years (IQR 56-75), SAPS II at baseline 50 (IQR 39-60) and site of infection 55% lungs, 33% abdomen, 13% urinary tract and 19% other. The cumulative amount of trial fluid was 3000 ml in both groups, which was given mainly within the first 2 days. Median AUC SOFA day 1 to 5 was 37 (IQR 27-54) in the HES group vs. 37 (27-51) in the Ringer’s group, Wilcoxon rank-sum test p=0.73. The new organ failures are shown in the figure. In the first 5 days after randomisation the use of RRT was significantly higher in the HES vs. the Ringer’s group (relative risk (RR) 1.48; 95 % CI 1.04-2.10;
p=0.02), and RRT was started earlier in the HES vs. the Ringer’s group, (logrank-test p=0.03) (figure). The HES group also had increased risk of the composite outcome new kidney failure or use of RRT (RR 1.31; 95% CI 1.00-1.70; p=0.04).
Conclusion: The observed increased use of RRT in the 6S trial seemed to occur already within the first five days after randomisation, indicating immediate deleterious effects of HES on kidney function. There were no statistically significant differences in organ failure between the HES and Ringer’s groups as assessed by SOFA scores.
References
1. Perner A, Haase N et al. N Engl J Med 2012; 367: 124.
2. Haase N, Perner A et al. BMJ 2013; 346: f839.
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... abstracts - ACTA Foredragskonkurrence Abstract 21
Korresponderende forfatter: Mohammad Sohail Asghar (MD, PhD)
Email: sohail@dadlnet.dk
Afdeling: Department of Anaesthesia, Centre of Head and Orthopaedics
Hospital/sygehus: Rigshospitalet
Medforfattere: Manuel Pereira (MD), Mads U.
Werner (MD, DMSc), Henrik B.W. Larsson (MD, DMSc), Jørgen B. Dahl (MD, DMSc)
Secondary Hyperalgesia Phenotypes Exhibit Different Brain Activation Patterns During Noxious Stimulation
Introduction: Development of secondary hyperalgesia (SH) following a cutaneous injury is a centrally mediated event1. Some individu- als develop large SH-areas (high-sensitization responders [HR]), while others develop small SH-areas (low-sensitization responders [LR]).
The size of SH-areas are reproducible and can be regarded as a phenotypic characteristic2.
It has been speculated that central sensitiza- tion phenotypes may have predictive value in propensity to develop both acute and persistent pain2. No studies have compared brain activity in HR and LR during painful stimulation. The aim was to analyze differences in brain activity in the two groups during mechanical noxious stimulation of primary hyperalgesia (PH), SH, and non-hyperalgesic (NH) areas.
Methods: 40 healthy volunteers (20 HR and 20 LR) received a first-degree burn injury (BI; 47ºC, 7 min, 9 cm2) on the lower leg. The SH-areas were assessed 100 min after the BI. In this functional MRI study, we measured neuronal activation by recording blood-oxygen-level- dependent (BOLD) signal during mechanical noxious stimulation (pain threshold by pin-prick (0.31 mm2, 1 Hz, 30s blocks)) before BI and after BI at different sites (PH-, SH- and NH-areas) Results: Significant differences in BOLD signal were observed between HR and LR at baseline (before BI) (Fig 1). After BI, there were signifi- cant differences between HR and LR during mechanical stimulation of the SH-, PH- and NH areas (Fig 2). Within each phenotype group, we recorded differences when comparing BOLD signal before BI to BOLD signal after BI in the SH-, PH- and NH-areas. No differences were found when comparing BOLD signal between SH and PH areas.
Conclusion: HR compared to LR seems to differ in neuronal activation to mechanical stimula- tion. This may reflect differences in central sen- sitization across these two phenotypes, which may be linked to the susceptibility to develop- ment of acute and persistent pain.
Fig 1. Baseline neuronal activation. Group analysis showing neuronal activation during pre-burn injury mechanical noxious stimulation in (a) HR and (b) LR. (c) Shows differences between HR and LR. Activity is displayed upon standardized inflated brain figures (red = regions-of-interest (ROI) with increased activation; blue = ROI’s with decreased activation). We found decreased activation in precentral gyrus (P<0
Fig 2. Differences in neuronal activation after BI. Group analysis showing differences in neuronal activation between HR and LR after mechanical noxious stimulation. Stimulation sites are shown on the right side. (a) Between SH areas we found decreased activation in precuneus (P=0.04). (b) Between HR (SH-areas) and LR (outside the SH-areas (NH)) we found increased activation in the post-central gyrus (P<0.01), precuneus (P=0.02) and lingual gyrus (P<0.01). (c) Between primary hyperalgesia (PH) areas there was decreased activation in precentral gyrus (P<0.01)..01) and superior temporal gyrus (P=0.04) in HR compared to LR.
23
... abstracts - ACTA Foredragskonkurrence Abstract 9
Korresponderende forfatter: Pia Jæger Email: pia_jaeger@hotmail.com
Afdeling: Anæstesi- og Operationsklinikken, HOC Hospital/sygehus: Rigshospitalet
Medforfattere: Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J, Mathiesen O, Larsen TK, Dahl JB
Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study BACKGROUND: The femoral nerve block (FNB), commonly used for postoperative pain treat- ment following total knee arthroplasty (TKA), reduces quadriceps muscle strength, essential for mobilization. In contrast the adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps muscle strength compared with FNB (primary endpoint), in patients follow- ing TKA. Secondary endpoints were effects on morphine consumption, pain, adductor strength, morphine related complications, and mobilization ability.
METHODS: We performed a double-blind, randomized controlled study, including patients scheduled for TKA under spinal anesthesia. The patients were randomized to receive either a continuous ACB or a FNB via a catheter (30 ml 0.5% ropivacaine given initially, followed by a continuous infusion of 0.2% ropivacaine, 8 ml/h for 24 h). We performed a sham procedure for the alternative treatment. All blocks were performed by two of the investigators (DZ and JSF), who subsequently refrained from any further contact
with the patient.
Additional analgesics consisted of oral paracetamol 1 g and ibuprofen 400 mg four times daily, and patient controlled analgesia with intra- venous morphine.
Muscle strength was assessed as maximum voluntary
isometric contraction (MVIC) with a handheld dynamometer preoperatively and at 24 h posto- peratively, along with mobilization ability. Other endpoints were assessed at 2, 4, 8 and 24 h postoperatively. Trial registration: clinicaltrials.
gov (NCT01470391).
RESULTS: We enrolled 54 patients, 48 were analyzed. Quadriceps strength as a percentage of baseline was significantly higher for subjects with an ACB, median 52% (9–92) compared with 18% (0–69) for those with a FNB (95% CI: 8 to 41, P = 0.004). There was no difference between the groups regarding analgesic efficacy. Mean morphine consumption was 22 ±9 mg in the ACB group vs. 22 ±21 mg in the FNB group (P=0.94). During flexion of the knee, mean pain scores (area under the curve for the interval 2–24 h/ 22 h) in the ACB group were 36 ±15 mm compared with 29 ± 19 mm in the FNB group (P = 0.16); and at rest: 16 ±12 mm in the ACB group compared with 12 ±12 mm in the FNB group (P = 0.21). Neither was there a difference in adductor muscle strength (P=0.39), morp- hine related side effects or mobilization ability (P>0.05).
DISCUSSION: Although strength loss was greater with a FNB, we were not able to show a difference in mobilization ability. However, a high walker was used for the ambulation test, thereby providing an opportunity to bypass the quadriceps function in the operated limb.
CONCLUSIONS: The ACB preserved quadriceps muscle strength better than the FNB, without a significant difference in postoperative pain.
Dansk Selskab for Anæstesiologi og Intensiv Medicin (DASAIM) Sekretariat
Rigshospitalet, AN-OP, HOC 4231 Blegdamsvej 9 - 2100 København Ø
Tlf. +45 3545 0420 Email: sekretariat@dasaim.dk
