Program  DASAIMs Årsmøde 20128. - 10. november

Program 

DASAIMs Årsmøde 2012 8. - 10. november

Radisson Blu Scandinavia Hotel Amager Boulevard 70, København Tlf. 3396 5000 www.radissonblu.dk/scandinaviahotel-koebenhavn

Hovedsponsorer

Vi vil gerne byde jer velkommen til DASAIMs Årsmøde 2012, der er det ellevte i rækken i aktuelle udformning. En stor tak til alle, der gennem årene har bidraget til at gøre mødet til en succes!

Som tidligere består årsmødet af 3 dage med forelæsninger, parallelsessioner, posterpræsen- tationer og foredragskonkurrence. DASAIMs bestyrelse og udvalg har sammen med organisa- tionskomiteen sammensat programmet, der udover faglig opdatering også giver mulighed for diskussion i pauserne.

Vi vil gerne takke de mange, der stiller op som fore- dragsholdere og moderatorer, men også sponsorer og udstillere, hvis støtte giver et solidt økonomisk fundament for dette arrangement.

Acta Anaesthesiologica Scandinavica sponsorerer præmierne til foredragskonkurrencen med en 1., 2. og 3. præmie. Derudover har vi en publikumspris samt en pris for bedste poster. Novo Nordisk giver igen i år Innovationsprisen til en yngre forsker, hvis abstract udmærker sig ved innovativ tankegang.

De heldige modtagere af ovennævnte præmier og priser vil være at finde blandt det store antal indsendte abstracts, nemlig i alt 59.

Vi glæder os til at se jer!

Steen Møiniche, Lars S. Rasmussen og Tina Calundann

sekretariat@dasaim.dk

Velkommen til DASAIMs Årsmøde 2012!

Kongresområde

08.00 - Registrering 09.00 - 10.00 Norway-Finland Room

Den 11. Secher-forelæsning Er det noget akut?

v/ Lars S. Rasmussen Moderator: Ole Nørregaard 10.00 - 10.30 Udstilling - kaffe 10.30 - 11.00 Sweden Room

Perioperativ anæmi v/ Astrid Nørgaard Moderator: Mette Hyllested Norway Room

Præhospitalt arbejde og jura v/ Per Fraulund Sørensen Moderator: Jesper Hedegaard Iceland Room

Ny målbeskrivelse for speciallægeuddannelsen v/ Kirsten Bested

Moderator: Karen Skjelsager Finland Room

Smertebehandling i akutafdelingen v/ Jesper Dirks

Moderator: Carsten Tollund

Torsdag d. 8. november 2012

Workshop ved Uddannelsesudvalget

Kan du klare de uddannelsessøgendes test?

Benyt lejligheden til at mærke på egen krop en lille smagsprøve på de praktiske tests, de uddannelsesøgende udsættes for i hoveduddannelsen.

10 min. intro, 10 min. til hver af de 4 korte stationer, inkl. feedback og så 10 min. diskussion.

Vi kører 4 runder torsdag d. 8. november, 2012 i Casino Ballroom fra kl. 10-11, 11-12, 12-13, og 13-14.

Tilmeld dig via email inden mødet til: Overlæge Anne Lippert; annlip01@heh.regionh.dk

Torsdag d. 8. november 2012, fortsat

Norpharma A/S inviterer til frokostsymposium torsdag d. 8. november 2012, kl. 11.00 - 11.45

Oxycodon – worth the money?

v/ Robin Christensen, cand.scient, phd.

Parker Instituttet, Frederiksberg Hospital

Frokostsymposiet afholdes i Denmark Room på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde 2012. Der vil være frokost i tilknytning til symposiet.

Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig.

11.00 - 12.00 Udstilling - let frokost i udstillingsområdet 11.00 - 11.45 Denmark Room - Frokostsymposium - Norpharma

11.00 - 12.00 Bag posteren. Se den nye danske forskning og mød forskeren bag posteren 12.00 - 13.30 Norway Room

Konflikthåndtering - navnlig præhospitalt v/ Henrik Lyng

Moderator: Charlotte Barfod Sweden Room

Væskebehandling - Sandheden 2012?

v/ Anders Perner og Carsten Tollund Moderator: Preben Berthelsen Finland Room

Etiske overvejelser i forbindelse med forskning på bevidstløse patienter v/ Kirsten Møller og Peter Rossel

Moderator: Asger Petersen Iceland Room

Postpartum neuropathy - it’s not my fault!

v/ Gudmundur Klemenzon

Moderator: Charlotte Krebs Albrechtsen 13.30-14.00 Udstilling - kaffe

Torsdag d. 8. november 2012, fortsat

14.00-15.30 Iceland Room Posterdiskussion I

Moderatorer: Jørn Wetterslev og Erika F. Christensen abstract nr.

23 Dansk Anæstesi Allergi Center - 8 års resultater v/ Louise Asserhøj 39 Induction of anaesthesia in the sitting versus the supine position

v/ Søren Lundgaard Larsen

35 6 years nationwide follow-up of persistent pain and sensory disturbances after breast cancer treatment v/ Mathias Kvist Mejdahl

A A comprehensive multimodal pain treatment improves postoperative mobilization after multilevel spine surgery v/ Ole Mathiesen

D The effect of transversus abdominis plane (TAP) block or local anaesthetic infiltra- tion in groin hernia repair. A randomized clinical trial v/ Pernille Lykke Petersen I Chronic pain, its recognition and handling, in a surgical population in a general

universitary teaching hospital in Denmark v/ Jon Jacobsen 4 Pædiatrisk anæstesi og brug af smartphone v/ René Christian Bleeg

27 Er propofol kontraindiceret hos æg-, soja- og peanutallergikere? v/ Louise Asserhøj Finland Room

Posterdiskussion II

Moderatorer: Jørgen B. Dahl og Jacob Steinmetz abstract nr.

3 The role of patient demographics for fast-track hip and knee replacement

v/ Christoffer Calov Jørgensen

34 NMR-based Metabonomics Reveals Complex Metabolic Networks in CABG-induced ALI Patients v/ Raluca G. Maltesen

14 Sympathovagal imbalance during early postoperative mobilization after hip arthroplasty v/ Øivind Jans

M Neuromuskulær monitorering opleves som en udfordring hos danske anæstetister

v/ Katrine Zwicky Eskildsen

J Clinical use of sugammadex v/ Jes Braagaard

10 Outcomes in smokers and alcohol users after fast-track hip- and knee replacement v/ Christoffer Calov Jørgensen

15 Risk of transfusion and readmission in patients with preoperative anaemia in fast-track hip- and knee arthroplasty v/ Øivind Jans

Norway Room Posterdiskussion III

Moderatorer: Karsten Skovgaard og Ann Møller abstract nr.

N Ultrasound guidance of labor epidural analgesia – the value for the learning and performance of a first year trainee in anaesthesiology v/ Zofia Piosik

16 Design og rationale - The Danish Anaesthesia Database and the prediction of DIFFICult AIRway management trial: “The DIFFICAIR-Trial”

v/ Anders Kehlet Nørskov

17 Formodet ropivacainudløst kardiel intoksikation med fatal udgang

v/ Simon Ladehoff Thomsen

19 Definition of the novel single penetration dual injection (SPEDI) block combination:

Peripheral blocks for leg surgery v/ Margrethe Duch Christensen

38 Truview PCD™ laryngoscope versus Macintosh laryngoscope in adult patients with SARI (Simplified Airway Risk Index) score 2-5: A randomized study

v/ Maren Tarpgaard

Torsdag d. 8. november 2012, fortsat

14.00-15.00 B Ultrasound-guided (USG) nerve block combinations. Femoral (FEM), Saphenous (fortsat) (SAPH) and Obturator, ramus posterior (ONP) for Anterior Cruciate Ligament

Reconstruction (ACL-R): double-blinded, randomized, placebo-controlled trial

v/ Katja Lenz

E Ultrasound-guided (USG) brachial plexus (BP) block efficacy at the Supraclavicular (SCL), Lateral- Infraclavicular (LIC) and Axillary (AX) level: Randomized,

observer-blinded study of the single-penetration multiple-injection-technique

v/ Mojgan Vazin

G Ultrasound-guided lateral infraclavicular block evaluated by infrared thermography and distal skin temperature v/ Semera Asghar

Denmark Room Posterdiskussion IV

Moderatorer: Hanne Ravn og Kirsten Møller abstract nr.

40 Do shock patients in the ICU fulfil the prerequisites for the arterial

waveform-derived diagnostic test of hypovolaemia? v/ Louise Inkeri Hennings 28 Remifentanil and topical lidocaine for bronchoalveolar lavage in a

human-experimental setup v/ Ronni R. Plovsing

33 Kan near-infrared spectroscopy detektere kritisk hypoperfusion i muskelvæv induceret under hjertelungemaskine i en dyremodel? v/ Sisse Anette Thomassen 36 Ultrasound guided radial artery cannulation is superior compared to the traditional

palpation technique. A randomized, blinded, crossover study

v/ Marlene Aagaard Hansen

22 Drainage of Pleural Effusion Increases Preload and may be part of Hemodynamic Optimisation v/ Johan Fridolf Hermansen

H Circulatory assessment of intensive care unit patients with shock

v/ Louise Inkeri Hennings

K Comparison of three inotropic strategies in the newborn after stunning of the right ventricle v/ Janus Adler Hyldebrandt

P Semi automated estimation of ejection fraction with AutoEF at the bedside shows good correlation with gold standard method v/ Christian Alcaraz Frederiksen Sweden Room

Posterdiskussion V

Moderatorer: Hans Kirkegaard og Anders Perner abstract nr.

7 Neutrophil Gelatinase Associated Lipocalcin (NGAL) is a reliable biomarker of dialysis-dependent acute kidney injury after infrarenal aortic surgery

v/ Helene Korvenius Jørgensen

37 Focus assessed transthoracic echocardiography as a scanning tool following open heart surgery v/ Lærke Kamstrup Christiansen

25 Employment status one year after out of hospital cardiac arrest in comatose patients treated with therapeutic hypothermia v/ Kristian Kragholm

26 The admission and subsequent course of treatment provided to the trauma patient:

from REsuscitation to REintegration v/ Martin Vedel Nielsen

30 Incidens, sværhedsgrad og varighed af delirium hos hjertekirurgiske patienter:

Et observationsstudie v/ Sofie Schrøder Pedersen

31 Triage af patienter til akut medicinsk team baseret på præhospitale observationer

v/ Christian Melchior Olesen

8 A comparison of bioimpedance and oesophageal doppler cardiac output monitoring during abdominal aoritc surgery v/ Helene Korvenius Jørgensen

14.00-15.00 O Estimering af patienters risiko for postoperative lav oxygenering ved non-invasiv

(fortsat) præoperativt estimering af abnormiteter i lungernes gasudveksling v/ Anna Henningsson

Chairmans Room Posterdiskussion VI

Moderatorer: Else Tønnesen og Susanne Ilkjær abstract nr.

1 Sleepmonitoring by polysomnography and delirium assessment with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in un-sedated, mechanically ventilated patients: Delirious patients do not show electrophysiologic sleep-characteristics v/ Hans Chr. Toft Boesen

2 Stress ulcer prophylaxis in the intensive care unit: unanswered research questions. A systematic review v/ Morten Hylander Møller

12 Dynamic cerebral autoregulation in sepsis as evaluated by the thigh cuff deflation technique v/ Ronan M. G. Berg

18 Citrat-calcium regional antikoagulation til kontinuerlig renal erstatningsterapi på dansk intensiv afdeling v/ Katrin Maria Thormar

C Prehospital care of children, a descriptive study v/ Mona Tarpgaard

L Lægebemandede akutbiler udgør stor økonomisk gevinst v/ Christian S. Langfrits R Kardioprotektiv effekt af transcutan muskelstimulation på patienter der skal have

foretaget koronar bypass v/ Maria Fedosova

S Endothelial dysfunction in a rat model of asphyxia induced cardiac arrest

v/ Thomas Troelsen

15.30-16.00 Udstilling - kaffe + frugt eller lign.

16.00-17.30 Sweden Room

Nyt om anæstesiologisk ultralyd

- CECLUS: Præsentation af Center of Clinical Ultrasound v/ Thomas Fichtner Bendtsen - UL-vejledte overekstremitetsblok med alternativ til scalenerblok

v/ Zbigniew Koscielniak-Nielsen

- UL-vejledte underekstremitetsblok specielt til hoftekirurgi v/ Thomas Fichtner Bendtsen - UL-vejledte trunkale blok - fascia quadratus lumborumblok v/ Jens Børglum

Moderator: Bo Gottschau Iceland Room

DAO Generalforsamling Finland Room

Forskningsinitiativet Moderator: Palle Toft

- Peter Juhl-Olsen. Effects of Levosimendan in patients eligible for aortic valve replacement with left ventricular hypertrophy

- Anders Gade Kjærgaard. Biomarkører for svær sepsis og septisk shock - et klinisk studie - Nicolai R.S. Haase. Sepsisinduceret endotelskade, koagulopati og blødning

- Kim Zillo Rokamp. Hjernens gennemblødning og stofskifte: Betydning af polymorfi i genet for den ß2-adrenerge receptor

- Niels Vidiendal Olsen. Erythropoietins renale virkninger hos mennesker

- Henrik Torup. Toksiske serum-værdier efter Transversus Abdominis Plane (TAP) blok?

- Hans Kirkegaard præsenterer projektet: Overflade versus invasiv kølings påvirkning af stressrespons og cerebrum. Et dyreeksperimentelt studie

16.00-17.30 - Yuliya Boyko. Undersøgelse af søvn hos respiratorbehandlede patienter på intensivt

Torsdag d. 8. november 2012, fortsat

Torsdag d. 8. november 2012, fortsat

Fredag d. 9. november 2012

(fortsat) terapeutisk afsnit: betydning af omgivelserne, ventilationsmodus samt melatoninbehandling 17.30-19.00 Casino Ballroom

Middag 19.00-22.30 Norway Room

DASAIM Generalforsamling 07.30 - Registrering

Novo Nordisk inviterer til morgenmadssymposium fredag d. 9. november 2012, kl. 08.00 - 08.45

Erhvervet Hæmofili

v/ Overlæge, dr.med. Jørn Dalsgaard Nielsen Center for Trombose og Hæmostase, Rigshospitalet

Moderator: TBA

Morgenmadssymposiet afholdes i Denmark Room på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde 2012. Der vil være morgenmad i tilknytning til symposiet.

Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig.

Fredag d. 9. november 2012, fortsat

Grünenthal A/S inviterer til frokostsymposium fredag d. 9. november 2012, kl. 12.00 - 12.45

MOR-NRI: ANOTHER CONCEPT OF UNDERSTANDING

Translating the MOR-NRI concept: Profile of Tapentadol and its Place in Pain Treatment v/ Albert Dahan, Professor of Anesthesiology, MD, Ph.d,

Leiden University Medical Center, Leiden, The Netherlands Optimizing Opioid Treatment – What can patients gain?

v/ Per Wagner Kristensen, Overlæge, Sektor for Hofte og Knæalloplastik, Ortopædkirurgisk afdeling, Vejle Sygehus, Denmark

Frokostsymposiet afholdes i Denmark Room på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde 2012. Der vil være frokost i tilknytning til symposiet.

Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig.

08.00-08.45 Denmark Room

Morgenmadssymposium - Novo Nordisk 08.00-08.30 Norway Room

Hvad sker der, når de perifere blok klinger af?

v/ Anders Rothe

Moderator: Mette Hyllested Finland Room

Akutlægeuddannelse - hvad blev det til?

v/ Kim Garde

Moderator: Susanne Jørgensen Iceland Room

Kritisk syge børn på (voksen-)intensiv

v/ Hanne Ravn

Moderator: Ole Pedersen Sweden Room

Køling efter hjertestop v/ Hans Kirkegaard

Moderator: Marianne Kjær Jensen 08.30-09.00 Udstilling - kaffe

09.00-09.30 Finland Room

Akkreditering af akutlægebiler - gør det en forskel?

v/ Henrik Jørgensen Moderator: Dennis Köhler Norway Room

Perioperative Stroke - no one told me it’s so common v/ Adrian Gelb

Moderator: Karsten Bülow Sweden Room

Myokardieiskæmi hos ITA patienter v/ Jens Flensted Lassen

Moderator: Katrin Thormar Iceland Room

Risiko for tilfældige fejl i meta-analyser v/ Jørn Wetterslev

Moderator: Jørgen B. Dahl 09.30-10.00 Udstilling - kaffe 10.00-12.00 Finland-Sweden Room

ACTA foredragskonkurrence - sponseret af SSAI Bedømmere: Hanne Ravn, Lars S. Rasmussen og Erik Sloth Moderator: Palle Toft

10.00-12.00 abstract nr.

Fredag d. 9. november 2012

Fredag d. 9. november 2012, fortsat

(fortsat)

9 Generel anæstesi til sectio og vanskelig/umulig intubation. Har vi et problem?

v/ Charlotte Vallentin Rosenstock

11 Rat to Pig Translation: Small-Volume 7.5% NaCl Adenocaine/Mg2+ has multiple physiological benefits during hypotensive and blood resuscitation in the porcine model of severe hemorrhagic shock v/ Asger Granfeldt

20 Predictive value of neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy in patients with severe sepsis v/ Peter Buhl Hjortrup 21 Hydroxyethyl starch 130/0.4 versus crystalloid or albumin in patients with sepsis:

Effects on mortality, kidney function and bleeding - a systematic review with meta-analysis and trial sequential analysis v/ Nicolai Haase

29 Adductor-canal-blockade versus femoral nerve block and quadriceps strength:

A randomized, double blind, placebo-controlled, crossover study in healthy volunteers v/ Pia Jæger

32 Effect of goal-directed fluid therapy on postoperative orthostatic intolerance;

A randomized trial v/ Morten Bundgaard-Nielsen 12.00-12.45 Udstilling - let frokost i udstillingsområdet

12.00-12.45 Frokostsymposium - Grünenthal 12.45-14.45 Norway Room

Lægehelikoptere i Danmark - erfaringer fra øst og vest v/ Lars Knudsen og Rasmus Hesselfeldt

Moderator: Annemarie Bondegaard Thomsen Finland Room

The role of the anaesthetist in the perioperative care: Treat the patient v/ Steven Butler

Moderator: Luana Jensen Sweden Room

Overvægt: The basics, adipositaskirurgi, den overvægtige ITA-patient v/ Kirsten Møller, Lars Naver og Morten Steensen

Moderator: Mette Østergaard Iceland Room

Mekanisk kredsløbsstøtte og etik

- Mekanisk kredsløbsstøtte efter hjertestop v/ Henrik Schmidt

- Skal vi virkelig alt det, som vi kan? v/ Hans-Henrik Bülow og Inge De Haas Moderatorer: Lars Folkersen og Lisbeth Bredahl

14.15-14.40 Udstilling - kaffe 14.40-15.10 Sweden Room

Nye antikoagulantia - hvordan virker de og hvordan monitoreres?

v/ Sisse Ostrowski Moderator: Mette Hyllested Finland Room

Præhospital visitation til neurologisk thrombektomi v/ Mads Rasmussen

Moderatorer: Jesper Hedegaard 14.40-15.10 Denmark Room

(fortsat) Inotropika ved almen kirurgi/intensiv terapi v/ Lars Algotsson

Moderator: Helle Laugesen Iceland Room

HELPv/ Søren Helbo Moderator: Eva Weitling Norway Room

FYA-session, del 1

Anæstesiolog kend dig selv - og undgå at blive skilt 1., 2. og 3. gang v/ Peter Lund Madsen og Stig Poulsen

Moderator: Øivind Jans 15.10-15.15 Kort pause

15.15-15.45 Norway Room FYA-session, del 2

Anæstesiolog kend dig selv - og undgå at blive skilt 1., 2. og 3. gang v/ Peter Lund Madsen og Stig Poulsen

Moderator: Øivind Jans Finland Room

Interventional neuroradiology - surviving in a remote location

v/ Adrian Gelb

Moderator: Niels Juul Denmark Room

Nye antikoagulantia - patienter med kardielle stents og atrieflimmer - hvem må pausere?

v/ Steen Husted

Moderator: Jonna Storm Fomsgaard Sweden Room

Akut, lægelig indsats i krigszoner v/ Christian Nielsen

Moderator: Charlotte Barfod Iceland Room

National rekommandation for triage af børn i FAM v/ Søren Kjærgaard

Moderator: Birgitte Uldahl Duch 15.45-18.00 PAUSE

18.00-19.00 Norway Room

Den 43. Husfeldt-forelæsning; Historien om et sygehus v/ Ole Helmig

Moderator: Ole Nørregaard 19.00-02.00 Scandinavian Ballroom

Middag og prisoverrækkelser 08.45- Registrering

Fredag d. 9. november 2012, fortsat

Lørdag d. 10. november 2012

09.00-09.45 Norway Room

“Boldt”spil og andre former for snyd i den anæstesiologiske forskning v/ Lars S. Rasmussen og Preben Berthelsen

Moderator: Jørgen B. Dahl Finland Room

Kvalitetsudvikling i speciallægepraksis v/ Kim Worm

Moderator: Carl Johan F. Erichsen 09.45-10.00 Kaffepause

10.00-11.30 Norway Room

Forebyggelse og behandling af perioperativt myokardieinfarkt - Det er hyppigere og farligere end vi tror v/ Christian Meyhoff - Forebyggelse med acetylsalisylsyre og clonidin v/ Christian Meyhoff - Behandling af postoperativt forhøjet troponin v/ Helena Dominguez Moderator: Jørn Wetterslev

Finland Room Akkreditering

- Den Danske Kvalitetsmodel - tankerne bag v/ Jesper Gad Christensen - Akkrediteringsprocessem i den kliniske hverdag v/ Lise Fonsmark - Pro et con v/ Kristian Antonsen og Anders Perner

Moderatorer: Nanna Reiter og Jan Bonde 11.30-12.15 Frokost

12.15-13.15 Finland Room

ICU-acquired weakness

- Patogenese og patofysiologi v/ Jesper Brøndum Poulsen

- Mobilisering i praksis på intensivafdeling v/ Anne Langvad og Maria Pedersen Moderator: Thomas Strøm

Norway Room Luftvejshåndtering

- “Apnøisk oxygenering ved akut intubation af risikopatienten” - gammel vin på nye flasker?

v/ Martin Kryspin Sørensen

- Larynxskader ved direkte- og videolaryngoskopi - et spørgsmål om (anæstesi-)teknik?

v/ Lars Hyldborg Lundstrøm Moderator: Anders Kehlet Nørskov 13.15-14.00 Norway Room

Politisk emne v/ T.B.A.

Moderator: T.B.A.

• Albrechtsen, Charlotte Krebs, overlæge, anæstesi- og operationsklinikken, JMC, Rigshospitalet

• Algotsson, Lars, overlæge, anæstesiafd., Universitetssygehuset i Lund

• Antonsen, Kristian, lægechef ved anæstesiologisk enhed for sygehusene i Hillerød, Helsingør og Frederikssund

• Barfod, Charlotte, afdelingslæge, ph.d., anæstesiafd., Hillerød Hospital

• Bendtsen, Thomas Fichtner, overlæge, ph.d., anæstesiafd., Århus Universitetshospital

• Berthelsen, Preben G., speciallæge

• Bested, Kirsten, overlæge, anæstesiafd., Sygehus Lillebælt Vejle

• Bonde, Jan, klinikchef, dr.med., Intensiv Terapi Klinik (ITA), ABD, Rigshospitalet

• Bredahl, Lisbeth, overlæge, thoraxanæstesiologisk afd., HJE, Rigshospitalet

• Butler, Steven, overlæge, smerteenheden, Uppsala Akademiska, Sverige

• Bülow, Hans-Henrik, overlæge, intensiv afd., Sygehus Nord, Holbæk Sygehus

• Bülow, Karsten, overlæge, anæstesi- og intensivafd., Odense Universitetshospital

• Børglum, Jens, overlæge, ph.d., anæstesiafd., Bispebjerg Hospital

• Christensen, Erika F., lægelig chef, Præhospitalet, Region Midt

• Christensen, Jesper Gad, direktør, Institut for Kvalitet og Akkreditering i Sundhedsvæsenet (IKAS)

• Dahl, Jørgen B., professor, overlæge, dr.med., anæstesi, Rigshospitalet

• Dirks, Jesper, overlæge, ph.d., anæstesi- og operationsklinikken, HOC, Rigshospitalet

• Dominguez, Helena, forskningsansvarlig overlæge, ph.d., kardiologisk afd., Herlev Hospital

• Duch, Birgitte Uldahl, overlæge, anæstesiafd., Århus Universitetshospital

• Erichsen, Carl Johan F., speciallæge i anæstesiologi, Speciallægepraksis

• Folkersen, Lars, overlæge, anæstesiafd., Århus Universitetshospital, Skejby

• Fomsgaard, Jonna Storm, overlæge, operations- og anæstesiafd., Glostrup Hospital

• Fonsmark, Lise, overlæge, Intensiv Terapi Klinik (ITA), ABD, Rigshospitalet

• Garde, Kim, klinikchef, neuroanæstesiologisk klinik, NEU, Rigshospitalet

• Gelb, Adrian, professor, Dept. of Anesthesia & Perioperative Care, University of California San Fran- cisco

• Gottschau, Bo, overlæge, anæstesiafd., Gentofte Hospital

• Haas De, Inge, overlæge, anæstesiafd., Århus Universitetshospital, Aalborg afs. Syd

• Hansen, Søren Helbo, overlæge, anæstesi- og intensivafd., Smertecenter Syd, Odense Universitets- hospital

• Hedegaard, Jesper, afdelingslæge, anæstesiafd., Århus Universitetshospital

• Helmig, Ole, overlæge, dr.med., ortopædkirurgi

• Hesselfeldt, Rasmus, læge, anæstesi- og operationsklinikken, HOC, Rigshospitalet

• Husted, Steen, overlæge, dr.med., hjertemedicinsk afdeling, Aarhus Universitetshospital

• Hyllested, Mette, overlæge, anæstesiafd., Bispebjerg Hospital

• Ilkjær, Susanne, overlæge, ph.d., anæstesi- og intensivafd., Århus Universitetshospital, Skejby

• Jans, Øivind, læge, ph.d.-studerende, enhed for kirurgisk patofysiologi, JMC, Rigshospitalet

• Jensen, Luana L., overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby

• Jensen, Marianne Kjær, overlæge, anæstesi- og intensivafd., Smertecenter Syd, Odense Universitets- hospital

• Juul, Niels, overlæge, anæstesi- og intensivafd., Århus Universitetshospital

• Jørgensen, Henrik, overlæge, ph.d., anæstesiafd., Herlev Hospital

• Jørgensen, Susanne, afdelingslæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet

• Kirkegaard, Hans, professor, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitetshospital

• Kjærgaard, Søren, overlæge, ph.d., Århus Universitetshospital, Aalborg afs. Syd

• Klemenzson, Gudmundur, Dept. of Anesthesia & Critical Care, Landspitali University Hospital of Iceland, Reykjavik, Iceland

• Knudsen, Lars, overlæge, lægelig leder, ph.d., anæstesiafd., Århus Universitetshospital

• Koscielniak-Nielsen, Zbigniew, overlæge, dr.med., anæstesi- og operationskinikken, HOC, Rigshospi- talet

• Köhler, Dennis, overlæge, Sanæstesiafd., Sygehus Lillebælt Kolding

• Langvad, Anne, sygeplejerske, Intensiv Terapi Klinik (ITA), ABD, Rigshospitalet

Foredragsholdere og mødeledere

• Lassen, Jens Flensted, overlæge, ph.d., Hjertemedicinsk afd. B, Århus Universitetshospital, Skejby

• Laugesen, Helle, overlæge, anæstsiafd., Århus Universitetshospital, Aalborg

• Lundstrøm, Lars Hyldborg, læge, anæstesiafd., Hillerød Hospital

• Lyng, Henrik, cand.psyk., Beredskabsstyrelsen og Røde kors

• Madsen, Peter Lund, læge, dr.med., foredragsholder

• Meyhoff, Christian, læge, anæstesiafd., Herlev Hospital

• Møller, Ann, overlæge, dr.med., anæstesiafd., Herlev Hospital

• Møller, Kirsten, overlæge, seniorforsker, dr.med., Neurointensiv Terapi Klinik, NEU, Rigshospitalet

• Naver, Lars, overlæge, kirurgisk afd. (bariatrisk kirurgi), Køge Sygehus

• Nielsen, Christian M., afdelingslæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet

• Nørgaard, Astrid, overlæge, ph.d., klinisk immunologisk afd., Blodbanken, Rigshospitalet

• Nørregaard, Ole, Århus Universitetshospital, Skejby, Respirationscenter Vest

• Nørskov, Anders Kehlet, læge, operations- og anæstesiafd., Glostrup Hospital

• Ostrowski, Sisse, 1. reservelæge, dr.med., klinisk immunologisk afd., DIA, Rigshospitalet

• Pedersen, Maria, fysioterapeut, Slagelse Sygehus

• Pedersen, Ole, overlæge, anæstesi- og intensivafd., Odense Universitetshospital

• Perner, Anders, professor, overlæge, ph.d., Intensiv Terapi Klinik (ITA), ABD, Rigshospitalet

• Petersen, J. Asger, overlæge, anæstesiafd., Bispebjerg Hospital

• Poulsen, Jesper Brøndum, læge, ph.d., anæstesiafd., Køge Sygehus

• Poulsen, Stig, cand.psyk., lektor, Københavns Universitet

• Ravn, Hanne, overlæge, dr.med., anæstesiafd., Århus Universitetshospital, Skejby

• Rasmussen, Lars S., professor, overlæge, dr.med., anæstesi- og operationsklinikken, HOC, Rigshospi- talet

• Rasmussen, Mads, afdelingslæge, ph.d., anæstesiafd., Århus Universitetshospital

• Reiter, Nanna, afdelingslæge, Intensiv Terapi Klinik (ITA), ABD, Rigshospitalet

• Rossel, Peter, lektor i medicinsk etik, Københavns Universitet

• Rothe, Anders, overlæge, anæstesiafd., Bispebjerg Hospital

• Schmidt, Henrik, overlæge, dr.med., anæstesi- og intensivafd., Smertecenter Syd, Odense Univer- sitetshospital

• Skjelsager, Karen, uddannelsesansvarlig overlæge, anæstesiafd., Næstved Sygehus

• Skovgaard, Karsten, overlæge, dr.med., operations- og anæstsiafd., Glostrup Hospital

• Sloth, Erik, professor, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitetshospital, Skejby

• Steensen, Morten, overlæge, anæstesiafd., Hvidovre Hospital

• Steinmetz, Jacob, traumemanager, overlæge, ph.d., anæstesi- og operationsklinikken, HOC, Rigshos- pitalet

• Strøm, Thomas, afdelingslæge, ph.d., anæstesi- og intensivafd., Smertecenter Syd, Odense Univer- sitetshospital

• Sørensen, Martin Kryspin, læge, ph.d., anæstesiafd., Hillerød Hospital

• Sørensen, Per Fraulund, fuldmægtig, cand.jur., juridisk sekretariat, Lægeforeningen

• Thomsen, Annemarie Bondegaard, overlæge, ph.d., anæstesi- og operationsklinikken, HOC, Rigshos- pitalet

• Thormar, Katrin, overlæge, anæstesi- og intensivafd., Gentofte Hospital

• Toft, Palle, professor, overlæge, dr.med., anæstesi- og intensivafd., Odense Universitetshospital

• Tollund, Carsten, overlæge, anæstesi- og operationsklinikken, ABD, Rigshospitalet

• Tønnesen, Else, professor, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitetshospital

• Weitling, Eva, overlæge, anæstesiafd., Sygehus Lillebælt, Kolding Sygehus

• Wetterslev, Jørn, overlæge, ph.d., Copenhagen Trial Unit, Rigshospitalet

• Worm, Kim, virksomhedskonsulent, General Manager, FabricAir,Inc

• Østergaard, Mette, overlæge, anæstesiafd., Hillerød Hospital

Foredragsholdere og mødeledere, fortsat

Abstracts - ACTA Foredragskonkurrence Abstract 9

Korresponderende forfatter:

Charlotte Vallentin Rosenstock Email: cros@hih.regionh.dk Afdeling: Anæstesiologisk afd. og Copenhagen Trial Unit, Center for Klinisk Interventionsforskning.

Hospital/sygehus: 1 Anæstesiologisk afdeling, Hillerød Hospital, 2 Copenhagen Trial Unit, Center for Klinisk Interventionsforskning, Rigshospitalet.

Medforfattere: Charlotte Vallentin Rosenstock1, Lars Hyldborg Lundstrøm1, Anders Kehlet Nørskov1, Jørn Wetterslev2 og Dansk Anæstesi Database.

Generel Anæstesi til Sectio og Vanskelig/

Umulig Intubation. Har vi et problem?

Introduktion: Vanskelig Intubation (VI) i forbindelse med generel anæstesi (GA) til sectio var tidligere forbundet med en høj mødre-dødelighed. Det forårsagede en ændring af anæstesiteknik til udbredt brug af regional anæstesi (RA) til sectio. GA bliver fortsat an- vendt ved hyperakut sectio, hvis der ikke er tid til anlæggelse af spinal anæstesi eller i tilfælde af en dysfungerende RA.

Formålet med denne undersøgelse er, at bestemme 1) Prævalensen af GA og RA ved sectio 2) Prævalensen af VI ved GA og 3) Anæstesilægers evne til at forudsige VI blandt sectio patienter registreret i Dansk Anæstesi Database(DAD).

Materiale og Metode: En kohorte på 20.507 patienter med relevante obstetriske diagno- sekoder blev udtrukket fra DAD i perioden juni 2008- juni 2011. Data for forventet VI og tilhørende luftvejshåndteringsplan blev indhen- tet og sammenlignet med den reelle luftvejs- håndteringsplan. Den diagnostiske præcision for forventet VI blev opgjort som sensitivitet, specificitet, positiv og negativ prædiktiv værdi, positiv og negativ likelihood ratio samt diagno- stisk odds ratio.

Resultater: GA blev anvendt ved sectio hos 9,6 % af patienterne. Prævalensen af VI var 1,8

% og heraf var 93 % uventede VI. Intubation blev opgivet hos 13 patienter (0,8 %). Anæste- siologers evne til at forudsige den vanskelige intubation fremgår af tabel 1.

Diskussion: Prævalensen af GA til sectio er dobbelt hhv tre gange så høj som i Eng- land og Canada1-2. Prævalensen af VI, blandt obstetriske patienter der fik fore- taget sectio i GA, var 1,8 % og svarende til prævalensen i en blandet kirurgisk kohorte registreret i DAD. En høj præ- valens af GA er af andre forfattere anset for at have positiv afsmittende affekt på anæstesiologers luftvejshåndteringsev- ner1-2. GA til sectio foregår i Danmark under medvirken af en anæstesiologisk speciallæge. Der ses ingen effekt heraf på prævalensen af VI og antallet af opgivne intubationer fandtes 70-100 % højere end i tilsvarende internationale undersøgelser1-2,. Dette er bekymrende, da mislykket intubation er hyppigste årsag til anæstesirelateret maternel død.

1) Anaesthesia 2009;64:1168-1171 2) Can J Anaesth 2011;58:514-524 Den diagnostiske præcision af vanskelig i ntubation ved

direkte laryngoskopi til sectio

Vanskelig intubation

Total

ja nej

Forventes vanskelig intubation

ja 2 6 8

nej 28 1650 1678

Total 30 1656 1686

95 % konfidens interval Diagnostisk odds ratio 19,6 3,8 101,6

Sensitivitet 0.07 0.01 0.24

Specificitet 0.996 0.992 0.999

Positiv prædiktiv værdi 0.25 0.04 0.64 Negativ prædiktiv værdi 0.98 0.98 0.99 Positiv likelihood ratio 18.4 3.9 87.5 Negativ likelihood ratio 0.94 0.85 1.03

Abstracts - ACTA Foredragskonkurrence, fortsat Abstract 11

Korresponderende forfatter: Asger Granfeldt Email: granfeldt@gmail.com

Afdeling: Anæstesiologisk afdeling N

Hospital/sygehus: Aarhus Universitetshospital Medforfattere: Hayley L. Letson, Janus A.

Hyldebrandt, Edward R. Wang, Pablo A.

Salcedo, Torben K. Nielsen, Jakob Vinten-Jo- hansen, Geoffrey P. Dobson, Else Tønnesen Rat to Pig Translation: Small-Volume 7.5%

NaCl Adenocaine/Mg2+ has multiple physiological benefits during hypotensive and blood resuscitation in the porcine model of severe hemorrhagic shock.

Background: Permissive hypotension resuscita- tion using small fluid volumes is an emerging concept of maintaining a lower systemic arterial pressure during hemorrhage. In the rat model of severe hemorrhagic shock, we have shown that a small bolus of 7.5% NaCl Adenocaine (adenosine and lidocaine, AL) and Mg2+ (ALM) had a significant hemodynamic and survival benefit. The present study tests whether small- volume 7.5% NaCl ALM translates from rat to the porcine model of severe hemorrhagic shock.

Methods: The study was approved by the National Committee on Animal Research Ethics.

Pigs (35-40kg) were subjected to pressure- controlled hemorrhage at a mean arterial pres- sure (MAP) of 35-40mmHg for 90 min (~75%

blood loss). Pigs were randomly assigned to receive either 4 ml/kg 7.5% NaCl ALM (ALM n=8) or 4 ml/kg 7.5% NaCl (Control n=8) at fluid resuscitation. Following 60min of hypotensive resuscitation, pigs were resuscitated with shed blood ± AL and observed for 3 hours. Systemic

hemodynamics, cardiac and renal function was continuously monitored. Power calculation was performed regarding an absolute mean differ- ence in MAP at 60 min resulting in 7 animals in each group: mean difference = 19mmHg (SD=10), β=0.1, α = 0.05.

Results: A single bolus of 7.5% NaCl ALM gener- ated a significantly higher MAP, cardiac output (CO), stroke volume (SV) and O2 delivery vs.

controls during hypotensive resuscitation.

Furthermore treatment with 7.5% NaCl ALM resulted in a higher pH, a lower base excess and lower plasma K+ after hypotensive resusci- tation vs. controls. The higher CO and SV were maintained at a significantly lower heart rate (HR). Systolic ejection times during hypoten- sive resuscitation were significantly increased in the ALM group and inversely related to HR.

One control died during hypotensive resuscita- tion. After 30 min blood return, whole body O2 consumption in ALM pigs transiently decreased with improvements in hemodynamics, pH and base excess. ALM pigs had lower lactate levels during both hypotensive resuscitation and after infusion of shed blood. No difference existed in renal parameters during hypotensive resuscitation. However following infusion of shed blood ± AL renal function, indicated by a lower plasma creatinine and urinary excretion of protein and N-Acetyl-b-D-Glucosaminidase, improved in ALM treated animals vs. controls.

Furthermore cardiac function evaluated by dP/

dtmax and dP/dtmin was significantly improved following infusion of shed blood in the ALM group vs. the control group. Core temperature were significantly lower (~0.5°C) in both resus- citation phases in ALM pigs, vs. controls.

Conclusion: Small-volume 7.5% NaCl ALM af- fords superior resuscitation benefits following severe hemorrhagic shock in pigs and may have applications in the pre-hospital environ- ment.

Disclosure: AG: Study was funded by Hiberna- tion Therapeutics. JVJ: Consultant for Hiberna- tion Therapeutics. GPD: Consultant for Hiberna- tion Therapeutics.

Abstracts - ACTA Foredragskonkurrence, fortsat Abstract 20

Korresponderende forfatter: Peter Buhl Hjortrup Email: pbhjortrup@gmail.com

Afdeling: Intensiv Terapiklinik 4131 Hospital/sygehus: Rigshospitalet

Medforfattere: Nicolai Haase, Frederik Treschow, Morten Hylander Møller, Anders Perner Predictive value of neutrophil gelatinase- associated lipocalin (NGAL) for use of renal replacement therapy in patients with severe sepsis

Introduction: NGAL has been proposed as an early marker of acute kidney injury (AKI) and renal replacement therapy (RRT). High NGAL concentrations have been reported in patients with inflammation without AKI. Patients with severe sepsis have systemic inflammation and the exact timing of renal insults is less clear, which may invalidate NGAL as a marker of AKI.

Our aim was to assess the predictive value of plasma and urine NGAL for use of RRT in patients with severe sepsis.

Methods: This was a prospective observational study in three ICUs in Denmark and a substudy of the 6S-trial where adult ICU patients with severe sepsis needing fluid resuscitation were randomly assigned to either hydroxyethyl starch or crystalloid.1 Patients receiving RRT at screening were excluded. Urine and plasma samples were taken at randomization and NGAL was measured using particle-enhanced turbidimetric immunoassay (Bioporto). The primary outcome measure was use of RRT in the ICU and secondary outcomes were develop- ment of AKI, defined as SOFA-score above 1 in the renal component within 5 days in patients not fulfilling this at enrollment, and 90-day mor- tality. The protocol was approved by the ethics committee and informed consent was obtained.

Results: 222 patients had samples taken (211 patients had plasma and 162 urine sampled) median 4 (IQR 0-13) hours after ICU admittance.

The age was 66 (57-75) years and SAPS II 54 (39-66). 71 patients had AKI at enrollment; of the remaining 151 patients 18% developed AKI during the first 5 days, 18% of the 222 patients had RRT in ICU and 55% died at 90 days. Areas

under receiver operator characteristics curve (AUC) for predicting use of RRT were 0.70 (95%

CI 0.61-0.78) and 0.62 (0.51-0.73) for plasma and urine NGAL, respectively. AUC for AKI within 5 days were 0.67 (0.57-0.77) and 0.74 (0.62-0.85) for plasma and urine NGAL, respectively, and 0.55 (0.47-0.63) and 0.61 (0.53-0.70) for 90-day mortality, respectively.

Discussion: This is the first study to assess plasma and urine NGAL’s value in predicting use of RRT, AKI and mortality in severe sepsis.

The results are less encouraging than those in general ICU patients. It may be that systemic inflammation in sepsis induces extrarenal NGAL confounding renal NGAL. Future ICU studies excluding patients with severe sepsis may show improved prediction of NGAL for RRT and AKI.

Conclusions: In ICU patients with severe sepsis plasma and urine NGAL had low or no predic- tive power for use of RRT, AKI or mortality.

Thus use of a single NGAL value as a predic- tive marker may not be recommended in these patients.

Acknowledgements: We are grateful to the staff at the participating ICUs. Bioporto supported the study

1. Perner et al.NEJM 2012;367:124

Abstracts - ACTA Foredragskonkurrence, fortsat Abstract 21

Korresponderende forfatter: Nicolai Haase¹ Email: nicolai.haase@rh.regionh.dk Afdeling: Intensiv Terapiklinik 4131 Hospital/sygehus: Rigshospitalet

Medforfattere: Anders Perner¹, Louise Inkeri Hennings¹, Martin Siegemund¹, Bo Lauridsen¹, Mik Wetterslev,¹ Jørn Wetterslev³

Hydroxyethyl starch 130/0.4 versus crystalloid or albumin in patients with sepsis: Effects on mortality, kidney function and bleeding – a systematic review with meta-analysis and trial sequential analysis

N Haase1, A Perner1, L Hennings1, M Siege- mund2, B Lauridsen1, M Wetterslev1, J Wet- terslev3

Introduction: Hydroxyethyl starch (HES) 130/0.4 is widely used for fluid therapy in critically ill patients, but its safety and efficacy remains to be established. We aimed to assess the effects of fluid therapy with HES 130/0.4 vs. crystal- loid or albumin on all-cause mortality, kidney function, bleeding, and serious adverse events (SAEs) in patients with sepsis.

METHODS

Design: Systematic review in compliance with the recommendations of the Cochrane Collabo- ration with meta-analyses and trial sequential analyses (TSA) of randomised clinical trials (RCTs). Data sources: Online databases to April 2012, hand search of reference lists and system- atic reviews, contact with authors and pharmaceutical companies. Inclusion criteria: Published and unpublished RCTs comparing HES 130/0.4 with either crystalloid or human albumin in patients with sepsis.

Results: Eight trials that randomised 1513 patients with sepsis were included.

Trial characteristics are shown in table 1. Overall HES 130/0.4 vs. crystalloid or

albumin did not affect the relative risk of death (relative risk (RR) 0.98, 95%-CI 0.77-1.25, 1493 patients, 7 trials), but post-hoc analyses showed increased risk of death in trials with low risk of methodological bias (RR 1.14, 95%-CI 1.01-1.29, TSA adjusted 95%-CI 1.00-1.30, 1291 patients, 4 trials) (figure 1) and in trials with follow-up for more than 28 days (RR 1.13, 95%-CI 1.00-1.29, TSA adjusted 95%-CI 0.99-1.30, 1235 patients, 3 trials), respectively.

More patients in the HES group developed acute kidney injury as compared with the control group (RR 1.18, 95%-CI 0.99-1.40, TSA adjusted 95%-CI 0.91-1.55, 949 patients, 3 trials) and renal replacement therapy was used more (RR 1.40, 95%-CI 1.04-1.88, TSA adjusted 95%-CI 0.91-2.15, 1070 patients, 4 trials).

More patients in the HES group were transfused with red blood cells (RR 1.29, 95%-CI 1.13-1.48, TSA adjusted 95%-CI 1.10-1.51, 973 patients, 3 trials) and more patients had SAEs (RR 1.30, 95%-CI 1.02-1.67, TSA adjusted CI 0.88-1.94, 1069 patients, 4 trials). Transfused volume of red blood cells did not differ between the groups (mean difference 65 ml, 95%-CI -20 to 149).

Conclusion: In trials of HES 130/0.4 vs. crystal- loid or albumin in sepsis with adequate bias control and a follow-up of more than 28 days, HES 130/0.4 increased mortality, impaired renal function, and increased the risk of having blood transfusion or SAEs. Even after adjustment for sparse data and multiple updating in meta- analysis harm seems imminent.

1 Dept of Intensive Care 4131, Rigshospitalet 2 Dept of Intensive Care, Baden State Hospital,

Switzerland.

3 Copenhagen Trial Unit, Rigshospitalet

Abstracts - ACTA Foredragskonkurrence, fortsat

Trial

No. of patients Single center /

multicenter

SettingBlinding

Number of inter

-

vention groups

Inclusion Criteria

Indication for inter

- vention

HES solutionCompa- ratorInter- vention period Length of follow

-up (mortality)

Metho- dological risk of bias

6S798MulticenterICUYes2Adults, severe sepsis and need of fluid resuscitation

Resuscita- tion6% Tetras- pan®Ringer’s acetate

ICU- stay

. Max. 90 days.

90 daysLow BaSES241Two ICUs in one hospital

ICUYes2

Adults, with sepsis. Hypotension, oliguria or altered mental state could replace SIRS-criteria

Resuscita- tion6% Voluven®

Isotonic saline

5 days1 yearLow CRYSTMAS196MulticenterICUYes2Adults, severe sepsis and need of fluid resuscitation

Resuscita- tion6% Voluven®

Isotonic saline

4 days90 daysLow Dolecek 200956SingleICUNo2Adults, severe sepsis and extra vascular lung water above up- per reference range

Fixed dose6% Voluven®Albumin 20%3 days28 daysLow Dubin 201025MulticenterICUNo2Adults, sepsis and tis- sue hypoperfusionResuscita- tion6% Voluven®

Isotonic saline

24 hours28 daysHigh Lv 201242SingleICUUnclear2Adults, septic shockResuscita- tionUnclearRinger’s lactate24 hoursUnclearHigh Palumbo 200620SingleICUNo2Adults, severe sepsis

To maintain pulmonary capillary wedge pressure

6% Voluven®Albumin 20%UnclearUnclearHigh Zhu 2011135SingleICUNo3Adults, severe sepsisResuscita- tion

6% HES 130/0.4

(unclear brand)

Ringer’s lactate24 hours24 hoursHigh

Abstracts - ACTA Foredragskonkurrence Abstract 29

Korresponderende forfatter: Pia Jæger Email: pia_jaeger@hotmail.com

Afdeling: Anæstesi- og Operationsklinikken 4231, HOC

Hospital/sygehus: Rigshospitalet

Medforfattere: Zbigniew J.K. Nielsen, Maria H.

Henningsen, Karen Lisa Hilsted, Ole Mathiesen, Jørgen B. Dahl

Adductor-Canal-Blockade Versus Femoral Nerve Block and Quadriceps Strength:

A Randomized, Double Blind, Placebo- Controlled, Crossover Study in Healthy Volunteers

Introduction: The Adductor-Canal-Blockade (ACB) is theoretically a predominantly sensory blockade, which has been shown to reduce morphine consumption and pain during activity compared with placebo after total knee arthro- plasty. 1 We hypothesized that the ACB reduces quadriceps strength to some extent compared with placebo (primary endpoint), but less than the femoral nerve block (FNB) (secondary endpoint). Other secondary endpoints were ad- ductor strength and ability to ambulate.

Methods: We enrolled healthy young men into this double blind, placebo-controlled, randomized, crossover study. The trial was approved by the local Regional Ethics Com- mittee (H-4-2011-057), the Danish Medicines Agency (2011-004285-15), and the Danish Data Protection Agency, and was registered at www.

clinicaltrials.gov (NCT01449097). Each subject was investigated on two separate study days.

On the first day of the study, subjects received a FNB in one limb and an ACB in the other limb.

In a double masked fashion and according to randomization 30 ml of 0.1% ropivacaine was

given in one block and isotonic saline in the other. This was reversed on the second day of the study. Muscle strength was assessed, with a handheld dynamometer, as maximum voluntary isometric contraction for quadriceps and adductor muscles (area under the curve 0.5–6 h). In addition, subjects performed three standardized mobilization tests at 1 and 6 h:

Timed-Up-and-Go test, the 10-m walk test and the 30-second Chair Stand test.

Results: Twelve subjects were randomized, 11 analyzed. Quadriceps strength (area under the curve, 0.5–6 h) was significantly reduced when comparing ACB with placebo (5.0 ± 1.0 vs.5.9 ± 0.6, P = 0.02, CI -1.5 to -0.2), FNB with placebo (P = 0.0004), and when comparing FNB with ACB (P = 0.002). The mean reduction from base- line was 8% with ACB and 49% with FNB. The only statistically significant difference in adduc- tor strength was between placebo and FNB (P

= 0.007). The mean reduction from baseline in adductor strength was 5% with ACB and 10%

with FNB. Performance in all mobilization tests was reduced after a FNB compared with an ACB (P < 0.05).

Discussion and Conclusion: Compared with placebo, ACB statistically significantly reduced quadriceps strength, but the reduction was only 8% from baseline. Such reduction may not be functionally important in patients, as a side-to- side difference of 10% in healthy individuals is a normal variance. ACB preserved quadriceps strength and ability to ambulate better than FNB.

None of the blocks reduced adductor strength to a degree of functional importance. This study confirms that the ACB is mainly a sensory block, which may be a useful analgesic adjuvant for acute pain management after knee surgery.

1. Jenstrup MT, Jaeger P, Lund J, Fomsgaard JS, Bache S, Mathiesen O, Larsen TK, Dahl JB: Effects of Adductor- Canal-Blockade on pain and ambulation after total knee arthroplasty: A randomized study. Acta Anaesthesiol.

Scand. 2012; 56: 357-64

Abstract 32

Korresponderende forfatter:

Morten Bundgaard-Nielsen (1,2)

Email: morten.bundgaard-nielsen@rh.regionh.dk Hospital/sygehus: Rigshospitalet

Medforfattere: Øivind Jans ⁽¹⁾, Rasmus G Müller

(1,2), André Korshin ⁽²⁾, Birgitte Ruhnau ⁽²⁾, Peter Bie ⁽³⁾, Niels H Secher ⁽²⁾, and Henrik Kehlet ⁽¹⁾ Effect of Goal-directed Fluid Therapy on Postoperative Orthostatic Intolerance; A Randomized Trial

Introduction: Early mobilization is crucial for enhanced recovery after surgery. Early mobilization may, however, be challenged by orthostatic intolerance (OI) characterized by an inability to maintain an upright posture because of symptoms of cerebral hypoperfusion, includ- ing dizziness, nausea, blurred vision, and even- tual syncope. The prevalence of OI has been reported as high as 50% 6 h after major surgery (1,2) and the pathophysiology is suggested to include dysregulation of cardiac output and vasomotor tone and presence of hypovolemia may, therefore, be involved. Stroke volume (SV) guided fluid therapy, so-called goal-directed therapy (GDT) corrects functional hypovolemia and we hypothesized that GDT could reduce the prevalence of OI (3).

Methods: Forty-two patients scheduled for open radical prostatectomy in general anesthesia were randomized to standard fluid therapy (control group) or GDT. Both groups received a fixed crystalloid regimen supplemented with 1:1 replacement of blood loss with colloid (HES 130/0.4) and the GDT group received additional colloid if needed to achieve a maximal SV (es- ophageal Doppler) during and after operation (3). The prevalence of OI was evaluated with a standardized mobilization protocol before and 6 h after surgery (1,2). Also, continuous hemody- namic variables (Modelflow®), tissue oxygena- tion (NIRS) and responses of angiotensin II, atrial natriuretic peptide, epinephrine, nor- epinephrine and vasopressin were measured during mobilization.

Results: 12 (57%) patients in the control group vs. 15 (71%) patients in the GDT group (P=0.33) had OI and there was no difference in cardio- vascular or hormonal responses to mobiliza- tion (Fig.). Patients in the GDT group received more colloid during surgery (1758 vs. 1057 ml;

P=0.001) and achieved a higher SV (102 vs.

89 ml; P=0.04). Patients with OI had impaired hemodynamic and norepinephrine responses upon mobilization.

Discussion: Although hypovolemia may contrib- ute to OI, GDT as a single intervention did not reduce the prevalence of OI. The attenuated nor- epinephrine response in OI patients suggests that use of vasopressors may be more rational.

Conclusion: GDT did not reduce the prevalence of OI. Patients with OI have impaired cardiovas- cular and hormonal responses. Studies on the insufficient orthostatic vasopressor response are warranted.

Approved by the ethics committee (H-D-2008-051).

References

1. Bundgaard-Nielsen M, Jørgensen CC, Jørgensen TB, Ruhnau B, Secher NH, Kehlet H. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization. Br J Anaesth 2009;102:756-62

2. Jans Ø, Bundgaard-Nielsen M, Solgaard S, Johansson PI, Kehlet H. Orthostatic intolerance during early mobiliza- tion after fast-track hip arthroplasty. Br J Anaesth 2012;

108:436-443

3. Bundgaard-Nielsen M, Holte K, Secher NH, Kehlet H.

Monitoring of peri-operative fluid administration by individualized goal-directed therapy. Acta Anaesthesiol Scand 2007;51:331-40

Afdeling:

(1) Section of Surgical Pathophysiology,

(2) Department of Anesthesiology, Rigshospitalet, Univer- sity of Copenhagen, Denmark and,

(3) Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.

Figure. Changes in cardiovascular variables before (Preoperative) and 6 h after surgery in pa- tients receiving standard therapy (Control) or indi- vidualized goal-directed therapy (GDT) during a standardized mobilization procedure. Preopera- tively Control and GDT are illustrated as one curve since there was no difference between groups in any variables (all P>0.05). SAP, systolic arterial pressure; DAP, diastolic arterial pressure;

HR, heart rate; SV, stroke volume; CO, cardiac output; TPR, total periph- eral resistance; SMO2, muscle tissue oxygena- tion; SCO2, frontal lobe cerebral oxygenation;

PLR, 30˚ passive leg raise test. *P<0.05 compared to supine; #P<0.05 com- pared to before surgery.

Dansk Selskab for Anæstesiologi og Intensiv Medicin (DASAIM) Sekretariat

Rigshospitalet, AN-OP, HOC 4231 Blegdamsvej 9 - 2100 København Ø

Tlf. 3545 6602 Email: sekretariat@dasaim.dk

Tak til hovedsponsorer for DASAIMs Årsmøde 2012