uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Frykholm, Peter
Publications (10 of 35) Show all publications
Saastamoinen, M., Larsson, J. & Frykholm, P. (2019). Checking mask ventilation before neuromuscular block: A nation-wide survey of anaesthetists' attitudes and thinking. Acta Anaesthesiologica Scandinavica, 63(9), 1178-1183
Open this publication in new window or tab >>Checking mask ventilation before neuromuscular block: A nation-wide survey of anaesthetists' attitudes and thinking
2019 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 9, p. 1178-1183Article in journal (Refereed) Published
Abstract [en]

Background: The value of checking mask ventilation before administering neuromuscular blocking drugs is still debated.

Method: We conducted a survey of the practice of anaesthetists in Sweden, first asking if they use a mask ventilation trial (MVT) as part of routine induction with intubation (not rapid sequence induction or expected difficult airway). We focused on the reasons for or against the MVT, probing the anaesthetists' attitudes in general but also in specific scenarios.

Results: The response rate was 54%. We found that 65.1% routinely use a MVT, 21.4% sometimes do and 13.5% never do so. There was no effect for years of experience on the distribution. The most common reason for checking mask ventilation was "to gather information about the airway," while the reason for not using the MVT was mostly "that muscle relaxation often improves mask ventilation."

Conclusion: We found several interesting comments about airway management at both practical and theoretical levels. The survey highlights that routinely performing a MVT is a common practice in Sweden in spite of the lack of evidence for increased patient safety. Future airway guidelines may need to address this practice.

Place, publisher, year, edition, pages
WILEY, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-396123 (URN)10.1111/aas.13426 (DOI)000481427700001 ()31359434 (PubMedID)
Available from: 2019-10-30 Created: 2019-10-30 Last updated: 2019-10-30Bibliographically approved
Andersson, H., Hellström, P. M. & Frykholm, P. (2018). Introducing the 6-4-0 fasting regimen and the incidence of prolonged preoperative fasting in children. Pediatric Anaesthesia, 28(1), 46-52
Open this publication in new window or tab >>Introducing the 6-4-0 fasting regimen and the incidence of prolonged preoperative fasting in children
2018 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 28, no 1, p. 46-52Article in journal (Refereed) Published
Abstract [en]

Background

Children often starve for longer than recommended by current preoperative fasting guidelines.

Aims

We studied the effects of implementing a more lenient fasting regimen on the duration of clear fluid fasting, as well as the incidence of extended fasting in children.

Methods

Preoperative duration of clear fluid fasting was recorded for patients scheduled for procedures in a unit applying the standard 6-4-2 fasting regimen. This group was compared with a cohort in the same unit 1year after transitioning to a 6-4-0 fasting regimen. The latter includes no limitations on clear fluid intake until the child is called to theater. A third cohort from a unit in which the 6-4-0 fasting regimen has been implemented for over a decade was also studied for comparison.

Results

Patients fasting according to the 6-4-2 fasting regimen (n=66) had a median fasting time for clear fluids of 4.0h and a 33.3% incidence of fasting more than 6h. After transitioning to the 6-4-0 fasting regimen (n=64), median duration of fasting for clear fluids decreased to 1.0h, and the incidence of fasting more than 6h decreased to 6.3%. In the second unit (n=73), median fasting time was 2.2h and the proportion of patients fasting more than 6h was 21.9%.

Conclusion

The introduction and implementation of the 6-4-0 fasting regimen reduces median fluid fasting duration and the number of children subjected to extended fasting.

Keywords
anesthesia, children, fasting, fluids, preoperative
National Category
Anesthesiology and Intensive Care Pediatrics
Identifiers
urn:nbn:se:uu:diva-343890 (URN)10.1111/pan.13282 (DOI)000417604600008 ()29168341 (PubMedID)
Available from: 2018-03-05 Created: 2018-03-05 Last updated: 2019-10-06Bibliographically approved
Andersson, H., Schmitz, A. & Frykholm, P. (2018). Preoperative fasting guidelines in pediatric anesthesia: are we ready for a change?. Current Opinion in Anaesthesiology, 31(3), 342-348
Open this publication in new window or tab >>Preoperative fasting guidelines in pediatric anesthesia: are we ready for a change?
2018 (English)In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 31, no 3, p. 342-348Article, review/survey (Refereed) Published
Abstract [en]

Purpose of review: Study after study shows that prolonged fasting before anesthesia is common in children. Pediatric anesthesiologists around the world are concerned that the current guidelines may be part of the problem. This review focuses on what can be done about it.

Recent findings: We discuss new insights into the physiology of gastric emptying of different categories of food and drink. The evidence for negative effects of prolonged fasting occurring in spite of implementation of the current guidelines is examined. We also critically appraise the concept of a strict association between fasting time and the risk of aspiration and discuss recent studies in which children have been allowed clear fluids less than 2 h before anesthesia induction.

Summary: Accumulating evidence indicates that changes of the current guidelines for preoperative fasting should be considered for children undergoing elective procedures.

Video abstract: http://links.lww.com/COAN/A50

Keywords
aspiration pneumonia, children, fasting hypoglycemia, gastric emptying, perioperative period
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-362650 (URN)10.1097/ACO.0000000000000582 (DOI)000434300800017 ()29443724 (PubMedID)
Available from: 2018-10-16 Created: 2018-10-16 Last updated: 2018-10-16Bibliographically approved
Frykholm, P., Schindler, E., Suempelmann, R., Walker, R. & Weiss, M. (2018). Preoperative fasting in children: review of existing guidelines and recent developments. British Journal of Anaesthesia, 120(3), 469-474
Open this publication in new window or tab >>Preoperative fasting in children: review of existing guidelines and recent developments
Show others...
2018 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 120, no 3, p. 469-474Article, review/survey (Refereed) Published
Abstract [en]

The current guidelines for preoperative fasting recommend intervals of 6, 4, and 2 h (6-4-2) of fasting for solids, breast milk, and clear fluids, respectively. The objective is to minimize the risk of pulmonary aspiration of gastric contents, but also to prevent unnecessarily long fasting intervals. Pulmonary aspiration is rare and associated with nearly no mortality in paediatric anaesthesia. The incidence may have decreased during the last decades, judging from several audits published recently. However, several reports of very long fasting intervals have also been published, in spite of the implementation of the 6-4-2 fasting regimens. In this review, we examine the physiological basis for various fasting recommendations, the temporal relationship between fluid intake and residual gastric content, and the pathophysiological effects of preoperative fasting, and review recent publications of various attempts to reduce the incidence of prolonged fasting in children. The pros and cons of the current guidelines will be addressed, and possible strategies for a future revision will be suggested.

Keywords
anaesthesia, aspiration pneumonia, children, gastric emptying, preoperative period
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-365270 (URN)10.1016/j.bja.2017.11.080 (DOI)000438191300011 ()29452803 (PubMedID)
Available from: 2018-11-19 Created: 2018-11-19 Last updated: 2018-11-19Bibliographically approved
Kostic, P., Lo Mauro, A., Larsson, A., Hedenstierna, G., Frykholm, P. & Aliverti, A. (2018). Specific anesthesia-induced lung volume changes from induction to emergence: a pilot study.. Acta Anaesthesiologica Scandinavica, 62(3), 282-292
Open this publication in new window or tab >>Specific anesthesia-induced lung volume changes from induction to emergence: a pilot study.
Show others...
2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 3, p. 282-292Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Studies aimed at maintaining intraoperative lung volume to reduce post-operative pulmonary complications have been inconclusive because they mixed up the effect of general anesthesia and the surgical procedure. Our aims were to study: (1) lung volume during the entire course of anesthesia without the confounding effects of surgical procedures; (2) the combination of three interventions to maintain lung volume; and (3) the emergence phase with focus on the restored activation of the respiratory muscles.

METHODS: Eighteen ASA I-II patients undergoing ENT surgery under general anesthesia without muscle relaxants were randomized to an intervention group, receiving lung recruitment maneuver (LRM) after induction, 7 cmH2 O positive end-expiratory pressure (PEEP) during anesthesia and continuous positive airway pressure (CPAP) during emergence with 0.4 inspired oxygen fraction (FiO2 ) or a control group, ventilated without LRM, with 0 cmH2 O PEEP, and 1.0 FiO2 during emergence without CPAP application. End-expiratory lung volume (EELV) was continuously estimated by opto-electronic plethysmography. Inspiratory and expiratory ribcage muscles electromyography was measured in a subset of seven patients.

RESULTS: End-expiratory lung volume decreased after induction in both groups. It remained low in the control group and further decreased at emergence, because of active expiratory muscle contraction. In the intervention group, EELV increased after LRM and remained high after extubation.

CONCLUSION: A combined intervention consisting of LRM, PEEP and CPAP during emergence may effectively maintain EELV during anesthesia and even after extubation. An unexpected finding was that the activation of the expiratory muscles may contribute to EELV reduction during the emergence phase.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-334187 (URN)10.1111/aas.13026 (DOI)000424150200001 ()29105056 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research Council, 5315, K2015-99X-22731-01-4
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-03-15Bibliographically approved
LoMauro, A., Aliverti, A., Privitera, E., Vergari, M., Righi, I., Sgroia, M., . . . Palleschi, A. (2018). The diaphragm before and after lung transplant (LT). Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>The diaphragm before and after lung transplant (LT)
Show others...
2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-376272 (URN)10.1183/13993003.congress-2018.PA2589 (DOI)000455567103163 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Note

Supplement: 62

Meeting Abstract: PA2589

Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-04Bibliographically approved
LoMauro, A., Aliverti, A., Alberigo, D., Persico, N., Frykholm, P., Briganti, F., . . . Righi, I. (2018). The Effect Of Pregnancy On Respiratory Function. Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>The Effect Of Pregnancy On Respiratory Function
Show others...
2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-376271 (URN)10.1183/13993003.congress-2018.OA2149 (DOI)000455567100137 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Note

Supplement: 62

Meeting Abstract: OA2149

Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-04Bibliographically approved
LoMauro, A., Johansson, H., Malinovschi, A., Frykholm, P., Mallmin, E., Norlander, K., . . . Nordang, L. (2018). The ventilatory pattern and the operational volumes during exercise in subjects with diagnosed exercise-induced laryngeal obstruction (EILO). Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>The ventilatory pattern and the operational volumes during exercise in subjects with diagnosed exercise-induced laryngeal obstruction (EILO)
Show others...
2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-376270 (URN)10.1183/13993003.congress-2018.OA3564 (DOI)000455567100276 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Note

Supplement: 62

Meeting Abstract: OA3564

Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-04Bibliographically approved
Mogensen, S., Lubenow, N., Nilsson, P., Engquist, H., Knutson, F., Enblad, P., . . . Frykholm, P. (2017). An evaluation of the mixed pediatric unit for blood loss replacement in pediatric craniofacial surgery. Pediatric Anaesthesia, 27(7), 711-717
Open this publication in new window or tab >>An evaluation of the mixed pediatric unit for blood loss replacement in pediatric craniofacial surgery
Show others...
2017 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 27, no 7, p. 711-717Article in journal (Refereed) Published
Abstract [en]

Background: Surgical correction for craniosynostosis is often associated with significant perioperative hemorrhage. We implemented a transfusion strategy with a strict protocol including transfusion triggers, frequent assessment of coagulation tests, and the use of a novel transfusion unit, the mixed pediatric unit. Aim: The aim of the study was to evaluate if the applied transfusion strategy could reduce total blood loss and number of blood donors. Methods: Children <1 year old admitted for craniosynostosis surgery were included for the study. On the day before surgery, an adult red blood cell unit was mixed with plasma and split into two mixed pediatric units-one intended for intraoperative use and the other saved for the postoperative period. A series of blood samples were obtained for standard coagulation parameters as well as thromboelastography to evaluate potential coagulopathy. Estimated blood loss, the number of additional standard packed red cell units opened in the first 24 h after surgery, the volume of fluid administered, and the total transfusion volumes were compared to a historical control group with similar age and characteristics. Results: Nineteen infants were included in the study group, and were compared to 21 historical controls. There was a significant reduction of intraoperative transfusion volume. Twelve patients were transfused postoperatively, but in 8 of these additional exposure to packed red cell donor blood was avoided by using the saved mixed pediatric unit. In the historical controls, a total of 10 packed red cell units were used in nine patients postoperatively. No additional transfusions of plasma, platelets, fibrinogen, or tranexamic acid were needed in either group, and the coagulation parameters including thromboelastography remained within their respective normal ranges in the study group. Conclusion: For craniofacial surgery in infants, moderate perioperative blood loss and avoidance of coagulopathy is possible when a multifactorial approach is implemented. In this setting, intraoperative, but not total perioperative blood loss was reduced with the studied protocol. The study indicates that there may be a role for mixed pediatric units to reduce exposure to multiple donors although the reduction in total donor exposure was not significant.

Keywords
craniosynostosis, blood loss, surgical, postoperative hemorrhage, blood transfusion, blood coagulation tests, thromboelastography, infants
National Category
Anesthesiology and Intensive Care Pediatrics
Identifiers
urn:nbn:se:uu:diva-330012 (URN)10.1111/pan.13140 (DOI)000405081500007 ()28436074 (PubMedID)
Available from: 2017-10-11 Created: 2017-10-11 Last updated: 2017-10-11Bibliographically approved
Nellgard, P., Hallen, K., Ullman, J., Lodenius, A., Cressy, C., Hallen, J., . . . Frykholm, P. (2017). Fourth Swedish difficult airway guidelines. Acta Anaesthesiologica Scandinavica, 61(8), 1035-1036
Open this publication in new window or tab >>Fourth Swedish difficult airway guidelines
Show others...
2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1035-1036Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-342130 (URN)000407231100125 ()
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-02-22Bibliographically approved
Organisations

Search in DiVA

Show all publications