När ett barn ska opereras upplever såväl barnet som dess föräldrar stress. I en sådan situation kan det vara svårt att fungera som stöd åt sitt barn. Olika faktorer kan underlätta för föräldrarna varav en är information. Problemområde för denna litteraturstudie är preoperativ information till föräldrar. Syftet var att kartlägga hur litteraturen beskriver information till föräldrar och hur informationen påverkar barn och föräldrar. Metoden har följt forskningsprocessen vid en litteraturstudie där fråga, problemformulering, litteratursökning, evaluering, tolkning och rapportering ingår. Efter databassökningar i framför allt PubMed har åtta artiklar valts ut som ligger till grund för resultatet. Resultatet visade att omvårdnadspersonal med hjälp av individuellt anpassad information kan reducera oron hos både föräldrar och barn. Resultatet visar också att den viktigaste informationsvägen fortfarande är den muntliga men att den behöver kompletteras med andra informationsvägar. / When a child is due for surgery, the child as well as it’s parents experience stress. In a stresssful situation it can be difficult to function as suppport to one’s child. The area of interest in this review is preoperative information to parents. The aim is to investigate the scientific description of how preoperative information to parents are communicated and how it affects the child as well as it’s parents. The review has followed the scientific procedure described in the following headings: formulating a scientific question, emphasizing a problem, seeking literature, evaluating, interpret and report. After searches in electronic databases, mainly in PubMed, we decided to use eight articles for our result. The result shows that we can reduce anxiety in parents and children by giving them individual preoperative information. Verbal information can never be replaced but needs to be combined by other sorts of information.

Man has a limited ability to accurately and continuously analyse large amounts of data. Observers are typically required to monitor displays over extended periods and to execute overt detection responses to the appearance of low probability critical signals. The signals are usually clearly perceivable when observers are alerted to them, but they can be missed in the operating environment. The challenge is to develop a computer application that will accumulate information on a variable, or several variables, over time and identify when the trend in observations has changed. In recent years, there has been a rapid growth in patient monitoring and medical data analysis using decision support systems, smart alarm monitoring systems, expert systems and many other computer aided protocols. The expert systems have the potential to improve clinician performance by accurately executing repetitive tasks, to which humans are ill-suited. Anaesthetists working in the operating theatre are responsible for carrying out a multitude of tasks which requires constant vigilance and thus a need for a smart decision support system has arisen. The decision support tools capable of detecting pathological events can enhance the anaesthetist’s performance by providing alternative diagnostic information. The main goal of this research was to develop a clinically useful diagnostic alarm system using two different techniques for monitoring a pathological event during anaesthesia. Several techniques including fuzzy logic, artificial neural networks, control and monitoring techniques were explored. Firstly, an industrial monitoring system called Supervisory Control and Data Acquisition (SCADA) software is used and implemented in the form of a prototype system called SCADA monitoring system (SMS). The output of the system in detecting hypovolaemia was classified into three levels; mild, moderate and severe using SCADA’s InTouch software. In addition, a new GUI display was developed for direct interaction with the anaesthetists. Secondly, a fuzzy logic monitoring system (FLMS) was developed using the fuzzy logic technique. New diagnostic rules and membership functions (MF) were developed using MATLAB. In addition, fuzzy inference system FIS, adaptive neuro fuzzy inference system ANFIS and clustering techniques were explored for developing the FLMS’s diagnostic modules. The raw physiological patient data acquired from an S/5 monitor were converted to a readable format using the DOMonitor application. The data was filtered, preprocessed, and analysed for detecting anaesthesia related events like hypovolaemia. The accuracy of diagnoses generated by SMS and FLMS was validated by comparing their diagnostic information with the one provided by the anaesthetist for each patient. Kappa-analysis was used for measuring the level of agreement between the anaesthetist’s, SMS’s, and FLMS’s diagnoses. In offline analysis both systems were tested with data from 15 patients. The SMS and FLMS achieved an overall agreement level of 87 and 88 percent respectively. It implies substantial level of agreement between SMS or FLMS and the anaesthetists. These diagnostic alarm systems (SMS and FLMS) have shown that evidence-based expert diagnostic systems can diagnose hypovolaemia, with a substantial degree of accuracy, in anaesthetized patients and could be useful in providing decision support to anaesthetists.

Man has a limited ability to accurately and continuously analyse large amounts of data. Observers are typically required to monitor displays over extended periods and to execute overt detection responses to the appearance of low probability critical signals. The signals are usually clearly perceivable when observers are alerted to them, but they can be missed in the operating environment. The challenge is to develop a computer application that will accumulate information on a variable, or several variables, over time and identify when the trend in observations has changed. In recent years, there has been a rapid growth in patient monitoring and medical data analysis using decision support systems, smart alarm monitoring systems, expert systems and many other computer aided protocols. The expert systems have the potential to improve clinician performance by accurately executing repetitive tasks, to which humans are ill-suited. Anaesthetists working in the operating theatre are responsible for carrying out a multitude of tasks which requires constant vigilance and thus a need for a smart decision support system has arisen. The decision support tools capable of detecting pathological events can enhance the anaesthetist’s performance by providing alternative diagnostic information. The main goal of this research was to develop a clinically useful diagnostic alarm system using two different techniques for monitoring a pathological event during anaesthesia. Several techniques including fuzzy logic, artificial neural networks, control and monitoring techniques were explored. Firstly, an industrial monitoring system called Supervisory Control and Data Acquisition (SCADA) software is used and implemented in the form of a prototype system called SCADA monitoring system (SMS). The output of the system in detecting hypovolaemia was classified into three levels; mild, moderate and severe using SCADA’s InTouch software. In addition, a new GUI display was developed for direct interaction with the anaesthetists. Secondly, a fuzzy logic monitoring system (FLMS) was developed using the fuzzy logic technique. New diagnostic rules and membership functions (MF) were developed using MATLAB. In addition, fuzzy inference system FIS, adaptive neuro fuzzy inference system ANFIS and clustering techniques were explored for developing the FLMS’s diagnostic modules. The raw physiological patient data acquired from an S/5 monitor were converted to a readable format using the DOMonitor application. The data was filtered, preprocessed, and analysed for detecting anaesthesia related events like hypovolaemia. The accuracy of diagnoses generated by SMS and FLMS was validated by comparing their diagnostic information with the one provided by the anaesthetist for each patient. Kappa-analysis was used for measuring the level of agreement between the anaesthetist’s, SMS’s, and FLMS’s diagnoses. In offline analysis both systems were tested with data from 15 patients. The SMS and FLMS achieved an overall agreement level of 87 and 88 percent respectively. It implies substantial level of agreement between SMS or FLMS and the anaesthetists. These diagnostic alarm systems (SMS and FLMS) have shown that evidence-based expert diagnostic systems can diagnose hypovolaemia, with a substantial degree of accuracy, in anaesthetized patients and could be useful in providing decision support to anaesthetists.

Safety and quality of care are considered to be one of the main priorities in anaesthesia and their management and monitoring should be continuous and systematic. Quality indicators in anaesthesia must be frequently evaluated. Their evidence and evaluation create not only safe environment for patients but also continuously improve quality of anaesthesiologic care. The main objective of this diploma thesis was to evaluate patient's satisfaction with provided anaesthesiologic care, one of the main quality indicators in anaesthesia. Other objectives were research of quality indicators recommended in the Czech Republic and quality indicators recommended by foreign medical societies. The last partial objective was to create quality indicators checklist tailored for specific department of anaesthesiology based on collected data. Quantitative method research was conducted, using unstandardised questionnaire for patients, hospitalized and anaesthetised. 140 questionnaires were distributed of which 117 questionnaires returned. Based on objective the author of diploma thesis found out that Czech society of anaesthesia, resuscitation and intensive care determines quality indicators monitored in the Czech Republic. Quality indicators in foreign countries are in form of criteria that are necessary to adhere to....

: Bakgrund och problemformulering: Extubation är ett avgörande moment inom anestesi. När patienten har tillfredsställande andningsmönster så kan trakealtuben tas ut ur patientens luftväg. Inga hundraprocentiga kriterier finns för hur extubationens utfall blir, utan utförs ofta utefter situation. Det är en komplex process som kräver noga övervakning och anpassning till varje patients individuella behov. Att bedöma, etablera och kontrollera luftvägen kräver att anestesisjuksköterskan har kunskap och erfarenhet av multidisciplinärt samarbete och etisk medvetenhet. För att undvika patientlidande är personcentrerad vård nödvändigt och kräver ett förhållningsätt baserat på omtanke. Riskerna för komplikation har inte tydligt minskat under åren och det upplevs svårt att planera och utföra en extubation. Syfte: Syftet var att undersöka anestesisjuksköterskan och anestesiologens erfarenheter av extubation. Metod: En systematisk litteraturöversikt med integrativ metod baserat på kvalitativa och kvantitativa artiklar. Artikelsökningen utfördes i databaser och webbsökning. Totalt inkluderades nio artiklar publicerade mellan år 2006–2022. Kvalitetsgranskning genomfördes utifrån CASP checklista av kvalitativa och randomiserad kontrollerad studie. Resultat: I resultatet framkommer det att erfarenhet är en betydande roll som ger bättre förutsättning för extubationen. Kommunikationsbrist, tidspress och bristande respekt påverkade anestesipersonal under utförandet. Planering och förberedelser är två viktiga faktorer för att underlätta handhavandet av extubation. Diskussion: Erfarenhet har en betydande roll för att skapa förutsättningar för trygghet, respekt och evidensbaserad vård. Anestesisjuksköterskor och anestesiologer har olika erfarenheter om extubation. Genom att öka kunskap gällande upplevelser av anestesipersonalens erfarenheter kan praktiska och teoretiska momentet kring extubering förbättras. / Background and Problem Statement: Extubation is a crucial step in anaesthesia. When the patient has a satisfactory breathing pattern, the tracheal tube can be removed from the patient's airway. There are no one-hundred- precent criteria for the outcome of extubation; it is often preformed based on the situation. It is a complex process that requires careful monitoring and adaptation to each patient’s individual needs. Assessing, establishing and controlling the airway require that the anaesthesia nurse possesses knowledge and experience with multidisciplinary collaboration and ethical awareness. To avoid patient suffering, person-centred care is necessary, which requires an approach based on compassion. The risk of complications has not clearly decreased over the years, and planning and preforming an extubation are often perceived as challenging. Aim: The aim was to examine the anesthesia nurse and the anesthesiologist's experiences with extubation. Method: A systematic literature review using an integrative method based on qualitative and quantitative articles. Articles searches were conducted in the databases Cinahl, PubMed and Scopus, as well through web searches. A total of nine articles published between 2006 and 2022 were included. Quality assessment was preformed using CASP checklist for qualitative and randomised controlled studies. Results: The results indicate that experience is a significant factor that provides better conditions for successful extubation. Communication problems, time pressure and lack of respect affected anaesthesia personnel during the procedure. Planning and preparing are two important factors that facilitate the management of extubation. Discussion: Experience plays a significant role in creating conditions for safety, respect and evidence-based care. Anaesthesia nurses and anaesthesiologist have mixed options about extubations. By increasing knowledge about the experiences of anaesthesia personnel, both the practical and theoretical aspects of extubation can be improved.

Each expectant mother comes into the hospital with some idea of how the delivery will proceed, including the c-section. These ideas, created on basis lay and professional opinions, can be dramatically different from the resulting reality. This work deals with the choice of anesthesia for planned c-section from the perspective of expectant mothers. The theoretical part of the work is devoted to current possibilities and trends in obstetric anaesthesia. It describes the types of anesthesia (local vs. total) from the perspective of medicine and from the perspective of mothers in preparation to this operational performance. The aim of the empirical part of the work is the comparison of preoperative expectations of expectant mothers with the resulting hospital reality. It was found out by the quantitative questionnaire method. The questionnaire is divided into two parts- the part before the c-section and the postoperative part. The aim of the work is the detection what information sources influence mothers ideas of the course of the operating, the influences for their decisions of the choice of anesthesia, and how the information is valid and objective. The data are treated in detail in the empirical part. The work also discussion in which the survey results are compared with the stated aims and claims...

Tesis por compendio de publicaciones / El presente estudio fue llevado a cabo para describir la apariencia ecográfica y desarrollar los abordajes ecoguiados para el bloqueo de los nervios ciático y femoral, así como evaluar la eficacia clínica del bloqueo ecoguiado del nervio ciático en el gato. Se realizaron disecciones anatómicas y criosecciones para determinar las marcas anatómicas para localizar los nervios de interés. La apariencia ecográfica de los nervios ciático y femoral fue estudiada tanto en cadáveres como en gatos vivos, utilizando un transductor linear de 4-13 MHz. EL bloqueo ecoguiado del nervio ciático se realizó insertando una aguja para bloqueo de nervios periféricos cerca del nervio ciático y se infiltró lidocaína alrededor del mismo. El abordaje medio-femoral y el abordaje dorsal permitieron la evaluación ecográfica y aproximación ecoguiada de los nervios ciático y femoral respectivamente. El abordaje medio-femoral permitió el bloqueo clínicamente efectivo del nervio ciático en el gato. Palabras clave: ecografía, anestesia, anestesia regional, bloqueo de nervios periféricos, nervio ciático, nervio femoral, gato. / Use of ultrasound for the blockade of the peripheral nerves of the pelvic limb in the cat (Felis catus L.) This study was carried out to describe the ultrasonographic appearance and to develop the ultrasound (US)-guided approaches to block the sciatic (SCN) and femoral (FN) nerves, and to evaluate the clinical efficacy of the US-guided blockade of the ScN in the cat. Anatomical dissections and transversal cryosections were performed to determine the anatomical landmarks to localise the ScN and FN nerves. The ultrasonographic appearance of the ScN and FN were determined on cadavers and alive cats using a 4-13MHz linear transducer. The US-guided blockade of the ScN was performed inserting a peripheral nerve block needle close to the ScN and lidocaine was infiltrated around it. The midfemoral approach for the ScN and the dorsal approach for the FN, allowed an optimal US-guided location to evaluate and block these nerves. The midfemoral allowed an accurate US-guided blockade of the ScN in felines.

Bakgrund: Anestesiinduktion av barn kräver särskild kompetens hos anestesisjuksköterskan. Trygghet och tillit behöver skapas i mötet med barnet, vilket kan utgöra en utmaning om mötet är kort och intensivt. Barns förmåga att samarbeta och delta i förberedelser och vid anestesiinduktionen påverkas av barnets ålder och utvecklingsnivå. Bristande följsamhet och samarbetsvilja hos barnet kan leda till att tvång tillämpas i samband med induktionen, vilket kan väcka varierande tankar och känslor hos anestesisjuksköterskan. Tidigare forskning fokuserar främst på barn och föräldrars upplevelse av anestesiinduktionen. Genom att beskriva anestesisjuksköterskans upplevelse kan ett bredare perspektiv på fenomenet belysas och kunskapen inom barnanestesi fördjupas.Syfte: Syftet var att beskriva anestesisjuksköterskans upplevelse av att anestesiinducera barn.Metod: En kvalitativ metod med induktiv ansats har genomförts. Datainsamlingen bestod av semistrukturerade intervjuer och materialet analyserades enligt Graneheim och Lundmans (2004) kvalitativa innehållsanalys.Resultat: Analysen resulterade i fem huvudkategorier med 10 underkategorier som formade två övergripande teman: att skapa goda förutsättningar inför anestesiinduktionen vilket innefattade att etablera kontakt, anpassa förberedelser samt att samverka med föräldrarna. Det andra temat var att möta och hantera utmaningar vilket innefattade handlingsberedskap och professionell utmaning.Slutsats: Att anestesiinducera barn kan vara både stimulerande och utmanande. Goda förutsättningar inför anestesiinduktionen främjas av en tillitsfull relation med barnet och föräldrarna, där leken utgör ett viktigt verktyg för att skapa delaktighet och lärande. Genom handlingsberedskap och strategier kan oron för komplikationer minskas. Anestesiinducering av barn kan ge upphov till etiska dilemman samt innebära en yrkesmässig påfrestning hos anestesisjuksköterskan. / Background: Anaesthesia induction of children requires special skills of the anaesthetic nurse, both physiological and emotional. The anaesthetic nurse needs to create security and trust in the meeting with the child, which can pose a challenge if the meeting is short and intense. Children's ability to cooperate and participate in preparations and in connection with the anesthesia is affected by the child's age, level of development and unique conditions. Lack of adherence and willingness to cooperate in the child can lead to the application of coercion in connection with the induction, which provokes different thoughts and feelings in the anesthesia nurse. Previous research focuses primarily on children and parents' experience of anaesthesia. By describing the anesthesia nurse's experience, a broader perspective on the phenomenon can be highlighted and knowledge in pediatric anesthesia increased.Aim: The aim of the study was to describe the anesthesia nurse's experience of anesthetize children.Method: To answer the purpose of the study, a qualitative method with an inductive approach was used. The data collection consisted of semi-structured interviews with 12 informants and the material was analyzed according to Graneheim and Lundman's (2004) qualitative content analysis.Results: The analysis resulted in five main categories with ten subcategories that shaped two overarching themes. The first theme was to create good conditions for the anesthesia induction, which included establishing a contact, adapting preparations and collaborating with the parents. The second theme was to meet and manage challenges, which included readiness to act and handling a professional challenge.Conclusion: Anesthetizing children can be both stimulating and challenging. Good conditions can be created through preparation, play and the establishment of contact with the child and its parents. The worry of complications can be reduced through readiness to act and strategies. Anesthetizing children can give rise to ethical dilemmas as well as involve a professional strain on the anaesthetic nurse.

En Magnetresonansundersökning, förkortat MR, upplevs av många som obehaglig då det är trångt, högt ljud och tar lång tid. Svårigheten med att ligga stilla under så lång tid är också ett problem och det ger rörelseartefakter i bilden. När det gäller barn är det viktigt med en god kommunikation och tydlig information. Många barn sövs ner på grund av rädsla och svårigheten att ligga stilla men det kan innebära risker. Syftet med denna studie var att sammanställa olika metoder som kan användas för att möjliggöra en minskning av narkosanvändning vid MR undersökningar av barn. Metoden som användes för att besvara syftet var en systematisk litteraturstudie där 16 kvantitativa artiklar studerades. Resultatet visade att en immobilisering, naturlig sömn, MR modell och åldersanpassade övningar minskade rädsla och användning av narkos. Ett A/V system gav signifikant skillnad i endast åldersgruppen 3-10 år. En fotobok gav motsatt effekt och ökade ångesten hos barn. Slutsatsen är att det finns metoder som kan underlätta för barn och minska användningen av narkos. Det visar sig också vara både tids- och kostnadseffektivt.

Formation of atelectasis, defined as reversible collapse of aerated lung, often occurs after induction of anaesthesia with mechanical ventilation. As a consequence, there is a risk for hypoxemia, altered hemodynamics and impaired respiratory system mechanics. In certain situations, the risk for atelectasis formation is increased and its consequences may also be more difficult to manage. Anesthesia for bariatric surgery in morbidly obese patients and surgery requiring one-lung ventilation (OLV) with capnothorax are examples of such situations. In Paper I (30 patients with BMI > 40 kg/m2 scheduled for bariatric surgery) a recruit­ment maneuver followed by positive end-expiratory pressure (PEEP) re­duced the amount of atelectasis and improved oxygenation for a prolonged period of time. PEEP or a recruitment maneuver alone did not reduce the amount of atelectasis. In paper II we investigated whether it is possible to predict respiratory function impairment in morbidly obese patients without pulmonary disease from a preoperative lung function test. Patients with mild signs of airway obstruction (reduced end-expiratory flow) in the preoperative spirometry developed less atelectasis during anaesthesia. In paper III we developed an experimental model of sequential OLV with capnothorax using electrical impedance tomography (EIT) that in real-time detected lung separation and dynamic changes in pulmonary ventilation and perfusion distributions. OLV to the left side caused a decrease in cardiac output, arterial oxygenation and mixed venous saturation. In paper IV we used our model of OLV with capnothorax and applied a CO2-insufflation pressure of 16 cm H2O. We demonstrated that a PEEP level of 12-16 cm H2O is needed for optimal oxygenation and lowest possible driving pressure without compromising hemodynamic variables. Thus, the optimal PEEP was closely related to the level of the capnothorax insufflation pressure. With insufficient PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the non-ventilated lung occurred.