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• Holtan-Hartwig, Ingvild; Johnsen, Linn Rise; Dahl, Vegard & Haidl, Frans Felxi (2021). Preoperative Gastric Ultrasound in Surgical Patients who Undergo Rapid Sequence Induction Intubation. Trends in Anaesthesia and Critical Care. ISSN 2210-8440. 38, s. 30–35. doi: 10.1016/j.tacc.2021.04.005. Fulltekst i vitenarkiv
• Haidl, Felix; Tronstad, Christian; Rosseland, Leiv Arne & Dahl, Vegard (2021). Maternal haemodynamics during labour epidural analgesia with and without adrenaline. Scandinavian Journal of Pain. ISSN 1877-8860. 21(4), s. 680–687. doi: 10.1515/sjpain-2020-0176. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Labour is one of the most painful experiences in a woman’s life. Epidural analgesia using low-concentration local anaesthetics and lipophilic opioids is the gold standard for pain relief during labour. Pregnancy in general, particularly labour, is associated with changes in maternal haemodynamic variables, such as cardiac output and heart rate, which increase and peak during uterine contractions. Adrenaline is added to labour epidural solutions to enhance efficacy by stimulating the α2-adrenoreceptor. The minimal effective concentration of adrenaline was found to be 2 μg mL−1 for postoperative analgesia. The addition of adrenaline may also produce vasoconstriction, limiting the absorption of fentanyl into the systemic circulation, thereby reducing foetal exposure. However, adrenaline may influence the haemodynamic fluctuations, possibly adding to the strain on the circulatory system. The aim of this study was to compare the haemodynamic changes after application of labour epidural analgesia with or without adrenaline 2 μg mL−1. Methods This was a secondary analysis of a single-centre, randomised double-blind trial. Forty-one nulliparous women in labour requesting epidural analgesia were randomised to receive epidural solution of bupivacaine 1 mg mL−1, fentanyl 2 μg mL−1 with or without adrenaline 2 μg mL−1. The participants were monitored using a Nexfin CC continuous non-invasive blood pressure and cardiac output monitor. The primary outcomes were changes in peak systolic blood pressure and cardiac output during uterine contraction within 30 min after epidural activation. The effect of adrenaline was tested statistically using a linear mixed-effects model of the outcome variables’ dependency on time, adrenaline, and their interaction. Results After excluding three patients due to poor data quality and two due to a malfunctioning epidural catheter, 36 patients (18 in each group) were analysed. The addition of adrenaline to the solution had no significant effect on the temporal changes in peak systolic blood pressure (p=0.26), peak cardiac output (0.84), or heart rate (p=0.91). Furthermore, no significant temporal changes in maternal haemodynamics (peak systolic blood pressure, p=0.54, peak cardiac output, p=0.59, or heart rate p=0.55) were associated with epidural analgesia during 30 min after epidural activation in both groups despite good analgesia. Conclusions The addition of 2 μg mL−1 adrenaline to the epidural solution is not likely to change maternal haemodynamics during labour.

• Dahlberg, Jørgen; Øverstad, Siri; Dahl, Vegard & Coman, Alina (2021). Autonomy and consent assessment for electroconvulsive therapy (ECT). A retrospective study of medical records. International Journal of Law and Psychiatry. ISSN 0160-2527. 77. doi: 10.1016/j.ijlp.2021.101716. Fulltekst i vitenarkiv
• Kuklin, Vladimir; Matri, Jonas Lindstad; Barlow, Nicholas; Tveit, Sjur Hansen; Kvernberg, Jan Erik & RINGVOLD, ELSE-MARIE [Vis alle 7 forfattere av denne artikkelen] (2021). Current trends in management of hyperglycaemia in surgical patients with diabetes mellitus: a review. Annals of Critical Care. ISSN 1726-9806. 3, s. 33–47. doi: 10.21320/1818-474X-2021-4-33-47. Fulltekst i vitenarkiv Vis sammendrag

  A large amount of clinical evidences demonstrates a clear association between long-term and/or stress-related hyperglycaemia, and development of complications after surgery. The incidences of perioperative hyperglycaemia are demonstrated in 20–80 % of all cases depending on the type of elective surgery, with the highest rate registered in cardiac surgery. The most studied pathophysiological complications of long-term hyperglycaemia in Diabetes Mellitus (DM) patients are; activation of the polyol pathway, diacylglycerol/protein kinase C and hexosamine pathways, advanced glycation product formation, and oxidative stress. The uncontrolled stress-related hyperglycaemia during and after surgery instigates: osmotic diuresis with further fluid and electrolyte imbalance, increased gluconeogenesis and glucogenolysis, breakdown of fats into free fatty acid and glycerol, proteins into amino acids, and increases generation of pro-inflammatory cytokines. All these changes may lead to development of diabetic ketoacidosis, immune deregulation and insulin resistance. Some clinical investigations seems to indicate that anaesthesia with propofol may have some advantages in keeping stable blood sugar over inhalational agents. Two clinical trials comparing the influence of different anaesthetic agents on perioperative glycaemic status in diabetic patients are currently underway. For better management of perioperative hyperglycaemia in diabetic patients under surgery we have proposed several important practical principles.

• Haidl, Frans Felxi; Rosseland, Leiv Arne; Rørvik, Anne-Marte & Dahl, Vegard (2020). Programmed intermittent boluses vs continuous epidural infusion in labor using an adrenaline containing solution: A randomized trial. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 64(10), s. 1505–1512. doi: 10.1111/aas.13689. Fulltekst i vitenarkiv Vis sammendrag

  Background Traditionally, epidural analgesia has been maintained using a continuous infusion (CEI) with the addition of patient‐controlled boluses (PCEA). In recent years, programmed intermittent boluses (PIEB) has emerged as an alternative showing better efficacy in randomized studies. In this study, the aim was to test PIEB + PCEA vs CEI + PCEA using an epidural solution containing adrenaline. Methods In total, 150 nulliparous and multiparous laboring women were randomized to maintain epidural analgesia with either PIEB + PCEA (5 ml bolus every hour, 5 ml PCEA bolus lockout 20 minutes) or CEI + PCEA (5 ml/h, 5 ml PCEA bolus, lockout 20 minutes) using a solution of bupivacaine 1mg/ml, fentanyl 2 mcg/ml and adrenaline 2 mcg/ml. The primary outcome was total hourly consumption of the epidural solution. Secondary outcomes included hourly pain scores, motor block at 60 minutes and 10 cm cervical dilation, maternal satisfaction, and the need for anesthetist intervention and time to this intervention. Results We found no differences in hourly drug consumption between the groups (mean 9.0 ml/h (SD 3.7) (CEI group) vs. 8.1 ml/h (SD 2.0) (PIEB group), P = .08). We found a significant difference in number of successfully administered PCEA boluses (mean no. 3.9 (SD 4.1) (CEI group) vs. 1.9 (SD 2.0) (PIEB group), P < .001). We found no significant differences in pain score, motor block, maternal satisfaction and the need for anesthetist intervention. Conclusion In this study, we found no clinically relevant differences using PIEB + PCEA compared to CEI + PCEA when using an epidural solution containing adrenaline. Editorial Comment For labor epidural analgesia infusions, to optimize the analgesic effect, additional programmed intermittent boluses can be used as an alternative to patient‐controlled boluses only. In this clinical trial, no differences in drug consumption or analgesic effect was observed when comparing these two different epidural bolus controls programs.

• Kuklin, Vladimir; Akhatov, Nurlan; Kondratyev, Timofey; Konkaev, Aidos; Baigenzhin, Abay K. & Konkaeva, Maya [Vis alle 10 forfattere av denne artikkelen] (2019). The influences of morphine or ketamine pre-treatment on hemodynamic, acid-base status, biochemical markers of brain damage and early survival in rats after asphyxial cardiac arrest. BMC Anesthesiology. 19:214, s. 1–9. doi: 10.1186/s12871-019-0884-6. Fulltekst i vitenarkiv Vis sammendrag

  <i>Background</i> - In different models of hypoxia, blockade of opioid or N-methyl-D-aspartate (NMDA) receptors shows cardio- and neuroprotective effects with a consequent increase in animal survival. The aim of the study was to investigate effects of pre-treatment with Morphine or Ketamine on hemodynamic, acid-base status, early survival, and biochemical markers of brain damage in a rat model of asphyxial cardiac arrest (ACA).<p><p> <i>Methods</i> - Under anaesthesia with Thiopental Sodium 60 mg/kg, i.p., Wistar rats (<i>n</i> = 42) were tracheostomized and catheters were inserted in a femoral vein and artery. After randomization, the rats were pre-treated with: Morphine 5 mg/kg i.v. (n = 14); Ketamine 40 mg/kg i.v. (n = 14); or equal volume of i.v. NaCl 0.9% as a Control (n = 14). ACA was induced by corking of the tracheal tube for 8 min, and defined as a mean arterial pressure (MAP) < 20 mmHg. Resuscitation was started at 5 min after cardiac arrest (CA). Invasive MAP was recorded during experiments. Arterial pH and blood gases were sampled at baseline (BL) and 10 min after CA. At the end of experiments, all surviving rats were euthanised, brain and blood samples for measurement of Neuron Specific Enolase (NSE), s100 calcium binding protein B (s100B) and Caspase-3 (CS-3) were retrieved.<p><p> <i>Results</i> - At BL no differences between groups were found in hemodynamic or acid-base status. After 3 min of asphyxia, all animals had cardiac arrest (CA). Return of spontaneous circulation (MAP > 60 mmHg) was achieved in all animals within 3 min after CA. At the end of the experiment, the Ketamine pre-treated group had increased survival (13 of 14; 93%) compared to the Control (7 of 14; 50%) and Morphine (10 of 14; 72%) groups (<i>p</i> = 0.035). Biochemical analysis of plasma concentration of NSE and s100B as well as an analysis of CS-3 levels in the brain tissue did not reveal any differences between the study groups.<p><p> <i>Conclusion</i> - In rats after ACA, pre-treatment with Morphine or Ketamine did not have any significant influence on hemodynamic and biochemical markers of brain damage. However, significantly better pH level and increased early survival were found in the Ketamine pre-treated group.

• Dahlberg, Jørgen; Dahl, Vegard; Førde, Reidun & Pedersen, Reidar (2019). Lack of informed consent for surgical procedures by elderly patients with inability to consent: a retrospective chart review from an academic medical center in Norway. Patient Safety in Surgery. 13(24). doi: 10.1186/s13037-019-0205-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Respect for patient autonomy and the requirement of informed consent is an essential basic patient right. It is constituted through international conventions and implemented in health law in Norway and most other countries. Healthcare without informed consent is only allowed under specific exceptions, which requires a record in the patient charts. In this study, we investigated how surgeons recorded decisions in situations where the elderly patient’s ability to provide a valid informed consent was questionable or clearly missing. Method We investigated all medical records of patients admitted to surgical departments in a Norwegian large academic emergency hospital over a period of 38 days (approximately 5000 patients). We selected records of patients above the age of 70 (570 patients) and searched through these 570 medical records for any noted clear indications of inability to consent such as “do not understand”, “confused” etc. (102 patients). We read through all the medical records on these 102 patients noting any recordings on lack of informed consent, any recordings on reasoning and process hereto. We also took note whether there were clear indications on the use of coercion. Results None of the 102 included patients´ charts contained legally valid recorded assessments (for example related to the patients´ competence to consent) when patients without the ability to consent were admitted and provided healthcare. Some charts contained records that the patient resisted treatment, thus indicating treatment with coercion. In these situations, we did not find any documentation related to legal requirements that regulate the use of coercion. Discussion and conclusion We found a substantial lack of compliance with the legal requirements that apply when obtaining valid informed consent. There are many possible reasons for this: Lack of knowledge of the legal requirements, disagreement about the rules, or that it is simply not possible to comply with the extensive formal and material legal requirements in clinical practice. The results do not point out whether the appropriate measures are amending the law, educating and requiring more compliance from surgeons, or both.

• Kaspersen, Erik Refsland; Ræder, Johan & Dahl, Vegard (2018). Retningslinjer for behandling av sepsis. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(4), s. 352–356. doi: 10.4045/tidsskr.17.0493. Fulltekst i vitenarkiv
• Haidl, Frans Felxi; Rosseland, Leiv Arne; Spigset, Olav & Dahl, Vegard (2018). Effects of Adrenaline on maternal and fetal fentanyl absorption in epidural analgesia: a randomized trial. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 62(9), s. 1267–1273. doi: 10.1111/aas.13175. Fulltekst i vitenarkiv Vis sammendrag

  Background The combination of low‐dose local anesthesia and lipophilic opioids such as fentanyl is established as a standard solution for labor epidural analgesia. Fentanyl increases efficacy, but may have negative effects on the neonate in terms of reduced neonatal neurologic and adaptive capacity scores and breast feeding. We hypothesized that addition of adrenaline 2 μg/mL to a solution of bupivacaine 1 mg/mL and fentanyl 2 μg/mL would reduce the systemic uptake of fentanyl, resulting in reduced serum fentanyl in the fetus at birth. Methods Forty‐one nulliparous women requesting epidural analgesia were randomized to epidural analgesia with or without adrenaline. Blood samples were drawn from the mother with regular intervals, and at delivery. An umbilical vein blood sample (used as a proxy for fetal exposure) was drawn after clamping. Results There were no significant differences between the groups in fentanyl concentrations in the umbilical vein and maternal serum at birth. There was a significantly lower mean area under the maternal serum‐concentration curve for the first 2 hours of treatment in the adrenaline group (mean difference 0.161 nmol h/L [0.034; 0.289], P = .015), implying slower systemic uptake in the adrenaline group initially. There were no significant differences in treatment duration, motor block, Apgar scores, umbilical pH and base excess, or mode of delivery. Conclusions The addition of adrenaline to an epidural solution containing fentanyl lowered maternal systemic serum fentanyl concentration during the first 2 hours, but did not lower serum fentanyl concentration in the umbilical vein and mother at delivery.

• Wikjord, Kristina Seo; Dahl, Vegard & Søvik, Signe (2017). Effects on nutritional care practice after implementation of a flow chart-based nutrition support protocol in an intensive care unit. Nursing Open. doi: 10.1002/nop2.99. Fulltekst i vitenarkiv Vis sammendrag

  Background: Enteral nutrition (EN) is associated with improved outcome in critically ill patients and is more affordable. We compared nutritional care practice in our ICU before and after modification of our nutrition support protocol: Several comprehensive documents were substituted with one flow chart and early EN was encouraged. Design: Retrospective observational study. Methods: Nutritional data were collected from admission up to 7 days in 25 patients before and 25 patients after protocol modification. Results: The percentage of patients receiving EN within 72 hr of admission increased from 64% before to 88% after protocol modification. Cumulative percentage energy from EN during ICU days 1–4 increased from 26–89% of total kcal. Overall amount of nutrition administered enterally increased, with a corresponding marked decline in use of parenteral nutrition. Pre-modification, >80% of patients received >65% of their calculated nutrition requirements by ICU Day 4; post-modification this goal was achieved by Day 7.

• Jerpseth, Heidi; Dahl, Vegard; Nortvedt, Per & Halvorsen, Kristin (2017). Older patients with late-stage COPD: their illness experiences and involvement in decision-making regarding mechanical ventilation and noninvasive ventilation. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 27(3-4), s. 582–592. doi: 10.1111/jocn.13925. Fulltekst i vitenarkiv Vis sammendrag

  Aims and objectives To explore the illness experiences of older patients with late-stage chronic obstructive pulmonary disease and to develop knowledge about how patients perceive their preferences to be taken into account in decision-making processes concerning mechanical ventilation and/or noninvasive ventilation. Background Decisions about whether older patients with late-stage chronic obstructive pulmonary disease will benefit from noninvasive ventilation treatment or whether the time has come for palliative treatment are complicated, both medically and ethically. Knowledge regarding patients' values and preferences concerning ventilation support is crucial yet often lacking. Design Qualitative design with a hermeneutic–phenomenological approach. Methods The data consist of qualitative in-depth interviews with 12 patients from Norway diagnosed with late-stage chronic obstructive pulmonary disease. The data were analysed within the three interpretative contexts described by Kvale and Brinkmann. Results The participants described their lives as fragile and burdensome, frequently interrupted by unpredictable and frightening exacerbations. They lacked information about their diagnosis and prognosis and were often not included in decisions about noninvasive ventilation or mechanical ventilation. Conclusion Findings indicate that these patients are highly vulnerable and have complex needs in terms of nursing care and medical treatment. Moreover, they need access to proactive advanced care planning and an opportunity to discuss their wishes for treatment and care. Relevance to clinical practice To provide competent care for these patients, healthcare personnel must be aware of how patients experience being seriously ill. Advanced care planning and shared decision-making should be initiated alongside the curative treatment.

• Dybvik, Lisa; Skraastad, Erlend Johan; Yeltayeva, Aigerim; Konkayev, Aidos; Musaeva, Tatiana & Zabolotskikh, Igor [Vis alle 10 forfattere av denne artikkelen] (2017). Influence of a New “Call-Out Algorithm” for Management of Postoperative Pain and Its Side Effects on Length of Stay in Hospital: A Two-Centre Prospective Randomized Trial. Pain Research and Management. ISSN 1203-6765. doi: 10.1155/2017/9431984. Fulltekst i vitenarkiv Vis sammendrag

  Background. We recently introduced the efficacy safety score (ESS) as a new “call-out algorithm” for management of postoperative pain and side effects. In this study, we report the influence of ESS recorded hourly during the first 8 hours after surgery on the mobility degree, postoperative nonsurgical complications, and length of hospital stay (LOS). Methods. We randomized 1152 surgical patients into three groups for postoperative observation: (1) ESS group (𝑛�� = 409), (2) Verbal Numeric Rate Scale (VNRS) for pain group (𝑛�� = 417), and (3) an ordinary qualitative observation (Control) group (𝑛�� = 326). An ESS > 10 or VNRS > 4 at rest or a nurse’s observation of pain or adverse reaction to analgesic treatment in the Control group served as a “call-out alarm” for an anaesthesiologist. Results. We found no significant differences in the mobility degree and number of postoperative nonsurgical complications between the groups. LOS was significantly shorter with 12.7±6.3 days (mean ± SD) in the ESS group versus 14.2±6.2 days in the Control group (𝑃�� < 0.001). Conclusion. Postoperative ESS recording in combination with the possibility to call upon an anaesthesiologist when exceeding the threshold score might have contributed to the reductions of LOS in this two-centre study.

• Skjaker, Stein Arve; Hoel, Henrik; Dahl, Vegard & Stavem, Knut (2017). Factors associated with life-sustaining treatment restriction in a general intensive care unit. PLOS ONE. 12:e0181312(7), s. 1–11. doi: 10.1371/journal.pone.0181312. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Purpose Few previous studies have investigated associations between clinical variables available after 24 hours in the intensive care unit (ICU), including the Charlson Comorbidity Index (CCI), and decisions to restrict life-sustaining treatment. The aim of this study was to identify factors associated with the life-sustaining treatment restriction and to explore if CCI contributes to explaining decisions to restrict life-sustaining treatment in the ICU at a university hospital in Norway from 2007 to 2009. Methods Patients’ Simplified Acute Physiology Score II (SAPS II), age, sex, type of admission, and length of hospital stay prior to being admitted to the unit were recorded. We retrospectively registered the CCI for all patients based on the medical records prior to the index stay. A multivariable logistic regression analysis was used to assess factors associated with treatment restriction during the ICU stay. Results We included 936 patients, comprising 685 (73%) medical, 204 (22%) unscheduled and 47 (5%) scheduled surgical patients. Treatment restriction was experienced by 241 (26%) patients during their ICU stay. The variables that were significantly associated with treatment restriction in multivariable analysis were older age (odds ratio [OR] = 1.48 per 10 years, 95% confidence interval [CI] = 1.28–1.72 per 10 years), higher SAPS II (OR = 1.05, 95% CI = 1.04–1.07) and CCI values relative to the reference of CCI = 0: CCI = 2 (OR = 2.08, 95% CI = 1.20–3.61) and CCI≥3 (OR = 2.72, 95% CI = 1.65–4.47). Conclusions In multivariable analysis, older age, greater illness severity after 24 h in the ICU and greater comorbidity at hospital admission were independently associated with subsequent life-sustaining treatment restriction. The CCI score contributed additional information independent of the SAPS II illness severity rating.

• Lenz, Harald; Norby, Gudrun; Dahl, Vegard; Ranheim, Trond Egil & Haagensen, Rolf E (2017). Five-year mortality in patients treated for severe community-acquired pneumonia ? a retrospective study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 61(4), s. 418–426. doi: 10.1111/aas.12863. Fulltekst i vitenarkiv
• Skraastad, Erlend Johan; Ræder, Johan; Dahl, Vegard; Bjertnaes, Lars J. & Kuklin, Vladimir (2017). Development and validation of the Efficacy Safety Score (ESS), a novel tool for postoperative patient management. BMC Anesthesiology. 17(1). doi: 10.1186/s12871-017-0344-0. Fulltekst i vitenarkiv Vis sammendrag

  Background: <br> Several reports have shown that postoperative monitoring of general safety and quality issues, including pain treatment, after discharge from recovery is often non-systematic and inadequate. We suggest a new score with assessment of key recovery parameters, as a supportive tool for postoperative care and a call-out algorithm for need of extra help. The aim of this investigation was to validate the score. <br> Methods: <br> After suggesting a prototype score from a pilot study in 182 postoperative patients, we performed a Delphi process by using international experts to create consensus on the final score contents and called the revised tool the Efficacy Safety Score (ESS). Then, we performed a prospective observational study with the ESS throughout the first 24 h postoperatively in 207 surgical in-patients. We compared ESS with Modified Early Warning Systems (MEWS), and postoperative journal information. We subsequently validated ESS by addressing recognized quality criteria for measurement of health status questionnaires. <br> Results: <br> A call-out value of ESS ≥10 correlated with MEWS > 0 values and journal information about postoperative concerns with a sensitivity of 94% and 92%, respectively. All serious safety issues were identified with the ESS ≥ 10, and a higher number of quality issues were identified than with routine care or MEWS. We obtained positive ratings for six out of seven tested criteria of questionnaire quality; one criterion had an indeterminate rating. <br> Conclusion: <br> ESS fulfils suggested criteria for score quality validation and reflects the patient’s postoperative status adequately and with high sensitivity. Further clinical trials are warranted to evaluate the usefulness of ESS as a simple tool for assessment of the postoperative safety and quality of patients.

• Ræder, Johan; Dahl, Vegard; Markestad, Anne; Nordbø, Arve; Roaldset, Anne Hilde & Stubhaug, Audun [Vis alle 10 forfattere av denne artikkelen] (2016). Fra ketobemidon til morfin eller oksykodon. Står ikke registrert som artikkel, og som kommentar og debatt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(18), s. 1518–1519. doi: 10.4045/tidsskr.16.0510. Fulltekst i vitenarkiv
• Jerpseth, Heidi; Dahl, Vegard; Nortvedt, Per & Halvorsen, Kristin (2016). Nurses' role and care practices in decision-making regarding artificial ventilation in late stage pulmonary disease. Nursing Ethics. ISSN 0969-7330. 24(7), s. 821–832. doi: 10.1177/0969733015626600. Fulltekst i vitenarkiv Vis sammendrag

  Background: Decisions regarding whether or not to institute mechanical ventilation during the later stages of chronic obstructive pulmonary disease is challenging both ethically, emotionally and medically. Caring for these patients is a multifaceted process where nurses play a crucial role. Research question and design: We have investigated how nurses experienced their own role in decision-making processes regarding mechanical v entilation in later stages of chronic obstructive pulmonary disease and how they consider the patients’ role in these processes. We applied a qualitative approach, with six focus-group interviews of nurses (n ¼ 26). Ethical considerations: The Regional Committees for Medical and Health Research Ethics approved the study. Voluntary informed consent was obtained. Findings: The nurses found themselves operating within a cure-directed treatment culture wherein they were unable to stand up for the caring values. They perceived their roles and responsibilities in decision- making processes regarding mechanical ventilation to patients as unclear and unsatisfactory. They also experienced inadequate interdisciplinary cooperation. Discussion: Lack of communication skills, the traditional hierarchical hospital culture together with operating in a medical-orientated treatment culture where caring values is rated as less important might explain the nurses’ absence in participation in the decision about mechanical ventilation. Conclusion: To be able to advocate for the patients’ and their own right to be included in decision-making processes, nurses need an awaren ess of their own responsibilities. This requires personal courage, leadership who are capable of organising common interpersonal meetings and willingness on the part of the physicians to include and value the nurses’ participation in decision-making processes.

• Kuhn, Jana Christine; Hauge, Tor Hugo; Rosseland, Leiv Arne; Dahl, Vegard & Langesæter, Eldrid (2016). Hemodynamics of phenylephrine infusion versus lower extremity compression during spinal anesthesia for cesarean delivery: A randomized, double-blind, placebo-controlled study. Anesthesia and Analgesia. ISSN 0003-2999. 122(4), s. 1120–1129. doi: 10.1213/ANE.0000000000001174. Fulltekst i vitenarkiv
• Jerpseth, Heidi; Dahl, Vegard; Nortvedt, Per & Halvorsen, Kristin (2016). Considerations and values in decision making regarding mechanical ventilation for older patients with severe to very severe COPD. Clinical Ethics. ISSN 1477-7509. 11(4), s. 140–148. doi: 10.1177/1477750916657657. Fulltekst i vitenarkiv Vis sammendrag

  Background The different considerations involved in decisions regarding whether or not to initiate mechanical ventilation for patients with severe chronic obstructive pulmonary disease (COPD) are challenging for health professionals. Aim To investigate the considerations and values that influences decision-making regarding mechanical ventilation in older patients (≥65-years-old) with severe to very severe COPD. Furthermore, it aims to elucidate how physicians involve their patient in decision-making process. Participants and setting Seven intensive care physicians and seven physicians working in the respiratory units at two university hospitals and two district hospitals in Norway. Methods This study had a qualitative design consisting of focus group interviews with 14 physicians. The data was analysed according to the interpretative contexts: self-understanding, critical common-sense understanding and theoretical understanding. Results Decisions regarding mechanical ventilation were mainly based on the physicians' own experiences, their perceptions of the patients' situation, and biomedical data. The patients were not involved in the decision-making and such decisions were only occasionally made in a multi-professional context. Conclusion To decide whether older patients with severe COPD should be treated with mechanical ventilation is both medically and ethically challenging for physicians. Decision making in this context seems to be mainly driven by a paternalistic attitude, since the physicians interviewed in our study, in general, make such decisions without involving either the patient, their next of kin or the nurses. There is a need for broader cooperation between health professional and for the involvement of patients in the decision-making process regarding mechanical ventilation in cases of late stage COPD.

• Al-Kazwini, Hadeel Sadik H.; Sandven, Irene; Dahl, Vegard & Rosseland, Leiv Arne (2016). Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review. Scandinavian Journal of Pain. ISSN 1877-8860. 13, s. 36–42. doi: 10.1016/j.sjpain.2016.06.010. Fulltekst i vitenarkiv
• Wu, Xinmin; Oerding, Helle; Liu, Jin; Vanacker, Bernard; Yao, Shanglong & Dahl, Vegard [Vis alle 13 forfattere av denne artikkelen] (2014). Rocuronium blockade reversal with sugammadex vs. neostigmine: randomized study in Chinese and Caucasian subjects. BMC Anesthesiology. 14>53. doi: 10.1186/1471-2253-14-53. Fulltekst i vitenarkiv
• Shafique, Muhammad; Yaqub, Sheraz; Lie, Erik Steensæth; Dahl, Vegard; Olsbø, Frode Arnt & Røkke, Ola (2013). New and Safe Treatment of Food Impacted in the Esophagus: A Single Center Experience of 100 Consecutive Cases. Gastroenterology Research and Practice. ISSN 1687-6121. doi: 10.1155/2013/142703. Fulltekst i vitenarkiv
• Dahl, Vegard; Spreng, Ulrich Johannes; Waage, Marianne & Ræder, Johan (2012). Short stay and less pain after ambulatory anterior cruciate ligament (ACL) repair: COX-2 inhibitor versus glucocorticoid versus both combined. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 56(1), s. 95–101. doi: 10.1111/j.1399-6576.2011.02584.x. Fulltekst i vitenarkiv
• Yaqub, Sheraz; Shafique, Muhammad; Kjæstad, Erik; Thorsen, Yngve; Lie, Erik Steensæth & Dahl, Vegard [Vis alle 8 forfattere av denne artikkelen] (2012). A safe treatment option for esophageal bezoars. International Journal of Surgery Case Reports (IJSCR). 3(8), s. 366–367. doi: 10.1016/j.ijscr.2012.04.008. Fulltekst i vitenarkiv
• Darvish, B.; Gupta, A.; Alahuhta, Seppo; Dahl, Vegard; Helbo-Hansen, S. & Thorsteinsson, A. [Vis alle 8 forfattere av denne artikkelen] (2011). Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 55(1), s. 46–53. doi: 10.1111/j.1399-6576.2010.02335.x. Fulltekst i vitenarkiv
• Spreng, Ulrich Johannes; Dahl, Vegard & Ræder, Johan (2011). Effect of a single dose of pregabalin on post-operative pain and pre-operative anxiety in patients undergoing discectomy. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 55(5), s. 571–576. doi: 10.1111/j.1399-6576.2011.02410.x. Fulltekst i vitenarkiv
• Spreng, Ulrich Johannes; Dahl, Vegard; Hjall, Asbjørn; Fagerland, Morten & Ræder, Johan (2010). High-volume local infiltration analgesia combined with intravenous or local ketorolac plus morphine compared with epidural analgesia after total knee arthroplasty. British Journal of Anaesthesia. ISSN 0007-0912. 105(5), s. 675–682. doi: 10.1093/bja/aeq232. Fulltekst i vitenarkiv
• Dahl, Vegard & Spreng, Ulrich Johannes (2009). Anaesthesia for urgent (grade 1) caesarean section. Current Opinion in Anaesthesiology. ISSN 0952-7907. 22(3), s. 352–356. doi: 10.1097/ACO.0b013e3283294c37. Fulltekst i vitenarkiv
• Dahl, Vegard; Pendeville, Philippe E.; Hollmann, Markus W.; Heier, Tom; Abels, Esther A.M. & Blobner, Manfred (2009). Safety and efficacy of sugammadex for the reversal of rocuronium-induced neuromuscular blockade in cardiac patients undergoing noncardiac surgery. European Journal of Anaesthesiology. ISSN 0265-0215. 26(10), s. 874–884. doi: 10.1097/EJA.0b013e32832c605b. Fulltekst i vitenarkiv

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• Ræder, Johan; Dahl, Vegard; Markestad, Anne; Nordbø, Arve; Roaldset, Anne Hilde & Stubhaug, Audun [Vis alle 10 forfattere av denne artikkelen] (2017). Re: Fra ketobemidon til morfin eller oksykodon. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(3), s. 170–170. doi: 10.4045/tidsskr.17.0045. Fulltekst i vitenarkiv
• Kuklin, Vladimir; Dybvik, Lisa; Skraastad, Erlend Johan; Yeltayeva, Aigerim; Konkayev, Aidos & Musaeva, Tatiana [Vis alle 10 forfattere av denne artikkelen] (2017). Clinical validation of a new “call-out algorithm” for postoperative pain management: a two-center prospective randomized trial. Fulltekst i vitenarkiv Vis sammendrag

  The goal of modern postoperative pain management is to relieve pain while keeping side effects to a minimum. Still, in recent investigations, between 20% and 40% of all postoperative patients report high levels of pain after surgery, while 20-30% experience adverse effects of opioid analgetics [1,2]. In a study, in which the hospitals had introduced pain management guided by the patients' own numerical scale scores, the investigators unexpectedly found that the side effects of drugs had more than doubled [3]. The authors suggested that more than just a one-dimensional numerical assessment of pain should be undertaken, for the postoperative treatment to be safe and effective [3]. Recently, Efficacy Safety Score (ESS), a new "call-out algorithm" for monitoring of efficacy and safety of postoperative pain management and its side effects, was developed and implemented in clinical practice at Kongsberg hospital in Norway [4]. ESS was established after obtaining consensus between 10 international experts in a DELPHI process on which parameters that should be included in the score [4]. ESS consists of the sum of two subjective scores (Verbal Numeric Rate Scale of pain (VNRS) at rest and during mobilization) and four vital scores (consciousness level, postoperative nausea and vomiting, circulation and respiration status) [4]. In the present trial, we aimed to validate the influence of ESS registration and the application of a "call-out algorithm" on hospital length of stay (LOS) in two university hospitals of Kazakhstan and Russian Federation in which a policy of routine registration of pain as "the fifth vital sign" had not been adopted yet. Thus, the primary endpoint for the study was to assess LOS in groups of patients with different types of clinical data registration, while secondary endpoints were to compare the degree of mobilization, number of postoperative nonsurgical complications, and 28 days survival between the groups.

• Kuklin, Vladimir; Kondratyev, Timofey; Konkayeva, Maya; Akhatov, Nurlan; Sovershaev, Mikhail & Konkayev, Aidos [Vis alle 8 forfattere av denne artikkelen] (2017). Effects of morphine or ketamine in rats with asphyxial cardiac arrest: a pilot study. Fulltekst i vitenarkiv Vis sammendrag

  Acute hypoxia results in uncontrolled release of glutamate and the consequent stimulation of N-methyl-D-aspartate (NMDA) receptors, which affects the whole ionic homeostasis and finally activates apoptosis of neurons. A potential therapeutic approach to prevent this sequence of events is a blockade of NMDA receptors. Meanwhile, in different models of acute hypoxia, activation of delta-opioid receptors demonstrates significant cardioand neuroprotective effects with a consequent increase in animal survival. Thus, we aimed to test the effects of Morphine or Ketamine on hemodynamics, acid-base status and early survival in rats after asphyxia cardiac arrest (ACA).

• Kuklin, Vladimir; Dybvik, Lisa; Skraastad, Erlend Johan; Yeltayeva, Aigerim; Konkayev, Aidos & Musaeva, Tatiana [Vis alle 10 forfattere av denne artikkelen] (2017). Influence of Post-operative Efficacy Safety Score (ESS) Recording and Application of a “Call-Out Algorithm” on Length of Hospital Stay: Results of a Two-Centre Prospective Randomized Trial. Fulltekst i vitenarkiv
• Kuklin, Vladimir; Dybvik, Lisa; Kazansky, Jan-Yuri; Barlow, Nicholas & Dahl, Vegard (2017). Ultrasound Guided Costaclavicular Approach to Infraclavicular Brachial Plexus block in an 84 Year Old Multi Morbid Woman for Radius and Ulnar Fracture Surgery: A Case report. Fulltekst i vitenarkiv
• Kuklin, Vladimir; Kondratyev, Timofey; Konkaeva, Maya; Akhatov, Nurlan; Sovershaev, MA & Konkaev, Aidos [Vis alle 8 forfattere av denne artikkelen] (2017). EFFECTS OF MORPHINE OR KETAMINE IN RATS WITH ASPHYXIAL CARDIAC ARREST: THE RESULTS OF PILOT STUDY. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Experimental studies demonstrate that opioids can preserve cellular status during acute hypoxia in many organs and tissues including: intestine, skeletal muscle, myocardium and brain [1]. In acute hypoxia conditions, Morphine has shown significant neuroprotective effect with a consequent increase in mice and rat survival [2,3]. Meanwhile, it has been also found that high doses of Morphine might inhibit NMDA receptors. Today it is well known that inhibiting of NMDA receptor by Ketamine reduces neuronal apoptosis, attenuates the systemic inflammatory response to tissue injury, and also maintains cerebral perfusion pressure as a result of sympathetic nervous system activation. However, to our knowledge nobody has tested the effects of Morphine or Ketamine in rats with acute hypoxia due to cardiac arrest. Thus, the aim of our pilot study was to elucidate effects of pre-treatment with Morphine or Ketamine on hemodynamics, acid-base status and early survival in rats after asphyxia cardiac arrest. Methods: After instrumentation under anesthesia with Thiopental sodium (60 mg/kg, i.p.), Wistar rats (n=21) weighing between 350–400 g were randomly assigned to three groups where: 1. Morphine 5 mg/kg iv (n=7) was given 10 min before ACA; 2. Ketamine 40 mg/kg iv (n=7) was given 10 min before ACA; 3. Control (n=7), the same amount of NaCl 0,9% iv was given 10 min before ACA. The rats were asphyxiated by corking the tracheostomia tube at the end of expiration for 5 min. Resuscitation was initiated by an injection of epinephrine (0.02 mg/kg, iv), followed by manual thoracic compressions (180 compressions/min) and mechanical ventilation (21% O2, 80 breaths/min). Invasive mean arterial pressure (MAP) was recorded at the baseline (BL), injections (Inj), every 1 min during ACA (As) and every 5 minin post-resuscitation (PR) period. Blood gas samples were taken at the BL and 10 minat the PR period. Early survival was determined at the 20 minafter ACA. Results: No differences in MAP between the rats was found at the BL period. On the one hand, iv injection of Ketamine significantly reduced MAP before ACA when compared to the Morphine and Control groups. On the other hand, the rats pre-treated with Ketamine had significantly higher MAP during PR period and had significantly lower production of lactate when compared to the rats treated with Morphine or only NaCl 0,9%. Six of the seven rats survived at the 20 min after ACA in the Ketamine group while four of the seven and two of the seven rats survived in the Morphine and Control groups respectively (P=0,122) Conclusion: Pre-treatment with Ketamine attenuated disturbances in hemodynamics and acid-base status after ACA, but it did not improve early survival when compared to the rats pre-treated by Morphine or only NaCl 0,9%.

• Dahlberg, Jørgen & Dahl, Vegard (2015). Re: Paternalisme på fremmarsj? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(4), s. 307–307. doi: 10.4045/tidsskr.15.0133. Fulltekst i vitenarkiv
• Dahlberg, Jørgen & Dahl, Vegard (2015). Sultestreikende asylsøker – hvor langt går pasientens rett til å nekte behandling? doi: 10.4045/tidsskr.14.0883. Fulltekst i vitenarkiv
• Dahl, Vegard (2014). Fettpartikler i blodet :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(12/13), s. 1253–1253. doi: 10.4045/tidsskr.14.0419. Fulltekst i vitenarkiv
• Stensby, Ellen Kristine; Søvik, Signe; Loewhagen, Bjørn & Dahl, Vegard (2013). The successful reversal of a fulminant anaphyactic reaction to rocuronium with suggammadex in an 11 year old boy: A case report. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 57, s. 15–15. Fulltekst i vitenarkiv
• Lu, Stephen; Szoka, Nova; Spreng, Ulrich Johannes & Dahl, Vegard (2013). Acute abdomen. I Velde, Marc van de; Scholefield, Helen & Plante, Lauren A. (Red.), Maternal Critical Care A Multidisciplinary Approach. Cambridge University Press. ISSN 9781107018495. s. 335–345. Fulltekst i vitenarkiv
• Spreng, Ulrich Johannes; Andersson, Elisabet & Dahl, Vegard (2012). Long-term Outcome after Total Knee Arthroplasty Local Infiltration Analgesia (LIA) vs. Epidural Analgesia. British Journal of Anaesthesia. ISSN 0007-0912. 108, s. 419–419. Fulltekst i vitenarkiv

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