28 results on '"YLI‐HANKALA, A."'
Search Results
2. Transfusion strategies in bleeding critically ill adults: A clinical practice guideline from the European Society of Intensive Care Medicine: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.
- Author
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Møller MH, Sigurðsson MI, Olkkola KT, Rehn M, Yli-Hankala A, and Chew MS
- Subjects
- Adult, Blood Transfusion, Critical Care, Hemorrhage therapy, Humans, Anesthesiology, Critical Illness therapy
- Abstract
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. This trustworthy clinical practice guideline serves as a useful decision aid for Nordic anaesthesiologists caring for critically ill patients with bleeding., (© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)
- Published
- 2022
- Full Text
- View/download PDF
3. Therapeutics and COVID-19-A living WHO guideline: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.
- Author
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Møller MH, Chew MS, Olkkola KT, Rehn M, Yli-Hankala A, and Sigurðsson MI
- Subjects
- Critical Care, Humans, Societies, Medical, World Health Organization, Anesthesiology, COVID-19
- Abstract
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the Living WHO guideline on therapeutics and COVID-19. This trustworthy continuously updated guideline serves as a highly useful decision aid for Nordic anaesthesiologists caring for patients with COVID-19., (© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)
- Published
- 2022
- Full Text
- View/download PDF
4. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock in adults 2021 - endorsement by the Scandinavian society of anaesthesiology and intensive care medicine.
- Author
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Rehn M, Chew MS, Olkkola KT, Ingi Sigurðsson M, Yli-Hankala A, and Hylander Møller M
- Subjects
- Adult, Critical Care, Humans, Anesthesiology, Sepsis therapy, Shock, Septic therapy
- Abstract
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. The guideline serves as a useful bedside decision aid for clinicians managing adults with suspected and confirmed septic shock and sepsis-associated organ dysfunction., (© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)
- Published
- 2022
- Full Text
- View/download PDF
5. Clinical practice guideline on the management of septic shock and sepsis-associated organ dysfunction in children: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.
- Author
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Rehn M, Chew MS, Olkkola KT, Sigurðsson MI, Yli-Hankala A, and Møller MH
- Subjects
- Child, Critical Care, Humans, Multiple Organ Failure, Societies, Medical, Anesthesiology, Sepsis complications, Sepsis therapy, Shock, Septic complications, Shock, Septic therapy
- Abstract
Background: The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. The guideline can serve as a useful decision aid for clinicians managing children with suspected and confirmed septic shock and sepsis-associated organ dysfunction., (© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)
- Published
- 2021
- Full Text
- View/download PDF
6. Clinical practice guideline on spinal stabilisation of adult trauma patients: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.
- Author
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Yli-Hankala A, Chew MS, Olkkola KT, Rehn M, Sverrisson KÖ, and Møller MH
- Subjects
- Adult, Consensus, Critical Care, Humans, Societies, Medical, Anesthesiology
- Abstract
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline New clinical guidelines on the spinal stabilisation of adult trauma patients-consensus and evidence based. The guideline can serve as a useful decision aid for clinicians caring for patients with traumatic spinal cord injury. However, it is important to acknowledge that the overall certainty of evidence supporting the guideline recommendations was low, implying that further research is likely to have an important impact on the confidence in the estimate of effect., (© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)
- Published
- 2021
- Full Text
- View/download PDF
7. Endorsement of clinical practice guidelines by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.
- Author
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Rehn M, Chew MS, Olkkola KT, Örn Sverrison K, Yli-Hankala A, and Møller MH
- Subjects
- Humans, Scandinavian and Nordic Countries, Societies, Medical, Anesthesiology standards, Critical Care standards, Practice Guidelines as Topic
- Abstract
Clinical practice guidelines from other organizations or societies with assumed clinical and contextualized relevance for Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) members, may trigger a formal evaluation by The Clinical Practice Committee (CPC) for possible SSAI endorsement. This avoids unnecessary duplicate processes and minimizes resource-waste. Identified guidelines are assessed for endorsement using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument. The SSAI CPC utilizes the AGREE II online coordinated group appraisal platform to assess the methodological rigor and transparency in which the guideline was developed. The results of the assessment, including the decision to endorse or not, are presented to the SSAI Board for sanctioning. This document briefly outlines the process for evaluation of non-SSAI guidelines by the CPC for possible SSAI endorsement., (© 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)
- Published
- 2019
- Full Text
- View/download PDF
8. Procedures for Evaluating the Adequacy of Anesthesia.
- Author
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van Gils M, Korhonen I, and Yli-Hankala A
- Subjects
- Electromyography methods, Evoked Potentials, Auditory physiology, Evoked Potentials, Somatosensory physiology, Humans, Hypnosis methods, Monitoring, Intraoperative standards, Pain prevention & control, Quality Assurance, Health Care methods, Anesthesia methods, Anesthesia standards, Anesthesiology methods, Anesthesiology standards, Monitoring, Intraoperative methods
- Abstract
Assessing adequacy of anesthesia requires evaluation of its components: hypnosis, analgesia, and neuromuscular transmission. In order to do this, many methods have been developed that process signals representing different modalities. Assessment of hypnosis requires cortical measures of the central nervous system (CNS); methods that assess analgesia concentrate on subcortical and spinal levels of the CNS; and neuromuscular transmission is a peripheral phenomenon. This article presents an overview of the current state of methods available for measuring each of these components. We conclude that, whereas important gains have been made in the area of assessment of hypnosis, mainly owing to the advancement of methods using EEG and auditory evoked potentials, and whereas neuromuscular transmission can be objectively monitored using motor nerve stimulation, assessment of analgesia still contains many challenges.
- Published
- 2017
- Full Text
- View/download PDF
9. [Is it possible to measure the depth of anesthesia using electroencephalogram?].
- Author
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Yli-Hankala A and Scheinin H
- Subjects
- Arousal drug effects, Awareness drug effects, Humans, Anesthesia, General, Anesthesiology instrumentation, Electroencephalography, Monitoring, Intraoperative instrumentation
- Abstract
Although anesthetic monitoring has rapidly developed over the past few years, accidental awareness during general anesthesia still remains a significant clinical problem. It occurs in one out of thousand surgical patients. In addition to conventional clinical signs, the adequacy of anesthesia can be assessed for instance by monitoring the changes occurring in the electroencephalogram (EEG). The EEG effects of different anesthetics are, however, highly varied, and attempts to develop an unequivocal neurophysiological measure or quantity for human consciousness or unconsciousness have so far been unsuccessful.
- Published
- 2015
10. Spurious electroencephalographic activity due to pulsation artifact in the depth of anesthesia monitor
- Author
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Kotoe Kamata, Tarmo Lipping, Arvi Yli-Hankala, Ville Jäntti, and Masanori Yamauchi
- Subjects
Artifact ,Depth of anesthesia ,Electroencephalogram ,Intraoperative ,Monitoring ,Pulse wave ,Anesthesiology ,RD78.3-87.3 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The depth of anesthesia (DOA) is estimated based on the anesthesia-induced electroencephalogram (EEG) changes. However, the surgical environment, as well as the patient him/herself, generates electrical interferences that cause EEG waveform distortion. Case presentation A 52-year-old patient required general anesthesia due to the right femur necrotizing fasciitis. He had no history of epilepsy or head injury. His cardiovascular status was stable without arrhythmia under propofol and remifentanil anesthesia. The DOA was evaluated with Root® with SedLine® Brain Function Monitoring (Masimo Inc, Irvine, CA). The EEG showed a rhythmic, heart rate time-locked pulsation artifact, which diminished after electrode repositioning. Offline analysis revealed that the pulse wave-like interference in EEG was observed at the heart rate frequency. Conclusions We experienced an anesthesia case that involves a pulsation artifact generated by the superficial temporal artery contaminating the EEG signal. Numerous clinical conditions, including pulsation artifact, disturb anesthesia EEG.
- Published
- 2021
- Full Text
- View/download PDF
11. Therapeutics and COVID-19-A living WHO guideline : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Author
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Morten H. Møller, Michelle S. Chew, Klaus T. Olkkola, Marius Rehn, Arvi Yli‐Hankala, Martin I. Sigurðsson, HUS Perioperative, Intensive Care and Pain Medicine, Department of Diagnostics and Therapeutics, Clinicum, Anestesiologian yksikkö, Tampere University, Department of Prehospital Emergency Care, Pain Management and Anaesthesiology, and Clinical Medicine
- Subjects
Critical Care ,Omvårdnad ,COVID-19 ,Nursing ,General Medicine ,3121 Internal medicine ,World Health Organization ,AGREE II ,3126 Surgery, anesthesiology, intensive care, radiology ,WHO ,Anesthesiology and Pain Medicine ,Anesthesiology ,therapeutics ,Humans ,clinical practice guideline ,human activities ,Societies, Medical - Abstract
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the Living WHO guideline on therapeutics and COVID-19. This trustworthy continuously updated guideline serves as a highly useful decision aid for Nordic anaesthesiologists caring for patients with COVID-19. Funding Agencies|Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Published
- 2022
12. Regional anaesthesia in patients on antithrombotic drugs – a joint ESAIC/ESRA guideline : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Author
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Morten Hylander Møller, Martin Ingi Sigurðsson, Klaus T. Olkkola, Marius Rehn, Arvi Yli‐Hankala, Michelle S. Chew, Tampere University, Department of Prehospital Emergency Care, Pain Management and Anaesthesiology, Clinical Medicine, HUS Perioperative, Intensive Care and Pain Medicine, Department of Diagnostics and Therapeutics, Clinicum, University of Helsinki, and Anestesiologian yksikkö
- Subjects
Critical Care ,General Medicine ,AGREE II ,bleeding ,3126 Surgery, anesthesiology, intensive care, radiology ,Anesthesiology and Pain Medicine ,Fibrinolytic Agents ,Anesthesia, Conduction ,Anesthesiology ,Medisinske Fag: 700 [VDP] ,regional anaesthesia ,Humans ,antithrombotic drugs ,Societies, Medical ,clinical practice guideline - Abstract
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Regional anaesthesia in patients on antithrombotic drugs – a joint ESAIC/ESRA guideline. This clinical practice guideline serves as a useful decision aid for Nordic anaesthesiologists providing regional anaesthesia to adult patients on antithrombotic drugs. publishedVersion Non
- Published
- 2022
13. Transfusion strategies in bleeding critically ill adults:A clinical practice guideline from the European Society of Intensive Care Medicine: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Author
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Morten Hylander Møller, Martin Ingi Sigurðsson, Klaus T. Olkkola, Marius Rehn, Arvi Yli‐Hankala, Michelle S. Chew, Tampere University, Department of Prehospital Emergency Care, Pain Management and Anaesthesiology, and Clinical Medicine
- Subjects
Adult ,Critical Care ,Omvårdnad ,Critical Illness ,critically ill ,AGREE II ,bleeding ,clinical practice guideline ,ICU ,transfusion ,Hemorrhage ,General Medicine ,Nursing ,3121 Internal medicine ,Anesthesiology and Pain Medicine ,Anesthesiology ,Humans ,Blood Transfusion - Abstract
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. This trustworthy clinical practice guideline serves as a useful decision aid for Nordic anaesthesiologists caring for critically ill patients with bleeding. Funding Agencies|Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Published
- 2022
14. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock in adults 2021 - endorsement by the Scandinavian society of anaesthesiology and intensive care medicine
- Author
-
Marius Rehn, Michelle S. Chew, Klaus T. Olkkola, Martin Ingi Sigurðsson, Arvi Yli‐Hankala, and Morten Hylander Møller
- Subjects
Adult ,Anestesi och intensivvård ,Critical Care ,Anesthesiology and Intensive Care ,General Medicine ,AGREE II ,Shock, Septic ,sepsis ,Anesthesiology and Pain Medicine ,Anesthesiology ,Medisinske Fag: 700 [VDP] ,Sepsis ,adults ,Humans ,septic shock ,clinical practice guideline - Abstract
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. The guideline serves as a useful bedside decision aid for clinicians managing adults with suspected and confirmed septic shock and sepsis-associated organ dysfunction. BACKGROUND Sepsis and septic shock remain a leading global cause of mortality and morbidity.1-3 Anaesthesiologists and intensivists are regularly involved in the identification, resuscitation and management of adults with sepsis and septic shock. In November 2021, the Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 was published.4 The Clinical Practice Committee (CPC) of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) decided to appraise this guideline for possible endorsement to guide Scandinavian anaesthesiologists and intensivists in the identification, resuscitation, and management of adults with sepsis and septic shock. METHODS The SSAI CPC assessed the guideline using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II tool,5 as per the outlined process for endorsement of non-SSAI guidelines.6 RESULTS Five SSAI CPC members completed the appraisal. One member co-authored the guideline and was excluded from the evaluation, as per the SSAI endorsement process.6 The individual domain totals were: 1) scope and purpose 89%; 2) stakeholder involvement 92%; 3) rigor of development 81%; 4) clarity of presentation 89%; 5) applicability 73%; 6) editorial independence 85%; 7) overall assessment 87% (Figure 1).
- Published
- 2022
15. Clinical practice guideline on the management of septic shock and sepsis-associated organ dysfunction in children: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Author
-
Martin Ingi Sigurðsson, Michelle S Chew, Arvi Yli-Hankala, Marius Rehn, Klaus T. Olkkola, Morten Hylander Møller, HUS Perioperative, Intensive Care and Pain Medicine, Department of Diagnostics and Therapeutics, Clinicum, and Anestesiologian yksikkö
- Subjects
medicine.medical_specialty ,Surviving Sepsis Campaign ,Critical Care ,Multiple Organ Failure ,Nursing ,paediatrics ,sepsis ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,children ,Anesthesiology ,medicine ,Humans ,Agree ii ,Intensive care medicine ,Child ,Societies, Medical ,Septic shock ,business.industry ,Omvårdnad ,Organ dysfunction ,030208 emergency & critical care medicine ,General Medicine ,Guideline ,3126 Surgery, anesthesiology, intensive care, radiology ,AGREE II ,medicine.disease ,clinical practice guideline ,septic shock ,Shock, Septic ,3. Good health ,Clinical Practice ,Anesthesiology and Pain Medicine ,030228 respiratory system ,medicine.symptom ,business - Abstract
Background The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. The guideline can serve as a useful decision aid for clinicians managing children with suspected and confirmed septic shock and sepsis-associated organ dysfunction. Funding Agencies|SSAI
- Published
- 2021
16. Clinical practice guideline on spinal stabilisation of adult trauma patients: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Author
-
Kristinn Orn Sverrisson, Klaus T. Olkkola, Morten Hylander Møller, Arvi Yli-Hankala, Marius Rehn, and Michelle S Chew
- Subjects
Adult ,medicine.medical_specialty ,Consensus ,Evidence-based practice ,Critical Care ,Traumatic spinal cord injury ,Nursing ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology ,Humans ,Medicine ,Intensive care medicine ,Societies, Medical ,business.industry ,Omvårdnad ,030208 emergency & critical care medicine ,General Medicine ,Guideline ,3. Good health ,Review article ,Clinical Practice ,Anesthesiology and Pain Medicine ,business ,030217 neurology & neurosurgery ,clinical practice guideline ,endorsement ,spinal stabilisation ,SSAI ,trauma - Abstract
The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline New clinical guidelines on the spinal stabilisation of adult trauma patients-consensus and evidence based. The guideline can serve as a useful decision aid for clinicians caring for patients with traumatic spinal cord injury. However, it is important to acknowledge that the overall certainty of evidence supporting the guideline recommendations was low, implying that further research is likely to have an important impact on the confidence in the estimate of effect. Funding Agencies|Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Published
- 2021
17. National early warning score (NEWS) in a Finnish multidisciplinary emergency department and direct vs. late admission to intensive care
- Author
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Sanna Hoppu, Mikko Kivipuro, Joonas Tirkkonen, Heini Huhtala, Arvi Yli-Hankala, Satu-Liisa Pauniaho, Juuso Solin, Timo Kontula, Jari Kalliomäki, Lääketieteen ja biotieteiden tiedekunta - Faculty of Medicine and Life Sciences, Yhteiskuntatieteiden tiedekunta - Faculty of Social Sciences, and University of Tampere
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Critical Care ,Critical Illness ,Kirurgia, anestesiologia, tehohoito, radiologia - Surgery, anesthesiology, intensive care, radiology ,030204 cardiovascular system & hematology ,Emergency Nursing ,Severity of Illness Index ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Multidisciplinary approach ,Intensive care ,Anesthesiology ,Humans ,Medicine ,Hospital Mortality ,Prospective Studies ,Finland ,Aged ,Chi-Square Distribution ,Clinical Deterioration ,Vital Signs ,business.industry ,030208 emergency & critical care medicine ,Emergency department ,Middle Aged ,Early warning score ,Intensive care unit ,Intensive Care Units ,Multivariate Analysis ,Emergency medicine ,Cohort ,Emergency Medicine ,Female ,Emergency Service, Hospital ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
We investigated the national early warning scores (NEWSs) and related outcomes of patients in a tertiary referral center's multidisciplinary emergency department (ED). Patients were further categorized into three groups: triaged directly to intensive care unit (EDICU), triaged to general ward with later ICU admission (EDwardICU) and triaged to general ward (EDward). NEWSs and subsequent outcomes among these sub groups were compared.We conducted a prospective one-month cohort study in Tampere University Hospital's ED, Finland. ED-NEWSs were obtained for all adult patients without treatment limitations, and control (ward) NEWSs were further obtained for the EDwardICU and EDward patients.Cohort consisted of 1,354 patients with a median ED-NEWS of 2, and higher ED-NEWS was associated with in-hospital mortality (OR 1.26, 95% CI 1.11-1.42; AUROC 0.75, 0.64‒0.86, p 0.001) and 30-day mortality (OR 1.27, 1.17-1.39; AUROC 0.78, 0.71‒0.84, p 0.001) irrespective of age and comorbidity. There were 64 patients in EDICU group, 12 patients in EDwardICU group and 1,278 patients in EDward group with median ED-NEWSs of 7, 3 and 2 (p 0.001), respectively. After the first 24 h in wards, median NEWSs of the EDwardICU patients had substantially increased as compared with EDward patients (6 vs. 2, p 0.001). There were no statistical differences in last NEWS before ICU admission between the EDICU and EDwardICU patients (7 vs. 8, p = 0.534), or in ICU severity-of-illness scores or patient outcomes.ED-NEWS is independently associated with in-hospital and 30-day mortality with acceptable discrimination capability. Direct and late ICU admissions occurred with comparable NEWSs at admission.
- Published
- 2018
18. Clinical practice guideline on prevention of rhabdomyolysis induced acute kidney injury: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Author
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Klaus T. Olkkola, Kristinn Orn Sverrisson, Marius Rehn, Morten Hylander Møller, Arvi Yli-Hankala, and Michelle S Chew
- Subjects
medicine.medical_specialty ,Critical Care ,Psychological intervention ,030204 cardiovascular system & hematology ,Rhabdomyolysis ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology ,medicine ,Humans ,Agree ii ,030212 general & internal medicine ,Intensive care medicine ,Societies, Medical ,business.industry ,Acute kidney injury ,General Medicine ,Guideline ,Acute Kidney Injury ,medicine.disease ,3. Good health ,Clinical Practice ,Quality of evidence ,Anesthesiology and Pain Medicine ,Practice Guidelines as Topic ,business - Abstract
The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical Practice Committee endorses the recent DASAIM/DSIT guideline for prevention of rhabdomyolysis-induced acute kidney injury. However, we emphasize the low quality of evidence with only weak recommendations for all interventions, highlighting that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimates.
- Published
- 2019
19. Endorsement of clinical practice guidelines by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine
- Author
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Arvi Yli-Hankala, Klaus T. Olkkola, Marius Rehn, Michelle S Chew, Morten Hylander Møller, and Kristinn Örn Sverrison
- Subjects
medicine.medical_specialty ,Critical Care ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Guideline ,Scandinavian and Nordic Countries ,Transparency (behavior) ,3. Good health ,Formal evaluation ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Anesthesiology ,Practice Guidelines as Topic ,Humans ,Relevance (law) ,Medicine ,Agree ii ,030212 general & internal medicine ,business ,Intensive care medicine ,Societies, Medical - Abstract
Clinical practice guidelines from other organizations or societies with assumed clinical and contextualized relevance for Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) members, may trigger a formal evaluation by The Clinical Practice Committee (CPC) for possible SSAI endorsement. This avoids unnecessary duplicate processes and minimizes resource-waste. Identified guidelines are assessed for endorsement using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument. The SSAI CPC utilizes the AGREE II online coordinated group appraisal platform to assess the methodological rigor and transparency in which the guideline was developed. The results of the assessment, including the decision to endorse or not, are presented to the SSAI Board for sanctioning. This document briefly outlines the process for evaluation of non-SSAI guidelines by the CPC for possible SSAI endorsement.
- Published
- 2018
20. Procedures for Evaluating the Adequacy of Anesthesia
- Author
-
Mark van Gils, Arvi Yli-Hankala, and Ilkka Korhonen
- Subjects
Hypnosis ,Quality Assurance, Health Care ,Central nervous system ,Biomedical Engineering ,Neuromuscular transmission ,Pain ,Motor nerve ,Electroencephalography ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology ,Evoked Potentials, Somatosensory ,Monitoring, Intraoperative ,medicine ,Humans ,Anesthesia ,030212 general & internal medicine ,Modalities ,medicine.diagnostic_test ,Electromyography ,business.industry ,030208 emergency & critical care medicine ,medicine.anatomical_structure ,Evoked Potentials, Auditory ,Auditory Physiology ,business - Abstract
Assessing adequacy of anesthesia requires evaluation of its components: hypnosis, analgesia, and neuromuscular transmission. In order to do this, many methods have been developed that process signals representing different modalities. Assessment of hypnosis requires cortical measures of the central nervous system (CNS); methods that assess analgesia concentrate on subcortical and spinal levels of the CNS; and neuromuscular transmission is a peripheral phenomenon. This article presents an overview of the current state of methods available for measuring each of these components. We conclude that, whereas important gains have been made in the area of assessment of hypnosis, mainly owing to the advancement of methods using EEG and auditory evoked potentials, and whereas neuromuscular transmission can be objectively monitored using motor nerve stimulation, assessment of analgesia still contains many challenges.
- Published
- 2017
21. Out-of-hospital cardiac arrests in nursing homes and primary care facilities in Pirkanmaa, Finland
- Author
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Heini Huhtala, Ilkka Virkkunen, Arvi Yli-Hankala, Sanna Hoppu, Heidi Kangasniemi, Antti Kämäräinen, Piritta Setälä, Esa Jämsen, Lääketieteen ja biotieteiden tiedekunta - Faculty of Medicine and Life Sciences, and Tampere University
- Subjects
Male ,medicine.medical_specialty ,Resuscitation ,medicine.medical_treatment ,Kirurgia, anestesiologia, tehohoito, radiologia - Surgery, anesthesiology, intensive care, radiology ,Allied Health Personnel ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,Anesthesiology ,Emergency medical services ,Medicine ,Humans ,Cardiopulmonary resuscitation ,Prospective Studies ,Prospective cohort study ,Finland ,Aged ,Resuscitation Orders ,Aged, 80 and over ,Primary Health Care ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,medicine.disease ,Survival Analysis ,Cardiopulmonary Resuscitation ,Nursing Homes ,Anesthesiology and Pain Medicine ,Treatment Outcome ,Ventricular fibrillation ,Emergency medicine ,Observational study ,Female ,business ,Medical Futility ,Out-of-Hospital Cardiac Arrest - Abstract
BACKGROUND Dispatching Emergency Medical Services to treat patients with deteriorating health in nursing homes and primary care facilities is common in Finland. We examined the cardiac arrest patients to describe this phenomenon. We had a special interest in patients for whom cardiopulmonary resuscitation was considered futile. METHODS We conducted an observational study between 1 June 2013 and 31 May 2014 in the Pirkanmaa area. We included cases in which Emergency Medical Services participated in the treatment of cardiac arrest patients in nursing homes and primary care facilities. RESULTS Emergency Medical Services attended to a total of 355 cardiac arrest patients, and 65 patients (18%) met the inclusion criteria. The included patients were generally older than 65 years, but otherwise heterogeneous. Nineteen patients (29%) had a valid do-not-attempt-resuscitation order, but paramedics were not informed about it in 10 (53%) of those cases. Eight (12%) of the 65 patients survived to hospital admission and 3 (5%) survived to hospital discharge with a neurologically favourable outcome. Two patients were alive 90 days after the cardiac arrest; both were younger than 70 years of age and had ventricular fibrillation as primary rhythm. There were no survivors in nursing homes. CONCLUSIONS The do-not-attempt-resuscitation orders were often unavailable during a cardiopulmonary resuscitation attempt. Although resuscitation attempts were futile for patients in nursing homes, some patients in primary care facilities demonstrated a favourable outcome after cardiac arrest. Emergency Medical Services seem to be able to recognise potential survivors and focus resources on their treatment.
- Published
- 2017
22. [Is it possible to measure the depth of anesthesia using electroencephalogram?]
- Author
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Arvi, Yli-Hankala and Harry, Scheinin
- Subjects
Anesthesiology ,Monitoring, Intraoperative ,Humans ,Electroencephalography ,Anesthesia, General ,Awareness ,Arousal - Abstract
Although anesthetic monitoring has rapidly developed over the past few years, accidental awareness during general anesthesia still remains a significant clinical problem. It occurs in one out of thousand surgical patients. In addition to conventional clinical signs, the adequacy of anesthesia can be assessed for instance by monitoring the changes occurring in the electroencephalogram (EEG). The EEG effects of different anesthetics are, however, highly varied, and attempts to develop an unequivocal neurophysiological measure or quantity for human consciousness or unconsciousness have so far been unsuccessful.
- Published
- 2015
23. Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1–3 yr
- Author
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Matti Viitanen, P. Annila, A. Yli-Hankala, and Hanna Viitanen
- Subjects
Male ,Methyl Ethers ,medicine.medical_specialty ,genetic structures ,medicine.drug_class ,Midazolam ,Anesthesia, General ,Sevoflurane ,Adenoidectomy ,Hypnotic ,Postoperative Complications ,Double-Blind Method ,Anesthesiology ,medicine ,Humans ,heterocyclic compounds ,Alfentanil ,Propofol ,business.industry ,Infant ,General Medicine ,Surgery ,Anesthesiology and Pain Medicine ,Ambulatory Surgical Procedures ,Child, Preschool ,Anesthesia ,Anesthesia Recovery Period ,Anesthetics, Inhalation ,Female ,Premedication ,business ,Anesthetics, Intravenous ,Adjuvants, Anesthesia ,medicine.drug - Abstract
To study the effect of midazolam premedication on the recovery characteristics of sevoflurane anesthesia induced with propofol in pediatric outpatients.Sixty children, one to three years, presenting for ambulatory adenoidectomy were randomly assigned , in a double-blind fashion, to receive either 0.5 mg x kg(-1) midazolam (Group M) or placebo (Group P) p.o. 30 min before anesthesia. Anesthesia was induced with 10 microg x kg(-1) atropine, 10 microg x kg(-1) alfentanil, and 3-4 mg x kg(-1) propofol i.v.. Tracheal intubation was facilitated with 0.2 mg x kg(-1) mivacurium. Anesthesia was maintained with nitrous oxide/oxygen (FiO2 0.3) and sevoflurane with controlled ventilation. Recovery characteristics were compared using the modified Aldrete scoring system, the Pain/Discomfort scale and measuring specific recovery end-points (emergence, full Aldrete score, discharge). A postoperative questionnaire was used to evaluate the children's well-being at home until 24 hr after discharge.Emergence from anesthesia (22 +/- 9 vs 16 +/- 6 min (mean +/- SD), P = 0.005) and achieving full Aldrete scores (30 +/- 11 vs 24 +/- 16 min, P = 0.006) were delayed in patients receiving midazolam. Children in the placebo group were given postoperative analgesia sooner than those in the midazolam group (18 +/- 11 vs 23 +/- 8 min, P = 0.009). More children premedicated with midazolam suffered from arousal distress (20% vs 3%, P = 0.04) and scored higher on the Pain/Discomfort scale (P = 0.004) at 20 min after arrival in the recovery room. Discharge was not affected by premedication and well-being at home was similar in the groups.Oral premedication with midazolam delays early recovery but not discharge after ambulatory sevoflurane anesthesia induced with propofol in children one to three years. Midazolam did not improve the quality of recovery.
- Published
- 1999
24. Method for the Automatic Detection of Epileptiform Waveforms in Sevoflurane-induced Anesthesia EEG
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Miikka Ermes, Ville Jäntti, Arvi Yli-Hankala, Mika Sarkela, Anne Vakkuri, and Mark van Gils
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Methyl Ethers ,medicine.medical_specialty ,Computer science ,Neurophysiology ,Electroencephalography ,Sensitivity and Specificity ,Sevoflurane ,Automation ,Anesthesiology ,medicine ,Humans ,Anesthesia ,EEG ,Probability ,Electronic Data Processing ,Models, Statistical ,medicine.diagnostic_test ,Volatile anesthetic ,Reproducibility of Results ,Signal Processing, Computer-Assisted ,Burst suppression ,Female ,Algorithms ,Sevoflurane anesthesia ,medicine.drug - Abstract
Sevoflurane is a volatile anesthetic which is reported to cause epileptiform EEG changes together with undesired symptoms such as convulsions. In this paper, an algorithm for the automatic detection of these EEG changes is presented which could enable safer induction of anesthesia with sevoflurane by informing the clinicians about the epileptiform EEG. EEG was recorded from 60 healthy female patients during sevoflurane anesthesia. A neurophysiologist classified the EEG waveforms. Each anesthesia period lasted 6 minutes. 48 signal features were extracted from the raw EEG. 5-sec segments of EEG were classified based on the extracted features using a decision tree with a logistic regression based decisions and the classification results were compared to the neurophysiologist's classifications. Awake EEG was recognized with 69% / 96% (sensitivity / specificity), Burst suppression with 56% / 98%, Epileptiform EEG with 83% / 87 %, normal slow anesthesia EEG with 86% / 64 %, slow anesthesia EEG with monophasic pattern with 65% / 80 %, and slow anesthesia EEG with monophasic pattern and spikes with 54% / 84%.
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- 2006
25. Clinical practice guideline on prevention of rhabdomyolysis induced acute kidney injury: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.
- Author
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Chew, Michelle S., Rehn, Marius, Olkkola, Klaus T., Örn Sverrisson, Kristinn, Yli‐Hankala, Arvi, Møller, Morten Hylander, and Yli-Hankala, Arvi
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ACUTE kidney failure ,CRITICAL care medicine ,MEDICAL practice ,ANESTHESIOLOGY ,CLINICAL medicine ,ACUTE kidney failure prevention ,RHABDOMYOLYSIS ,MEDICAL protocols ,RESEARCH funding ,MEDICAL societies ,DISEASE complications - Abstract
The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical Practice Committee endorses the recent DASAIM/DSIT guideline for prevention of rhabdomyolysis-induced acute kidney injury. However, we emphasize the low quality of evidence with only weak recommendations for all interventions, highlighting that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimates. [ABSTRACT FROM AUTHOR]
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- 2019
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- View/download PDF
26. Using a simplified pre-hospital ' MET' score to predict in-hospital care and outcomes.
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JOKELA, K., SETÄLÄ, P., VIRTA, J., HUHTALA, H., YLI‐HANKALA, A., and HOPPU, S.
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EMERGENCY medical personnel ,HOSPITAL care ,INPATIENT care ,ANESTHESIOLOGY ,LIFE tables - Abstract
Background Medical emergency team ( MET) activation criteria serve as a predictor of serious adverse events on hospital wards and in the emergency department ( ED). We aimed to determine whether in-hospital MET activation criteria would be useful in identifying patients at risk in pre-hospital care. Methods The data were collected retrospectively from 610 adult patients treated by physician-staffed helicopter emergency medical services. Pre-hospital vital signs were compared with MET activation criteria and scored accordingly to receive a simplified pre-hospital ' MET' score. The primary outcome measure was hospital mortality. The secondary outcome measures were admission to intensive care unit and the length of ED stay, intensive care unit ( ICU) stay and hospital stay. The simplified pre-hospital ' MET' score was also compared with Emergency Severity Index ( ESI) used as a triage tool in ED. Results Higher simplified pre-hospital ' MET' scores were associated with hospital mortality ( P < 0.001), the need for ICU treatment ( P < 0.001) and a more urgent ESI class in the ED ( P < 0.001). Higher simplified pre-hospital ' MET' scores were associated with shorter stay in the ED ( P < 0.001), longer stay in the ICU ( P < 0.001) and longer hospital stay ( P < 0.001). A simplified pre-hospital ' MET' score was an independent predictor for hospital mortality (odds ratio 2.42, confidence interval 1.84 3.18, P < 0.001), regardless of age or patient's previous overall physical health classified by American Society of Anesthesiologists physical status classification system. Conclusion A simplified pre-hospital ' MET' score is a predictor for patient outcome and could serve as a risk assessment tool for the health care provider on-scene. [ABSTRACT FROM AUTHOR]
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- 2015
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27. EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia.
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Seitsonen, E. R. J., Korhonen, I. K. J., van Gils, M. J., Huiku, M., Lötjönen, J. M. P., Korttila, K. T., and Yli-Hankala, A. M.
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ANESTHESIA ,NOCICEPTORS ,ELECTROENCEPHALOGRAPHY ,ENTROPY ,HEART beat ,MOTOR ability ,INTRAOPERATIVE monitoring ,ANESTHESIOLOGY - Abstract
Analgesia is a part of balanced anaesthesia, but direct indicators of nociception do not exist. We examined the relationship between motor reactions and physiological variables during skin incision in sevoflurane anaesthesia and hypothesized that nociception could be detected and graded by significant changes in these variables.Thirty-one women scheduled for abdominal hysterectomy participated in the study. Anaesthesia was induced with fentanyl (1 µg kg
−1 ), propofol (1 mg kg−1 ) and sevoflurane. Skin incision was performed 14 min after induction during 1.6% end-tidal sevoflurane anaesthesia without neuromuscular blockade. Electrocardiography (ECG), photoplethysmography (PPG) and electroencephalography (EEG) were registered, and a range of variables was computed from these signals. The postincision values, normalized with respect to their preincision values, of movers vs. non-movers were compared. The variables showing significant differences between movers and non-movers were used to develop a logistic regression equation for the classification of patients into movers or non-movers.Twenty-six patients were eligible for analysis, and 12 (46%) displayed a motor reaction to skin incision (movers). Many ECG, PPG and EEG-related variables showed significant differences between the pre- and postincision periods. The best classification performance, assessed by leave-one-out cross-validation, between movers and non-movers was achieved with the combination of response entropy of EEG, RR-interval and PPG notch amplitude. The corresponding equation yielded 96% correct classification with 90% sensitivity and 100% specificity. The classification performance of any single variable alone was considerably worse.Combination of information from different sources may be required for monitoring the adequacy of analgesia during anaesthesia. [ABSTRACT FROM AUTHOR]- Published
- 2005
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28. Assessment of surgical stress during general anaesthesia.
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M. Huiku, K. Uutela, M. van Gils, I. Korhonen, M. Kymäläinen, P. Meriläinen, M. Paloheimo, M. Rantanen, P. Takala, H. Viertiö-Oja, and A. Yli-Hankala
- Subjects
- *
ANESTHESIA , *ANESTHESIOLOGY , *BIOLOGY , *MEDICAL sciences - Abstract
: Background Inadequate analgesia during general anaesthesia may present as undesirable haemodynamic responses. No objective measures of the adequacy of analgesia exist. We aimed at developing a simple numerical measure of the level of surgical stress in an anaesthetized patient. : Methods Sixty and 12 female patients were included in the development and validation data sets, respectively. All patients had elective surgery with propofol–remifentanil target controlled anaesthesia. Finger photoplethysmography and electrocardiography waveforms were recorded throughout anaesthesia and various waveform parameters were extracted off-line. Total surgical stress (TSS) for a patient was estimated based on stimulus intensity and remifentanil concentration. The surgical stress index (SSI) was developed to correlate with the TSS estimate in the development data set. The performance of SSI was validated within the validation data set during and before surgery, especially at skin incision and during changes of the predicted remifentanil effect-site concentration. : Results SSI was computed as a combination of normalized heart beat interval (HBInorm) and plethysmographic pulse wave amplitude (PPGAnorm): SSI = 100–(0.7*PPGAnorm+0.3*HBInorm). SSI increased at skin incision and stayed higher during surgery than before surgery; SSI responded to remifentanil concentration changes and was higher at the lower concentrations of remifentanil. : Conclusions SSI reacts to surgical nociceptive stimuli and analgesic drug concentration changes during propofol–remifentanil anaesthesia. Further validation studies of SSI are needed to elucidate its usefulness during other anaesthetic and surgical conditions. [ABSTRACT FROM AUTHOR]
- Published
- 2007
- Full Text
- View/download PDF
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