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Karolinska Anaesthesia Research Group for Major Surgery (KARISMA)

The main objective of our research group is to improve outcome after major surgery. We focus on the development of methods for monitoring circulation and ventilation during anaesthesia as well as clinical studies on fluid management, cognitive recovery and risk factors for complications after major surgery.

surgical procedure with nurses and surgeons.

The research group is located at the Department of Anesthesiology, Surgical Services and Intensive Care Medicine (ANOPIVA) at Karolinska University Hospital, Solna.

Projects

Development of a capnodynamic method for monitoring circulation and ventilation during anaesthesia

Major surgery is associated with a high risk of postoperative complications. Hemodynamic and respiratory optimization has been shown to improve outcome in high-risk surgical patients. In this setting it is important to accurately monitor cardiac output and lung mechanics. In collaboration with the Micro and Nanosystems lab at The Royal Institute of Technology and the research department at Maquet Critical Care AB, we are developing a new carbon dioxide based method for assessment of cardiac output and effective lung volume during anaesthesia and intensive care. The method is continuously validated using both experimental and clinical studies.

Risk factors for post-operative complications in high risk surgery

In order to optimize the perioperative management, we need to correctly identify patients with a high risk for post-operative morbidity. In collaboration with several University Hospitals in Sweden, a prospective multicentre cohort study will start in 2015. The focus of the study will be to update the criteria for high risk surgery in Sweden and to assess the predictive strength of various risk factors.

Fluid management and acute renal injury in HIPEC surgery at Karolinska University Hospital

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option for selected patients with peritoneal carcinomatosis. The HIPEC procedure has improved the five-year survival rate from 5% to 30-50% in this group of patients and was introduced in 2013 at Karolinska, Solna. CRS with HIPEC may adversely affect renal function due to hemodynamic instability, fluid shifts and the potential nephrotoxic effects of the chemotherapeutic agent. We will prospectively study how risk factors, perioperative events including shifts in temperature, electrolytes and fluid will affect renal function and the incidence of acute kidney injury.

Albumin volume kinetics in the perioperative setting

Internationally, albumin is considered one of the first line colloids used for plasma expansion in the perioperative setting. However, the volume kinetics during anaesthesia and surgery is not extensively studied. Our study involves healthy subjects, patients having general anaesthesia for minor surgery, and patients in a presumed state of inflammatory response following major surgery. Volume kinetics, the duration and rate of plasma expansion including capillary leakage will be assessed, as well as effects on the endothelial glycocalyx layer.

Group members

PhD students

Collaborators

Mikro och Nanosystem, Kungliga tekniska högskolan

  • Kristinn B Gylfason, Med Dr
  • Floria Ottonello Briano, doktorand
  • Maquet Critical Care AB utvecklingsavdelning
  • Mats Wallin, Med Dr
  • Magnus Hallbäck, Med Dr

Financial support

  • Karolinska Institutet
  • ALF-medel
  • KTH/SLL (HMT)Vinnova
  • European Society of Anaesthesia
  • Maquet Critical Care AB

Publications

Fluid volume kinetics of 20% albumin.
Hahn RG, Zdolsek M, Hasselgren E, Zdolsek J, Björne H
Br J Clin Pharmacol 2019 06;85(6):1303-1311

Long Intravascular Persistence of 20% Albumin in Postoperative Patients.
Hasselgren E, Zdolsek M, Zdolsek JH, Björne H, Krizhanovskii C, Ntika S, et al
Anesth. Analg. 2019 Nov;129(5):1232-1239

Biomarkers of endothelial injury in plasma are dependent on kidney function.
Hahn RG, Hasselgren E, Björne H, Zdolsek M, Zdolsek J
Clin. Hemorheol. Microcirc. 2019 ;72(2):161-168

Does intraperitoneal ropivacaine reduce postoperative inflammation? A prospective, double-blind, placebo-controlled pilot study.
Hayden J, Gupta A, Thörn SE, Thulin P, Block L, Oras J
Acta Anaesthesiol Scand 2019 Sep;63(8):1048-1054

Effect of lidocaine and ropivacaine on primary (SW480) and metastatic (SW620) colon cancer cell lines.
Siekmann W, Tina E, Von Sydow AK, Gupta A
Oncol Lett 2019 Jul;18(1):395-401

How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence.
Forget P, Aguirre JA, Bencic I, Borgeat A, Cama A, Condron C, et al
Cancers (Basel) 2019 Apr;11(5):

Performance of a capnodynamic method estimating effective pulmonary blood flow during transient and sustained hypercapnia.
Sigmundsson TS, Öhman T, Hallbäck M, Redondo E, Sipmann FS, Wallin M, et al
J Clin Monit Comput 2018 Apr;32(2):311-319

A modified breathing pattern improves the performance of a continuous capnodynamic method for estimation of effective pulmonary blood flow.
Sander CH, Sigmundsson T, Hallbäck M, Sipmann FS, Wallin M, Oldner A, et al
J Clin Monit Comput 2017 Aug;31(4):717-725

Capnodynamic assessment of effective lung volume during cardiac output manipulations in a porcine model.
Hällsjö Sander C, Lönnqvist PA, Hallbäck M, Sipmann FS, Wallin M, Oldner A, et al
J Clin Monit Comput 2016 Dec;30(6):761-769

A novel continuous capnodynamic method for cardiac output assessment in a porcine model of lung lavage.
Hällsjö Sander C, Hallbäck M, Suarez Sipmann F, Wallin M, Oldner A, Björne H
Acta Anaesthesiol Scand 2015 Sep;59(8):1022-31

Intraperitoneal local anesthetics have predominant local analgesic effect: a randomized, double-blind study.
Perniola A, Magnuson A, Axelsson K, Gupta A
Anesthesiology 2014 Aug;121(2):352-61

Cognitive recovery after ambulatory anaesthesia based on desflurane or propofol: a prospective randomised study.
Lindqvist M, Schening A, Granstrom A, Bjorne H, Jakobsson JG
Acta Anaesthesiol Scand 2014 Oct;58(9):1111-20

Novel continuous capnodynamic method for cardiac output assessment during mechanical ventilation.
Hällsjö Sander C, Hallbäck M, Wallin M, Emtell P, Oldner A, Björne H
Br J Anaesth 2014 May;112(5):824-31

Stroke volume optimization in elective bowel surgery: a comparison between pulse power wave analysis (LiDCOrapid) and oesophageal Doppler (CardioQ).
Nordström J, Hällsjö-Sander C, Shore R, Björne H
Br J Anaesth 2013 Mar;110(3):374-80

Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy.
Fant F, Tina E, Sandblom D, Andersson SO, Magnuson A, Hultgren-Hörnkvist E, et al
Br J Anaesth 2013 May;110(5):747-57

Mortality after surgery in Europe: a 7 day cohort study.
Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al
Lancet 2012 Sep;380(9847):1059-65

Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery: a retrospective analysis of data from 655 patients in central Sweden.
Gupta A, Björnsson A, Fredriksson M, Hallböök O, Eintrei C
Br J Anaesth 2011 Aug;107(2):164-70

Correct fluid in right time and correct amount! Goal-directed fluid therapy in major bowel surgery yields less complications.
Björne H
Läkartidningen. 2011;108:1953.

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