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52. Scale size of cometary bow shocks

Author

Edberg, Niklas J. T., primary, Eriksson, Anders I., additional, Nilsson, Hans, additional, Gunell, Herbert, additional, Goetz, Charlotte, additional, Richter, Ingo, additional, Henri, Pierre, additional, and de Keyser, Johan, additional

Published
2023
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54. 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

Author

Thilen, Stephan R., primary, Weigel, Wade A., additional, Todd, Michael M., additional, Dutton, Richard P., additional, Lien, Cynthia A., additional, Grant, Stuart A., additional, Szokol, Joseph W., additional, Eriksson, Lars I., additional, Yaster, Myron, additional, Grant, Mark D., additional, Agarkar, Madhulika, additional, Marbella, Anne M., additional, Blanck, Jaime F., additional, and Domino, Karen B., additional

Published
2023
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55. Dust observations at orbital altitudes surrounding Mars

Author

Andersson, L., Weber, T. D., Malaspina, D., Crary, F., Ergun, R. E., Delory, G. T., Fowler, C. M., Morooka, M. W., McEnulty, T., Eriksson, A. I., Andrews, D. J., Horanyi, M., Collette, A., Yelle, R., and Jakosky, B. M.

Published
2015

57. Feeding and Respiration

Author

Ekberg, Olle, Hårdemark Cedborg, Anna I., Bodén, Katarina, Hedström, Hanne Witt, Kuylenstierna, Richard, Eriksson, Lars I., Sundman, Eva, and Ekberg, Olle, editor

Published
2012
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58. Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group

Author

Berger, Miles, Schenning, Katie J., Brown, Charles H., IV, Deiner, Stacie G., Whittington, Robert A., Eckenhoff, Roderic G., Angst, Martin S., Avramescu, Sinziana, Bekker, Alex, Brzezinski, Marek, Crosby, Greg, Culley, Deborah J., Eckenhoff, Maryellen, Eriksson, Lars I., Evered, Lis, Ibinson, Jim, Kline, Richard P., Kofke, Andy, Ma, Daqing, Mathew, Joseph P., Maze, Mervyn, Orser, Beverley A., Price, Catherine C., Scott, David A., Silbert, Brendan, Su, Diansan, Terrando, Niccolo, Wang, Dian-Shi, Wei, Huafeng, Xie, Zhoncong, and Zuo, Zhiyi

Published
2018
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60. Feeding and Respiration

Author

Ekberg, Olle, primary, Hårdemark Cedborg, Anna I., additional, Bodén, Katarina, additional, Witt Hedström, Hanne, additional, Kuylenstierna, Richard, additional, Eriksson, Lars I., additional, and Sundman, Eva, additional

Published
2017
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61. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents III: The 2023 Geneva revision.

Author

Fuchs‐Buder, Thomas, Brull, Sorin J., Fagerlund, Malin Jonsson, Renew, J. Ross, Cammu, Guy, Murphy, Glenn S., Warlé, Michiel, Vested, Matias, Fülesdi, Béla, Nemes, Reka, Columb, Malachy O., Damian, Daniela, Davis, Peter J., Iwasaki, Hajime, and Eriksson, Lars I.

Subjects
NEUROMUSCULAR blocking agents, MEDICAL research, SUGAMMADEX, NEUROMUSCULAR blockade
Abstract

The set of guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents was developed following an international consensus conference in Copenhagen in 1996 (Viby‐Mogensen et al., Acta Anaesthesiol Scand 1996, 40, 59–74); the guidelines were later revised and updated following the second consensus conference in Stockholm in 2005 (Fuchs‐Buder et al., Acta Anaesthesiol Scand 2007, 51, 789–808). In view of new devices and further development of monitoring technologies that emerged since then, (e.g., electromyography, three‐dimensional acceleromyography, kinemyography) as well as novel compounds (e.g., sugammadex) a review and update of these recommendations became necessary. The intent of these revised guidelines is to continue to help clinical researchers to conduct high‐quality work and advance the field by enhancing the standards, consistency, and comparability of clinical studies. There is growing awareness of the importance of consensus‐based reporting standards in clinical trials and observational studies. Such global initiatives are necessary in order to minimize heterogeneous and inadequate data reporting and to improve clarity and comparability between different studies and study cohorts. Variations in definitions of endpoints or outcome variables can introduce confusion and difficulties in interpretation of data, but more importantly, it may preclude building of an adequate body of evidence to achieve reliable conclusions and recommendations. Clinical research in neuromuscular pharmacology and physiology is no exception. [ABSTRACT FROM AUTHOR]

Published
2023
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65. Haptoglobin Genotype Does Not Confer a Risk of Stroke in Type 1 Diabetes

Author

Syreeni, Anna, primary, Dahlström, Emma H., primary, Hägg-Holmberg, Stefanie, primary, Forsblom, Carol, primary, Eriksson, Marika I., primary, Harjutsalo, Valma, primary, Putaala, Jukka, primary, Groop, Per-Henrik, primary, Sandholm, Niina, primary, Thorn, Lena M., primary, and Group, on behalf of the FinnDiane Study, primary

Published
2022
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71. Radial distribution of plasma at comet 67P : Implications for cometary flyby missions

Author

Edberg, Niklas J. T., Johansson, Fredrik L., Eriksson, Anders I., Vigren, Erik, Henri, P., De Keyser, J., Edberg, Niklas J. T., Johansson, Fredrik L., Eriksson, Anders I., Vigren, Erik, Henri, P., and De Keyser, J.

Abstract

Context. The Rosetta spacecraft followed comet 67P/Churyumov-Gerasimenko (67P) for more than two years at a slow walking pace (similar to 1 m s(-1)) within 1500 km from the nucleus. During one of the radial movements of the spacecraft in the early phase of the mission, the radial distribution of the plasma density could be estimated, and the ionospheric density was found to be inversely proportional to the cometocentric distance r from the nucleus (a 1/r distribution). Aims. This study aims to further characterise the radial distribution of plasma around 67P throughout the mission and to expand on the initial results. We also aim to investigate how a 1/r distribution would be observed during a flyby with a fast (similar to 10's km s(-1)) spacecraft, such as the upcoming Comet Interceptor mission, when there is also an asymmetry introduced to the outgassing over the comet surface. Methods. To determine the radial distribution of the plasma, we used data from the Langmuir probe and Mutual Impedance instruments from the Rosetta Plasma Consortium during six intervals throughout the mission, for which the motion of Rosetta was approximately radial with respect to the comet. We then simulated what distribution a fast flyby mission would actually observe during its passage through a coma when there is a 1/r plasma density distribution as well as a sinusoidal variation with a phase angle (and then a sawtooth variation) multiplied to the outgassing rate. Results. The plasma density around comet 67P is found to roughly follow a 1/r dependence, although significant deviations occur in some intervals. If we normalise all data to a common outgassing rate (or heliocentric distance) and combine the intervals to a radial range of 10-1500 km, we find a 1/r(1.19) average distribution. The simulated observed density from a fast spacecraft flying through a coma with a 1/r distribution and an asymmetric outgassing can, in fact, appear anywhere in the range from a 1/r distribution to a 1

Published
2022
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72. On positively charged dust in the coma of comet 67P

Author

Vigren, Erik, Eriksson, A. , I, Bergman, S., Vigren, Erik, Eriksson, A. , I, and Bergman, S.

Abstract

Moment analysis of ion spectrograms measured by the Ion Composition Analyser (ICA) in the coma of comet 67P typically produces an ion number density estimate markedly lower than the number density of free electrons as measured by the Mutual Impedance Probe and the dual Langmuir Probe. While there are good reasons to distrust the ion density moment estimate in these circumstances, the issue cannot yet be considered fully understood and it is of interest to see whether any natural non-instrumental cause is possible. An obvious such cause would be whether a significant fraction of the positive charge density resides in positively charged dust grains that are not measured by the ICA. Here, we show that this scenario is highly unlikely, even near perihelion where photoemission is the strongest. In our semi-analytical grain charging model, we balance the current contributions to grains of photoelectron emission and electron attachment so as to find the expected charge state for a grain of a given radius. The charge state is affected by the ambient electron number density, the electron temperature, and the heliocentric distance. While at times the bulk of the dust population around comet 67P could be charged positive, dust charging, including photoelectron emission, should have a negligible influence on the overall ionization balance in the cometary coma simply because the dust particles are not ubiquitous enough.

Published
2022
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73. Microbial Interactions - Underexplored Links Between Public Health Relevant Bacteria and Protozoa in Coastal Environments

Author

Eriksson, Karolina I. A., Thelaus, Johanna, Andersson, Agneta, Ahlinder, Jon, Eriksson, Karolina I. A., Thelaus, Johanna, Andersson, Agneta, and Ahlinder, Jon

Abstract

The co-existence of bacteria and protozoa in aquatic environments has led to the evolution of predation defense mechanisms by the bacteria. Some of the predation-resistant bacteria (PRB) are also pathogenic to humans and other mammals. The links between PRB and protozoa in natural aquatic systems are poorly known, but they are important in predicting outbreaks and determining the long-term consequences of a contamination event. To elucidate co-occurrence patterns between PRB (16S rRNA) and bacterivorous protozoa (18S rRNA), we performed a field study in a coastal area in the northern Baltic Sea. Interactions between bacteria and protozoa were explored by using two complementary statistical tools. We found co-occurrence patterns between specific PRB and protozoa, such as Legionella and Ciliophora, and we also found that the interactions are genotype-specific as, for example, Rickettsia. The PRB sequence diversity was larger in bays and freshwater inlets compared to offshore sites, indicating local adaptions. Considering the PRB diversity in the freshwater in combination with the large spring floods in the area, freshwater influxes should be considered a potential source of PRB in the coastal northern Baltic Sea. These findings are relevant for the knowledge of survival and dispersal of potential pathogens in the environment.

Published
2022
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74. Empirical Photochemical Modeling of Saturn's Ionization Balance Including Grain Charging

Author

Vigren, Erik, Dreyer, Joshua, Eriksson, Anders I., Johansson, Fredrik L., Morooka, Michiko, Wahlund, Jan-Erik, Vigren, Erik, Dreyer, Joshua, Eriksson, Anders I., Johansson, Fredrik L., Morooka, Michiko, and Wahlund, Jan-Erik

Abstract

We present a semianalytical photochemical model of Saturn's near-equatorial ionosphere and adapt it to two regions (similar to 2200 and similar to 1700 km above the 1 bar level) probed during the inbound portion of Cassini's orbit 292 (2017 September 9). The model uses as input the measured concentrations of molecular hydrogen, hydrogen ion species, and free electrons, as well as the measured electron temperature. The output includes upper limits, or constraints, on the mixing ratios of two families of molecules, on ion concentrations, and on the attachment rates of electrons and ions onto dust grains. The model suggests mixing ratios of the two molecular families that, particularly near similar to 1700 km, differ notably from what independent measurements by the Ion Neutral Mass Spectrometer suggest. Possibly connected to this, the model suggests an electron-depleted plasma with a level of electron depletion of around 50%. This is in qualitative agreement with interpretations of Radio Plasma Wave Science/Langmuir Probe measurements, but an additional conundrum arises in the fact that a coherent photochemical equilibrium scenario then relies on a dust component with typical grain radii smaller than 3 angstrom.

Published
2022
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75. The Karolinska NeuroCOVID study protocol : Neurocognitive impairment, biomarkers and advanced imaging in critical care survivors

Author

Nelson, David W., Granberg, Tobias, Andersen, Pia, Jokhadar, Elias, Kahlin, Jessica, Granstrom, Anna, Hallinder, Helena, Schening, Anna, Thunborg, Charlotta, Walles, Hakan, Hagman, Goran, Shams-Latifi, Roya, Yu, Jimmy, Petersson, Sven, Tzortzakakis, Antonios, Levak, Nicholas, Aspo, Malin, Piehl, Fredrik, Zetterberg, Henrik, Kivipelto, Miia, Eriksson, Lars I., Nelson, David W., Granberg, Tobias, Andersen, Pia, Jokhadar, Elias, Kahlin, Jessica, Granstrom, Anna, Hallinder, Helena, Schening, Anna, Thunborg, Charlotta, Walles, Hakan, Hagman, Goran, Shams-Latifi, Roya, Yu, Jimmy, Petersson, Sven, Tzortzakakis, Antonios, Levak, Nicholas, Aspo, Malin, Piehl, Fredrik, Zetterberg, Henrik, Kivipelto, Miia, and Eriksson, Lars I.

Abstract

Background: This is the study plan of the Karolinska NeuroCOVID study, a study of neurocognitive impairment after severe COVID-19, relating post-intensive care unit (ICU) cognitive and neurological deficits to biofluid markers and MRI. The COVID-19 pandemic has posed enormous health challenges to individuals and health- systems worldwide. An emerging feature of severe COVID-19 is that of temporary and extended neurocognitive impairment, exhibiting a myriad of symptoms and signs. The causes of this symptomatology have not yet been fully elucidated. Methods: In this study, we aim to investigate patients treated for severe COVID-19 in the ICU, as to describe and relate serum-, plasma- and cerebrospinal fluid-borne molecular and cellular biomarkers of immune activity, coagulopathy, cerebral damage, neuronal inflammation, and degeneration, to the temporal development of structural and functional changes within the brain as evident by serial MRI and extensive cognitive assessments at 3-12 months after ICU discharge. Results: To date, we have performed 51 3-month follow-up MRIs in the ICU survivors. Of these, two patients (similar to 4%) have had incidental findings on brain MRI findings requiring activation of the Incidental Findings Management Plan. Furthermore, the neuropsychological and neurological examinations have so far revealed varying and mixed patterns. Several patients expressed cognitive and/or mental concerns and fatigue, complaints closely related to brain fog. Conclusion: The study goal is to gain a better understanding of the pathological mechanisms and neurological consequences of this new disease, with a special emphasis on neurodegenerative and neuroinflammatory processes, in order to identify targets of intervention and rehabilitation.

Published
2022
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77. Atrophy of the optic chiasm is associated with microvascular diabetic complications in type 1 diabetes.

Author

Tarkkonen, Aleksi, Claesson, Tor-Björn, Eriksson, Marika I., Forsblom, Carol, Thorn, Lena M., Summanen, Paula, Groop, Per-Henrik, Putaala, Jukka, Gordin, Daniel, and Martola, and Juha

Subjects
TYPE 1 diabetes, GLYCOSYLATED hemoglobin, MAGNETIC resonance imaging, DIABETIC neuropathies, EYE diseases
Abstract

Introduction: Diabetic neuropathy and diabetic eye disease are well known complications of type 1 diabetes. We hypothesized that chronic hyperglycemia also damages the optic tract, which can be measured using routine magnetic resonance imaging. Our aim was to compare morphological differences in the optic tract between individuals with type 1 diabetes and healthy control subjects. Associations between optic tract atrophy and metabolic measures, cerebrovascular and microvascular diabetic complications were further studied among individuals with type 1 diabetes. Methods: We included 188 subjects with type 1 diabetes and 30 healthy controls, all recruited as part of the Finnish Diabetic Nephropathy Study. All participants underwent a clinical examination, biochemical work-up, and brain magnetic resonance imaging (MRI). Two different raters manually measured the optic tract. Results: The coronal area of the optic chiasm was smaller among those with type 1 diabetes compared to non-diabetic controls (median area 24.7 [21.0-28.5] vs 30.0 [26.7-33.3] mm2, p<0.001). In participants with type 1 diabetes, a smaller chiasmatic area was associated with duration of diabetes, glycated hemoglobin, and body mass index. Diabetic eye disease, kidney disease, neuropathy and the presence of cerebral microbleeds (CMBs) in brain MRI were associated with smaller chiasmatic size (p<0.05 for all). Conclusion: Individuals with type 1 diabetes had smaller optic chiasms than healthy controls, suggesting that diabetic neurodegenerative changes extend to the optic nerve tract. This hypothesis was further supported by the association of smaller chiasm with chronic hyperglycemia, duration of diabetes, diabetic microvascular complications, as well as and CMBs in individuals with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Published
2023
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86. The Karolinska NeuroCOVID study protocol: Neurocognitive impairment, biomarkers and advanced imaging in critical care survivors

Author

Nelson, David W., primary, Granberg, Tobias, additional, Andersen, Pia, additional, Jokhadar, Elias, additional, Kåhlin, Jessica, additional, Granström, Anna, additional, Hallinder, Helena, additional, Schening, Anna, additional, Thunborg, Charlotta, additional, Walles, Håkan, additional, Hagman, Göran, additional, Shams‐Latifi, Roya, additional, Yu, Jimmy, additional, Petersson, Sven, additional, Tzortzakakis, Antonios, additional, Levak, Nicholas, additional, Aspö, Malin, additional, Piehl, Fredrik, additional, Zetterberg, Henrik, additional, Kivipelto, Miia, additional, and Eriksson, Lars I., additional

Published
2022
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88. The Karolinska KI/K COVID-19 immune atlas: An open resource for immunological research and educational purposes

Author

Ljunggren, Hans-Gustaf, Ask, Eivind Heggernes, Cornillet, Martin, Strunz, Benedikt, Chen, Puran, Rao Muvva, Jagadeeswara, Akber, Mira, Buggert, Marcus, Chambers, Benedict J., Cuapio Gomez, Angelica, Dzidic, Majda, Filipovic, Iva, Flodström-Tullberg, Malin, Garcia, Marina, Gorin, Jean-Baptiste, Gredmark-Russ, Sara, Hertwig, Laura, Klingström, Jonas, Kokkinou, Efthymia, Kvedaraite, Egle, Lourda, Magda, Mjösberg, Jenny, Maucourant, Christopher, Norrby-Teglund, Anna, Palma Medina, Laura M., Parrot, Tiphaine, Perez-Potti, André, Ponzetta, Andrea, Ringqvist, Emma, Rivera-Ballesteros, Olga, Rooyackers, Olav, Sandberg, Johan K., Sandberg, John Tyler, Sekine, Takuya, Svensson, Mattias, Varnaite, Renata, Wullimann, David, Eriksson, Lars I., Aleman, Soo, Malmberg, Karl-Johan, Strålin, Kristoffer, and Björkström, Niklas K.

Subjects
Immunology, General Medicine
Abstract

The Karolinska KI/K COVID-19 Immune Atlas project was conceptualized in March 2020 as a part of the academic research response to the developing SARS-CoV-2 pandemic. The aim was to rapidly provide a curated dataset covering the acute immune response towards SARS-CoV-2 infection in humans, as it occurred during the first wave. The Immune Atlas was built as an open resource for broad research and educational purposes. It contains a presentation of the response evoked by different immune and inflammatory cells in defined naïve patient-groups as they presented with moderate and severe COVID-19 disease. The present Resource Article describes how the Karolinska KI/K COVID-19 Immune Atlas allows scientists, students, and other interested parties to freely explore the nature of the immune response towards human SARS-CoV-2 infection in an online setting.

Published
2022

92. Perioperative Cognitive Decline in the Aging Population

Author

Terrando, Niccolò, Brzezinski, Marek, Degos, Vincent, Eriksson, Lars I., Kramer, Joel H., Leung, Jacqueline M., Miller, Bruce L., Seeley, William W., Vacas, Susana, Weiner, Michael W., Yaffe, Kristine, Young, William L., Xie, Zhongcong, and Maze, Mervyn

Published
2011
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96. Developing Creative Thinking through an Integrated Arts Programme for Talented Children.

Author

Eriksson, Gillian I.

Abstract

Described is a K-12 integrative arts program of the Schmerenbeck Educational Centre, Johannesburg, South Africa, designed to help gifted and talented children develop an understanding of the nature of creative thinking as expressed through different art forms. The report discusses how the program defines talent; how gifted students are identified for program participation; the role that creative thinking plays in child development; the integrative model of education used; educational strategies used to develop creative thinking from the four perspectives of perception, affect, cognition, and behavior; course content; and program evaluation. The program offers skill based courses in visual perception, exploration of sound and movement, communication, and learning and thinking skills. Also offered are a series of optional workshops in different art disciplines, including drama, dance, music, and film. In some experimental sessions professional artists and teachers worked with the students. Concepts and ideas initiated by students are explored through sensory stimulation, creative problem solving, and reflection. Both teachers and students rated the program very highly. (RM)

Published
1984

97. An Integrated Creative Arts Programme for Exceptionally Talented Children.

Author

Eriksson, Gillian I.

Abstract

A creative arts program for talented students in Johannesburg (South Africa) is intended to foster perceptual-, aesthetic-, cultural-, social-, and self-awareness, understanding of the arts, as well as an emphasis on expanding creative potential focuses on the processes of sensory, intellectual creative, and aesthetic development. A four-phase system of identification is based on a multifaceted and expanded definition of giftedness. In designing the program, developers examined models of creativity, characteristics of the creative personality, criteria for determining creative thinking ability, and specific teaching models. Among desirable teacher characteristics are a willingness to risk, acceptance of the uniqueness of others, and the ability to be structured in a flexible way in response to the students' experience and motivation. Procedures for screening and placement, selection criteria, the curriculum outline, and evaluation procedures are described. Program options include core courses (e.g., Creative Thinking, Effective Thinking, Body Language, Study Skills), workshops in language, visual, performing, and cultural arts, and integrated arts/creativity workshops at primary and secondary levels. (JW)

Published
1984

100. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Author

Kirmeier E. a, Eriksson L. I. c, Lewald H. a, Jonsson Fagerlund, M. c Hoeft, A. f Hollmann, M. g Meistelman, C. e Hunter, J. M. d Ulm, K. b Blobner, M. aEmail Author, Abad Gurumeta, A. Abernethy, C. Abigail, P. Achaibar, K. Adam, E. Afshari, Agudelo Montoya, M. E. Akgün, F. N. Aletti, G. Alkış, N. Allan, K. Allan, A. Allaouchiche, B. Allcock, C. Almasy, E. Amey, I. Amigoni, M. Andersen, E. Andersson, P. Anipchenko, N. Antunes, P. Armstrong, E. Aslam, T. N. Aslin, B. Assunção, J. P. Ausserer, J. Avvai, M. Awad, Ayas Montero, B. Ayuso, M. Azevedo, P. Badarau, V. Badescu, Baiardo Redaelli, M. Baird, C. Baird, Y. Baker, T. Balaji, P. Bălan, C. Balandin, A. Balescu-Arion, C. Baliuliene, Baltasar Isabel, J. Baluch, S. N. Bandrabur, D. Bankewitz, C. Barber, K. Barbera, F. Barcraft-Barnes, H. Barletti, V. Barnett, G. Baron, K. Barros, A. Barsan, V. Bartlett, P. Batistaki, C. Baumgarten, G. Baytas, V. Beauchamp, Becerra Cayetano, I. A. Bell, S. Bellandi, M. Belletti, Belmonte Cuenca, J. Benitez-Cano, A. Beretta, L. Berger, M. Bergmann, N. Bergmark, Bermudez Lopez, M. Bernotaite, M. Beurskens, C. Bidd, H. Bifulco, F. Bignami, E. Bilic, A. Bilskiene, D. Bischoff, P. Bishop, L. Bjonness, T. Blaylock, H. Blethyn, K. Blincoe, T. Blokhin, I. Blunt, N. Boer, C. Bois, G. Bonicolini, E. Booth, J. Borecka-Kedzierska, M. Borstnar, K. Borys, M. Boselli, E. Bouvet, L. Bouwman, A. Bowen, L. Bowrey, S. Boxall, L. Božić, T. Bradley, T. Branco, T. Brazzi, L. Brazzoni, M. Brear, T. Brogly, N. Brohi, F. Broms, J. Bubliauskas, A. Bucolo, G. E. Buerkle, H. Buggy, D. Buhre, W. Bukauskas, T. Butturini, F. Byttner, Cabrera Díaz, I. Calderon, A. Calhau, R. Callejo, A. Cammu, G. Campesato, M. Can, Ö. S. Candeias, M. Cantor, A. Carise, E. Carmona, C. Carreteiro, J. Carrieri, C. Carter, A. Casal, M. Casanova, I. Cascella, M. Casero, L. M. Casiraghi, G. M. Castelo-Branco, Castro Arranz, C. Cernea, D. D. Cervantes, J. Chandler, B. Charnock, R. Chatzimicali, A. Chinery, E. Chishti, A. Chondhury, P. Christie, E. Christodoudiles, G. Ciardo, S. Cimpeanu, L. Cindea, I. Cinnella, G. Clark, S. Clayton, M. Cocu, S. Collyer, T. Colvin, C. Cope, S. Copeta, F. Copotoiu, S. -M., Correia de Barros, F. Corso, R. M. Cortegiani, A. Costa, G. Cowton, A. Cox, N. Craig, J. Cricca, V. Cronin, J. Cunha, M. Cuomo, A. Curley, K. Czuczwar, M. Dabrowska, D. Damster, Danguy des Déserts, M. Daniliuc, A. Danninger, T. Darwish, I. Dascalu, C. Davies, K. Davies, De Boer, De Flaviis, De Selincourt, G. Deana, C. Debaene, B. Debreceni, G. Dedhia, Delgado Garcia, Della Rocca, G. Delroy-Buelles, L. Desai, T. Dhillon, Di Giacinto, Di Mauro, Diaz Gomez, T. V. Dimitrovski, A. Dinic, V. Dîrzu, D. -S., Divander M. B., Dolinar J., Domingues S., Doolan J., Downes C., Dragoescu N. A., Droc G., Dum E., Dumitrescu A., Duncan L., Dzurňáková P., Eberl S., Edwards J., Edwards M., Ekelund K., Ekengren P., Elghouty E., Ellerkmann R., Ellis H., Elme A., Ernst T., Errando C. L., Estenes S., Ewaldsson C., Farid N., Featherstone J., Febres D., Fedorov S., Feggeler J., Feijten P., Fellmann T., Fernandez Candil, Fernandez Castineira, Fernández Castineira, J. Fernando, A. Ferrando, C. Ferreira, L. Ferreira, P. Feyling, A. Filipescu, D. Fleischer, A. Floris, L. Foerster, U. Fox, B. Franke, U. Frasca, D. Frey, C. Frost, V. Fullin, G. Fumagalli, J. Furneval, J. Fusari, M. Gallacher, S. Galushka, S. Gambale, G. Gambino, I. Garcia-Perez, M. L. Garg, S. Garlak, J. Gavranovic, Z. Gavrilov, R. Gaynor, Gecaj Gashi, A. Georghiou, M. Gerjevic, B. Gferer, G. Giarratano, A. Gibson, A. Gievski, V. Giles, J. Gillberg, L. Gilowska, Gilsanz Rodriguez, F. Gioia, A. Giovannoni, C. Girotra, V. Gkinas, D. Gkiokas, G. Godoroja, D. Goebel, U. Goel, V. Gonzalez, M. Goranovic, T. Gornik-Wlaszczuk, E. Gosavi, S. Gottfridsson, P. Gottschalk, A. Granell, M. Granstrom, A. Grassetto, A. Greenwood, A. Grigoras, I. Grintescu, I. Gritsan, A. Gritsan, G. Grynyuk, A. Guadagnin, G. M. Guarnieri, M. Güçlü, Guerrero Diez, M. Gunenc, F. Günther, U. Gupta, P. Guttenthaler, V. Hack, Y. Hafisayena, A. Hagau, N. Haldar, J. Hales, D. Hancı, V. Hanna-Jumma, S. Harazim, H. Harlet, P. Harper, D. Harris, B. Harvey, O. Hashimi, M. Hawkins, L. Hayes, C. Heaton, J. Heier, T. Helliwell, L. Hemmes, S. Henderson, K. Hermanides, J. Hermanns, Herrera Hueso, B. Hestenes, S. Hettiarachchi, R. Highgate, J. Hodgson, K. Hoelbling, D. Holland, J. Horhota, L. Hormis, A. Hribar, R. Hua, A. Humphreys, S. Humphries, R. Humpliková, S. Hunt, J. Husnain, A. Hussein, A. Hyams, B. Iannuccelli, F. Ilette, K. Ilyas, C. Inan, T. India, I. Ionițăv, V. Irwin, F. Jain, V. Janez, B. Jankovic, R. Jenkins, S. Jenko, M. Jimenez, Jiménez Gomez, B. Joachim, S. Joelsson-Alm, E. John, J. Jonikaite, L. Jovic, M. Jungwirth, B. Junke, E. Kabakov, B. 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André, Razaque, Usman, Real Navacerrada, M. 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Agostina, Wade, Andrew, Wallberg, Hanna, Wallden, Jakob, Wallner, Johann, Walther Sturesson, Louise, Watson, Davina, Weber, Stefan, Wegiel Leskiewiq, Anna, Weller, Debbie, Wensing, Carine, Werkmann, Marku, Westberg, Henrik, Wikström, Erik, Williams, Benedict, Wilson, Robin, Wirth, Steffen, Wittmann, Maria, Wood, Laura, Wright, Stella, Zachoval, Christian, Zambon, Massimo, Zampieri, Silvia, Zampone, Salvatore, Zangrillo, Alberto, Zani, Gianluca, Zavackiene, Asta, Zieglerder, Raphael, Zonneveldt, Harry, Zsisku, Lajo, Zucker, Tom-Philipp, Żukowski, Maciej, Zuleika, Mehrun, and Zupanĕiĕ, Darja

Subjects
Pulmonary and Respiratory Medicine, pulmonary complications, muscle relaxants, Post-anaesthesia complications, Neuromuscular Blockade, pulmonary complication, muscle relaxant, neuromuscular block, postoperative pulmonary complication, business.industry, Retrospective cohort study, post-operative pulmonary complications, Neuromuscular monitoring, Neuromuscular Blocking Agents, Sugammadex, NO, Anaesthesia, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Anesthesia, Medicine, General anaesthesia, Neuromuscular Agents, 030212 general & internal medicine, MED/41 - ANESTESIOLOGIA, Prospective cohort study, business, medicine.drug
Abstract

Background: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications. Funding: European Society of Anaesthesiology.

Published
2019
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