Publications by authors named "Felix Haidl"

5 Publications

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Maternal haemodynamics during labour epidural analgesia with and without adrenaline.

Scand J Pain 2021 May 10. Epub 2021 May 10.

Department of Anaesthesia, Akershus University Hospital, Lørenskog, Norway.

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 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.

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, fentanyl 2 μg mL with or without adrenaline 2 μg mL. 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 (p0.26), peak cardiac output (0.84), or heart rate (p0.91). 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 adrenaline to the epidural solution is not likely to change maternal haemodynamics during labour.
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http://dx.doi.org/10.1515/sjpain-2020-0176DOI Listing
May 2021

Programmed intermittent boluses vs continuous epidural infusion in labor using an adrenaline containing solution: A randomized trial.

Acta Anaesthesiol Scand 2020 11 7;64(10):1505-1512. Epub 2020 Sep 7.

Department of Anesthesia, Akershus University hospital, Lørenskog, Norway.

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.
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http://dx.doi.org/10.1111/aas.13689DOI Listing
November 2020

Lactate is associated with increased 10-day mortality in acute medical patients: a hospital-based cohort study.

Eur J Emerg Med 2015 Aug;22(4):282-4

aDepartment of Anesthesia, Lillebaelt Hospital, Kolding bDepartment of Emergency Medicine, Odense University Hospital, Odense cDepartment of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.

An increased lactate level is related to increased mortality in subpopulations of critically ill patients. The aim of this study was to investigate whether lactate was related to mortality in an emergency department (ED) setting of undifferentiated medical patients. All adult patients admitted from March 2009 to August 2011 to a medical ED with lactate measured within 6 h after arrival were studied. Lactate was stratified into 1-mmol/l intervals and analysed in a multivariate logistic regression analysis. A total of 5317 patients were included, 46.9% men, median age 71 years (5-95% percentiles 25-90 years). The median lactate level was 1.2 mmol/l (5-95% percentiles 0.6-3.8 mmol/l, range 0.2-22 mmol/l). Lactate was associated with 10-day mortality independent of age, comorbidity and presence of hypotension, with an odds ratio of 1.54 (95% confidence interval 1.44-1.63) per 1 mmol/l increase. Lactate is an independent predictor of 10-day mortality among patients admitted to a medical ED.
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http://dx.doi.org/10.1097/MEJ.0000000000000210DOI Listing
August 2015

Use of predefined biochemical admission profiles does not reduce the number of tests or total cost: a randomized-controlled pilot study.

Eur J Emerg Med 2014 Feb;21(1):42-5

Departments of aMedicine bEndocrinology, Sydvestjysk Sygehus Esbjerg, Esbjerg cDepartment of Medicine, Sygehus Lillebælt Vejle, Vejle, Denmark.

Objective: The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost.

Patients And Methods: This was a randomized-controlled trial of 191 adult patients admitted to a medical admission unit. Upon admission, the patients were randomized to have their blood tests determined by either using a predefined profile (used routinely and designed by the department head) or ordered individually by the treating physician. All patients were initially assessed by junior physicians. We compared the number of tests, estimated total cost, and length of stay. Data are presented as median (interquartile range). Differences were compared using the Wilcoxon rank-sum test and Fishers' exact test.

Results: Ninety-two patients were men, median age 65 years. Patients randomized to the use of the predefined profile had median 17 (14-22) blood tests drawn and patients randomized to physician discretion had median 17 (12-21) tests drawn (P=0.3). The median total cost of tests in the profile group was 618 DKK (493-803) and the cost in the physician group was 564 DKK (434-812) (P=0.19). Length of stay in the profile group was a median of 4 days (2-6 days) and 2 days (2-6 days) in the physician group (P=0.08).

Conclusion: The use of a predefined blood test panel did not significantly affect the number of tests, total cost, or length of stay for acutely admitted medical patients compared with tests ordered at the discretion of the treating physician.
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http://dx.doi.org/10.1097/MEJ.0b013e32836437ebDOI Listing
February 2014

Treatment with bortezomib in multiple myeloma is associated with only a transient and brief increase of bone specific alkaline phosphatase.

Leuk Res 2012 Oct 29;36(10):1296-9. Epub 2012 Jun 29.

Department of Haematology, Vejle Hospital, Vejle, Denmark.

There are indications of a bone anabolic effect associated with bortezomib treatment. We present a study with long follow up, measuring bone specific alkaline phosphatase (bALP) for a year during and after treatment in an unselected cohort of myeloma patients treated with bortezomib, and assess factors of potential influence on the increase of bALP. Our main findings are that bALP increase is of short duration and declines significantly even during continued treatment with bortezomib. Only myeloma response was associated with a significant increase of bALP; whereas previous treatment with bortezomib, previous or concomitant treatment with zoledronic acid i.v., dose of bortezomib, line of treatment, or combination with other chemotherapy was not.
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http://dx.doi.org/10.1016/j.leukres.2012.06.007DOI Listing
October 2012