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Filter by:Laparoscopic total hysterectomy is the most common gynaecological surgical procedure after caesarean section. In laparoscopic total hysterectomy, intraabdominal pressure increases, venous return decreases, hypercarbia and acidosis may occur due to pneumoperitoneum due to CO2 insufflation and upright trendelenburg position (TP). Cerebral blood flow, intracranial pressure (ICP) and intraocular pressure (IOP) increase. One study showed that TP and an intraabdominal pressure of mmHg significantly increased ICP. CO2 insufflation into the abdominal cavity causes upward displacement of the diaphragm, resulting in an increased risk of regurgitation, decreased lung volumes and compliance, atelectasis, increased airway resistance and ventilation-perfusion mismatch. At the same time, combined with the effects of general anaesthesia, a decrease in partial arterial oxygen pressure (PaO2) is expected in patients. The alveolar recirculation manoeuvre (ARM), is based on the technique of opening atelectatic lung fields by keeping the airway pressure high for a while. This manoeuvre can be performed with methods such as PEEP, CPAP, and pressure-controlled mechanical ventilation. High PEEP application may cause an increase in ICP and a decrease in cerebral perfusion pressure by increasing intrathoracic pressure and decreasing cerebral venous return. Therefore, intracranial pressure monitoring should be performed especially in patients with PEEP above 8-10 cmH2O. Intraventricular and intraparenchymal measurements, which are the gold standard methods for ICP monitoring, are invasive procedures with various risks. Noninvasive methods such as cranial CT, brain MRI, transcranial Doppler, and measurement of optic nerve sheath diameter (ONSD) can also be used for ICP measurement. Ultrasonography of the optic nerve sheath diameter is an increasingly common method because it is noninvasive and can be performed at the bedside. The optic nerve sheath is the continuation of the transverse subarachnoid space and the cerebral duramater. It is connected to the intracranial subarachnoid space with cerebrospinal fluid. Therefore, an increase in ICP increases the optic nerve sheath diameter (ONSD). Maissan et al. They think that ONSD reflects the changes in ICP simultaneously. The aim of this study was to evaluate the effect of ARM on intracranial pressure in patients undergoing total laparoscopic hysterectomy under general anaesthesia using optic nerve sheath diameter.
Aim The aim of the study is to characterize the typical basic life support (BLS) course participant. The characterization include age, sex, education, ethnicity, income, health care data and cohabitation. All data will be compared with that of the general population. Hereby the study wish identify potential focus areas for recruitment of willing and able bystanders to increase survival. Furthermore, this study will provide a foundation for evaluation of current initiatives. Significance In Denmark, several population-based campaigns have been initiated to increase the amount of able and willing laypersons to assist at out-of-hospital cardiac arrest (OHCA). The main focus has been on increasing the quantity of laypersons attending BLS courses. Even measures of changing legislation mandating course participation have been passed and implemented. Estimates state that approximately 3-4.5% of the entire Danish population participates in BLS courses annually. Consequently, a substantial amount of resources has been spent on educating and certifying laypersons in BLS on a population level. In this study, the characteristics of these BLS course participants will be described. This will provide the basis for evaluation of already implemented interventions. Additionally, this study will be able to support course distributors, foundations and national councils in making strategies for further recruitment based on evidence. The present study will assist in pinpointing society groups with a theoretical bystander potential, but low level of BLS education. This can guide future efforts in trying to improve bystander initiated cardiopulmonary resuscitation (CPR) and survival from OHCA. Methods The study population includes all Danish citizens who attended a BLS training course certificate from 2016-2018 above the age of 15. This cut off is based on the earliest mandatory BLS training in primary school. Using Personal Identifications Numbers (PIN) of BLS course participant from January 1st, 2016 to December 31st, 2018, data will be extracted and delivered anonymously, including information on age, sex, income, education, ethnicity and cohabitation, from the Statistics Denmark. The relative risk of BLS course attendance stratified by education and income level, cohabitation status, age of youngest child, urbanization level, sex and ethnicity of the Danish BLS course participants compared to the general population will be presented. Prevalence of BLS courses participants by age and sex will be analyzed and graphically display and prevalence of BLS course participants by income and age will be calculated by regression models. A layperson focus group interview consisting of BLS course participants will be conducted to explore the attending courses participants views of the project and to revise accordingly. Anonymity is secured through a data processing agreement between the Danish First Aid Council and Statistics Denmark, facilitated by the Copenhagen Emergency Medical Services. An application will be formulated to the Danish Data protection agency regarding storage of data. Expected outcome A characterization of the typical BLS course participants in Denmark with median age, sex, cohabitation, income and education. The association between sociodemographic characteristics of BLS course participants and relevant prevalence's by the entire population will be presented.