Sven Erik Gisvold
Norwegian University of Science and Technology
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Featured researches published by Sven Erik Gisvold.
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2000
Sigurd Fasting; Sven Erik Gisvold
Purpose: To describe the frequency and pattern of drug errors in clinical anesthesia, and to evaluate whether a change to colour coded syringe labels, along with education, could reduce the problem of drug errors.Methods: We prospectively recorded anesthesia-related information from all anesthetic cases for 36 mo, totally 55,426 procedures. Intraoperative problems, including drug errors, were recorded. After eighteen months we changed to colour coded syringe labels, and the effect of this change and education on drug errors was assessed. Errors were divided into four groups: syringe swap, ampoule swap, other ‘wrong drug’ errors, and wrong dose errors. The problems were graded into four levels, according to severity.Results: A drug error was recorded in 63 cases (0.11%). There were 28 syringe swaps, and muscle relaxants were erroneously given in 15. There were nine ampoule swaps. There were eight ‘other wrong drug’ cases, and 18 cases where a wrong dose of the correct drug was given. Three of the drug errors were classified as serious, and 27 were of moderate severity. We found no differences between the two periods except for decreased number of ampoule swaps (P=0.04).Conclusion: Drug errors are uncommon, and represent a small part of anesthesia problems but still have the potential for serious morbidity. Syringe swaps occurred most often between syringes of equal size, and were not eliminated by colour coding of labels. As muscle relaxant drugs are most commonly involved, and can cause lasting morbidity, special preventive measures should be taken for this group of drugs.RésuméObjectif: Décrire les erreurs de médicaments en anesthésie clinique selon leur fréquence et leur nature et évaluer si une modification de la couleur des étiquettes codées des seringues pouvait, avec une certaine formation, résoudre ce problème.Méthode: On a enregistré, lors d’une étude prospective, les informations reliées à tous les cas d’anesthésie, 55 426, pendant 36 ms. ainsi que les problèmes peropératoires, y compris les erreurs de médicaments. Après 18 ms, on a introduit des étiquettes de couleur codées et évalué l’effet de ce changement et de l’information donnée sur les erreurs de médicaments. On a divisé les erreurs en quatre catégories: échange de seringue, échange d’ampoule, autre «médicament incorrect» et erreurs de doses, et classé les problèmes selon quatre niveaux de sévérité.Résultats: Il y a eu 63 cas d’erreurs de médicaments (0,11 %). On a noté 28 échanges de seringues et 15 cas ontreçu des myorelaxants par erreur. De plus, 9 échanges d’ampoules ont eu lieu, 7 cas d’«autres médicaments incorrects» et 18 cas d’erreurs de doses pour le médicament requis. Parmi ces erreurs, 3 étaient sévères et 37 étaient modérées. Il n’y a pas eu de différence entre les deux périodes, sauf en ce qui concerne la baisse d’échanges d’ampoules (P=0,04).Conclusion: Les erreurs de médicaments sont rares et ne représentent qu’une petite partie des problèmes anesthésiques, mais elles sont toujours potentiellement dangereuses. Les échanges de seringues surviennent le plus souvent entre seringues de même taille et ils ne sont pas réduits par les étiquettes de couleurs codées. Les myorelaxants, le plus souvent en cause, peuvent entraîner une morbidité résiduelle. Des mesures préventives spéciales devaient être envisagées dans ce cas.
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2002
Sigurd Fasting; Sven Erik Gisvold
PurposeThe low incidence of mortality and major morbidity in anesthesia makes it difficult to study the pattern of potential accidents and to develop preventive strategies. Anesthetic ‘near-misses’, however, occur more frequently. Using data from a simple routine-based system of problem reporting, we have analyzed the pattern and causes of serious non-fatal problems, in order to improve preventive strategies.MethodsWe prospectively recorded anesthesia-related information from all anesthetics for five years. The data included intraoperative problems, which were graded into four levels, according to severity. We analyzed only the serious nonfatal problems, which were sorted according to clinical presentation, and also according to which factor was most important in the development of the problem. We assessed any untoward consequences for the patient, and whether the problems could have been prevented.ResultsSerious problems were recorded in 315 cases out of 83,844 (0.4%). Anesthesia was considered the major contributing factor in III cases. Difficult intubation, difficult emergence from general anesthesia, allergic reactions, arrhythmia and hypotension were the dominating problems. Twenty-six anesthesia related problems resulted in changes in level of postoperative care, and one patient later died in the intensive care unit after anaphylactic shock. Eighty-two problems could have been prevented by simple strategies.ConclusionAnalysis of serious nonfatal problems during anesthesia may contribute to improved preventive strategies. Data from a routine-based system are suitable for this type of analysis. Intubation, emergence, arrhythmia, hypotension and anaphylaxis cause most serious problems, and should be the object of preventive strategies.RésuméObjectifLa faible incidence de mortalité et de morbidité importante en anesthésie complique l’étude des types d’accidents potentiels et la mise au point de stratégies préventives. Les quasi accidents anesthésiques, par contre, surviennent plus fréquemment. En utilisant les données d’un simple système de notification de cours normal, nous avons analysé le type et les causes de problèmes graves, non mortels, dans le but d’améliorer les stratégies préventives.MéthodeNous avons enregistré prospectivement les informations reliées à toutes les anesthésies réalisées pendant cinq ans. Les données comprenaient les problèmes peropératoires que nous avons classés selon quatre niveaux de sévérité. Nous avons analysé les problèmes graves, non mortels, qui ont été retenus d’après la présentation clinique et aussi en fonction du facteur le plus important de l’évolution du problème. Nous avons évalué toutes les conséquences négatives pour le patient et la possibilité de prévention de ces problèmes.RésultatsDes problèmes graves ont été notés dans 315 cas sur 83 844 (0,4 %). Lanesthésie a été considérée comme le principal facteur dans III cas. L’intubation difficile, le retour à la conscience difficile après l’anesthésie générale, les réactions allergiques, l’arythmie et l’hypotension ont dominé le tableau. Vingt-six problèmes reliés à l’anesthésie ont entraîné la modification des soins postopératoires et un patient est décédé à l’unité des soins intensifs d’un choc anaphylactique. Quatre-vingt-deux problèmes auraient pu être évités par de simples interventions.ConclusionLanalyse de problèmes graves, mais non mortels, survenus pendant l’anesthésie peut contribuer à l’amélioration de stratégies préventives. Les données obtenus d’un système régulier de notification sont pertinentes à ce genre d’analyse. L’intubation, le retour à la conscience, l’arythmie, l’hypotension et l’anaphylaxie causent les problèmes les plus graves et devraient être prévenus.
Acta Anaesthesiologica Scandinavica | 1996
J. Mellin-Olsen; S. Fasting; Sven Erik Gisvold
Background: The aim of this study was to determine the incidence and severity of pulmonary aspiration of gastric contents during anaesthesia, to determine the short‐ and long‐term morbidity, and to evaluate present routines for preoperative gastric emptying. During the study period, preoperative gastric emptying was done only when intestinal obstruction was suspected.
Acta Anaesthesiologica Scandinavica | 1999
Eirik Skogvoll; Isern E; Sangolt Gk; Sven Erik Gisvold
Background: Direct comparison of survival rates from in‐hospital cardiopulmonary resuscitation (CPR) remains difficult. The objective of this study was to report outcome according to the Utstein template for in‐hospital cardiac arrest and to evaluate the Utstein template itself as applied to a retrospective material.
Acta Anaesthesiologica Scandinavica | 1994
Roar Stenseth; Lise Bjella; Einar M. Berg; Oddbjoern Christensen; Olaf W. Levang; Sven Erik Gisvold
Thoracic epidural analgesia (TEA) may offer haemodynamic benefits for patients with coronary heart disease going through major surgery. This may – in part – be secondary to an effect on the endocrine and metabolic response to surgery. We therefore investigated the effect of TEA on the endocrine metabolic response to aortocoronary bypass surgery (ACBS).
Acta Anaesthesiologica Scandinavica | 2007
Kari Schirmer-Mikalsen; Anne Vik; Sven Erik Gisvold; Toril Skandsen; H. Hynne; Pål Klepstad
Background: In patients with severe head injury, control of physiological variables is important to avoid intracranial hypertension and secondary injury to the brain. The aims of this retrospective study were to evaluate deviations of physiological variables and the incidence of extracranial complications in patients with severe head injury. We also studied if these deviations could be related to outcome.
Acta Anaesthesiologica Scandinavica | 1994
Roar Stenseth; Lise Bjella; Einar M. Berg; Oddbjoern Christensen; Olaf W. Levang; Sven Erik Gisvold
Tachycardia and hypertension may cause myocardial ischaemia in patients with coronary heart disease going through major surgery. Thoracic epidural analgesia (TEA) has been reported to be beneficial in this situation.
European Journal of Emergency Medicine | 1999
Eirik Skogvoll; Sangolt Gk; Isern E; Sven Erik Gisvold
The Trondheim regions (315 km2, population 154,000) emergency medical service (EMS) provides advanced cardiac life support (ACLS) with combined paramedic and physician response. This EMS system is commonly employed in Norway, yet no population based study of outcome in cardiac arrest has been published to date. This retrospective study reports incidence and outcome from every attempted out-of-hospital cardiopulmonary resuscitation (CPR) during 1990 through 1994 according to the Utstein template. Information on the patients pre-morbid conditions and final outcome was obtained from hospital records. The incidence of cardiac arrest and CPR from all causes was 68 per 100,000 per year, with 83% primary cardiac aetiology. The median alarm to patient arrival interval for ambulance and emergency physician was 8 minutes and 11 minutes, respectively. The presenting rhythm was ventricular fibrillation or tachycardia in 51%, asystole in 34%, pulseless electrical activity in 8% and undetermined in 8%. Definite return of spontaneous circulation occurred in 211 patients (40%, 27 per 100,000 per year) and 57 patients (11%, 7.4 per 100,000 per year) survived to discharge. Most patients made a favourable cerebral outcome, although nine were severely disabled. This is the first population-based Norwegian study of outcome from out-of-hospital cardiac arrest in this combined paramedic/physician staffed EMS. Incidence, survival and neurological outcome are comparable with results obtained in other EMS systems.
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2003
Sigurd Fasting; Sven Erik Gisvold
PurposeQuality aspects of the anesthetic process are reflected in the rate of intraoperative adverse events. The purpose of this report is to illustrate how the quality of the anesthesia process can be analyzed using statistical process control methods, and exemplify how this analysis can be used for quality improvement.MethodsWe prospectively recorded anesthesia-related data from all anesthetics for five years. The data included intraoperative adverse events, which were graded into four levels, according to severity. We selected four adverse events, representing important quality and safety aspects, for statistical process control analysis. These were: inadequate regional anesthesia, difficult emergence from general anesthesia, intubation difficulties and drug errors. We analyzed the underlying process using ‘p-charts’ for statistical process control.ResultsIn 65,170 anesthetics we recorded adverse events in 18.3%; mostly of lesser severity. Control charts were used to define statistically the predictable normal variation in problem rate, and then used as a basis for analysis of the selected problems with the following results:- Inadequate plexus anesthesia: stable process, but unacceptably high failure rate;- Difficult emergence: unstable process, because of quality improvement efforts;- Intubation difficulties: stable process, rate acceptable;- Medication errors: methodology not suited because of low rate of errors.ConclusionBy applying statistical process control methods to the analysis of adverse events, we have exemplified how this allows us to determine if a process is stable, whether an intervention is required, and if quality improvement efforts have the desired effect.RésuméObjectifLa qualité du processus anesthésique se vérifie par le taux d’événements peropératoires indésirables. Nous avons voulu illustrer comment analyser la qualité de l’anesthésie en utilisant les méthodes de contrôle statistique du processus et comment cette analyse peut améliorer la qualité.MéthodeNous avons prospectivement recueilli des données anesthésiques sur cinq ans. Elles comprenaient des événements indésirables, classés selon quatre niveaux de sévérité. Nous avons sélectionné quatre événements indésirables qui représentent des aspects importants de la qualité et de la sécurité pour l’analyse du contrôle statistique du processus. Il s’agissait : de l’anesthésie régionale inadéquate, du retour à la conscience difficile après une anesthésie générale, des difficultés d’intubation et des erreurs de médicaments. Nous avons analysé le processus d’origine à l’aide des “graphiques-p” pour le contrôle statistique du processus.RésultatsPour 65 170 anesthésies réalisées, nous avons noté des événements indésirables dans 18,3 % des cas, la plupart bénins. Nous avons utilisé les graphiques de contrôle pour définir statistiquement la variation prévisible normale du taux de problème et, ensuite, l’utiliser comme base de l’analyse des problèmes sélectionnés. Les résultats sont les suivants :- Anesthésie régionale inadéquate : processus stable, mais taux d’échec élevé inacceptable.- Réveil difficile : processus instable à cause des efforts d’amélioration de la qualité.- Difficultés d’intubation : processus stable, taux acceptable.- Erreurs de médicaments : méthodologie inappropriée à cause du faible taux d’erreurs.ConclusionEn appliquant le contrôle statistique du processus à l’analyse d’événements indésirables, nous avons montré comment il permet de déterminer si un processus est stable, si une intervention est nécessaire et si les efforts d’amélioration de la qualité ont produit les effets recherchés.
Journal of Cardiothoracic and Vascular Anesthesia | 1995
Roar Stenseth; Einar M. Berg; Lise Bjella; Oddbjoern Christensen; Olaf W. Levang; Sven Erik Gisvold
OBJECTIVE A possible influence of thoracic epidural analgesia on coronary hemodynamics and myocardial metabolism in coronary artery bypass grafting was investigated. DESIGN The study was prospective and randomized. SETTING The study was performed in a university hospital. PARTICIPANTS Thirty male patients less than 65 years of age and with ejection fraction greater than 0.5 participated. They were randomized into 3 groups: the high fentanyl (HF) group receiving high-dose fentanyl (55 micrograms/kg) anesthesia, the HF + thoracic epidural analgesia (TEA) group receiving the same general anesthesia plus thoracic epidural analgesia, and the low-fentanyl (LF) + TEA group receiving low-dose fentanyl (15 micrograms/kg) anesthesia plus thoracic epidural analgesia. INTERVENTIONS A thoracic epidural catheter, a peripheral and central venous catheter, a radial artery catheter, a thermodilution pulmonary artery catheter, and a coronary sinus reverse thermodilution catheter were inserted. MEASUREMENTS AND MAIN RESULTS Coronary circulatory parameters, myocardial oxygenation, and myocardial substrate utilization were investigated before bypass and for 9 hours after bypass. Before bypass, the most striking finding was a reduction in myocardial lactate extraction in all groups, but also coronary flow and myocardial oxygen consumption decreased compared with baseline. After bypass, the only significant finding was a lower coronary vascular resistance early postoperatively in the epidural groups, but coronary blood flow was adequate in all groups. Myocardial metabolism was essentially unchanged both with and without epidural analgesia after bypass. CONCLUSION With regard to the coronary circulation and myocardial metabolism, no hard data supporting the use of thoracic epidural analgesia in coronary artery bypass grafting were found.