dc.date.accessioned | 2013-03-12T12:15:06Z | |
dc.date.available | 2013-03-12T12:15:06Z | |
dc.date.issued | 2011 | en_US |
dc.date.submitted | 2012-01-23 | en_US |
dc.identifier.citation | Gjerstad, Ann Christin. Is skin conductance a predictor of arousal, noxious stimuli and pain in the sedated and anaesthetized patient?. Doktoravhandling, University of Oslo, 2011 | en_US |
dc.identifier.uri | http://hdl.handle.net/10852/28019 | |
dc.description.abstract | Hudledningsevne som mål på smertefulle stimuli.
Lege og forsker Ann Christin Gjerstad har sett på en metode for å oppdage ubehag og smerte hos pasienter som ligger på sykehus og av ulike grunner ikke kan meddele seg på vanlig måte. Dette er gjort ved hjelp av hudledningsevne som måler svetteutsondring i håndflater eller under føttene.
En fryktet komplikasjon for pasienter som skal gjennom et sykehusopphold er muligheten for å oppleve smerte uten mulighet til å få kommunisert dette til omgivelsene på grunn av sederende narkose midler, muskelparalyserende midler eller fordi pasienten ligger intubert undre opphold på intensivavdeling eller i forbindelse med kirurgi. Smerte under intensivopphold og under narkose er også noe av det anestesilegen frykter mest å overse.
Det er anslått at mellom 0.13 og 0.18 prosent av pasienter under narkose har en oppvåkningsepisode som de senere kan huske og at ca 30 prosent av disse rapporterer om opplevelse av smerte. Hos små barn på en intensivavdeling er en usikker på forekomsten av ubehag og smerte fordi disse barna i etterkant også verbalt har vanskelig for å uttrykke hva de har opplevd.
I sin avhandling Is skin conductance a predictor of arousal, noxious stimuli and pain in the sedated and anaesthetized patient? har Ann Christin Gjerstad og hennes medarbeidere vist at hudledningsevne kan reflektere antatt smertefulle stimuli hos små barn som ligger kunstig ventilert ved en intensivavdeling og hos voksne kvinner ved innledningen til generell narkose og kirurgi. Hudledningsevne reflekterte også antatt ubehagelige lydstimuli ved økende bevissthetssløring frem mot bevissthetstap og kunne forutsi oppvåkning etter generell narkose. | nor |
dc.description.abstract | A feared complication in the sedated patient in the intensive care unit is the experience of pain without the ability to communicate this to the health care personnel. During general anaesthesia and surgery the patient is also unable to communicate and should hopefully not experience pain. If however the amount of analgesia is insufficient and the load of noxious stimuli is heavy, arousal and eventually the experience of pain may occur. If the patient is under muscle relaxing medication, this could be difficult to realize for the anaesthesiologist.
The main aims of this thesis were to examine if skin conductance could detect noxious stimulation in the sedated and anaesthetized patient in clinical situations. Skin conductance as a method is based upon measuring the outflow of sweat in the palms of the hands or palmar under the feet triggered by sympathetic stimulation. Supposedly noxious stimulus´ were suction from trachea in respirator treated children, and tetanic stimulation and intubation in the introduction towards general anaesthesia and surgery in women. Entropy measurements are based on extraction from the electroencephalogram and measure the level of sedation in anaesthetized patients. Skin conductance was thus compared with a sedation scale, entropy measurements, blood pressure and heart rate as parameters reflecting sympathetic activation.
Secondary, the thesis looked into skin conductance during supposedly arousal stimuli in sedated patients, and also at the transition from general anaesthesia towards emergence. Skin conductance was in this situation compared with entropy measurements and a sedation score.
Skin conductance proved to rise during supposedly noxious stimuli and also during supposedly arousal stimuli in different clinical settings. This novel method can thus help the anaesthesiologist to detect arousal and possible noxious stimulation in sedated and intubated patients at different age. | eng |
dc.language.iso | eng | en_US |
dc.relation.haspart | Paper I. Gjerstad AC, Wagner K, Henrichsen T, Storm H. Skin conductance versus the modified COMFORT sedation score as a measure of discomfort in artificially ventilated children. Pediatrics 2008; 122: 848-853. The paper is removed from the thesis in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1542/peds.2007-2545 | |
dc.relation.haspart | Paper II. Gjerstad AC, Storm H, Hagen R, Huiku M, Qvigstad E, Ræder J. Comparison of skin conductance with entropy during intubation, tetanic stimulation and emergence from general anaesthesia. Acta Anaesthesiologica Scandinavica 2007; 51: 8-15. The paper is removed from the thesis in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1111/j.1399-6576.2006.01189.x | |
dc.relation.haspart | Paper III. Gjerstad AC, Storm H, Hagen R, Huiku M, Qvigstad E, Ræder J. Skin conductance or entropy for detection of non-noxious stimulation during different clinical levels of sedation. Acta Anaesthesiologica Scandinavica 2007; 51: 1-7. The paper is removed from the thesis in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1111/j.1399-6576.2006.01188.x | |
dc.relation.uri | https://doi.org/10.1542/peds.2007-2545 | |
dc.relation.uri | https://doi.org/10.1111/j.1399-6576.2006.01189.x | |
dc.relation.uri | https://doi.org/10.1111/j.1399-6576.2006.01188.x | |
dc.title | Is skin conductance a predictor of arousal, noxious stimuli and pain in the sedated and anaesthetized patient? | en_US |
dc.type | Doctoral thesis | en_US |
dc.date.updated | 2012-03-12 | en_US |
dc.creator.author | Gjerstad, Ann Christin | en_US |
dc.subject.nsi | VDP::700 | en_US |
cristin.unitcode | 130000 | en_US |
cristin.unitname | Medisinske fakultet | en_US |
dc.identifier.bibliographiccitation | info:ofi/fmt:kev:mtx:ctx&ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft.au=Gjerstad, Ann Christin&rft.title=Is skin conductance a predictor of arousal, noxious stimuli and pain in the sedated and anaesthetized patient?&rft.inst=University of Oslo&rft.date=2011&rft.degree=Doktoravhandling | en_US |
dc.identifier.urn | URN:NBN:no-30472 | en_US |
dc.type.document | Doktoravhandling | en_US |
dc.identifier.duo | 149677 | en_US |
dc.contributor.supervisor | Hanne Storm | en_US |
dc.identifier.bibsys | 120520826 | en_US |
dc.identifier.fulltext | Fulltext https://www.duo.uio.no/bitstream/handle/10852/28019/3/dravhandling-gjerstad.pdf | |