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Program

Radisson Blu Scandinavia HotelAmager Boulevard 70, KøbenhavnTlf. 3396 5000www.radissonblu.dk/scandinaviahotel-koebenhavn

DASAIMs Årsmøde 201110.-12. november

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Velkommen til DASAIMs Årsmøde 2011

Acta Anaesthesiologica Scandinavica sponsorerer præmierne til foredragskonkurrencen med en 1., .2. og 3. præmie. Derudover har vi en publikumspris samt en pris for bedste poster. Novo Nordisk giver igen i år Innova-tionsprisen til en yngre forsker, hvis abstract udmærker sig ved innovativ tankegang. De heldige modtagere af ovennævnte præmier og priser vil være at finde blandt det rekordstore antal indsendte abstracts, nemlig i alt 66.

Vi glæder os til at se jer!

Steen Møiniche, Lars S. Rasmussen og Tina Calundann

Vi vil gerne byde jer velkommen til DASAIMs Årsmøde 2011, der er det tiende i rækken i aktuelle udformning. En stor tak til alle, der gennem årene har bidraget til at gøre mødet til en succes!

Som tidligere består årsmødet af 3 dage med forelæs-ninger, parallelsessioner, posterpræsentationer og foredragskonkurrence. DASAIMs bestyrelse og udvalg har sammen med organisationskomiteen sammensat programmet, der udover faglig opdatering også giver mulighed for diskussion i pauserne.

Vi vil gerne takke de mange, der stiller op som foredrags-holdere og moderatorer, men også sponsorer og ud-stillere, hvis støtte giver et solidt økonomisk fundament for dette arrangement.

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Kongresområdet

Hovedsponsorer

Registrering

Kongresområde

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Torsdag d. 10. november

08.00 - Registrering

09.00 - 10.00 Norway-Finland Room Den 11. Ibsen-forelæsning Intensiv terapi - hvad har vi lært siden polioepidemien? Moderator:OleNørregaard v/ElseTønnesen

10.00 - 10.30 Udstilling - kaffe

10.30 - 11.00 Norway Room Hjertestop udløst af hypotermi - hvordan opnås optimalt outcome? Moderator:AnneMøllerNielsen v/SteenBarnung

Sweden Room Akut lungesvigt ved influenza-pneumonitis; ECMO og HFO Moderator:DorteKeld v/ReinholdJensen

Finland Room What good is talk? Evidence based psychological management of chronic pain Moderator:LuanaL.Jensen v/ChristopherEccleston

Iceland Room Ny målbeskrivelse for speciallægeuddannelsen Moderator:KarenSkjelsager v/KirstenBested

11.00 - 12.00 Udstilling - sandwich/vand i udstillingsområdet

11.00 - 12.00 Bag posteren. Se den nye danske forskning og mød forskeren bag posteren

11.00 - 11.45 Denmark Room Frokostsymposium - Astellas

12.00 - 13.30 Finland Room Lindring af fødselssmerter - er der en afløser for fødeepiduralkateteret? Moderator:EvaWeitling v/PetriVolmanen

Iceland Room Hvordan sikres de rigtige kompetencer i præhospital behandling? Moderator:KarenSkjelsager v/KimGarde,GustavGerstrømogLeifK.Rognås

Sweden Room Moderne teknologi i pædiatrisk anæstesi Moderator:TorstenLauritsen -Din nye bedste ven - optisk intubationsudstyrv/RolfHolm-Knudsen -Ultralyd og det akutte barnv/ThomasLohse

Norway Room Iltbehandling og atelektaser ved anæstesi Moderator:PoulLunauChristensen v/GöranHedenstiernam.fl.

13.30 - 14.00 Udstilling - kaffe

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Torsdag d. 10. november, fortsat

14.00 - 15.30 Norway Room Posterdiskussion 1 Moderatorer:JacobSteinmetzogJørgenB.Dahl abstract nr.

29 Patienter, opereret elektivt for abdominalt aortaaneurisme har større behov for postoperativ intensivbehandling end patienter, opereret for okklusiv sygdom i abdominale aorta v/JannieBisgaardetal 5 Intubation of morbidly obese patients. A randomized clinical trial, comparing GlideScope® videolaryngoscope with FastrachTM Intubation Laryngeal Mask v/MogensVibergYdemannNielsenetal 14 Flexibelt fiberoptisk versus videolaryngoskopisk intubation hos sederede patienter med forventet vanskelig luftvej v/CharlotteRosenstocketal 37 Prædiktion af vanskelig luftvejshåndtering - et kohortestudie af 188.000 patienter registreret i Dansk Anæstesi Database v/AndersKehletNørskovetal 40 Identification of the cricothyroid membrane using ultrasound - a novel stepwise approach v/MichaelSeltzKristensenetal 41 Comparison of tracheal intubation with a flexible fibreoptic endoscope and the McGrath series five video laryngoscope in simulated difficult airway scenarios v/CecilieE.H.Jepsenetal A Patients’ experience of awake versus anaesthetised orotracheal intubation: a controlled study v/DiddeTrærupSchnacketal 30 Perioperativ optimering af slagvolumen og oxygen delivery kan reducere antallet af postoperative komplikationer efter elektiv åben perifer karkirurgi v/JannieBisgaardetal

Sweden Room Posterdiskussion 2 Moderatorer:AnnMøllerogKarstenSkovgaardOlsen abstract nr.

L Beneficial effect of Transversus Abdominis Plane (TAP) block after laparoscopic cholecystectomy in day-case surgery: A randomized clinical trial v/PernilleLykkePedersenetal M Pain and opioid consumption following ultrasound-guided ilioinguinal/ iliohypogastric nerve block for open inquinal hernia repair in adults v/FinnØstergaardBærentzen

Astellas Pharma A/S inviterer til frokostsymposiumtorsdag d. 10. november 2011, kl. 11.00 - 11.45

New local treatment for localized neuropathic pain

v/ Dr Till WagnerHead of Pain Therapy and Palliative Care

Medizinisches Zentrum Städteregion AachenAachen, Germany

Frokostsymposiet afholdes i Denmark Room på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde 2011. Der vil være frokost i tilknytning til symposiet.

Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig (se tilmeldingsblanket).

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Torsdag d. 10. november, fortsat

14.00 - 15.30 6 Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative (fortsat) intercostal catheter v/KimWildgaardetal 9 Transversus Abdominal Plane (TAP) kateter anlæggelse til colonresektion: et metodestudie v/NilsBjerregaardetal 22 Ultrasound-guided bilateral dual transversus abdominis plane (TAP) block: Magnetic resonance (MR) imaging of the distribution of local anaesthetic v/TejsJansenetal 27 Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for persistent inguinal postherniorrhaphy pain: A randomized, double-blind, placebo-controlled, cross-over trial v/JoakimM.Bischoffetal 45 Why in the post anaesthesia care unit after total hip and knee arthroplasty? v/TroelsHaxholdtLunnetal D Hvilken nål anvender neurologer ved lumbalpunktur? v/LineStendelletal

Denmark Room Posterdiskussion 3 Moderatorer:SørenMikkelsenogJonnaStormFomsgaard abstract nr.

46 Preoperative prediction of acute postoperative pain in total knee arthroplasty v/TroelsHaxholdtLunnetal B Pain treatment after craniotomy - where is the (procedure-specific) evidence? A systematic review v/MortenSejerHansenetal 44 Recovery after total hip arthroplasty with preoperative high-dose methylprednisolone: A randomized, double-blind, placebo-controlled trial v/TroelsHaxholdtLunnetal 19 Partners’ experiences of the post-discharge period after day surgery - a qualitative study v/BirgitteMajholmetal 11 Perioperative transfusion threshold and ambulation after hip revision surgery - a randomized trial v/KamillaNielsenetal 32 Transfusion ratios during massive postpartum haemorrhage - does it protect the patient from hysterectomy? v/AnneJuulWikkelsøetal C Intranasal fentanyl in the treatment of acute pain - a systematic review v/MortenSejerHansenetal 21 Triage of high-risk surgical patients with peptic ulcer perforation. An observational study v/DavidLevarettBucketal

Finland Room Posterdiskussion 4 Moderatorer:JanBondeogKirstenMøller abstract nr.

28 Predictors of mortality in ARDS patients due to viral pneumonia with influenza A or B v/MathiasP.Goldingeretal 24 Ex-vivo response to blood products and haemostatic agents in whole blood coagulation after cardiac surgery in children v/JoBøndingAndreasenetal 42 Genotyping of the butyrylcholinesterase gene is beneficial for selected patients v/KarstenKindbergetal P Respiratory rate monitored by sternal photoplethysmography v/MetteH.Toftetal Q Development of technical skills in focus assessed transthoracic echocardiography v/ChristianAlcarazFrederiksenetal 20 Brain death changes renal COX-1 and COX-2 mRNA expression in pigs v/ChristineLodbergHvasetal 33 1 års follow-up undersøgelse af intensiv patienter efter svær H1N1 influenza pneumoni v/MathiasP.Goldingeretal 2 Skades- og mortalitetsmønster hos svært tilskadekomne børn på Rigshospitalet v/HienQuocDoetal

Iceland Room Posterdiskussion 5 Moderatorer:SusanneIlkjærogJørnWetterslev abstract nr.

3 Long term psychological effects of a no sedation protocol in critically ill patients v/ThomasStrømetal J CRRT for critically ill infants and children v/OlePedersenetal K One-year mortality after acute kidney injury among Danish intensive care patients: a cohort study v/HenrikGammelageretal O Do soluble levels of endothelial adhesion molecules reflect endothelial expression? v/AndersGadeKjærgaardetal R The use of fresh frozen plasma in ICU patients with septic shock v/NannaReiteretal T Systolic heart function remains depressed for at least one month after on-pump cardiac surgery v/PeterJuhl-Olsenetal

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Torsdag d. 10. november, fortsat

14.00 - 15.30 I Evaluation of the effect of three different inotropic support strategies in the normal newborn piglet heart on (fortsat) hemodynamics and myocardial metabolism v/JanusAdlerHyldebrandt 4 The outcome of critically illness in decompensated liver cirrhosis v/ThomasStrøm

Chairmans Room Posterdiskussion 6 Moderatorer:AndersPernerogErikaF.Christensen abstract nr.

7 A novel non-invasive method for measuring fatigability of the quadriceps muscle in non-cooperating subjects: Assessment of reliability v/JesperB.Poulsenetal 34 The Scandinavian starch for severe sepsis/septic shock (6S) trial: characteristics and outcome of the first 400 patients v/NicolaiHaaseetal 17 Lower mortality with higher fluid volume in patients with persisting septic shock v/SørenH.Smithetal 25 Mortality in elderly patients admitted to the intensive care unit: a Danish one year cohort study v/MaleneSchouNielssonetal 43 Pleural effusion is a potential confounder for correct interpretation of conventional hemodynamic parameters. An experimental porcine study v/KristianB.Wemmelundetal 38 Targeted delivery of dexamethasone to macrophages attenuates the cytokine response without decreasing cortisole levels - a porcine study v/AsgerGranfeldtetal 8 Reduced rate of force development and maximal volunary torque in ICU survivors 12-month after discharge v/JesperB.Poulsenetal 35 Clinical characteristics and outcome associated with blood transfusion in septic shock v/RagnhildG.Roslandetal

15.30 - 16.00 Udstilling - kaffe + frugt eller lign.

16.00 - 17.30 Sweden Room Utøya/Oslo 22/7: Hvad kan vi lære af en katastrofe i en skandinavisk hovedstad? Moderator:JakobStensballe v/TinaGaarder

Denmark Room FYA goes higher - HEMS og CATS fra London Moderator:ØivindJans v/HarisBegovicogMonaTarpgaard

Iceland Room DAO Generalforsamling

Finland Room Forskningsinitiativet Moderator:PalleToft -AnneJuulWikkelsø.Multitransfusion i relation til postpartum blødning -ChristineL.Hvas.Intrakraniel blødning i en organdonor-model -HenrikTorup.Effekten af Transversus Abdominis Plane (TAP) blok som postoperativ smertebehandling efter åben hysterektomi -MathiasPaulGoldinger.12 måneders follow-up undersøgelse af intensivpatienter efter H1N1 influenza-pneumoni -MortenRuneEckhardt.Fra akutte til kroniske smerter. Betydningen af postoperative meddelte smerter -NicolaiR.S.Haase.Blødning og hæmostase hos patienter med svær sepsis -SianI.Robinson.Evaluering af den optimale dosis af profylaktisk antikoagulation med lavmolekylær heparin subkutant til kritisk syge patienter - delstudie 2 -SisseA.Thommassen. Individuel tilpasning af blood flow ved brug af kardiopulmonal bypass 17.30 - 19.00 Middag i Casino Ballroom

19.00 - 22.30 Norway Room DASAIM generalforsamling

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Fredag d. 11. november

07.30 - Registrering

08.00 - 08.30 Norway Room Kan enhver bedøve en hovedtraumepatient, der skal have et søm i benet? Moderator:Karen-LiseWelling v/PernilleHaure

Finland Room Indsatsleder sundhed/KOOL - den nye pige i klassen Moderator:KimGarde v/CharlotteBarfod

Sweden Room Perioperativ transfusionsstrategi: Hvad kan vi optimere? Moderator:MetteHyllested v/AstridNørgaard

Iceland Room Unge og voksne med medfødt hjertefejl (GUCH) Moderator:LisbethBredahl v/MortenHelvindogVibekeHornbak

08.30 - 09.00 Udstilling - kaffe

09.00 - 09.30 Sweden Room Thermografi - en mulig, objektiv metode til vurdering af udbredelsen af nerveblok på overekstremiteten Moderator:JonnaStormFomsgaard v/SemeraAsgher

Iceland Room Behandling af mitralinsufficiens, kirurgisk vs. endovaskulært Moderator:MarianneKjærJensen v/JensThiisogOlafFranzen

Finland Room Hvordan indretter man en intensiv afdeling? Moderator:JensSchierbeck v/ErikJylling

Norway Room Hvad var nytten af den lægebemandede helikopter? Moderator:KimGarde v/RasmusHesselfeldt

09.30 - 10.00 Udstilling - kaffe

10.00 - 12.00 Finland-Sweden-Iceland Room ACTA Foredragskonkurrence Bedømmere:ElseTønnesen,PalleToft,NielsHenrySecherogJørnWetterslev Moderator:JørgenB.Dahl abstract nr.

12 Impaired hypoxic cerebral vasodilation after lipopolysaccharide infusion in healthy humans: implications for sepsis-associated encephalopathy? v/RonanM.G.Bergetal 18 Local anaesthesia and remifentanil sedation versus total intravenous anaesthesia for operative hysteroscopic procedures in day surgery. A randomised clinical trial v/BirgitteMajholmetal 36 Response to succinylcholine in patients carrying the K-variant in the butyrylcholinesterase gene v/ClausBretlauetal 23 Remote ischemic preconditioning in children operated for complex congenital heart disease does not reduce the risk of postoperative acute kidney injury: A randomized single center study v/KirstenRønholtPedersenetal 15 Effect of continuous adductor-canal-blockade on pain and mobilization after total knee arthroplasty v/PiaJægeretal 26 Engaging a whole community in resuscitation v/AnneMøllerNielsenetal

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Fredag d. 11. november, fortsat

12.00 - 12.45 Udstilling - sandwich/vand i udstillingsområdet

12.00 - 12.45 Denmark Room Frokostsymposium - Norpharma

12.45 - 14.15 Finland Room Efteruddannelse i præhospital behandling Moderator:KimGarde v/LeifRognås,HenrikJørgensen,PeterMartinHansen,FreddyLippert

Iceland Room Trombektomi - en ny neurointerventionel behandling af cerebrale tromber Moderator:KarstenBülow v/ClausZieglerSimonsenogNielsJuul

Norway Room Nyere blokader Moderator:EgonGodthåbHansenogJonnaStormFomsgaard - TAP - en update v/PernilleLykkePedersenogHenrikTorup - Adductor kanal blok til knækirurgi v/PiaJæger,MaleneEspelundogJørgenLund - Selektiv n. axillaris blok v/ChristianRothe

Sweden Room Etiske dilemmaer omkring organdonation Moderator:J.AsgerPetersen v/MickeyGjerrisogHelleHaubroAndersen

Norpharma A/S inviterer til frokostsymposiumfredag d. 11. november 2011, kl. 12.00 - 12.45

Derfor er der forskel på opioider

v/ Asbjørn Mohr Drewes, professor, overlæge, dr.med., ph.d.̧ Gastroenterologisk afdeling, Aalborg Sygehus

Frokostsymposiet afholdes i Denmark Room på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde 2011. Der vil være frokost i tilknytning til symposiet.

Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig (se tilmeldingsblanket).

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Fredag d. 11. november, fortsat

14.15 - 14.40 Udstilling - kaffe

Sweden Room14.40 - 15.10 Smertensbarnet (i) FAM Moderator:PeterBerlac v/IbenSorgenfreiogMarie-LaureB.Jacobsson

Finland Room Etiske udfordringer i en travl klinisk hverdag Moderator: v/J.AsgerPetersen

Iceland Room Kvalitetssikring og certificering i FATE og TEE Moderator:HelleLaugesen v/AngelaMahdi

Norway Room Immunomodulation in acute lung injury Moderator:KirstenMøller v/EllenBurnham

15.10 - 15.15 Kort pause

15.15 - 15.45 Denmark Room Strategi ved akut kirurgi til patienter i antitrombotisk behandling Moderator:LarsFolkersen v/SisseRyeOstrowskiogPärJohansson

Iceland Room Overlægers bijob - fritid eller arbejde Moderator:KimGarde v/BeritHandbergogMichaelBraünerSchmidt

Norway Room Alcohol and the lung Moderator:KirstenMøller v/EllenBurnham

Sweden Room Ultralyd til luftvejshåndtering Moderator:RasmusHesselfeldt v/MichaelSeltzKristensen

15.45 - 18.00 PAUSE

18.00 - 19.00 Den 42. Husfeldt-forelæsning Anæstesi af ekstremer - fra 30 g til 5 tons Moderator:KarenSkjelsager v/CarstenGrøndahl

19.00 - 02.00 Middag og prisoverrækkelser

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Lørdag d. 12. november

08.45 - Registrering

09.00 - 09.45 Norway Room Professorerne har ordet Moderator:LarsS.Rasmussen

Finland Room Invasiv og non-invasiv behandling af neuropatiske smerter Moderator:LuanaL.Jensen - Nyt om neuropatiske smerterv/TroelsS.Jensen -Bagstrengsstimulation v/ThomasP.Enggaard

09.45 - 10.00 Kaffepause

10.00 - 11.30 Norway Room Kronisk pulmonal hypertension - medicinsk og kirurgisk intervention Moderator:LarsFolkersen v/JensErikNielsen-Kudsk,HanneRavnogLarsIlkjær

Finland Room Ledelse i sundhedsvæsenet Moderator:JørgenB.Dahl - Skal læger lede - eller skal vi overlade det til djøf’erne?v/PeterEmmerichHansen - Hvad er en god lægelig leder? v/JanBondeogKristianAntonsen - Hvad er udfordringerne som lægelig mellemleder? v/MetteHyllestedogBirgitteRuhnau

11.30 - 12.45 Frokost

12.45 - 13.15 Norway Room Autonomiens grænser, koder og behandlingsophør Moderator:AsgerBendtsen v/AsgerPetersen

Finland Room Kæderedning Moderator:SørenLoumannNielsen v/JesperDirks

13.15 - 14.00 Norway Room Evt. politisk emne Moderator: v/

• Andersen, Helle Haubro, centerleder Dansk Center for Organdonation, Århus• Asgher, Semera, læge, ph.d.-studerende, anæstesiafd., Hillerød Hospital• Antonsen, Kristian, lægechef ved Anæstesiologisk enhed for sygehusene i Hillerød, Helsingør og Frederikssund• Barfod, Charlotte, afd.læge, ph.d., anæstesiafd., Hillerød Hospital• Barnung, Steen, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet• Bested, Kirsten, overlæge, anæstesiafd., Sygehus Lillebælt Vejle• Begovic, Haris, læge, London’s Air Ambulance• Bendtsen, Asger, overlæge, operations- og anæstesiafd., Glostrup Hospital• Berlac, Peter, ledende overlæge, akutafd., Hillerød Hospital• Bonde, Jan, klinikchef, overlæge, dr.med., Intensiv Terapi Afsnit (ITA), ABD, Rigshospitalet• Bredahl, Lisbeth, overlæge, thoraxanæstesiologisk afd., Rigshospitalet• Burnham, Ellen, MD, MS, Associate Professor, Medical ICU Director, University of Colorado Hospital• Bülow, Karsten, overlæge, anæstesi- og intensiv afd., Odense Universitetshospital• Christensen, Erika F., lægelig chef, Præhospitalet, Region Midt• Christensen, Poul Lunau, uddannelsesansvarlig overlæge, anæstesiafd., Bispebjerg Hospital• Dahl, Jørgen B., professor, overlæge, dr.med., anæstesi, Rigshospitalet• Dirks, Jesper, overlæge, ph.d., anæstesiafd., Hvidovre Hospital

Foredragsholdere og mødeledere

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Foredragsholdere og mødeledere, fortsat• Eccleston, Christopher, Professor, Coordinating Editor, PaPaS Cochrane Review Group & Director, Centre for Pain Research, The Univer-

sity of Bath• Enggaard, Thomas P., overlæge, ph.d., anæstesi- og intensiv afd., Odense Universitetshospital• Espelund, Malene, læge, ph.d.-studerende, operations- og anæstesiafd., Glostrup Hospital• Fomsgaard, Jonna Storm, overlæge, operations- og anæstesiafd., Glostrup Hospital• Folkersen, Lars, overlæge, anæstesiafd., Århus Universitetshospital, Skejby• Franzen, Olaf, overlæge, kardiologisk afd., Rigshospitalet• Gaarder, Tina, MD, ph.d., Trauma Surgeon, Head of Dept. of Traumatology, Oslo University Hospital, Ullevål• Garde, Kim, ledende overlæge, anæstesiafd., Næstved Sygehus• Gerstrøm, Gustav, afdelingslæge, anæstesiafd., Århus Universitetshospital• Gjerris, Mickey, teolog, lektor i biotik, Det Biovidenskabelige Fakultet, Københavns Universitet• Grøndahl, Carsten, leder, dyrlæge, Zoologisk Have, København• Handberg, Berit, afd.læge, anæstesiafd., Århus Universitetshospital, Skejby• Hansen, Egon Godthåb, overlæge, SDL, anæstesiafd., Herlev Hospital• Hansen, Peter Emmerich, cand.phil. et. cand.scient.pol., partner Implement Consulting Group• Hansen, Peter Martin, afd.læge, anæstesi- og intensiv afd., Odense Universitetshospital• Haure, Pernille, overlæge, anæstesiafd., Århus Universitetshospital/Aalborg afsnit Syd• Hedenstierna, Göran, professor, Department of Clinical Physiology, Uppsala University Hospital• Helvind, Morten, overlæge, thoraxkirurgisk afd., Rigshospitalet• Hesselfeldt, Rasmus, læge, ph.d.-studerende, anæstesi- og operationsklinikken, HOC, Rigshospitalet• Holm-Knudsen, Rolf, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet• Hornbak, Vibeke, overlæge, thoraxanæstesiologisk afd., Rigshospitalet• Hyllested, Mette, overlæge, anæstesiafd., Bispebjerg Hospital• Ilkjær, Lars, ledende overlæge, Hjerte-Lunge-Kar Kir. afd. T, Århus Universitetshospital, Skejby• Ilkjær, Susanne, overlæge, ph.d., Århus Universitetshospital, Skejby• Jacobsson, Marie-Laure B., overlæge, FAM, Hillerød Hospital• Jans, Øivind, læge, ph.d.-studerende, enhed for kirurgisk patofysiologi, JMC, Rigshospitalet• Jensen, Luana L., overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby• Jensen, Marianne Kjær, overlæge, anæstesi- og intensivafd., Smertecenter Syd, Odense Universitetshospital• Jensen, Reinhold, overlæge, Århus Universitetshospital, Skejby• Jensen, Troels Staehelin, professor, overlæge, dr.med., neurologisk afd., Århus Universitetshospital• Johansson, Pär, overlæge, dr.med., Blodbanken, Rigshospitalet• Juul, Niels, overlæge, anæstesi- og intensivafd., Århus Universitetshospital• Jylling, Erik, anæstesi- og intensivafd., Smertecenter Syd, Odense Universitetshospital• Jæger, Pia, læge, ph.d.-studerende, anæstesi- og operationsklinikken, HOC, Rigshospitalet• Jørgensen, Henrik, overlæge, ph.d., anæstesiafd., Herlev Hospital• Keld, Dorte, overlæge, overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby• Kristensen, Michael Seltz, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet• Laugesen, Helle, overlæge, anæstesiafd., Ålborg Sygehus• Lauritsen, Torsten, overlæge, anæstesi- og operationsklinikken, JMC, Rigshospitalet• Lippert, Freddy, overlæge, chef, Akut Medicin og Sundhedsberedskab, Region Hovedstaden• Lohse, Thomas, overlæge, dr.med., anæstesisektor Nordjylland, 1. afd.• Lund, Jørgen, overlæge, Privathospitalet Hamlet• Mahdi, Angela, overlæge, thoraxanæstesiologisk afd., Ålborg Sygehus• Mikkelsen, Søren, anæstesi- og intensivafd., Smertecenter Syd, Odense Universitetshospital• Møller, Ann, forskningslektor, overlæge, dr.med., anæstesiafd., Herlev Hospital• Møller, Kirsten, overlæge, seniorforsker, dr.med., anæstesiafd., Bispebjerg Hospital• Nielsen, Anne Møller, læge, ph.d.-studerende, anæstesi- og operationsklinikken, HOC, Rigshospitalet• Nielsen, Søren Loumann, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet• Nielsen-Kudsk, Jens Erik, overlæge, dr.med., Århus Universitetshospital Skejby, Hjertemedicinsk afd. B• Nørgaard, Astrid, overlæge, ph.d., klinisk immunologisk afd., H:S Blodbank, Rigshospitalet• Nørregaard, Ole, overlæge, Århus Universitetshospital, Skejby, Respirationscenter Vest• Olsen, Karsten Skovgaard, overlæge, dr.med., operations- og anæstesiafd., Glostrup Hospital• Ostrowski, Sisse Rye, afd.læge, dr.med., Blodbanken, Rigshospitalet• Pedersen, Pernille Lykke, afd.læge, operations- og anæstesiafd., Glostrup Hospital• Perner, Anders, overlæge, klinisk lektor, ph.d., Intensiv Terapi Afsnit (ITA), ABD, Rigshospitalet• Petersen, J. Asger, overlæge, anæstesiafd., Bispebjerg Hospital• Rasmussen, Lars S., professor, overlæge, dr.med., anæstesi- og operationsklinikken, HOC, Rigshospitalet• Ravn, Hanne, overlæge, dr.med., anæstesiafd., Århus Universitetshospital, Skejby• Rognås, Leif K., overlæge, anæstesi- og operationsafd., Regionshospitalet Viborg• Rothe, Christian, læge, ph.d.-studerende, anæstesiafd., Hillerød Hospital• Ruhnau, Birgitte, uddannelsesansvarlig overlæge, AN-OP, ABD, Rigshospitalet• Schierbeck, Jens, overlæge, anæstesi- og intensiv afd., Odense Universitetshospital• Schmidt, Michael Braüner, ledende overlæge, anæstesiafd., Århus Universitetshospital, Skejby• Simonsen, Claus Ziegler, læge, ph.d., neurologisk afd., Århus Universitetshospital• Skjelsager, Karen, uddannelsesansvarlig overlæge, anæstesiafd., Næstved Sygehus• Sorgenfrei, Iben, overlæge, anæstesiologisk afd., Hillerød Hospital• Stensballe, Jakob, afd.læge, ph.d., anæstesi- og operationsklinikken, HOC og transfusionsmedicinsk enhed, Blodbanken, Rigshospitalet• Steinmetz, Jacob, traumemanager, overlæge, ph.d., anæstesi- og operationsklinikken, HOC• Tarpgaard, Mona, anæstesiolog, fellow på Great Ormond Street Hospital for Sick Children• Thiis, Jens, overlæge, thoraxkirurgisk afd., Rigshospitalet• Toft, Palle, professor, overlæge, dr.med., anæstesi- og intensivafd., Odense Universitetshospital• Torup, Henrik, læge, ph.d.-studerende, anæstesiafd., Herlev Hospital• Tønnesen, Else, professor, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitetshospital• Volmanen, Petri, MD, ph.d., Lapland Central Hospital, Rovaniemi, Finland• Weitling, Eva, overlæge, anæstesiafd., Sygehus Lillebælt Kolding• Welling, Karen-Lise, overlæge, ph.d., neurointensivafd., Rigshospitalet• Wetterslev, Jørn, overlæge, ph.d., Copenhagen Trial Unit, Rigshospitalet

13

Abstracts - ACTA Foredragskonkurence

12. Førsteforfatter: Ronan M. G. BergE-mail: ronan@dadlnet.dkAfdeling: Center for Inflammation og MetabolismeHospital/Sygehus: RigshospitaletMedforfattere: Kevin A. Evans, Ronni R. Plovsing, Claus B. Christiansen, Niels-Henrik Holstein-Rathlou, Damian M. Bailey, Kirsten Møller

Impaired hypoxic cerebral vasodilation after lipopolysaccharide infusion in healthy humans: implications for sepsis-associated encephalopathy?

Background: Sepsis, the systemic inflammatory response to infection, is frequently complicated by brain dysfunction, which may involve disturbances in cerebral oxygen transport (Berg et al. 2011). We have previously established lipopolysaccharide (LPS) infusion as a human-experimental model of systemic in-flammation that mimics the early stages of sepsis (Taudorf et al. 2007). In the present study, we hypothesised that LPS infusion impairs cerebral oxygen vasoreactivity (COVR).

Methods: Ten healthy male volunteers aged 23 (mean, SD 2) years were enrolled in the study. A catheter was inserted in the radial artery, and volunteers underwent a four-hour intra-venous infusion of Escherichia coli LPS (total dose of 2 ng/kg). Prior to the infusion and immediately after, cortical oxygenation and middle cerebral artery blood flow velocity (MCAv) were measured by dual-wavelength near-infrared light spectroscopy (NIRS) and transcranial Doppler ultrasonography, respectively. During measurements, three interventions were conducted in a randomised fashion using a closed system (Ambu ’E’ valve) with a tight-fitting mask: - 20 minutes of normoxia (21% O2), - 20 minutes of hyperoxia (40% O2), and - 20 minutes of hypoxia (12% O2).

To avoid the interference of hypocapnia-mediated vasoconstric-tion, all interventions were conducted in eucapnia by conti-nuously monitoring and adjusting end-tidal CO2. The cerebrova-scular resistance (CVR) was calculated as mean arterial pressure/MCAv, and the arterial blood content of oxygen (CaO2) was calculated as Hgb x SaO2 + PaO2 x 0.01,where Hgb is the haemoglobin concentration, and SaO2 and PaO2 is the arterial oxygen saturation and partial pressure of oxygen, respectively. COVR was subsequently calculated as the % change in CVR per kPa change in CaO2 during hyperoxia and

hypoxia, respectively. The pro-inflammatory cytokine tumour necrosis factor a (TNF-a) was measured in arterial plasma by use of a Multiplex assay (Luminex).

Results: LPS induced an immense systemic inflammatory response with fever, flu-like symptoms, neutrocytosis, and a 34-fold increase in the circulating levels of TNF-a (all P< 0.001). Although LPS infusion per se neither influenced CaO2 or cortical oxygenation (Table 1), hypoxic cerebral vasodilation was specifi-cally blunted after LPS (Figure 1).

Conclusion: LPS-induced systemic inflammation may affect COVR by impairing hypoxic vasodilation. This may contribute to brain dysfunction in critically ill, septic patients, by rendering the brain more vulnerable to fluctuations in CaO2.

Figure 1. Cerebrovascular responses to eucapnic hyperoxia (red) and hypoxia (blue) before and after lipopolysaccharide (LPS) in-fusion, calculated as the % change in cerebovascular resistance per kPa change in CaO2. ** Different from baseline, P < 0.0001.

Figure 1. Celipopolysaccin CaO2. **

Table 1. Artcerebral oxypresented asequential B

erebrovascucharide (LPSDifferent fro

terial blood gygen vasoreaas mean ± SDBonferroni co

lar responseS) infusion, com baseline,

gases, corticaactivity (COVD. * Differentorrection.

es to eucapnialculated as P < 0.0001.

al oxygenatioVR) after lipot from normo

ic hyperoxia the % chang

on (NIRS) duopolysaccharoxia, P < 0.0

(red) and hyge in cerebo

uring inspiratride (LPS) in1. All P-value

ypoxia (blue) vascular res

tory hyperoxifusion in heaes are adjust

) before and sistance per k

ia and hypoxalthy humansted accordin

after kPa change

xia, and s. Data are g to Holm's

Figure 1. Celipopolysaccin CaO2. **

Table 1. Artcerebral oxypresented asequential B

erebrovascucharide (LPSDifferent fro

terial blood gygen vasoreaas mean ± SDBonferroni co

lar responseS) infusion, com baseline,

gases, corticaactivity (COVD. * Differentorrection.

es to eucapnialculated as P < 0.0001.

al oxygenatioVR) after lipot from normo

ic hyperoxia the % chang

on (NIRS) duopolysaccharoxia, P < 0.0

(red) and hyge in cerebo

uring inspiratride (LPS) in1. All P-value

ypoxia (blue) vascular res

tory hyperoxifusion in heaes are adjust

) before and sistance per k

ia and hypoxalthy humansted accordin

after kPa change

xia, and s. Data are g to Holm's

Table 1. Arterial blood gases, cortical oxygenation (NIRS) du-ring inspiratory hyperoxia and hypoxia, and cerebral oxygen vasoreactivity (COVR) after lipopolysaccharide (LPS) infusion in healthy humans. Data are presented as mean ± SD. * Different from normoxia, P < 0.01. All P-values are adjusted according to Holm’s sequential Bonferroni correction.

Table 1 Time intervals related to patient flow for the MAC group and TIVA group respectively.

MAC-group* TIVA-group* P-værdi** PC***

Time at the operating room 43 (22-92) 41 (25-75) 0.6 0.6

Recovery room – time to mobilisation

53 (18-192) 69 (24-215) 0.017 0.034

Time from arrival at the OR§ to discharge readiness

118 (68-241) 138 (91-301) 0.0009 0.0027

Time from discharge readiness to departure from DSU§§

21 (0-165) 25 (0-128) 0.8 -

§) OR: Operating room, §§) DSU: Day surgery unit*) median and range, (all in minutes)**) Mann-Whitney test***) Correction for multiple testing by the Bonferroni-Holm method.

(”Time from discharge readiness to departure from the DSU” is a security parameter and has therefore not been corrected.)

18.Førsteforfatter: Birgitte MajholmE-mail: Birmaj01@heh.regionh.dkAfdeling: Anæstesiologisk Afdeling IHospital/Sygehus: Herlev HospitalMedforfattere: Jens Bartholdy, Helle V Clausen, Rie A Virkus, Jens Engbæk, Ann M Møller

Local anaesthesia and remifentanil sedation versus total intravenous anaesthesia for operative hysteroscopic procedures in day surgery. A randomised clinical trial

Introduction: Operative hysteroscopic procedures are often per-formed during general anaesthesia in the day surgery setting. However, by intravenous sedation-analgesia with supplement of local anaesthesia (monitored anaesthesia care (MAC)); it may be possible to minimize the time each patient occupies the operating room and postoperatively to achieve faster mobilisa-tion and discharge readiness. Thereby increasing effectiveness in the day surgery unit while maintaining safety and quality for the patients.

Aim: To compare total intravenous anaesthesia (TIVA) with MAC during operative hysteroscopy in a day surgical setting focusing

on the time spent in the operation room, the time until mobilisa-tion and discharge readiness as well as patient satisfaction.

Methods: Randomised clinical trial with parallel groups and no blinding. Randomisation to either MAC group: Remifentanil, (Ultiva®), sedation-analgesia combined with paracervical local anaesthesia or to TIVA group: Propofol and remifentanil. We ▼ ▼ ▼

14

Abstracts - ACTA Foredragskonkurence

36.Førsteforfatter: Claus BretlauE-mail: clausbretlau@gmail.comAfdeling: Dansk Kolinesterase KartotekHospital/Sygehus: Herlev HospitalMedforfattere: Martin Kryspin, Lars S. Rasmussen, Mona Ring Gätke

Response to Succinylcholine in Patients carrying the K-Variant in the Butyrylcholinesterase Gene

Background: Succinylcholine remains the drug of choice for rapid sequence induction (RSI), electroconvulsive therapy or reduction of joint dislocation. The butyrylcholinesterase enzyme (BChE) usually metabolizes succinylcholine quickly but genetic variants of BChE may prolong the duration of action of succi-nylcholine. A prolonged neuromuscular blockade may result in residual curarization or in a potentially catastrophic situation if “cannot ventilate, cannot intubate” scenario emerges. The most common mutation in the butyrylcholinesterase gene (BCHE) is the Kalow (K) variant but the clinical significance has not been well studied. We hypothesised that the duration of action of suc-cinylcholine would be prolonged in patients with the K-variant genotype as compared to the normal genotype (wild type).

Methods: Ethics Committee approved this study. We included 70 elective adult surgical patients scheduled for general anesthe-sia with RSI consisting of alfentanil (10 µg/kg), propofol (2 mg/kg) and succinylcholine (1 mg/kg). Duration of action of succi-nylcholine was assessed by acceleromyography. BChE activity and genotype were determined. Genotyping of BCHE K- and A-variants was done on isolated leucocyte DNA using the Taqman assay. The primary endpoint was the time to 90% recovery of first twitch in train-of-four (T1 90%) stimulation of the adductor pollicis longus muscle.

Results: Heterozygous presence of the K-variant prolonged the time T1 90% from 9.5 ±2.67 min to 11.6 ±3.5 min (p=0.0476), when compared to the wild type. Patients heterozygous for the K-variant had a BChE activity of 5.978 U/l compared with 7.703 U/l in the wild type group (p=0.0045). The wild type BCHE was present in 38 patients and 21 were heterozygous for the K-variant. Five patients had other genotypes and six patients were excluded due to technical errors.

Conclusion: The duration of action of succinylcholine was sig-nificantly prolonged in patients who carried the heterozygous K-variant of the butyrylcholinesterase gene.

Table 1 Time intervals related to patient flow for the MAC group and TIVA group respectively.

MAC-group* TIVA-group* P-værdi** PC***

Time at the operating room 43 (22-92) 41 (25-75)

0.6 0.6

Recovery room – time to mobilisation 53 (18-192) 69 (24-215)

0.017 0.034

Figure 1, flow diagram

Assessed for eligibility (n = 310) )

Excluded (n = 219) Not meeting inclusion criteria (n = 65) Risk of aspiration (4), antidepressants/

pain medication (16), not general anaesthesia (2), allergies (6),

language (7), ASA III (5), BMI (9), surgical reasons (15).

Declined to participate (n = 114) Other reasons (n = 40) Fear of needles (1), no project surgeon

at work (5), logistic reasons (34).

Analysed (n = 49) Excluded from analysis (n = 0)

Lost to follow-up (n = 0) Discontinued intervention due to surgical difficulties and pain related to dilatation of the cervix (n = 1)

Allocated to MAC (n = 49) Received allocated intervention (n = 49)

Lost to follow-up (n = 0) Discontinued intervention (n = 0)

Allocated to TIVA (n = 42) Received allocated intervention (n = 42)

Analysed (n =42) Excluded from analysis (n = 0)

Allocation 

Analysis 

Follow‐Up 

Randomized (n =91)

23.Førsteforfatter: Kirsten Rønholt PedersenE-mail: kirstenronholt@hotmail.comAfdeling: Anæstesiologisk-Intensiv afd IHospital/Sygehus: AUH, SkejbyMedforfattere: Johan Vestergaard Povlsen, Michael Rahbek Sch-midt, Erland Jørn Erlandsen,Vibeke Elisabeth Hjortdal, Hanne Berg Ravn

Remote ischemic preconditioning in children operated for complex congenital heart disease does not reduce the risk of postoperative acute kidney injury: A randomized single center study

Introduction: Acute kidney injury (AKI) requiring dialysis occurs in 10-15% of children operated for congenital heart disease and AKI is independently associated with increased risk of death. Remote ischemic preconditioning (RIPC) has primarily been de-monstrated to protect the heart in adults and children undergo-ing cardiac surgery. Studies on the effect of RIPC on kidney func-tion in adults undergoing cardiovascular surgery have shown conflicting results. The effect of RIPC on kidney function in children operated for congenital heart disease has not yet been investigated. The objective of the present study was to evaluate if remote ischemic preconditioning can protect kidney function in children operated for complex congenital heart disease.

Methods: Children (n= 113) aged 0-15 years admitted for com-plex congenital heart disease were randomized according to age group to remote ischemic preconditioning or control group. After exclusion of eight patients we conducted the analysis on 105 patients (remote ischemic preconditioning group n= 54 and control group n= 51). Before surgery, remote ischemic precon-ditioning was performed as 4 cycles of 5 minutes ischemia by inflating a cuff around one leg to 40 mmHg above the systolic pressure. End points were development of AKI, initiation of dia-lysis, plasma creatinine and the estimated glomerular filtration rate, plasma cystatin C, plasma and urine Neutrophil Gelatinase-Associated Lipocalin, and urine output. Secondary end points included postoperative blood pressure, inotropic score, and mortality, as well as morbidity reflected by reoperation, length of stay in the intensive care unit and in hospital.

included 91 healthy (ASA I or II) women aged 18 years or older and speaking the Danish language (figure 1). All women were scheduled for an operative hysteroscopic procedure at the day surgery units of the Copenhagen University Hosptails in Herlev and Hillerød, Denmark, between August 2008 and July 2010. The study was approved by the local Ethic Committee.

Primary outcome: Time from arrival to leaving the operating room.

Results: We found no significant differences between groups in the time from arrival to leaving the operating room (P = 0.6). However, both the time until the patients were mobilised (P = 0.017) as well as their total time spent in the day surgery unit (P = 0.0009) were significantly reduced for patients in the MAC group. (Table 1). More patients in the MAC group (45 (91.8%)) than (24 (64.9%)) in the TIVA group have answered positive to the question: Would you like to receive the same kind of anaes-thesia for a similar procedure in the future? (P = 0.003).

Conclusion: Sedation-analgesia combined with paracervical local anaesthesia is suitable for hysteroscopy in the day surgery setting. Patients are mobilised and discharged faster compared to traditional total intravenous anaesthesia.

Acknowledgement: Study support by The Tryg Foundation.

15

Abstracts - ACTA Foredragskonkurence

15.Førsteforfatter: Pia JægerE-mail: pia.jaeger@rh.regionh.dkAfdeling: Anæstesi- og Operationsklinikken, HOCHospital/Sygehus: RigshospitaletMedforfattere: Jenstrup MT, Lund J, Fomsgaard JS, Bache S, Mathiesen O, Larsen TK, Dahl JB.

Effect of Continuous Adductor-Canal-Blockade on pain and mobilization after total knee arthroplasty

Introduction: Total knee arthroplasty (TKA) is associated with intense postoperative pain. Besides providing optimal analgesia, reduction of side effects and enhanced mobilization is impor-tant in this elderly population. The Adductor-Canal-Blockade is theoretically an almost pure sensory blockade. Except from the nerve to the vastus medialis, there are only sensory fibers - from the saphenous nerve and the distal part of the posterior branch of the obturator nerve - traversing the adductor canal. We hypothesized that the Adductor-Canal-Blockade would reduce morphine consumption (primary endpoint), improve pain relief, enhance early mobilization ability, and reduce side effects after TKA compared with placebo (secondary endpoints).

Methods: We included 71 patients scheduled for TKA into this double-blind placebo-controlled randomized trial. The trial was approved by the Danish Medicines Agency, the local Regional Ethics Committee (H-1-2009-143) and the Danish Data Protection Agency, and registered at www.clinicaltrials.gov (NCT01104883). Patients were allocated to a continuous Adductor-Canal-Block-ade via a catheter with either ropivacaine 0.75% (n=34) or pla-

cebo (n=37), administered in boluses, 30 ml initially followed by 15 ml every six hours. At 24 h all patients received ropivacaine 0.75%, 15 ml. Surgery was performed under spinal anesthesia. Postoperative pain treatment consisted of paracetamol 1 g and ibuprofen 400 mg four times daily, and patient controlled anal-gesia with intravenous morphine. Morphine consumption, pain, nausea, vomiting, and sedation were assessed at 2, 4, 8, 24 and 26 h. Mobilization ability was assessed with the Timed-Up-and-Go (TUG) test, at 24 and 26 h.

Results: Total morphine consumption (0-24 h) was significantly reduced in the ropivacaine group compared with the placebo group (40 (21) mg vs.. 56 (26) mg (mean (SD), p=0.006). Pain (AUC 2-24 h) was significantly reduced during 45 degrees flexion of the knee (p = 0.01), but not at rest (p=0.058). Patients in the ropivacaine group performed the TUG test at 24 h significantly faster than patients in the placebo group (36 (17) seconds versus 50 (29) seconds, (mean (SD), p=0.03). At 26 h, two hours after administration of ropivacaine in both study groups, pain scores decreased significantly in the saline group compared with the ropivacaine group, both during flexion of the knee (p<0.001) and at rest (p=0.01). Furthermore, the statistically significant diffe-rence in mobilization ability disappeared at 26 h (p=0.21). There were no statistically significant differences between groups with regard to nausea, vomiting or sedation, but significantly fewer patients in the ropivacaine group required ondansetron (p=0.01).

Conclusion: The Adductor-Canal-Blockade significantly reduced morphine consumption and pain during 45 degrees flexion of the knee compared with placebo after TKA. Furthermore, it significantly enhanced mobilization ability at 24 h assessed with the TUG test.

26.Anne Møller Nielsena*, Dan Isbye, Freddy Lippertb, Lars S. Rasmussena

a Department of Anaesthesia, Centre of Head and Orthopaedics, Copen-hagen University Hospital, Rigshospitalet, Denmark

b Head Office, The Capital Region of Denmark, Denmark* Corresponding author: anne.mn@dadlnet.dk

Engaging a Whole Community in Resuscitation

Introduction: Survival after out-of-hospital cardiac arrest (OHCA) is influenced by each link in the chain of survival. On the Danish island of Bornholm (population 42.000, area 588 km2) 22% of witnessed OHCA patients (2004) received bystander basic life support (BLS) and none survived an OHCA in 2001-2003. Therefore, a project was conducted aiming to improve BLS rates and survival after OHCA by strengthening each link in the chain of survival combined with a mass media focus on resuscitation.

Methods: Lay people completed a 24-min DVD-based-self-in-struction BLS course (MiniAnne, Laerdal), mainly at their work-places, or a 4-h BLS/AED course. The local television station had broadcasts about resuscitation and the purchase of automated external defibrillators (AED) was encouraged. The dispatch centre implemented an IT solution for referring bystanders to

the nearest AED. At the Emergency Medical Services (EMS) the ambulance attendants were assessed in a mock cardiac arrest scenario and individual feedback was given. Staff at the island hospital completed a BLS course or more advanced courses. Therapeutic hypothermia was implemented. Resuscitation data according to the Utstein recommendations were collected prospectively by the EMS.

Results: During the 2-year project period there were 103 OHCAs and 96 had presumed cardiac aetiology. Fiftyfour percent of these OHCAs occurred in public places and 35 were bystander witnessed. Among them 17 (49%) had ventricular fibrillation (VF), 7 (20%) had pulseless electrical activity (PEA), and 11 (31%) had asystole as the initial rhythm. The bystander BLS rate for witnessed OHCAs with presumed cardiac origin (N=35) incre-ased significantly from 22% (2004) to 74% [95% CI 58-86]. These patients had a median age of 66 years [25-75% range 55-75] and 63% were male. Of the thirty-five, 7 (20%) had Return of Spontaneous Circulation (ROSC) at hospital admission. Survival to hospital discharge among those with bystander witnessed VF, PEA and asystole of cardiac aetiology was 19% (3/16) [95% CI 6-44], 14% (1/7) [95% CI 5-54] and 0%, respectively.

Conclusion: Strengthening all links in the chain of survival was associated with significant increases in bystander BLS rate and survival after out-of-hospital cardiac arrest.

Results: Overall, 57 (54%) of the children developed acute kidney injury with 27 (50%) in the remote ischemic precondi-tioning group and 30 (59%) in the control group (p >0.2) (Table 1). Remote ischemic preconditioning was not associated with improvement in any of the renal biomarkers or in any of the secondary end points (Table 1).

Discussion: We found a tendency towards a lower incidence of AKI based on changes in plasma creatinine and urine output (the

RIFLE criteria), but this was not supported by changes in more recently developed renal biomarkers. AKI was lower in RIPC-children above the age of 6 months, indicating that a certain maturation of the kidneys may be needed to respond to RIPC.

Conclusions: We found no evidence that remote ischemic pre-conditioning provided protection of kidney function in children operated for complex congenital heart disease.

16

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