Paediatric anesthesia and perioperative medicine

Coordinator: Peter Frykholm, Associate Professor at the Department of Surgical Sciences, Anaesthesiology and Intensive Care, e-mail: peter.frykholm@surgsci.uu.se.

Our research field is outcome in pediatric anesthesia and airway management, ventilation and respiratory mechanics during anesthesia and intensive care. We have four main areas of investigation, all active.

The first area of investigation is the impact of preoperative fasting and the development of new guidelines for fasting. The aim is to provide a solid evidence base for optimized preoperative fasting regarding clear fluids, semi-solids and solids.

The second area of investigation is outcome in pediatric anesthesia, in a broad sense. We collaborate with Child and Baby Lab at the Department of Psychology, Uppsala University, the department of Psychology, Karolinska Institute as well as the international pediatric anesthesia community via the European Society for Pediatric Anaesthesia and the Safetots initiative. We aim to use the novel technique for evaluating cognitive function with eye movement detection developed at Baby Lab to investigate the effects of anesthesia on cognitive function in infants with the overarching goal to develop safer anesthesia methods. We also aim to investigate the effects of physiological changes and adverse events on behavioral changes after pediatric anesthesia.

The third area of investigation exploits the use of the non-invasive technologies Opto-electronic plethysmography (OEP), Forced Oscillation Technique, (FOT) and recently Electrical Impedance Tomography (EIT) to monitor ventilation. Our aim is to develop and improve strategies for optimization of mechanical ventilation and to study the use of alternative methods of oxygenation and ventilation such as high frequency jet ventilation and apneic oxygenation with the overall goal to improve airway management, preoxygenation and lung immobilization for radiotherapy. We have a long-standing bilateral collaboration with bioengineers at Politecnica di Milano, who have developed the above methods (OEP and FOT) and participated in a wide range of pre-clinical and clinical studies at the Hedenstierna lab and at Uppsala University Hospital.

The fourth area of investigation is airway management. The aim is to improve airway management in adult and pediatric anesthesia practice. We have been a leading force in the development of new difficult airway guidelines in Sweden.

Our Contribution to Medical Research

1. 

Since the publication of the audit of 10 000 pediatric anesthetics, we have been a prominent force aiming towards liberalization of preoperative fasting guidelines on an international level. We are active contributors in the task force on pediatric preoperative fasting commissioned by the European Society of Anaesthesiology and Intensive Care, with a new guideline planned to be published in May 2021.

  • Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite. Andersson H, Zarén B, Frykholm P. Paediatr Anaesth 2015:25(8):770-777.

  • Introducing the 6-4-0 fasting regimen and the incidence of prolonged preoperative fasting in children. Andersson H, Hellström PM, Frykholm P. Paediatr Anaesth 2018:28(1):46-52.

2. 

We have two ongoing studies on outcome in pediatric anesthesia but they are currently on halt due to resource re-allocation and down-prioritization of elective procedures due to the Covid-19 pandemic. In the meantime, we are in the process of analyzing the effects of the pandemic on pediatric anesthesia services on a national level, using the Swedish Perioperative Registry.

  • The Covid-19 pandemic first wave in Sweden: a national registry study of the effects on pediatric anesthesia and surgery. Melander S, Almström J, Enlund G, Frykholm P. Submitted to Paediatric Anaesthesia.

3. 

We have been among the first to apply OEP and FOT for PEEP optimization during anesthesia and experimental lung injury. This research has contributed to the development of monitoring tools now incorporated in commercial ventilators.

  • Lung recruitment assessed by total respiratory system input reactance. Dellaca RL, Andersson Olerud M, Zannin E, Kostic P, Pompilio PP, Hedenstierna G, Pedotti A, Frykholm P. Intensive Care Med 2009:35(12):2164-72.

  • Positive end-expiratory pressure optimization with forced oscillation technique reduces ventilator induced lung injury: a controlled experimental study in pigs with saline lavage lung injury. Kostic P, Zannin E, Andersson Olerud M, Pompilio PP, Hedenstierna G, Pedotti A, Larsson A, Frykholm P, Dellaca RL. Crit Care 2011:15(3):R126.

  • Specific anesthesia-induced lung volume changes from induction to emergence: a pilot study. Kostic P, LoMauro A, Larsson A, Hedenstierna G, Frykholm P, Aliverti A. Acta Anaesthiol Scand 2018: Mar;62(3):282-292.

We have used OEP to investigate the potential of jet ventilation and apneic oxygenation for lung immobilization and we are in the process of publishing data from a RCT of high flow nasal oxygenation during anesthesia induction of obese patients. We have also used OEP as part of a multimodal monitoring of diaphragmatic function in physiological and pathophysiological conditions.

  • The impaired diaphragmatic function after bilateral lung transplantation: A multifactorial longitudinal study. LoMauro A, Righi I, Privitera E, Vergari M, Nigro M, Aliverti A, Frykholm P, Tarsia P, Morlacchi L, Nosotti M, Palleschi A. J Heart Lung Transplant. 2020

4. 

We have developed a novel concept for difficult airway management and since 2011 participated in the development of several new guidelines for difficult airway management in Sweden (www.sfai.se/riktlinjer). We have questioned the common practice of testing mask ventilation before muscle relaxation and are in the process of providing further evidence against this practice.

  • Visual aids for paediatric airway management. Frykholm P.  Paediatr Anaesth 2020; 30(3): 371-374

Our research has been supported by grants from the following sources:

  • The Swedish Heart and Lung foundation
  • The ALF grant from Region Uppsala
  • The Allvar Gullstrand grant

For experimental work, our base is the Hedenstierna Laboratory at Uppsala University which is equipped with state of the art technologies, including monitors, ventilators, dialysis machines, infusion pumps, data acquisition systems.

It is organized as an intensive care unit, able to perform simultaneous measurements up to seven stations simultaneously. The laboratory has several high specialized research assistants / medical technicians.

With us it is possible to develop projects of different complexity, from the undergraduate level to post-doctoral research.

Contact
If you want to join our research group, please send an e-mail to Eva-Maria Hedin eva-maria.hedin@medsci.uu.se. Specify what you are interested in and which type of project you want to develop (PhD thesis, ST-project, student project, international collaboration, research visit).

Members of the research group 2021

Coordination
Frykholm Peter, MD, Specialist, PhD, Associate Professor
Hedin, Eva-Maria, Research Assistant

Collaborators/Senior Researchers
Anders Larsson, Professor Emeritus
Gustav Gredebäck, Professor
Gustaf Ljungman, Professor
Per Hellström, Professor
Shirin Ziaei, Associate Professor
Daniel Nowinski, Associate Professor
Jenny Thorsell Cederberg, PostDoc Karolinska Institutet
Göran Hedenstierna, Senior Professor
Gaetano Perchiazzi, Associate Professor
Robert Sütterlin, MD, PhD, Head of ENT Anaesthesia Unit
Diddi Fors, MD, PhD

Former PhD students
Hanna Andersson
Antonella Lo Mauro
Robert Sütterlin
Peter Kostic

Junior researchers/PhD Students
Stefan Mogensen
Jimmy Almström
Mark Solomon Mlamba
Jacob Rosén
Anna Klaucane
Peetu Sillanpää

Peter Frykholm

consultant at Department of Surgical Sciences, Anaesthesiology and Intensive Care

Email:
peter.frykholm[AT-sign]surgsci.uu.se
Telephone:
+46-72 2397347
Mobile phone:
+46 70 8454969
Last modified: 2021-04-16