Rolf Karlsten

Uppsala University | UU · Department of Surgical Sciences

Purpose To study patient safety in third molar surgery, where two different doses of S-ketamine were administered for pain relief and compared to a placebo (saline). The primary focus was capillary oxygen saturation of the blood (SpO 2 ) and secondarily, alterations in respiratory rate, blood pressure, pulse or adverse events. Methods One hundred...

Introduction Despite advancements in implanted hardware and development of novel stimulation paradigms in Spinal Cord Stimulation (SCS), real world evidence suggests a large variation in patient reported outcomes and a proportion of patients are later explanted due to loss of analgesia. Possible predictors for outcome have been explored in smaller...

Objective To evaluate the construct validity and internal consistency of the Work Ability Index (WAI) in patients with chronic pain in secondary and tertiary care. Methods Cross-sectional study based on 200 patients with chronic pain (> 3 months), with a final sample of 118 participants, 18–64-years-old. Construct validity was assessed by explorat...

Introduction About 20% of the adult population have chronic pain, often associated with psychological distress, sick leave and poor health. There are large variations in the clinical picture. A biopsychosocial approach is used in investigation and treatment. The concept of personalised medicine, that is, optimising medication types and dosages for...

Valid assessment of pain is essential in daily clinical practice to enhance the quality of care for the patients and to avoid the risk of addiction to strong analgesics. The aim of this paper is to find a method for objective and quantitative evaluation of pain using multiple physiological markers. Data was obtained from healthy volunteers exposed...

Background: As yet, there is limited research that can identify factors that differentiate between painful and nonpainful neuropathies after traumatic nerve injury. The aim of this study was to compare subjects with pain and without pain, all after operative nerve repair in the upper extremities. Methods: Subjects in both groups (pain, n = 69; p...

Background and aims Aside from the long term side effects of a nerve injury in the upper extremity with devastating consequences there is often the problem of chronic neuropathic pain. The studies concerning the prevalence of persistent pain of neuropathic origin after peripheral nerve injuries are sparse. The prevalence and risk factors associated...

Background and aims Recent research indicates a previously unknown low-grade systemic or neurogenic inflammation in groups of chronic pain (CP) patients. Low-grade inflammation may have an important role in symptoms that have previously not been well depicted: widespread pain, tiredness and cognitive dysfunctions frequently seen in severely impaire...

Background and aims The RELIEF (Real Life) study by AstraZeneca was designed as an observational study to validate a series of Patient Reported Outcome (PRO) questionnaires in a mixed population of subjects with neuropathic pain (NP) coming from diabetes, neurology and primary care clinics. This article is an analysis of a subset of the information...

Background and aims: Patients suffering from chronic nonmalignant pain constitute a heterogeneous population in terms of clinical presentation and treatment results. Few data are available about what distinguishes different groups in this huge population of patients with chronic persistent pain (CPP). A subgroup that is poorly studied, consists of...

Aims A few previous studies indicate an ongoing of low-grade systemic inflammation in chronic pain patients (CPP) [1, 2]. In the present study we investigated the plasma inflammatory profile in severely impaired chronic pain patients. In addition we studied if there were any alterations in inflammation patterns at one-year follow up, after the pati...

Introduction The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3 min' mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2 min' manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2 min' algorithm found worse outcome for patients with...

Introduction: The aim of this analysis was to evaluate outcome among patients with VT/VF in the LINC trial and its association to delayed defibrillation and the amount of adrenaline used. Methods: The LINC database was searched for patients with an initial rhythm of VT or VF. The data were analysed with regards to return of spontaneous circulation...

To perform two predefined sub-group analyses within the LINC study and evaluate if the results were supportive of the previous reported intention to treat (ITT) analysis. Predefined subgroup analyses from the previously published LINC study were performed. The Per-Protocol population (PPP) included the randomised patients included in the ITT-popula...

Aims Treatment of the most complex chronic pain patients, often not accepted in regular pain management programs, remains a challenge.To beable todesign interventions for these patients we must know what characterize them. The aim of this study was to characterize a subgroup of pain patients, treated in our in-patient rehabilitation programme, orga...

Aims Many new potential medicines fail in early clinical development. AZD1386 is a TRPV1 antagonist and was developed for treatment of osteoarthritis pain at AstraZeneca. Following preclinical studies to characterize the compound, translational studies and first time in man studies the challenge is great to select the right doses and study populati...

Importance: A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials. Objective: To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with...

The effects of a TRPV1 antagonist (AZD1386) were investigated in patients with acute pain. After removal of a mandibular third molar and at request of analgesia 103 patients randomly received 95mg AZD1386 (n=40), placebo (n=40) or 500mg naproxen (n=23) in a double-blind manner. Plasma samples were drawn, and pain intensity and body temperature were...

AimTo evaluate the analgesic efficacy of AZD1940, a novel peripherally acting cannabinoid CB1/CB2 receptor agonist, in patients undergoing third molar surgical removal.Methods This was a randomized, double-blind, placebo-controlled study in patients scheduled for surgical removal of an impacted lower third molar. Patients received a single oral dos...

Background The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hos...

The aim of the present study was to investigate the effects of AZD 1940, a novel peripherally acting cannabinoid CB 1 / CB 2 receptor agonist, on capsaicin‐induced pain and hyperalgesia, as well as on biomarkers of cannabinoid central nervous system ( CNS ) effects. The present study was a randomized, double‐blind, placebo‐controlled, four‐sequence...

Due to high prevalence and unmet medical need, chronic pain has become an important area for development of new medicines. Chronic pain disorders are heterogeneous with regard to pathophysiological mechanisms and clinical presentation. While a mechanism-based classification of pain is generally advocated, it is not yet applicable for diagnostic use...

The Prehospital Trauma Life Support (PHTLS) course has been widely implemented and approximately half a million prehospital caregivers in over 50 countries have taken this course. Still, the effect on injury outcome remains to be established. The objective of this study was to investigate the association between PHTLS training of ambulance crew mem...

The aim of the present study was to investigate the effects of nabilone on capsaicin‐induced pain and hyperalgesia, as well as on biomarkers of cannabinoid central nervous system ( CNS ) effects. A randomized, double‐blind, placebo‐controlled, crossover study was conducted in 30 healthy male volunteers receiving single doses of nabilone (1, 2 or 3...

Objectives: As a part of the chain of survival, the emergency medical communication centre (EMCC) and the emergency medical dispatcher (EMD) has an important role in early identification of out-of-hospital cardiac arrests (OHCA). The EMD may provide instructions to the caller and thereby initiate cardiopulmonary resuscitation in a substantial numb...

Mechanical chest compression devices are being implemented as an aid in cardiopulmonary resuscitation (CPR), despite lack of evidence of improved outcome. This manikin study evaluates the CPR-performance of ambulance crews, who had a mechanical chest compression device implemented in their routine clinical practice 8 months previously. The objectiv...

We aimed to find functional and structural differences in neuropathy between patients with and without chronic pain following nerve injury. We included 30 patients requiring hand surgery after a trauma, with 21 reporting chronic pain for more than one year after the injury, while 9 did not suffer from injury-related chronic pain. We assessed mechan...

The aim of the study was to evaluate the feasibility of a newly developed computer-assisted feedback system between dispatch centre and ambulances in Stockholm, Sweden. A computer-assisted feedback system based on a Finnish model was designed to fit the Swedish emergency medical system. Feedback codes were identified and divided into three categori...

This was a double-blind, randomised, placebo-controlled, crossover study of the acute cognitive and subjective effects of nabilone 1-3 mg in healthy male volunteers. The Cognitive Drug Research computerised system (CDR system) was used to assess changes in attention, working and episodic memory. In addition, a number of self-ratings were conducted...

Objectives: To establish a uniform framework describing the system and organisation of emergency medical response centres and the process of emergency medical dispatching (EMD) when reporting results from studies in emergency medicine and prehospital care. Design and results: In September 2005 a task force of 22 experts from 12 countries met in...

There is a need to improve postoperative pain organisation and management in hospitals. One of the most important factors in achieving this is to improve active assessment of pain in the postoperative phase. Repeated audits on an annual basis over a 3 year period. Ward nurses, appointed as "pain control representatives", performed the data collecti...

LUCAS is a new device for mechanical compression and decompression of the chest during cardiopulmonary resuscitation (CPR). The aim of this study was to compare the efficacy of this new device with standard manual external chest compressions using cerebral cortical blood flow, cerebral oxygen extraction, and end-tidal CO2 for indirect measurement o...

Adenosine and adenosine analogues induce antinociception both after systemic and intrathecal (i.t.) administration in animal models. Further, patients with neuropathic pain have been treated successfully with i.t. adenosine. Prior to introducing new analgesic drugs for regular spinal use in humans, experimental studies must be undertaken to evaluat...

The dispatcher plays a key role in allocating the right resource to patients in cases of medical emergency. In order to evaluate the performance of the dispatcher, it is necessary to analyse who is the caller, because this has an impact on the development of decision support systems. In the present study, all calls for an ambulance (n=565) during a...

Pain following spinal cord injury (SCI) is a therapeutic challenge. Only a few treatments have been assessed in randomized, controlled trials. The primary objective of the present study was to examine the analgesic effect of ketamine and lidocaine in a group of patients with neuropathic pain below the level of spinal cord injury. We also wanted to...

Neuropathic pain is often severe and resistant to pharmacological treatment. The aims of the present study were to assess the analgesic effect of ketamine and lidocaine and to investigate if measurement of different variables of sensibility could be used to identify responders. We also wanted to study if treatment resulted in changes of sensibility...

To study the successful implementation of paramedic administered prehospital thrombolysis in Sweden, and to consider the implications of this for the UK. A series of research visits were undertaken, including visits to Uppsala Hospital and dispatch centre, ambulance stations in several counties of Sweden and Dalarna County, which has one of the lon...

Post-sternotomy pain is sometimes a sequela of cardiac surgery. The incidence, characteristics and clinical course of post-sternotomy pain are not well known. The aim of our study was to determine the incidence of chronic post-sternotomy pain in patients undergoing sternotomy for cardiac surgery in general and according to the specific surgical pro...

Systemic adenosine has been shown in earlier case reports and a small placebo-controlled study to reduce pathological sensory dysfunction such as tactile allodynia in neuropathic pain. To evaluate this further, the effects of systemic adenosine infusion (50 microg/kg/min for 60 min) on tactile sensory dysfunction and pain was evaluated in 26 patien...

In Sweden, as in many other countries, paramedics or nurses constitute the majority of prehospital personnel. If tasks usually performed by doctors are to be performed by these personnel, there is a need for guidelines and triage in the handling of medical emergencies. We describe an information management system used in ambulances for data communi...

The endogenous compound adenosine is known to have various modulatory effects both in the peripheral and central nervous system. Adenosine and its analogues induce antinociception in animal models when administrated systemically and intrathecally (IT), both in acute and chronic models of pain. Before a new drug is introduced for spinal pain treatme...

Sameridine is a type of compound with both local anaesthetic and analgesic effects with the clinical intention to be used intrathecally (i.t.) in order to provide both surgical anaesthesia and prolonged postoperative analgesia. Before new drugs are introduced for clinical use, they must be tested for potential toxic effects. In the present study sa...

Ropivacaine is a new local anaesthetic available for spinal and epidural anaesthesia. When new drugs are being introduced for spinal application, their effect on spinal cord blood flow (SCBF) should be studied for safety and toxicological aspects. In the present study, SCBF was studied after intrathecal (i.t.) application of ropivacaine and bupivac...

Neurogenic pain is experienced by about 1% of the population. The efficacy of drug treatment for this condition has been poorly evaluated, and only recently have certain treatments been shown to have significant analgesic effects. Monotherapy with topical agents such as capsaicin is not usually sufficient. Oral agents that have proven effective in...

The study of spinal cord blood flow (SCBF) after spinal drug application is an important aspect of preclinical neurotoxicological screening. This investigation was designed to study how a new local anesthetic, ropivacaine, affects SCBF after intrathecal (IT) administration in the rat. SCBF was measured continuously in spontaneously breathing, enflu...

Islet-like cell clusters (ICCs) were prepared from the fetal porcine pancreas by a culture technique. The ICCs (approximately 500) were implanted under the left renal capsule of nude (nu/nu) C57BL/6J mice. Six weeks, months, 12 months, or 16-24 months later, the animals were anesthetized and the blood flows to the xenogeneic islet graft and the adj...

The study of spinal cord blood flow (SCBF) after spinal drug application is an important aspect of preclinical neurotoxicological screening.This investigation was designed to study how a new local anesthetic, ropivacaine, affects SCBF after intrathecal (IT) administration in the rat. SCBF was measured continuously in spontaneously breathing, enflur...

Plasma concentrations, maximum regional brain concentrations, and specific regional binding in the brain after administration of 0, 0.1, and 0.2 mg/kg doses of (S)-ketamine were measured in a randomized, double-blind, crossover study in five volunteers and were related to induced effects such as analgesia, amnesia, and mood changes. Specific bindin...

The aims of the present investigation were to study the blood flow rate in transplanted fetal porcine islet-like cell clusters (ICC) with laser-Doppler flowmetry and to evaluate the influence of hyperglycemia on this process. In order to investigate the degree of stress in transplanted beta cells during engraftment, the amount of heat shock protein...

Understanding of the complex pharmacology of the spinal cord may lead to rational advances in pain treatment. It appears that a number of specific neurochemical mechanisms exist, by which spinally administered receptor selective agents may modify nociceptive transmission. Spinal administration of pure competitive N-methyl-D-aspartate (NMDA) antagon...

The N-methyl-D-aspartate (NMDA) receptor complex plays a central role in the modulation of neuronal information in the central nervous system. This study was designed to examine the pharmacokinetics of the NMDA antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP) in plasma and cerebrospinal fluid (CSF) and rostral spread in the CSF...

The N-methyl-D-aspartate (NMDA) receptor antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP), which produces antinociception in experimental animal models after spinal administration, may be of value in clinical pain treatment. Safety screening of drugs intended for spinal administration includes evaluation of the drug's effect on...

This behavioral study was performed in order to delineate the antinociceptive effects of and the influence on motor function of a highly potent, competitive NMDA receptor antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP). After intrathecal (i.t.) administration of CPP to chronically catheterized rats, antinociception was studied...

Lysine acetylsalicylic acid has been reported to induce analgesic effects in humans after intrathecal (i.t.) injection. Before conducting further studies in humans with this drug, it is important to evaluate potential toxicological effects on the spinal cord in animals. In the present study the effects of chronic intrathecal administration of provo...

Studies in animals have shown that the adenosine receptor agonist R-phenylisopropyl adenosine (R-PIA) induces antinociceptive effects after intrathecal administration. Before such a potentially antinociceptive drug could be considered for intrathecal injection in humans, a neurotoxicologic examination of the spinal cord must be performed in animal...

Evaluation of spinal cord blood flow (SCBF) is important as a preclinical screening for potential neurotoxicologic side effects before introducing new therapeutic drugs for intrathecal (IT) administration. This study was undertaken to determine whether two drugs with possible antinociceptive effects, the N-methyl-D-aspartate receptor antagonist 3-(...

The present study was initiated to evaluate the effects of nitrous oxide on the surgeon's ratings of operating conditions in lower abdominal surgery. Forty patients without known gastrointestinal disorder, scheduled for elective hysterectomy were randomized into one of two groups. In both groups anaesthesia was induced with propofol and endotrachea...

We have examined the use of continuous positive airway pressure (CPAP) and apnoeic oxygenation for restoration of spontaneous breathing at the end of anaesthesia after controlled ventilation. We studied 45 adult patients without a history of acute or chronic respiratory disturbances. Anaesthesia wos inducsd with thiopentone or prnnnfnl and maintain...

The A1-adenosine receptor agonist, R-phenylisopropyl-adenosine (R-PIA), demonstrated antinociceptive properties in animal studies after intrathecal administration. In the evaluation of a drug for possible spinal injection in humans, the effects of intrathecal R-PIA on spinal cord blood flow (SCBF) were investigated using the laser-Doppler flow-metr...

: Adenosine administered to humans has been reported to induce pain after intravenous administration. On the other hand adenosine analogues have been shown to possess antinociceptive effects after peripheral and intrathecal administration in animals. The aim of the present study was to investigate the effect of peripheral administration of adenosin...

The frequency of cough 15-45 s after intravenous administration of a low dose of the opioid receptor agonist ketobemidone given for postoperative pain relief was assessed in 121 patients undergoing gynaecological or obstetrical operations. In patients subjected to caesarean section under spinal anaesthesia using bupivacaine, the frequency of an ear...

The aim of the present study was to investigate the effects of peripheral administration of R-PIA and NECA on a persistent pain stimulus using the formalin test. Both compounds significantly reduced licking activity.

In the present study, the antinociceptive effects after intrathecal injection of each of 6 N6-substituted adenosine analogs and of 2-phenylaminoadenosine were compared with the affinity for the A1- and A2-adenosine receptors. Adenosine analogs, substituted in the N6-position, had stereoselective structure-dependent antinociceptive effects in the ta...

R-phenylisopropyl-adenosine, which has an affinity for the adenosine A1 receptor higher than that for the A2 receptor, and N-ethylcarboxamide-adenosine, which has near equal affinity for the A1 and A2 receptors, were injected intrathecally into rats to evaluate differences in antinociceptive effect and motor impairment. Using the tail-immersion tes...