Examining the quality of health economic analyses submitted to the Pharmaceutical Benefits Board in Sweden. The first year.

This study assessed the quality of health economic documentation submitted to the Pharmaceutical Benefits Board (PBB) in Sweden. Two different instruments were used in the evaluation: the PBB checklist, which was constructed by the authors from the PBB guidelines for health economic evaluations, and the QHES, a validated quality assessment instrument. Some areas that seem especially problematic, or where the quality was particularly low are identified and discussed.

Pneumoperitoneum for laparoscopic cholecystectomy is not associated with compromised splanchnic circulation.

Objective: To investigate the influence of increased intra-abdominal pressure during pneumoperitoneum on splanchnic circulation.

Design: Open study.

Setting: University hospital, Sweden.

Lack of neurohumoral response to pneumoperitoneum for laparoscopic cholecystectomy.

Background: Pneumoperitoneum (PP) for laparoscopic surgery induces prompt changes in circulatory parameters. The rapid onset of these changes suggests a reflex origin, and the present study was undertaken to evaluate whether release of vasopressor substances could be responsible for these alterations. The influence of two different anesthesia techniques was also evaluated.

Vectorcardiographic changes during laparoscopic cholecystectomy may mimic signs of myocardial ischaemia.

Background: Laparoscopic surgery involves the use of intra-abdominal carbon dioxide insufflation (pneumoperitoneum). The increased intra-abdominal pressure causes marked haemodynamic changes, which may influence electrocardiographic monitoring. The aim of the present study was to elucidate the influence of pneumoperitoneum on vectorcardiographic recordings.

Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling.

Background: Laparoscopic surgery requires the use of pneumoperitoneum (PP). When combined with positional changes, pneumoperitoneum may cause marked circulatory alterations.

Methods: Eight anaesthetized cardiovascularly healthy patients, scheduled for laparoscopic cholecystectomy, were studied before and during pneumoperitoneum in three different postures (supine, Trendelenburg and reversed Trendelenburg), employing transesophageal echocardiography and pulmonary artery pressure monitoring.

Pneumoperitoneum for laparoscopic surgery does not increase venous admixture.

Venous admixture as a measure of pulmonary gas exchange was studied before and during laparascopic cholecystectomy in 12 patients with normal healthy cardio-pulmonary function. After induction of anaesthesia the patients were studied by radial and pulmonary arterial catheterization and simultaneous arterial and mixed venous blood gas sampling in the horizontal, 15-20 degrees head-down and 15-20 degrees head-up tilt positions. After establishing the pneumoperitoneum (PP) by insufflation of carbon dioxide to an intraabdominal pressure level of 11-12 mmHg, the measurements were repeated in the same positions.

Haemodynamic effects of pneumoperitoneum and the influence of posture during anaesthesia for laparoscopic surgery.

The laparoscopic operating technique is being applied increasingly to a variety of intra-abdominal operations. Intra-abdominal gas insufflation, i.e.