Affiliated to research
I am a teacher and researcher at heart and believe in continuing quality improvement in my personal and professional life. Learning is a life-long process and I enjoy learning as much as teaching. And the best part about my job is to take care of my patients. So, I try to understand the weakness in the management of our patients today, assess the problem in details, perform qualitative and quantitative research on how we can improve management and apply the results in my daily care of patients. In other words, I am basically a clinical researcher.
In my private time I love to read and travel and enjoy walking the mountains as a hobby since I feel one with nature. I am deeply concerned about the planet and the flora and fauna and take every opportunity to treat them as I would my patients – with care.
1. Postoperative pain and management: My main focus has been the evaluation and management of acute postoperative pain after surgery. My research group has analysed best management techniques following a wide range of procedures including abdominal hysterectomy (Andrea Perniola), radical retropubic prostatectomy (Federica Fant), total knee arthroplasty (Per Essving), total hip arthroplasty (Jan Kuchalik), hand surgery (Marcus Sagerfors) and colo-rectal surgery (Wiebke Siekmann). These projects and theses have led to improved pain management and new insights into pain.
2. Regional anesthesia and cancer progression: This is a hot topic in perioperative anesthesia. In a retrospective study from Central Sweden in patients undergoing surgery for colo-rectal cancer, we found that the application of epidural analgesia, in contrast to morphine-based intravenous anesthesia lead to longer survival. Several hypotheses have been presented and we are currently studying mechanisms that may explain this. In a study on patients undergoing prostate cancer surgery, we could not demonstrate that natural killer cell (NK cell) activity could explain the findings (Federica Fant). However, we have recently demonstrated that the inflammatory response is dampened with minimally invasive surgery (laparoscopic/robotic) compared to open surgery and this may partly explain the results. We are presently studying the role of local anesthetics on colo-rectal tumor cell proliferation in vivo. We are even studying the long-term effects of epidurals on metastases and survival in a prospective study in patients undergoing colo-rectal cancer surgery (Wiebke Siekmann).
3. Post-dural puncture headache (PDPH) in Obstetrics:Accidental dural puncture (ADP) and the resulting PDPH is a rare but well recognized complication of epidural analgesia during labor, affecting 1% patients. This is devastating for a mother with a newborn baby and affects bonding between the mother and child at a vulnerable period of time (post-partum). Auditory changes following ADP are well-described but not in the obstetric population using large gauge epidural needles. We have demonstrated that audiometry cannot be used as a diagnostic method for the clinical diagnosis of PDPH and long-term effects of PDPH on audiometric function (deterioration) occur, although the magnitude is small (Bijan Darvish). In a multicenter (> 150 centers in Europe), we are currently studying the incidence of PDPH, current trends in management and reasons for failure of epidural blood patch (EBP) that is often used as an invasive method for its management in > 1000 patients (EPiMAP Obstetrics) with myself as primary investigator and funded by the European Society of Anesthesiology.
4. Myocardial injury in patients undergoing non-cardiac surgery (MINS): Perioperative myocardial injury in patients < 70 years undergoing major surgery is not uncommon and may be associated with a high mortality. Most cases of myocardial injury during non-cardiac surgery (MINS) are seen within the first 48-72 h after surgery, diagnosed by elevated plasma troponin (TnT) alone and a majority have no symptoms or EKG changes. In contrast to myocardial infarction diagnosed in the emergency room (non-surgical patient) where treatment is well established, patients with MINS have a poorer outcome since the etiology of myocardial injury is unknown, non-invasive diagnostic tools are not widely available and management options remain unexplored. Importantly, elevated TnT in the perioperative period is an independent predictor of 30-day mortality. Surgical trauma also causes an increase in several pro-inflammatory cytokines, and together with sympathetic over-activity and platelet activation, usually leads to a hyper-coagulant state, which may lead to coronary thrombosis. There is also a risk of “cardiac stress” (cardiomyopathy) due to sympathetic over activity. Finally, hemodynamic changes may also contribute to an oxygen supply-delivery mismatch and may act synergistically with other factors named above, or independently, to cause MINS. Our aim is to investigate patients diagnosed with MINS using newly developed non-invasive radiological and physiological techniques as well as laboratory tests in order to better understand the etiology of MINS, and thereafter develop focused strategies to prevent and manage this major complication after surgery (Anna Tapper).
I have always enjoyed teaching nurses, medical students and doctors in my special areas of interest. I like to connect basic science to clinical application in order to better understand the translational connection. I have worked as a Senior Lecturer at Linköping University (2007-2011) and often invited to lecture at National and International Conferences, specifically in Europe. During my daily clinical work I am actively involved in teaching and training of nurses and junior doctors. I have written several book chapters and review articles in National and International literature. I have been a Leader and Examiner for a Continuing Course for Anesthesia Nurses at Örebro University.
1993 Specialist (Anesthesiology), Sweden
1986 Specialist, Fellow of the Royal College of Anesthetists (FRCA), London, UK
1982-86 Residency in Anesthesiology and Intensive Care, (UK and India)
1983 Diploma in Anesthesia (DA) (Delhi University), New Delhi
1981 Bachelor of Medicine and Surgery (MBBS) (Delhi University), N Delhi, India
Academic honours, awards and prizes
I have received several stipends and awards from National and International organizations but no award has been as great as the appreciation from my patients about my continuous care and constant indulgence in improving their perioperative journey through the traumas of surgery.