Liisanantti Janne

Research group of Anesthesiology

 

Research unit: Surgery, Anesthesiology and Intensive Care

 

Group leader

Professor of Anesthesiology Janne Liisanantti (MD, PhD)

 

What do we do

Over the following years, we are facing an increasing need for medical care due to a higher proportion of elderly people. At the same time, new and more efficient but also more expensive and more resource-demanding treatment options are developed. On the other hand, surgical procedures become less invasive and procedures are expanding from the surgical unit to different hybrid environments, which sets new requirements for the anesthesia care. Moreover, the monitoring of the patient during the perioperative process also becomes less invasive and new technologies will be available. At the same time, the economical recourses for facing these phenomena are limited as the size of the workforce decreases in developed countries. The focus of the unit’s research is the impact of patient-, technology- and society-related factors on the outcome of the perioperative process and different patient processes of acute care. The research questions are raised from the daily clinical life in the developing environment, organization and technology. The research group will closely collaborate with the clinicians and heads of the units to solve these clinical problems using a scientific approach.

To face the research challenge, the focus of the research group of anesthesiology include the following branches:

1. Outcome of the process of major surgery and invasive procedures

Our previous results clearly showed that patient-related factors, such as malnutrition, increase the risk of unfavorable outcomes after major surgery for the cancer of the head and neck. We also found a significant reduction in daily life–related quality of life, observed, for example, in difficulties in eating and speaking. We have now built up a project to examine these factors and create preventive interventions.  We previously found postoperative medical complications to be the most significant risk factors for adverse outcomes, poor quality of life, and long-term mortality, and we also aim to find the factors that increase the risk of unfavorable outcomes within the perioperative process. The possible factors include pre- and postoperative nutritional status and nutritional therapy. This risk analysis will be implemented also to other patient groups, such as urgent laparotomies and invasive procedures due to ischemic strokes, hip fractures and intestinal resections due to chronic inflammatory bowel diseases. The coordinators of this branch are Sanna Lahtinen (M.D., Ph.D.) and Janne Liisanantti (M.D., Ph.D.).

2. Intraoperative monitoring as a part of the perioperative process

Optimal fluid management and the use of vasoactive medications, so called goal-directed therapy, is  of paramount importance in major cardiac and noncardiac surgery. Managing the goal directed therapy in these settings is challenging and often requires invasive procedures such as central cannulation, which is prone to complications, although they are rare. We examined the use of stroke volume variation in fluid management in the free flap surgery for the cancer of the head and neck and found a significant decrease in the volume load in these patients. We have started a project to validate the use of non-invasive cardiac output monitoring using bioreactance and non-calibrated mini-invasive pulse contour techniques in major surgery including off-pump coronary bypass grafting, on-pump cardiac surgery, abdominal aortic surgery and major abdominal surgery. Moreover, we are aiming to further validate the current paradigm of performing goal-directed therapy in cardiac surgery patients at our institution. Initiatives to reduce the need for invasive monitoring could reduce costs and reduce complications related to the use of invasive devices. Finally, optimal therapeutical targets in guiding the fluid and vasoactive therapies during major cardiac and noncardiac surgery may further lead to improved patient outcomes. The coordinators of this branch are Timo Kaakinen (M.D., Ph.D.) and Tiina Erkinaro (M.D., Ph.D.)

3. The impact of anesthesia method on the perioperative process outcomes

The ideal choice of the anesthesia method is of great importance in the perioperative process. The chosen method may influence the long-term outcome such as mortality, morbidity and e the length of stay as well as short term outcomes such as postoperative pain, nausea and functional recovery. In a retrospective series we found that in below-knee amputations spinal anesthesia had several benefits compared to general anesthesia.  We have started to examine the differences in postoperative pain and recovery in patients with ankle and tibial shaft fractures in various settings. The coordinators of this branch are Timo Kaakinen (M.D., Ph.D.) and Merja Vakkala (M.D., Ph.D.).

4. Substance usage in acute care

The use of alcohol and other substances is a major concern in acute care. In our study material, every third ICU-admitted trauma patient was intoxicated by alcohol or other substances on admission; furthermore, every third non-traumatic ICU patient had alcohol-related health problems. We have started a project with Northern Finland Birth Cohort 1966 to examine the role of substance use in ICU-admitted patients. This prospective cohort data includes more than 250 persons admitted to ICU, with prospectively collected data on general health. The same project includes socioeconomic data, and we plan to compare the socioeconomic well-being of the ICU-admitted patients with the situation of the rest of the cohort population.  We have also on-going study of epidemiology of poisonings in the area. The coordinator of this branch is Janne Liisanantti (M.D., Ph.D.) and the projects collaborates with the research group of intensive care medicine.

5. Pre-hospital emergency care and the treatment pathways of urgent patient

The pre-hospital care has developed over the years. New techniques and diagnostic tools, such as bedside laboratory tests, are now part of the daily practice. Also, advanced level pre-hospital care is delivered by more educated personnel and the patients are transported multimodally, by EMS or HEMS. Using a large pre-hospital care database (nearly 70,000 missions per year), which includes vital parameters and data on commenced care, we aim to analyze the impact of pre-hospital care on the outcomes and treatment pathways. We have found large regional differences in the use of EMS-services and we continue to examine this phenomenon. Moreover, urgent care in the Northern Ostrobothnia Hospital District is centralized in Oulu University hospital, which makes a challenge to the EMS.  The coordinators of this branch are Lasse Raatiniemi (M.D., Ph.D.) and Janne Liisanantti (M.D., Ph.D.) .

Funding :
Finnish Association For Alcohol Research
Thelma Mäkikyrö Foundation
Finnish Medical Association Duodecim

 

Our team

Senior researchers

  • Tiina Erkinaro, M.D., Ph.D.
  • Timo Kaakinen, M.D., Ph.D.
  • Sanna Lahtinen, M.D., Ph.D.
  • Lasse Raatiniemi, M.D., Ph.D.
  • Merja Vakkala, M.D., Ph.D.

PhD-students

  • Mia Aitavaara-Anttila, M.D.
  • Siiri Hietanen, M.D.
  • Ulla Junttola, M.D.
  • Lauri Koskela, B.M.
  • Pasi Lehto, M.D.
  • Ilona Niemelä, M.Sci
  • Okke Nikkinen, M.D.
  • Juho Nurkkala, B.M.
  • Terhi Puhto, M.D.
  • Laura Ylikauma, M.D.
  • Tellervo Ylimartimo, M.D.

 

Where are we headed

Over the years, the outcomes of many critical conditions have improved and undoubtedly this development will continue. Nevertheless in many diseases, especially in cancers, the borderline between curative and palliative situations is inconsistent. Also, when operative care is provided to elderly patients, the final result of the care extends beyond initial intraoperative or immediate recovery phases. Therefore, the outcomes used in scientific work in this field should be long-term outcomes and not just “hard” outcomes such as mortality. Other long-term outcomes include the quality of life, recover, and functionality after care and the factors affecting them. The effect of each part of the perioperative process on these outcomes is in the focus of the present research unit. The intent is to conduct research on the treatment processes and their impact on the long-term outcomes but also to develop more efficient and safe methods to provide anesthesia care and intra- and postoperative monitoring.

 

Our main collaborators

Research group of Intensive Care medicine, PEDEGO, Research group of Surgery

 

How to find us

Research unit: Surgery, Anesthesiology and Intensive Care

janne.liisantti[at]oulu.fi

Last updated: 28.1.2020