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  • 1
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Rocuronium ; Intubationsbedingungen ; Key words Rocuronium ; Intubation conditions ; Endoscopic upper airway surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Rocuronium is a new nondepolarizing muscle relaxant for which a fast onset has been described. The goal of this study was to examine whether the characteristics of rocuronium could make it an appropriate relaxant for the anaesthetic management of operations of intermediate duration such as endoscopic upper airway surgery. These operations, which require the anaesthesiologist and surgeon to ”share” the patient’s airway, require good muscle relaxation for endotracheal intubation and placement of endoscopic instruments. In addition, the time course of neuromuscular blockade and its relation to the quality of intubating conditions were analysed. Methods: The study was approved by the local ethics committee; 30 patients (ASA status 1–3) scheduled for elective endoscopic upper airway surgery were included after written informed consent. Exclusion criteria were suspected difficult intubating conditions, neuromuscular disease, or antibiotic therapy with aminoglycosides during the last 24 h. Anaesthesia was induced by propofol 2 mg/kg and alfentanil 1 mg after volume loading with 500 ml Ringer’s lactate and preoxygenation, and was maintained by propofol infusion 5–8 mg/kg/h and repetitive alfentanil injections according to clinical needs. Endotracheal intubation was performed by a senior anaesthesiologist 90 s after injection of rocuronium 0.6 mg/kg (2×ED95). Intubating conditions were graded 1 to 4 (1=excellent, 2=good, 3=sufficient, 4=inadequate). Acceleromyography was used for neuromuscular monitoring by means of the TOF-guard (Organon Teknika/Biometer). The adduction movement of the thumb was measured by an acceleration transducer while stimulating the ulnar nerve at the wrist via surface electrodes in a supramaximal train-of-four (TOF) mode (2 Hz every 15 s). Twitch height and TOF ratio were documented during the course of neuromuscular blockade. Data are presented as mean±standard deviation. Results: Patients were aged 37 to 64 years (mean 54±7). Intubating conditions were excellent in 17 cases and good in 7. In 2 cases intubating conditions were graded sufficient, as patients could be easily intubated but showed clear diaphragmatic movements at intubation. In 4 patients intubating conditions could not be judged, as a laryngoscopic view of the glottic structures was impossible for anatomic reasons. Neuromuscular block at intubation was 78±22%, onset time 152±62 s, clinical duration 30±8 min, and recovery index 11±4 min. The TOF ratio required 51±14 min to return to 0.7. Conclusions: Good to excellent intubating conditions can be expected 90 s after injection of rocuronium 0.6 mg/kg. Diaphragmatic reactions cannot be excluded. Complete relaxation of the adductor pollicis muscle is not necessary for endotracheal intubation. Intubation at a certain time interval, for example, 90 s after injection of rocuronium 0.6 mg/kg, can be recommended. Onset and recovery characteristics of rocuronium make it an appropriate relaxant for the anaesthetic management of operations of intermediate duration such as endoscopic upper airway surgery. Care should be given, however, to detect inadequate recovery of neuromuscular transmission, as there are considerable interindividual differences in recovery.
    Notes: Zusammenfassung In dieser Studie sollte am Beispiel von endoskopischen Eingriffen in der HNO-Heilkunde untersucht werden, ob Rocuronium ein geeignetes Muskelrelaxans für die Anästhesie bei mittellang dauernden Operationen ist. Analysiert wurden die Intubationsbedingungen 90 s nach Injektion von 0,6 mg/kg Rocuronium und die Wirkdauer dieser Dosis. Daneben wurden der zeitliche Verlauf der neuromuskulären Blockade und deren Beziehung zu der Qualität der Intubationsbedingungen erfaßt. 30 Patienten der ASA-Klassen 1–3 nahmen an der Untersuchung teil. 90 Sekunden nach Injektion von Rocuronium 0,6 mg/kg beurteilte ein erfahrener Anästhesist die Intubationsbedingungen. Die Messung der Relaxation erfolgte durch die Akzeleromyographie unter supramaximaler Train-of-four Stimulation des N. ulnaris. Bei 17 Patienten fanden sich sehr gute, bei 7 Patienten gute und bei zwei Patienten befriedigende Intubationsbedingungen. 4 Patienten zeigten anatomisch bedingt eine eingeschränkte laryngoskopische Sicht der Glottisstrukturen, so daß bei ihnen die Relaxanzwirkung an der Larynxmuskulatur nicht beurteilt werden konnte. Die maximale Relaxation war nach 152±62 s erreicht. Die klinische Wirkdauer betrug 30±8 min, der Erholungsindex 11±5 min. Nach 51±14 min war ein TOF-Quotient von 0,7 erreicht. Die neuromuskuläre Blockade zum Intubationszeitpunkt betrug 78±22%.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 22 (1996), S. 1466-1467 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1238
    Keywords: Key words Transportation of patients ; Critical illness ; Mechanical ventilation ; Critical care ; Predictors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: Critically ill patients are often transferred due to the growing number of diagnostic procedures required to be performed outside the intensive care unit. These transfers have proved to be very critical. The aim of this study was to evaluate predictors for the deterioration of respiratory function in critically ill patients after transfer. Design: Prospective, clinical, observational study. Setting: 1800-bed university teaching hospital. Subjects: 98 mechanically ventilated patients were investigated during transfer. Measurement and main results: Before transfer, all patients were classified according to the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Therapeutic Intervention Scoring System (TISS). Haemodynamics and arterial blood gases were measured at 11 different times. Arterial oxgen tension (PaO2), fractional inspired oxygen (FIO2), PaO2/FIO2 ratio, lowest PaO2/FIO2 ratio, minimal PaO2 and maximal FIO2, APACHE II score, TISS before transfer, age and duration of transfer were analysed as potential predictors for deterioration of respiratory function after transfer. Variables were analysed using Classification and Regression Trees and Clustering by Response. In 54 transports (55 %) there was a decrease in the PaO2/FIO2 ratio, and a decrease of more than 20 % from baseline was noted in 23 of the transferred patients (24 %). Age 〉 43 years and FIO2 〉 0.5 were identified as predictors for respiratory deterioration. Conclusions: Our predictors were able to indicate deterioration after transfer correctly in 20 of 22 patients (91 %), combined with a false-positive rate in 17 of 49 (35 %).
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1238
    Keywords: Key words C1-esterase inhibitor ; Complement system ; Sepsis ; Liver transplantation ; Caroli's disease ; Colloid osmotic pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The extent of complement and contact activation is related to outcome in sepsis. A low functional index of their main blocker C1-esterase inhibitor (C1-INH) is considered as a relative deficiency of C1-INH and might contribute to the development of fatal complications in the intensive care unit. The first results of therapeutic intervention with C1-INH concentrate in septic shock are promising. We report on our experience of C1-INH concentrate administration in a young woman with Caroli's disease as ultimate rescue therapy for septic shock with capillary leakage syndrome after combined liver and kidney transplantation. No focus of infection was detectable and thus surgical intervention was not indicated. Antibiotic therapy at that time included vancomycin, tobramycin, meropenem and fluconazol. Hemodynamic stabilization occurred within hours after administration of C1-INH concentrate. Simultaneously a reduction in vasopressor medication was possible and negative fluid balance was achieved.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1238
    Keywords: Key words Cyclosporine ; Liver transplantation ; Polymorphonuclear neutrophils ; Respiratory burst ; GM-CSF ; Multiparameter flow cytometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Superoxide production by polymorphonuclear neutrophils (PMNs) under cyclosporin A (CsA) therapy following kidney transplantation is impaired. We investigated if the respiratory burst of PMNs is similarly depressed in patients undergoing CsA treatment following orthotopic liver transplantation (OLTx). Additionally, the in vitro influence of granulocyte-macrophage colony-stimulating factor (GM-CSF) on the superoxide anion production was examined during the respiratory burst. Patients: 10 patients after OLTx and 10 healthy blood donors (control group). Measurements and results: PMNs were stimulated with bacteria (Escherichia coli) or a combination of tumour necrosis factor alpha (TNFα) and N-formyl-methionyl-leucyl-phenylalanine (FMLP). The respiratory burst was measured by oxidation of non-fluorescent dihydrorhodamine to the fluorescent rhodamine by means of flow cytometry. No differences in respiratory bursts from OLTx patients compared to those from healthy blood donors could be seen. Under TNFα/FMLP stimulation, the respiratory burst was significantly increased after in vitro incubation with GM-CSF (500 U ml–1) in patients following OLTx (from 58.2 to 74.5 %) as well as in the control group (from 47.4 to 61.9 %). Conclusions: Our results demonstrate that superoxide production is not impaired under CsA treatment following OLTx. The respiratory burst of these patients' PMNs can even be augmented by GM-CSF in vitro.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-1084
    Keywords: Key words: Aortic aneurysm – Endovascular grafting – Endograft – Endoleak
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to evaluate the Talent endoluminal stent graft (TESG) in treating abdominal aortic aneurysms (AAA). The TESG is a polyester-covered nitinol endograft (proximal diameters 20–38 mm and iliac limb diameters 8–22 mm). Twenty-two men were treated with the TESG via bilateral femoral arteriotomies. Pre-implantation, coil embolization of various vessels arising from the aneurysm was performed in 6 patients. Plain radiographs and spiral CT angiograms (CTA) were carried out at 7 days, 3, 6, and 12 months following TESG implantation or re-intervention. Median aortic and iliac diameters were 27 mm (range 20–34 mm) and 14 mm (range 10–19 mm). The corresponding graft diameters were 30 mm (range 24–38 mm) and 14 mm (range 12–20 mm). No patient was rejected purely on the basis of too large aortic or iliac diameters. Eight patients required custom-made grafts. Graft implantation was successful in all patients. There were no blood transfusions, distal embolic episodes, or conversions to open surgery. Re-intervention was necessary in 1 patient. Complications included one fatal myocardial infarction, one inguinal hematoma, and two superficial wound infections. The aneurysm thrombosed completely following implantation in 14 patients and at 3 or 6 months in 4 other patients. One patient with endoleak is awaiting his 3-month control and 2 patients show tiny endoleaks but reduction of aneurysm size. The mean aneurysm size decreased significantly from 58 ± 10 to 53 ± 13 mm (p 〈 0.0005). Due to the large sizes available and the option of custom-made grafts, the TESG helps widen the spectrum of patients who can be treated with endoluminal grafting. The treatment is associated with a significant reduction in aneurysm size.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford : Blackwell Science Ltd
    Anaesthesia 54 (1999), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We evaluated safety and efficacy of a sedation technique based on rectal and intravenous S-(+)-ketamine and midazolam to achieve immobilization during Magnetic Resonance Imaging (MRI). Thirty-four paediatric patients were randomly assigned to undergo either the sedation protocol (study group) or general anaesthesia (control group). Imaging was successfully completed in all children. Children in the study group received a rectal bolus (0.5 mg·kg−1 midazolam and 5 mg·kg–1 S-(+)-ketamine) and required additional i.v. supplementation (20 ± 10 μg·kg–1·min–1 S-(+)-ketamine and 4 ± 2 μg· kg−1· min−1 midazolam), spontaneous ventilation was maintained. Transient desaturation occurred once during sedation and four times in the control group (P=0.34). P ECO2 was 5.3 ± 0.5 kPa (40 ± 4 mmHg) in the study group and 4.1 ± 0.6 kPa (31 ± 5 mmHg) in the control group (P 〈 0.001). Induction and discharge times were shorter in the study group (P 〈 0.001), recovery times did not differ significantly between the groups. Our study confirms that a combination of rectal and supplemental intravenous S-(+)-ketamine plus midazolam is a safe and useful alternative to general anaesthesia for MRI in selected paediatric patients.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1436-0578
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Die endotracheale Intubation zählt zu den etablierten Methoden zur Sicherung der Atemwege von Notfallpatienten im präklinischen und klinischen Bereich [6]. Im Rettungsdienst erfolgt die Intubation nicht nur bei manifester respiratorischer Insuffizienz, sondern bei einer Vielzahl von Krankheitsbildern. Sie gewährleistet sicheren Schutz vor Aspiration, erleichtert die Korrektur einer vorbestehenden Hypoxie oder Hyperkapnie wie auch das Absaugen des Tracheobronchialsystems und ermöglicht die Applikation kardiovaskulär wirksamer Medikamente. Intubationsschwierigkeiten im Rahmen der präklinischen Notfallmedizin treten in aller Regel unvermittelt auf und können sich rasch zu einer akuten vitalen Bedrohung des Patienten entwickeln, die eine zerebrale Schädigung oder den Tod des Patienten zur Folge hat. Von einer schwierigen Intubation spricht man, wenn die direkte Laryngoskopie, die Plazierung oder das Einführen des Endotrachealtubus durch die Stimmritze problematisch oder unmöglich ist [8]. Der Algorithmus der endotrachealen Intubation sowie Alternativen zur Sicherung der Atemwege müssen allen im Rettungsdienst tätigen Personen vertraut sein (Abb. 1). Hierzu zählen die Oxygenierung des Patienten über eine Gesichtsmaske, die Anwendung der Larynxmaske [4, 7] und des Kombitubus © [12]. Zu den invasiven Zugangsmöglichkeiten zur Sicherung der Atemwege zählen die Koniotomie und Tracheotomie [11].
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1238
    Keywords: Key words Alcohol withdrawal syndrome ; Ethanol kinetics ; Ethanol dosage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Alcohol withdrawal syndrome (AWS) is a severe complication during postoperative treatment of alcohol-dependent patients. Besides the use of clomethiazole, clonidine, and benzodiazepines, there is another possible way to prevent AWS by deliberate administration of ethanol. The appropriate dosage of ethanol has not been known up to now and it could be defined according to the average ethanol elimination rate (EER) which, from forensic analysis, is known to be 15 mg/dl per h in a normal population. However, it is questionable whether these data are suitable for the calculation of the correct dosage in alcohol-dependent patients. Design: Preliminary retrospective descriptive study. Setting: Intensive care unit of a university teaching hospital. Patients: 11 alcohol-dependent patients (9 males, 2 females, mean age 50.8 years, range 33 to 60 years). Interventions: Ethanol substitution (ES) by parenteral application. Measurements and results: Ethanol kinetics were evaluated by repeated measurement of the blood ethanol concentration (BEC) over a period of at least 6 h parallel to the administration of ethanol. The average EER was found to be 28 mg/dl per h with a standard deviation of 11 mg/dl per h. The minimum value was 18 mg/dl per h and the maximum 50 mg/dl per h. These EERs were significantly higher than the EERs known from forensic analysis. AWS was prevented in all 11 patients. Conclusions: Close control of BEC and precise adjustment of ethanol administration are necessary prerequisites for ES. The standard EER is not sufficient to define the appropriate ethanol dosage due to enormous variations in the ethanol metabolism of alcohol-dependent patients.
    Type of Medium: Electronic Resource
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