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  • 1
    Electronic Resource
    Electronic Resource
    Zur Ableitungsauswahl für ein EEG-Monitoring in der Anästhesie (1995)
    Springer
    Der Anaesthesist 44 (1995), S. 473-477 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter EEG ; Anästhesie ; Monitoring ; Ableitungsauswahl ; automatische Narkosetiefebestimmung ; Key words EEG ; Anaesthesia ; Monitoring ; Selection of channels ; Automatic staging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The conventional multichannel electroencephalogram is quite inconvenient for long-term monitoring in the operating theatre or intensive care unit. Recording of the EEG would be easier if a small number of channels was sufficient. Aiming at reduction of channels, leads from different regions of the scalp were analysed visually and with regard to their spectral content. Methods. Electrode placements corresponded to the International 10/20 System (Fig. 1). EEG recordings were made with a conventional device (ES 12000), a personal computer, and a spectral analyser. Two-channel recordings. Retrospective analysis was performed on data from 392 patients (age 14–90 years) whose anaesthesia was induced with various anaesthetics/narcotics, for instance thiopental, ketamine, etomidate, halothane, and enflurane. The EEG was recorded using C3–P3 and Cz–A1. For each patient the changes of spectral parameters during the course of the induction were plotted and visually analysed. For statistical analyses a 30-s epoch of each patient was randomly selected from the first few minutes after the beginning of induction. Ten-channel recordings. In ten gynaecological patients (age 26–55 years) EEG recordings were performed during induction of anaesthesia with thiopental in combination with fentanyl, N2O and O2. The set of channels consisted of Fz′–Cb1, F3′–Cb1, Cz–Cb1, C3–Cb1, P3–Cb1, Oz–Cb1, Fz′–F3′, F3′–C3, C3–P3, and P3–Oz. The electrodes Fz′ and F3′ were positioned on the forehead near to Fz and F3, respectively. These sites were chosen because they allow easy application of electrodes. The relationship between channels was calculated with Bravais-Pearson's coefficient of correlation for the power and the absolute power in the frequency bands delta (0.5–3.5 Hz), theta (3.5–7.5 Hz), alpha (7.5–12.5 Hz), and beta (〉12.5 Hz). Results. In visual and statistical analyses of the two- and ten-channel recordings under the influence of anaesthetics/narcotics, similar changes of EEG activity could be observed in all channels. Although differences in the absolute power of the frequency bands were present, there was high conformity in the composition of the spectral content of the different channels. Classification of the EEG into stages of anaesthesia by means of a single channel led to consistent results for all channels. Alpha activity as leading feature of the awake state predominated occipitally. In channels including the region around the ears, contamination with EKG artifacts was observed. Conclusions. EEG patterns under the influence of different anaesthetics/narcotics are adequately represented by a reduced number of channels. For the choice of an appropriate set of channels the following aspects should be considered. Contamination with artifacts should be as low as possible, electrode sites should easily be accessible, and special features of the awake state should be identifiable. Experience with routinely conducted EEG recordings in the operating theatre and the intensive care unit showed that the channels C3–P3 or C4–P4 provide a sufficient basis for automatic staging of the depth of anaesthesia, which is implemented in the EEG monitor Narkograph.
    Notes: Zusammenfassung EEG-Registrierungen mit einer größeren Anzahl von Ableitungen sind technisch aufwendig. Als Routinemonitoringverfahren z.B. zur Beurteilung der Effekte von Anästhetika/Narkotika bei der Steuerung der Narkose sind sie daher wenig geeignet. Die EEG-Ableitung wäre einfacher, wenn sie mit wenigen Kanälen erfolgen könnte. Daher sollten in dieser Arbeit EEG-Ableitungen von unterschiedlichen Regionen des Kopfs mit dem Ziel einer Kanalreduktion visuell und im Hinblick auf den spektralen Gehalt verglichen werden. Dazu wurden 392 EEG-Kurven mit zwei Kanälen aus Narkoseeinleitungen mit unterschiedlichen Anästhetika/Narkotika und zehn EEG-Aufzeichnungen mit jeweils zehn Kanälen bei Narkoseeinleitungen mit Fentanyl und Thiopental untersucht. Die visuellen und statistischen Auswertungen zeigen, daß unter dem Einfluß von Anästhetika/Narkotika in unterschiedlichen Ableitungen gleichartige EEG-Bilder auftreten und anhand einer einzelnen dieser Ableitungen eine Stadienklassifikation möglich ist. Bei eigenen Routinemessungen haben sich die Ableitungen C 3 −P 3 oder C 4 −P 4 als Grundlage für ein EEG-Monitoring in der Anästhesie als geeignet erwiesen. Diese Ableitungen bieten neben leichter Zugänglichkeit der Ableiteelektroden gute Voraussetzungen für die Erkennung des Wach-EEG und sind im Vergleich mit anderen Ableitungen artefaktarm.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050178
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  • 2
    Electronic Resource
    Electronic Resource
    Altersabhängige Korrelation zwischen EEG-Parametern und zunehmender Narkosetiefe unter Propofol Effekte von Fentanyl (1996)
    Springer
    Der Anaesthesist 45 (1996), S. 722-730 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Narkosetiefe ; Propofolinfusion ; Alterseffekte ; EEG-Parameter ; Fentanyl ; Key words Anaesthetic depth ; Propofol infusion ; Age-effects ; EEG-descriptors ; Fentanyl
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract This study was designed to determine the relationship between the electroencephalogram (EEG) and clinical signs of depth of anaesthesia during induction of anaesthesia by slow infusion of propofol (18 mg/kg·h). Methods. Four groups of 12 patients each were studied (groups I and II: 18–50 years; groups III and IV: 〉70 years). Groups II and IV were given 0.15 mg fentanyl before the infusion of propofol was started. The clinical signs recorded were: (1) loss of eyelash reflex; (2) respiratory insufficiency; (3) tolerance to painful stimuli; and (4) intubation. Cardiovascular reactions were documented. The dosage was calculated from the infusion time (time from start of infusion until specific clinical event). Bipolar electrodes were placed at the C4/P4 positions (10–20 placement system) to record the EEG, which was processed by a personal computer (Narkograph) using fast-fourier transformation. The Narkograph calculates multiparametric EEG stages ranging from A to F (according to Kugler) as well as median frequency and spectral-edge frequency 95% (SEF). Stage A represents alpha rhythm, stage F is equivalent to a burst suppression pattern. For statistical analysis a Student t-test was performed. Results. The infusion of propofol led to slowly developing anaesthesia with loss of eyelash reflex followed by loss of pain response, respiratory insufficiency, and intubation. In the younger patients the clinical signs coincided with well-differentiable EEG patterns. Above 70 years of age there were problems in distinguishing the EEG patterns, as there are alterations of the EEG with advanced age. The multiparametric EEG stage calculated by the Narkograph showed a better correlation with the clinical signs than median or SEF. Fentanyl shortened the induction time remarkably: less propofol was needed to achieve corresponding clinical signs when fentanyl was added. The EEG patterns typical for a specific clinical condition remained unchanged by fentanyl. Similar clinical situations showed equal EEG stages in all groups. Different clinical situations could be distinguished by significant changes in the EEG. The infusion times for tolerance to pain and respiratory insufficiency were not significantly different, and there were no significant differences between the EEG patterns and propofol doses for these two clinical parameters. Intubation was performed after 18.5±4.6 min in group I with a propofol dose of 5.6±1.4 mg/kg. This time was shortened by fentanyl in group II to 10.1±3.7 min and a propofol dose of 3.0±1.1 mg/kg. Conclusion. Different clinical signs corresponding to different levels of depth of anaesthesia could be differentiated by their EEG parameters. The EEG stage allowed better differentiation of the clinical conditions than the single-parameter EEG derivatives median and SEF. The results of this study show that EEG monitoring provides information about depth of anaesthesia.
    Notes: Zusammenfassung Mit dieser Studie soll der Zusammenhang zwischen klinisch unterschiedlichen Narkosetiefen und drei EEG-Parametern (Median, SEF und ein multivariat berechnetes EEG-Stadium) während einer langsamen Narkoseeinleitung mit Propofol (18 mg/kg/h) bestimmt werden. Es wurden 48 Patienten aus zwei Altersgruppen untersucht. Die Hälfte der Patienten erhielt vor Beginn der Propofolinfusion 0,15 mg Fentanyl. Die klinische Narkosetiefe wurde anhand definierter Zeichen wie z.B. Wegfall des Lidreflexes bestimmt. Insgesamt zeigte sich, daß klinisch unterschiedliche Narkosezustände anhand von EEG-Parametern abzugrenzen sind, wobei das multivariat berechnete EEG-Stadium den Monoparametern Median und SEF teilweise überlegen ist. Dies war unabhängig von alleiniger Propofolgabe oder additiver Fentanylapplikation. Es ergab sich eine deutliche Veränderung des EEG mit zunehmendem Alter, die die Interpretation erschwerte. Fentanyl führte zu einer Verkürzung der Einleitung. Eine Abwehrreaktion auf die Intubation ließ sich nachträglich nur unter bestimmten Bedingungen aus dem EEG ableiten, während das Auftreten von hämodynamischen Reaktionen bei Intubation nicht durch EEG-Parameter abgeschätzt werden konnte.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050304
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  • 3
    Electronic Resource
    Electronic Resource
    Veränderung des Narkose-EEG mit dem Lebensalter (1995)
    Springer
    Der Anaesthesist 44 (1995), S. 467-472 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter EEG ; Alterseffekte ; Anästhesie ; Deltaleistung ; Monitoring ; Key words EEG ; Aging ; Anaesthesia ; Delta power ; Monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The number of older persons who have to undergo surgical procedures is steadily growing. For these patients the risks of anaesthesia are often increased because of their past medical history and their restricted physiological resources. Apart from parameters of the cardiovascular system, the electroencephalogram (EEG) represents a supplementary method for intraoperative monitoring, because cerebral alterations caused by anaesthetics or narcotics are directly reflected in the EEG. In routinely conducted registrations of the EEG in the operating theatre it appeared that the EEG of older persons differed from the EEG of younger patients. The aim of the present study was to further investigate the effect of patients' age on the EEG during anaesthesia. Methods. Three data sets from different EEG registrations were analysed. The first data set consisted of inductions of anaesthesia with 7 mg/kg body weight thiopental in 43 patients from 17 to 80 years of age (mean 53.6±16.7 years) using derivations C3-P3 and Cz-A1. The second data set included 69 EEG registrations of general anaesthesia induced with barbiturates and maintained with enflurane in patients from 16 to 83 years (mean 51.4±17.7 years). The third data set comprised inductions of anaesthesia with 2 mg/kg body weight propofol. EEGs of the second and third data set were recorded with the EEG monitor `Narkograph' using derivation C3-P3 and derivations C3-P3/C4-P4, respectively. Classification of the EEGs was performed according to the proposals of Kugler [12]. The basis for the statistical analysis of all data sets was formed by parameters from the power spectra of the EEG recordings. Results. The data from inductions of anaesthesia with thiopental and propofol showed EEG patterns from alpha-EEG to burst suppression activity, whereby periods with burst suppressions could more often be observed in the EEG of older people. Under thiopental burst suppression activity occured in 20% of patients up to 50 years, in 47% of those between 50 and 70 years and in 89% over 70 years. The corresponding figures for propofol were 0%, 5% and 54%, respectively. Figure 2 depicts the correlation between age and power for the thiopental data. The power decreases with increasing age of the patients. This result led to further investigations of the effect of patients' age on the power in different EEG stages. Of special interest were deep stages of anaesthesia, because especially in these stages visual inspections revealed smaller amplitudes of the EEG signal for older patients than for younger persons. Figure 3 shows the power in the delta frequency band in deep stages of barbiturate-induced enflurane anaesthesia for patients of different age groups. The power in the delta frequency band distinctly decreases for geriatric patients. The same effect could be observed for the propofol data (Fig. 4). Conclusions. The EEG represents an important method for effective intraoperative monitoring and contributes to an individually adjusted couse of anaesthesia, especially for geriatric patients. In these patients, clinical signs such as parameters of the cardiovascular system, which are usually used to judge the depth of anaethesia, are often altered by the patient's past medical history or by drugs. Furthermore, geriatric patients show a reduced need for narcotic agents. However, the variation of the required dosage is greater in older than in younger persons. The results of the present study show that with regard to an automatic classification of the EEG during anaesthesia, alterations of the EEG with age have to be taken into account.
    Notes: Zusammenfassung In routinemäßigen intraoperativen EEG-Registrierungen von älteren Patienten wurden in tiefer Narkose häufig niedrigere Amplituden beobachtet als bei jüngeren Personen. Daher sollte das Narkose-EEG mit Hilfe mehrerer Meßreihen gezielt auf Alterseffekte untersucht werden. Ausgewertet wurden EEG-Registrierungen aus Einleitungsphasen mit 7 mg/kg KG Thiopental bzw. 2 mg/kg KG Propofol sowie aus barbituratinduzierten Enflurannarkosen. Bewertungen des Original-EEG erfolgten in Anlehnung an die Kriterien von Kugler [12]. In den Narkoseeinleitungen mit Thiopental und Propofol traten EEG-Stadien vom Wachzustand bis zu Burst-Suppression-Aktivität auf. In beiden Gruppen erreichten alte Patienten besonders häufig Burst-Suppression-Phasen. In D- und E-Stadien der tiefen Narkose fand sich bei älteren Patienten eine geringere Leistung im Deltaband sowie eine niedrigere Gesamtleistung. Die Ergebnisse zeigen, daß es für den Einsatz einer automatischen EEG-Interpretation erforderlich ist, altersabhängige Veränderungen des Narkose-EEG zu berücksichtigen. Gerade für ältere Patienten, bei denen häufig Vorerkrankungen und eingeschränkte physiologische Leistungsreserven vorhanden sind, ist ein intraoperatives EEG-Monitoring von besonderem Wert, denn das Elektroenzephalogramm erleichtert die Beurteilung der Wirkung zentral wirksamer Medikamente und trägt so zu einer differenzierten Narkoseführung bei.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050177
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  • 4
    Electronic Resource
    Electronic Resource
    Herstellung heterologer Immunseren gegen Lymphocyten des Hundes (1967)
    Springer
    Journal of molecular medicine 45 (1967), S. 199-204 
    Details
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Heterologous antidog-lymphocytesera were produced by immunizing a horse, a calf and two sheeps with lymphocytes of the thoracic duct lymph respectivly with thymocytes of pupies. Serologically tested, the immunsera showed antibodies against lymphatic cells, granulocytes, erythrocytes and serumprotein of dog. The horseantidoglymphocyteserum reached the highest antibody content with a lymphagglutinating titer of 1:8192. The antibodies against erythrocytes and protein could be absorbed separately from the antibody against lymphocytes. The antibodies against lymphocytes were not individual-, strain- and speciesspecific.
    Notes: Zusammenfassung Zur Herstellung heterologer Immunseren gegen Lymphocyten des Hundes wurden ein Pferd, ein Kalb und zwei Schafe mit Lymphocyten der Ductus-thoracicus-Lymphe bzw. mit Thymuszellen neugeborener Hunde immunisiert. Die Immunseren wiesen bei serologischer Prüfung Antikörper gegen lymphatische Zellen, Granulocyten, Erythrocyten und Serumeiweiß des Hundes auf. Das Immunserum vom Pferd erreichte mit einem Lymphagglutinationstiter von 1:8192 den höchsten Antikörpergehalt. Die Antikörperwirkung gegen Erythrocyten und Hundeserum konnte isoliert von derjenigen gegen Lymphocyten absorbiert werden. Die Antikörper gegen Lymphocyten waren individuum-, rassen- und artunspezifisch.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01716908
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  • 5
    Electronic Resource
    Electronic Resource
    Gewinnung von heterologen Immunseren gegen menschliche Lymphocyten (1968)
    Springer
    Journal of molecular medicine 46 (1968), S. 249-258 
    Details
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Basing on the experiences with horse-antidog-lymphocytesera immunsera from horse against human lymphatic cells have been produced. 7 horses have been immunized: 4 with thoracic duct lymphocytes, each one with lymphocytes from blood of patients suffering from lymphadenosis, with spleen cells and with thymushomogenates. Up to now immunsera against thoracic duct lymphocytes and leucemic lymphocytes have been used in vivo. Details of the preparation of antigens, of immunization and purification of immunsera are described. The leucoagglutinating titer of the immunsera ranged between 1:2000–1:64000. The problems of the in vitro testing are discussed.
    Notes: Zusammenfassung Auf Grund der Erfahrungen mit Pferdeantihundelymphocytenseren wurden Immunseren vom Pferd gegen menschliche Lymphocyten hergestellt. 7 Pferde wurden bisher immunisiert: 4 mit Lymphocyten aus der Lymphe des Ductus thoracicus, je 1 Pferd mit Lymphocyten von Patienten mit Lymphadenose, mit Milzzellen und mit Thymushomogenaten. In vivo wurden bisher Seren gegen Ductus thoracicus-Lymphocyten und leukämische Lymphocyten erprobt. Einzelheiten der Antigengewinnung, Immunisierung und Präparation der Immunseren werden geschildert. Nach der in vitro-Testung im Leukoagglutinationstest, dessen Problematik geschildert wird, liegen die erreichten Titerhöhen zwischen 1:2000–1:64000.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01770881
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  • 6
    Electronic Resource
    Electronic Resource
    Sind spezielle Scores für Schwerverbrannte nötig? (1997)
    Springer
    Intensivmedizin und Notfallmedizin 34 (1997), S. 220-226 
    Details
    ISSN: 1435-1420
    Keywords: Key words Score ; intensive care ; burn care ; Schlüsselwörter Score ; Intensivmedizin ; Verbrennungmedizin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Conclusion: Regarding the prediction of mortality, specific scores for burned patients showed no advantages in comparison to general intensive scores. Prediction of sepsis does not seem to be possible with the analyzed score systems. For the monitoring of sepsis general intensive scores as well as the specific BSS seem to be a useful tool. This study gives evidence for a possibility of reduction of number of scoring systems, which would increase their acceptance.
    Abstract: Zusammenfassung Ein Vergleich der Mortalitäts- und Sepsis-Vorhersage zwischen speziellen Verbrennungs-Scores und allgemeinen Intensiv-Scores stand im Mittelpunkt dieser retrospektiven Untersuchung. Hierbei wurden bei 51 Schwerverbrannten der ,,Abbreviated Burn Severity Index`` (ABSI) und der ,,Baltimore Sepsis Scale`` (BSS) als spezielle Verbrennungs-Scores auf der einen Seite sowie die allgemeinen Intensiv-Scores ,,Mortality Prediction Model`` (MPM II), ,,Simplified Acute Physiology Score`` (SAPS II), APACHE II (ApII), ,,Hannover Intensiv Score`` (HIS) und der Sepsis-Score nach Elebute und Stoner (ES) auf der anderen Seite erhoben. Am Tag 1 und 3 wurde für alle Scores aus der Sensitivität und Spezifität eine ,,Receiver Operating Characteristic – ROC`` erstellt und die Fläche unter dem Graphen als Gütekriterium der Scores berechnet (ROC-Wert: max. 1,0; min. 0,5). Weiterhin wurden die Score-Werte von Patienten mit und ohne septischen Verlauf an den Tagen 1, 2, 3, 5, 7, 10, 14, 21 und 28 auf einen statistischen Unterschied (Mann-Whitney-U-Test) geprüft. Ergebnisse: Bezüglich der Mortalitätsvorhersage zeigten ABSI, BSS sowie die allgemeinen Scores HIS, ApII und ES ROC-Werte von über 0,8 und eine absolute Korrektheit von über 75%. Der MPM II und der SAPS II schnitten deutlich schlechter ab. Für die Sepsisvorhersage zeigten alle Systeme ROC-Werte zwischen 0,6 und 0,7. Obwohl die ROC-Werte am Tag 3 gegenüber dem ersten Behandlungstag teilweise anstiegen, so blieben insgesamt doch die ROC-Werte, die absolute Richtigkeit und der positiv prädiktive Wert hinter den Ergebnissen der Mortalitätsvorhersage zurück. Die Unterscheidungskraft der Scores zwischen Patienten mit und ohne septischen Verlauf war am deutlichsten und frühesten mit Hilfe von BSS und HIS möglich. Bereits am 2. Behandlungstag zeigte sich ein signi-fikanter Unterschied im Mann-Whitney-U-Test. Schlußfolgerung: Spe-zielle Verbrennungs-Scores bieten hinsichtlich einer Mortalitätsvorhersage keine entscheidenden Vorteile gegenüber allgemeinen Intensiv-Scores. Die Vorhersage einer Sepsis scheint hingegen mit keinem der untersuchten Systeme möglich. Ein Sepsis-Monitoring ist sowohl mit dem speziellen Verbrennungs-Score BSS als auch mit den allgemeinen Systemen möglich. Die vorliegende Arbeit liefert einen Hinweis auf eine mögliche Vereinfachung der immer verwirrenderen Vielfalt von Score-Systemen. Eine Reduktion würde jedoch wesentlich zur allgemeinen Akzeptanz beitragen.
    Notes: Summary The comparison of prediction of mortality and sepsis by different score systems was the objective of this retrospective study in 51 patients. Specific scores for burned patients – ``Abbreviated Burn Severity Index'' (ABSI) and the ``Baltimore Sepsis Scale'' (BSS) were compared with the general intensive score systems: ``Mortality Prediction Model'' (MPM II), ``Simplified Acute Physiology Score'' (SAPS II), APACHE II (ApII), ``Hannover Intensive Score'' (HIS) and the sepsis score developed by Elebute and Stoner (ES). On days 1 and 3 the true-positive ratio (sensitivity) was plotted against false-positive ratio (1-specifity) for each score. The area under the curve (max. 1; min. 0.5) correlates with the quality of the score system. We also tested the discrimination of septic and nonseptic patients by using the different scores.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050040
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  • 7
    Electronic Resource
    Electronic Resource
    Untersuchungen über das Verhalten der Leberdurchblutung während Narkose und Operation (1965)
    Springer
    Langenbeck's archives of surgery 313 (1965), S. 932-935 
    Details
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01449447
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  • 8
    Electronic Resource
    Electronic Resource
    Die immunsuppressive Wirkung eines heterologen Antihundelymphocytenserums (1967)
    Springer
    Clinical and experimental medicine 143 (1967), S. 313-320 
    Details
    ISSN: 1591-9528
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The survival time of dogs after renal homografts was markedly prolonged by administrating an horse-anti-dog-lymphocyte-serum. By pretreatment with this serum the production of free circulating antibodies against sheep erythrocytes was diminished. There was no significant influence upon the defense against infections.
    Notes: Zusammenfassung Durch Gabe eines Pferdeantihundelymphocytenserums konnte die überlebenszeit nach homologer Nierentransplantation beim Hund wesentlich verlängert werden. Die Bildung freizirkulierender Antikörper gegen Schaferythrocyten wurde bei den Tieren gehemmt, die mit Antilymphocytenserum vorbehandelt waren. Eine starke Minderung der Infektabwehr konnte klinisch nicht festgestellt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02044987
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  • 9
    Electronic Resource
    Electronic Resource
    Die Versorgung von ambulanten Tumorpatienten mit Opioidanalgetika (1996)
    Springer
    Der Schmerz 10 (1996), S. 283-291 
    Details
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Tumorschmerz ; Niedergelassene Ärzte ; Morphinmythos ; Betäubungsmittel-Verschreibung ; Gesetzliche Bestimmungen ; Key words Cancer pain ; Practitioners ; Opioids ; Narcotic regulations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Introduction. Treatment of chronic cancer pain with strong opioids is indicated in about 60–70 % of patients. Surprisingly, these very potent analgesics are prescribed with great reservations in many countries, including Germany. The aim of our investigation was to analyse the supply of opioid analgesics to outpatients with cancer pain in the region of Hannover, which has about 1.1 million inhabitants. Methods. In Germany special prescription forms, i. e. triplicate forms, have to be used for the prescription of strong opioids. At the time when our investigation took place prescriptions for outpatients had to be renewed every 7 days. For two observation periods of 6 months lasting from January to June 1988 and from January to June 1991 all of the opioid prescription forms that had been issued by general practitioners for clients of the AOK Hannover (one of the major medical insurance companies) were evaluated. The reasons for prescribing opioids were analysed by recording the diagnosis. The individual treatment period on an outpatient basis during these 6 months was determined, excluding, e. g. days of hospitalization. Results. During the two observation periods only 16.2 % (1988) and 19.5 % (1991) of the practitioners in the region of Hannover prescribed strong opioids to outpatients. The majority of the practitioners consisted of general practitioners and specialists in internal medicine. Although these two groups mainly function as family doctors who are responsible for the basic therapeutical needs of their patients, only 22.6–33.8 % of these doctors prescribed opioids to outpatients. In two-thirds of the patients, cancer pain was the reason for prescribing the drug. The total number of patients with a prescription for cancer pain was 164 in 1988 and 196 in 1991. Altogether 1002 prescription forms in 1988 and 1065 prescription forms in 1991 had been issued for these patients. Applied to the individual treatment period as an outpatient, only 36.0 % of the patients in 1988 and 32.1 % in 1991 received a regular prescription of strong opioids every 7 days. The mean time interval between separate prescriptions was 16.8 ± 25.4 days in 1988 and 19.4 ± 29.1 days in 1991. Accordingly, the majority of patients with chronic cancer pain had been supplied with opioids only occasionally. Conclusion. Our data indicate a significant undertreatment of outpatients suffering from cancer pain. Taking into account the estimated total number of patients suffering from cancer, only 14.5 % (1988) and 19.0 % (1991) of all outpatients in need of strong opioids were supplied sufficiently with those analgesics. Comparing the results from the observation period in 1988 with the results from 1991 it becomes obvious that the situation has not changed. There are different reasons for the insufficiency of opioid treatment: many physicians as well as their patients are still afraid of the side effects of strong opioids. Therefore, it is necessary to improve education concerning this issue. The legal restrictions on the use of narcotics and their complexity are another important reason for doctors not to prescribe strong opioids. In 1993 the regulations were simplified; nevertheless, this has not led to a profound change in the attitude of the prescribing practitioners. Thus, further changes in legislation seem to be necessary so that the requirements for the prescription of strong opioids do not differ from other drugs.
    Notes: Zusammenfassung Starke Opioide werden in Deutschland bei Patienten mit Tumorschmerzen extrem selten eingesetzt. In den Jahren 1988 und 1991 haben in der Region Hannover nur 16,2 % bzw. 19,5 % der niedergelassenen Ärzte derartige Analgetika verordnet. Von den Tumorpatienten, die überhaupt mit Opioiden versorgt wurden, erhielten 1988 nur 36,0 % und 1991 nur 32,1 % ihre Medikamente regelmäßig und kontinuierlich. Hochgerechnet auf die Gesamtzahl der Patienten mit einer Tumorerkrankung bedeutet dies, daß nur 14,5 % (1988) bzw. 19,0 % (1991) aller Patienten, bei denen opioidpflichtige Schmerzen bestanden, im ambulanten Bereich suffizient mit Opioidanalgetika versorgt wurden. Die Ursachen für die restriktive Verschreibung von Opioiden und damit für die Defizite in der Schmerztherapie bei Tumorpatienten sind vielschichtig. Zum einen bestehen bei vielen Ärzten, erstaunlicherweise aber auch bei den betroffenen Patienten selber, irrationale Ängste vor Nebenwirkungen und Risiken einer Opioidmedikation. Ein weiterer wichtiger Grund sind die gesetzlichen Bestimmungen, die bei der Verordnung von Opioiden beachtet werden müssen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004820050052
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