Gottfried Bogusch

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (12)20.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Supraglottic airway devices are increasingly used in anaesthesia and emergency medicine. This study was designed to investigate the oesophageal seal of the novel supralaryngeal airway device, I-Gel (I-Gel), in comparison with two of the laryngeal mask airways, Classic (cLMA) and ProSeal (pLMA), in a model of elevated oesophageal pressure. The three supralaryngeal airway devices were inserted into eight unfixed cadaver models with exposed oesophagi that had been connected to a water column producing both a slow and a fast oesophageal pressure increase. The pressure applied until the loss of oesophageal seal during a slow and fast pressure increase was measured. During the slow increase of pressure, the pLMA withstood an oesophageal pressure up to a median of 58 cm H(2)O, while the cLMA was able to block the oesophagus up to a median of 37 cm H(2)O, and I-Gel already lost its seal at 13 cm H(2)O. One minute after maximum pressure had been applied, the pLMA withstood an oesophageal pressure of 59 cm H(2)O, the cLMA of 46 cm H(2)O, and I-Gel airway of 21 cm H(2)O. A fast release of oesophageal fluid was accomplished through the oesophageal lumen of both the pLMA and I-Gel. Both the pLMA and cLMA provided a better seal of the oesophagus than the novel I-Gel airway. The pLMA and I-Gel drain off gastrointestinal fluid fast through the oesophageal lumen. Thus, tracheal aspiration may be prevented with their use. Further study is necessary.
    BJA British Journal of Anaesthesia 11/2008; 102(1):135-9. DOI:10.1093/bja/aen319 · 4.35 Impact Factor
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    ABSTRACT: Purpose: Isolated fractures of the hamate hook can be treated by conservative or surgical means. Because nonoperative treatment is associated with high nonunion rates, surgical treatment with open reduction and internal fixation through a palmar approach is often preferred. The aim of this study was to refine surgical treatment of hamate hook fractures using a cannulated mini compression screw through a dorsal percutaneous approach. Methods: Artificial fractures of the hamate hook were created in five male cadaver hands under fluoroscopy. Using an ulnar approach, the hamate hook was fractured at the base (n = 3) and middle third (n = 2) of the hook using an osteotome. Each fracture was visualized by X-ray and computed tomography. Under fluoroscopy, the fracture was stabilized with a 1.1 mm K wire through a dorsal percutaneous approach which guided the introduction of a 3 mm diameter cannulated mini compression screw. The screw position was then controlled by X-ray and computed tomography. Results: Percutaneous fixation of the fractured hook through the dorsal approach was achieved in all cases. Regardless of the fracture location, all fragments were adapted into anatomically correct positions. No displacement or disruption of the cortex of the hook was observed with central screw positioning. Conclusion: Minimal invasive repair of isolated hamate hook fractures through a dorsal percutaneous approach is feasible. The special properties of the cannulated mini compression screw allow optimal screw positioning and stable fixation without risk of diplacement or disruption of the hook fragment.
    European Journal of Trauma and Emergency Surgery 08/2008; 35(4):397-402. DOI:10.1007/s00068-008-8112-y · 0.38 Impact Factor
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    ABSTRACT: Supraglottic airway devices are increasingly important in clinical anesthesia and prehospital emergency medicine, but there are only few data to assess the risk for aspiration. We designed this study to compare the seal of seven supraglottic airway devices in a cadaver model of elevated esophageal pressure. The classic laryngeal mask airway, laryngeal mask airway ProSeal, intubating laryngeal mask airway Fastrach, laryngeal tube, laryngeal tube LTS II, Combitube, and Easytube were inserted into unfixed human cadavers with an exposed esophagus that had been connected to a water column of 130 cm height. Slow and fast increases of esophageal pressure were performed and the water pressure at which leakage appeared was registered. The Combitube, Easytube, and intubating laryngeal mask Fastrach withstood the water pressure up to more than 120 cm H2O. The laryngeal mask airway ProSeal, laryngeal tube, and laryngeal tube LTS II were able to block the esophagus until 72-82 cm H2O. The classic laryngeal mask airway showed leakage at 48 cm H2O, but only minor leakage was found in the trachea. Devices with an additional esophageal drain tube drained fluid sufficiently without pulmonary aspiration. Concerning the risk of aspiration, the use of devices with an additional esophageal drainage lumen might be superior for use in patients with an increased risk of aspiration. The Combitube, Easytube, and intubating laryngeal mask Fastrach showed the best capacity to withstand an increase of esophageal pressure.
    Anesthesia and analgesia 03/2008; 106(2):445-8, table of contents. DOI:10.1213/ane.0b013e3181602ae1 · 3.42 Impact Factor
  • J Birnbaum, E Klotz, G Bogusch, T Volk
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    ABSTRACT: Despite the increasing use of ultrasound, electrical nerve stimulation is commonly used as the standard for both plexus and peripheral nerve blocks. Several recent randomized trials have contributed to a better understanding of physiological and clinical correlations. Traditionally used currents and impulse widths are better defined in relation to the distance between needle tip and nerves. Commercially available devices enable transcutaneous nerve stimulation and provide new opportunities for the detection of puncture sites and for training. The electrically ideal position of the needle usually is defined by motor responses which can not be interpreted without profound anatomical knowledge. For instance, interscalene blocks can be successful even after motor responses of deltoid or pectoral muscles. Infraclavicular blocks should be aimed at stimulation of the posterior fascicle (extension). In contrast to multiple single nerve blocks, axillary single-shot blocks more commonly result in incomplete anaesthesia. Blockade of the femoral nerve can be performed without any nerve stimulation if the fascia iliaca block is used. Independently of the various approaches to the sciatic nerve, inversion and plantar flexion are the best options for single-shot blocks. Further clinical trials are needed to define the advantages of stimulating catheters in continuous nerve blocks.
    Der Anaesthesist 12/2007; 56(11):1155-62. · 0.74 Impact Factor
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    ABSTRACT: The Division of Evidence Based Medicine (dEBM), Clinic for Dermatology, Venerology and Allergology, Charité--Universitätsmedizin Berlin, offers on a regular basis workshops focusing on different areas of aesthetic medicine. Once a year a joint course is provided in cooperation with the Institute of Anatomy, offering the participants the possibility to improve their injection techniques as well as their knowledge on the facial anatomy. This course is focused on treatment with hyaluronic acids of different particle size. Besides the classical indications, it considers new indications such as correcting the shape of the nose or lacrimal groove. Thirteen physicians participated in the course, which was evaluated as very helpful as it improved not only the injection technique but also the knowledge of anatomy.
    Journal der Deutschen Dermatologischen Gesellschaft 04/2007; 5(3):226-9. · 1.40 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 03/2007; 5(3):226-229. DOI:10.1111/j.1610-0387.2007.06242.x · 1.40 Impact Factor
  • J. Birnbaum, E. Klotz, G. Bogusch, T. Volk
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    ABSTRACT: Trotz der zunehmenden Anwendung des Ultraschalls repräsentiert die elektrische Nervenstimulation derzeit wahrscheinlich noch den quantitativ überwiegenden Standard bei der Durchführung von Plexusanästhesien und peripheren Nervenblockaden. In den letzten Jahren haben zahlreiche Untersuchungen zu einem besseren Verständnis physiologischer und klinischer Zusammenhänge beigetragen. Die verwendeten Stromstärken und Impulsbreiten in Abhängigkeit vom Abstand zwischen Nadelspitze und Nerv sind mittlerweile auch an Patienten besser definiert worden. Handelsübliche Geräte erlauben eine transkutane Nervenstimulation und eröffnen damit neue Möglichkeiten beim Auffinden von Punktionsstellen sowie bei der Ausbildung. Eine elektrisch optimale Nadelposition wird in der Regel über motorische Stimulationsantworten definiert, die ohne profunde funktionell-anatomische Kenntnisse nicht interpretierbar sind. So können interskalenäre Blockaden auch über motorische Reaktionen im M.deltoideus oder in der Pektoralismuskulatur erfolgreich sein. Infraklavikuläre Blockaden sollten eine Stimulation des posterioren Faszikels anstreben (Extensionsbewegungen). Axilläre Single-shot-Verfahren führen häufiger zu inkompletten Blockaden verglichen mit dem Aufsuchen der Einzelnerven weiter distal. Für Blockaden des N.femoralis ist es möglich, ganz auf Stimulationen zu verzichten, wenn ein Fascia-iliaca-Block durchgeführt wird. Unabhängig von den zahllosen Zugangsvarianten für den N.ischiadicus sind eine Supinations-/Inversionsbewegung oder die Plantarflexion die beste Option für Single-shot-Blockaden. Ob Stimulationskatheter einen entscheidenden Vorteil bei kontinuierlichen Blockaden bieten, bleibt Gegenstand weiterer klinischer Untersuchungen. Despite the increasing use of ultrasound, electrical nerve stimulation is commonly used as the standard for both plexus and peripheral nerve blocks. Several recent randomized trials have contributed to a better understanding of physiological and clinical correlations. Traditionally used currents and impulse widths are better defined in relation to the distance between needle tip and nerves. Commercially available devices enable transcutaneous nerve stimulation and provide new opportunities for the detection of puncture sites and for training. The electrically ideal position of the needle usually is defined by motor responses which can not be interpreted without profound anatomical knowledge. For instance, interscalene blocks can be successful even after motor responses of deltoid or pectoral muscles. Infraclavicular blocks should be aimed at stimulation of the posterior fascicle (extension). In contrast to multiple single nerve blocks, axillary single-shot blocks more commonly result in incomplete anaesthesia. Blockade of the femoral nerve can be performed without any nerve stimulation if the fascia iliaca block is used. Independently of the various approaches to the sciatic nerve, inversion and plantar flexion are the best options for single-shot blocks. Further clinical trials are needed to define the advantages of stimulating catheters in continuous nerve blocks.
    Der Anaesthesist 01/2007; 56(11):1155-1162. DOI:10.1007/s00101-007-1238-1 · 0.74 Impact Factor
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    ABSTRACT: Fractures of the hook of the hamate are a rare event. The fracture cannot always be detected clinically and standard radiographs do not always provide an overlap-free image of the hook of the hamate, so that fractures can easily be overlooked. The objective of the present study was to examine if the sensitivity of detecting hamulus ossis hamati fractures can further be improved by a modified conventional radiographic projection.After dissection of the hook of the hamate on 10 cadaver hands, a fracture was produced close to the base using a surgical chisel. Conventional radiographs were then performed in four different projections (dorso-palmar, lateral, carpal-tunnel and oblique view). The oblique view was obtained in a 45° supination position, slight extension and radial duction, with the tube tilted from distal to proximal by 30°. An axial spiral CT was used as a reference for detection of the fracture.The highest sensitivity of the conventional radiographs, with 8/10 identified fractures (80%), was achieved by the oblique view. The carpal-tunnel view with 4/10 (40%) and the dorso-palmar projection with 3/10 (30%) were much lower. All fractures were missed in the lateral projection. If all of the conventional radiographic projections are taken into account, the sensitivity is increased to 90%. All of the fractures were reliably detected in the axial CT-image.If a hamulus ossis hamati fracture is suspected clinically, in addition to the dorso-palmar and carpal-tunnel view, the special oblique view described here should be performed as a third projection plane, while the lateral view can be dispensed with. However, even if all projections are taken into account, a negative finding in the conventional radiographic imaging does not exclude a fracture with absolute certainty. In such cases, a CT or MRI should be performed to exclude a fracture.
    Rontgenpraxis 05/2006; DOI:10.1016/j.rontge.2005.08.001
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fractures of the hook of the hamate are a rare event. The fracture cannot always be detected clinically and standard radiographs do not always provide an overlap-free image of the hook of the hamate, so that fractures can easily be overlooked. The objective of the present study was to examine if the sensitivity of detecting hamulus ossis hamati fractures can further be improved by a modified conventional radiographic projection. After dissection of the hook of the hamate on 10 cadaver hands, a fracture was produced close to the base using a surgical chisel. Conventional radiographs were then performed in four different projections (dorso-palmar, lateral, carpal-tunnel and oblique view). The oblique view was obtained in a 45 degrees supination position, slight extension and radial duction, with the tube tilted from distal to proximal by 30 degrees. An axial spiral CT was used as a reference for detection of the fracture. The highest sensitivity of the conventional radiographs, with 8/10 identified fractures (80%), was achieved by the oblique view. The carpal-tunnel view with 4/10 (40%) and the dorso-palmar projection with 3/10 (30%) were much lower. All fractures were missed in the lateral projection. If all of the conventional radiographic projections are taken into account, the sensitivity is increased to 90%. All of the fractures were reliably detected in the axial CT-image. If a hamulus ossis hamati fracture is suspected clinically, in addition to the dorso-palmar and carpal-tunnel view, the special oblique view described here should be performed as a third projection plane, while the lateral view can be dispensed with. However, even if all projections are taken into account, a negative finding in the conventional radiographic imaging does not exclude a fracture with absolute certainty. In such cases, a CT or MRI should be performed to exclude a fracture.
    Rontgenpraxis 02/2006; 56(2):59-65.
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    ABSTRACT: To examine the ability to image fractures of the body and hook of the hamate bone in conventional X-rays and high-resolution computed tomography (HR-CT). In an in vitro experiment using 18 cadaver hands, the hamate bone was fractured at different places. Before and after fracture, conventional X-rays were taken in different planes (anteroposterior, lateral, oblique, and carpal tunnel), and HR-CT was performed with 2-mm layer thickness in the axial, sagittal, and coronal plane. Taking into account all the conventional X-ray projections applied, the in vivo experiment revealed a sensitivity of 72.2%, a specificity of 88.8%, and an accuracy of 80.5%. For the HR-CT, the sensitivity was 100%, the specificity was 94.4%, and the accuracy was 97.2%. Fractures of the body and hook of the hamate cannot always be detected with certainty in the conventional X-ray image, even if different projectional planes are used. The HR-CT is the imaging procedure of choice for further clarification, and an axial or sagittal plane should be selected.
    Investigative Radiology 02/1999; 34(1):46-50. DOI:10.1097/00004424-199901000-00007 · 4.45 Impact Factor
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    ABSTRACT: Examination of the ability to image fractures of the body and hook of the hamate bone in conventional X-rays and HR-CT. In an in vitro experiment on 18 cadaver hands, the hamate bone was fractured at different localisations. Before and after fracture, conventional x-rays were taken in different projectional planes: a.-p., lateral, oblique and carpal tunnel view, as well as an HR-CT with 2 mm layer thickness in the axial, sagittal and coronal plane. In addition, 15 clinically verified hamate bone fractures (two body and 13 hook of hamate fractures) were reviewed retrospectively to assess the value of the imaging procedures that led to diagnosis. Taking into account all conventional x-ray projections applied, the in vitro experiment yielded a sensitivity of 72.2%, a specificity of 88.8% and an accuracy of 80.5%. For CT, the sensitivity was 100%, the specificity 94.4% and the accuracy 97.2%. In retrospective clinical evaluation, 60% of the existing fractures were identified in the conventional x-ray images. The remaining fractures were detected by additional procedures like scintigraphy, conventional tomography and CT. For the diagnosis of fractures of the body and hook of the hamate HR-CT is the imaging procedure of choice, in which case an axial or sagittal plane should be chosen.
    RöFo - Fortschritte auf dem Gebiet der R 08/1998; 169(1):53-7. · 1.96 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 01/1998; 169(07):53-57. DOI:10.1055/s-2007-1015049 · 1.96 Impact Factor

Publication Stats

114 Citations
20.82 Total Impact Points

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Institutions

  • 2008
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
  • 2006
    • University of Rostock
      Rostock, Mecklenburg-Vorpommern, Germany
  • 1999–2006
    • Humboldt-Universität zu Berlin
      • Institute of Finance
      Berlín, Berlin, Germany
  • 1998
    • Freie Universität Berlin
      • Institute of Social and Cultural Anthropology
      Berlin, Land Berlin, Germany