Publications (6)12.15 Total impact
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Article: [Occupational exposure to inhalation anesthetics at the work-place of veterinary surgery].
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ABSTRACT: In a prospective study we evaluated the work-place pollution by isoflurane and nitrous oxide during various anaesthetic procedures in animal surgery. The study was conducted during one working week at an University Animal Department. Trace concentrations of isoflurane and nitrous oxide were directly measured every minute in the breathing zone by means of a photoacoustic infrared spectrometer in two different operating rooms (OR) with an air turnover of 17 changes per hour. In one OR the 8-hour time-weighted average (mean +/- SEM) was calculated to be 12.3 +/- 9.9 ppm nitrous oxide and 1.9 +/- 2.5 ppm isoflurane. The other OR, where only isoflurane was used, was contaminated with 5.3 +/- 8.1 ppm isoflurane. In the first OR, the trace gas concentrations were low and comparable to values obtained under human anaesthesia in adults and children. The higher contamination in the second OR resulted from performing inhalational anaesthesia with an open mask system in birds and small animals. Although the mean values were below the recommended occupational exposure standards, some high peak values (> 300 ppm isoflurane) violated these threshold limits. We recommend the use of a local scavenging device, if other alternatives such as total intravenous anaesthesia are not possible.Zentralblatt für Hygiene und Umweltmedizin = International journal of hygiene and environmental medicine 12/1998; 201(4-5):405-12. -
Article: Waste gas exposure during desflurane and isoflurane anaesthesia.
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ABSTRACT: Currently, there are no data available concerning the occupational exposure to desflurane during general anaesthesia. This prospective, randomized study reports on occupational exposure to desflurane, compared to isoflurane, in a modern operation theatre (OT). The study was performed in an OT equipped with a modern air-conditioning system and with a low-leakage anaesthesia machine connected to a central scavenging system. Trace concentrations of the anaesthetics were measured continuously by means of a photoacoustic infrared spectrometer during general anaesthesia in 30 patients undergoing eye surgery. Values were obtained within the breathing zone of the anaesthetist, the surgeon, the auxiliary nurse and at the mouth of the patient. Desflurane and isoflurane were administered with median (range) endtidal concentrations of 4.7 (3.8-10.3) vol% and 0.9 (0.6-1.4) vol%, respectively. The personnel-related median values of the average trace concentrations of desflurane and isoflurane were 0.5 (0.01-7.5) ppm and 0.2 (0.01-1.6) ppm, respectively. Occupational exposure to desflurane is low in the environment of a modern OT, even though it has to be administered in approximately 5-fold higher concentrations compared to isoflurane.Acta Anaesthesiologica Scandinavica 09/1998; 42(7):864-7. · 2.19 Impact Factor -
Article: Waste gas exposure during desflurane and isoflurane anaesthesia
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ABSTRACT: Background: Currently, there are no data available concerning the occupational exposure to desflurane during general anaesthesia. This prospective, randomized study reports on occupational exposure to desflurane, compared to isoflurane, in a modern operation theatre (OT).Methods: The study was performed in an OT equipped with a modern air-conditioning system and with a low-leakage anaesthesia machine connected to a central scavenging system. Trace concentrations of the anaesthetics were measured continuously by means of a photoacoustic infrared spectrometer during general anaesthesia in 30 patients undergoing eye surgery. Values were obtained within the breathing zone of the anaesthetist, the surgeon, the auxiliary nurse and at the mouth of the patient.Results: Desflurane and isoflurane were administered with median (range) endtidal concentrations of 4.7 (3.8–10.3) vol% and 0.9 (0.6–1.4) vol%, respectively. The personnel-related median values of the average trace concentrations of desflurane and isoflurane were 0.5 (0.01–7.5) ppm and 0.2 (0.01–1.6) ppm, respectively.Conclusions: Occupational exposure to desflurane is low in the environment of a modern OT, even though it has to be administered in approximately 5-fold higher concentrations compared to isoflurane.Acta Anaesthesiologica Scandinavica 07/1998; 42(7):864 - 867. · 2.19 Impact Factor -
Article: [Combined sciatic nerve-3 in 1 block in high risk patient].
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ABSTRACT: We report on a case of combined sciatic nerve block and 3-in-1 block for amputation of lower limb in an ASA IV-V patient 6 days after intraoperative cardiopulmonary resuscitation following induction of general anaesthesia. A 54-year old male patient was admitted for necrosectomy of a crural ulcer due to end-stage peripheral vascular disease and non-insulin dependent diabetes mellitus. The patient also suffered from toxic cardiomyopathy. After induction for general anaesthesia the haemodynamic situation deteriorated progressively and ended up in cardiac arrest with consequent successful cardiopulmonary resuscitation. The operation was cancelled and the patient was admitted to the intensive-care unit, where he was extubated after 2 days of further haemodynamic stabilisation. Following development of a septic situation of the lower limb the patient was again admitted for amputation six days after the cardiopulmonary resuscitation. Regional anaesthesia was conducted with a combination of a sciatic nerve block via the posterior approach and a 3-in-1 block facilitated by ultrasonographic guidance. For each of the blocks we used 20 mL mepivacaine 1%. Sensory blockade was sufficient and the patient remained haemodynamic and respiratorily stable. The combined sciatic and 3-in-1 block is a rarely used technique, but for haemodynamically unstable patients it is a safe method for surgery of the lower limb.ains · Anästhesiologie · Intensivmedizin 07/1998; 33(6):399-401. · 0.41 Impact Factor -
Article: Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks.
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ABSTRACT: The use of ultrasound reduces the onset time, improves the quality of sensory block, and minimizes the risks associated with the supraclavicular approach for brachial plexus and stellate ganglion blockade. The present study was designed to evaluate whether ultrasound also facilitates the approach for 3-in-1 blocks. Forty patients (ASA physical status II or III) undergoing hip surgery after trauma were randomly assigned to two groups. In the ultrasound (US) group, 20 mL bupivacaine 0.5% was administered under US guidance, whereas in the control group, the same amount and concentration of local anesthetic was administered with the assistance of a nerve stimulator (NS). After US- or NS-based identification of the femoral nerve, the local anesthetic solution was administered, and the distribution of the local anesthetic solution was visualized and recorded on videotape in the US group. The quality and the onset of the sensory block was assessed by using the pinprick test in the central sensory region of each of the three nerves and compared with the same stimulation on the contralateral leg every 10 min for 60 min. The rating was performed using a scale from 100% (uncompromised sensibility) to 0% (no sensory sensation). Heart rate, noninvasive blood pressure, and oxygen saturation were measured at short intervals for 60 min. The onset of sensory blockade was significantly shorter in Group US compared with Group NS (US 16 +/- 14 min, NS 27 +/- 16 min, P < 0.05). The quality of the sensory block after injection of the local anesthetic was also significantly better in Group US compared with Group NS (US 15% +/- 10% of initial value, NS 27% +/- 14% of initial value, P < 0.05). A good analgesic effect was achieved in 95% of the patients in the US group and in 85% of the patients in the NS group. In the US group, visualization of the cannula tip, the femoral nerve, the major vessels, and the local anesthetic spread was possible in 85% of patients. Incidental arterial puncture (n = 3) was observed only in the NS group. We conclude that an US-guided approach for 3-in-1 block reduces the onset time, improves the quality of the sensory block and minimizes the risks associated with this regional anesthetic technique. Implications: The onset time and the quality of a regional anesthetic technique for the lower extremity is improved by ultrasonographic nerve identification compared with older techniques.Anesthesia & Analgesia 10/1997; 85(4):854-7. · 3.29 Impact Factor -
Article: Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks.
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ABSTRACT: Recently it has been demonstrated that the use of ultrasound (US) improves the onset time and the quality of sensory block for 3-in-1 blocks compared with conventional nerve stimulator (NS) techniques. The present study was designed to evaluate if US guidance for 3-in-1 blocks reduces the amount of local anesthetic compared to NS guidance. After institutional approval and informed consent, 60 patients undergoing hip surgery following trauma were randomly assigned to three groups of 20 patients each. In group A, the 3-in-1 block was performed using US guidance with 20 mL 0.5% bupivacaine. Group B received 20 mL 0.5% bupivacaine, and group C received 30 mL 0.5% bupivacaine during NS guidance. The quality and the onset time was assessed by pinprick test in the central sensory region of each of the three targeted nerves and compared with the contralateral leg every 10 minutes for 1 hour by a blinded observer. The rating was undertaken using a scale from 100% (uncompromised sensibility) to 0% (no sensation). Overall success for the 3-in-1 block in group A was 95% and in groups B and C 80%. Onset time was significantly shorter in the US-guided group compared with both NS-guided groups (group A 13+/-6 minutes; group B 27+/-12 minutes; and group C 26+/-13 minutes; P < .01 to groups B and C). Quality of sensory block was significantly better in group A (4%+/-5% of initial value) compared with groups B and C (group B 21%+/-11% of initial value, P < .01 to group A; group C 22%+/-19%, P < .01 to group A). The amount of local anesthetic for 3-in-1 blocks can be reduced by using US guidance compared with the conventional NS-guided technique.Regional Anesthesia and Pain Medicine 23(6):584-8. · 4.08 Impact Factor
