D M Albrecht

Technische Universität Dresden, Dresden, Saxony, Germany

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Publications (67)136.17 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Patienten, die sich einer radikalen Prostatektomie (rPE) einschließlich retroperitonealer Lymphadenektomie (rLA) unterziehen, haben aufgrund ihres Alters und ihrer Begleiterkrankungen ein erhöhtes perioperativen Risiko. Ziel dieser Untersuchung war es, den intra- und postoperativen Verlauf der standardisierten Operation rPE+rLA unter verschiedenen Anästhesieregimen zu analysieren. Krankenakten von 433 Patienten, die sich zwischen 1994 und 1999 in unserer Einrichtung einer rPE+rLA unterzogen, wurden retrospektiv ausgewertet. Die Patienten wurden nach dem durchgeführten Anästhesieverfahren eingeteilt: 1. Allgemeinanästhesie (AA), 2. Kombination lumbale Epiduralanästhesie (LEA)+AA, 3. thorakale Epiduralanästhesie (TEA)+AA. Für die intra- und postoperative Katheteranalgesie wurden Bupivacain 0,25% oder Ropivacain 0,2%, 8–12 ml/h verwendet. Die Allgemeinanästhesie wurde als balancierte Anästhesie durchgeführt. Diese retrospektive Erhebung zeigt unter epiduraler Analgesie, gemessen an Tachykardien und hypertensiven Episoden, eine reduzierte intra- und postoperative Stressantwort, kürzere Extubationszeiten, früheres Wiedereinsetzen der gastrointestinalen Motilität ([h] AA: 50,6±11,1/ LEA: 39,3±13,6/ TEA:33,8±13,0), tendenziell selteneres Erbrechen und eine um einen Tag verkürzte Krankenhausverweildauer ([d] AA: 12,4±5,8/ LEA: 11,1±3,1/ TEA: 11,5±3,8). Dabei war unter TEA die Dauer der Anästhesiepräsenz im OP-Bereich vergleichbar mit AA ([min] AA: 222,9±43,5/ LEA: 238,2±41,8/ TEA: 227,0±46,2), und der Wachstationsaufenthalt verkürzt. Daneben war unter TEA die Anzahl der auffälligen postoperativen Thoraxröntgenbefunde reduziert. Zum Erreichen einer der TEA vergleichbaren Analgesie mussten unter LEA häufiger sensomotorische Blockaden, saO2-Abfälle und tendenziell eine höhere Anzahl kardialer Komplikationen in Kauf genommen werden. Gemessen an den von uns erhobenen Parametern stellt damit die Kombination einer Allgemeinanästhesie, insbesondere mit thorakaler Epiduralanalgesie ein sicheres und auch betriebswirtschaftlich effizientes anästhesiologisches Vorgehen bei radikalen Prostatektomien dar. Patients requiring radical prostatectomy (rPE), including retroperitoneal lymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in terms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hospital were retrospectively reviewed. Patients were divided in those who received: 1. general anaesthesia (GA) alone, 2. a combination of lumbar epidural anaesthesia (LEA)+GA or, 3. thoracic epidural anaesthesia (TEA)+GA. General anaesthesia was performed as balanced anaesthesia, and epidural administered local anaesthetics were bupivacaine 0.25% or ropivacaine 0.2%, 8–12 ml/h. In terms of intra- and postoperative numbers of tachycardic and hypertensive episodes, a reduced stress response was observed under epidural anaesthesia (EA). Moreover, the weaning duration was shorter under EA and onset of gastrointestinal motility was found earlier ([h] GA: 50.6±11.1/ LEA: 39.3±13.6/ TEA:33.8±13.0). Furthermore, a trend to rarer phases of postoperative vomiting and a significant decrease of in hospital stay of about one day ([d] GA: 12.4±5.8/ LEA: 11.1±3.1/ TEA: 11.5±3.8) was observed. The duration of personnel binding in the OR did not differ significantly between GA and TEA ([min] GA: 222.9±43.5/ LEA: 238.2±41.8/ TEA: 227.0±46.2), but ICU stay was shortened under TEA. Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO2 and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.
    Der Anaesthesist 04/2012; 49(11):949-959. · 0.85 Impact Factor
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    ABSTRACT: The German Social Act V section sign 12 is aimed towards competition, efficiency and quality in healthcare. Because surgical departments are billing standard diagnosis-related group (DRG) case costs to health insurance companies, they claim best value for money for internal services. Thus, anaesthesia concepts are being closely scrutinized. The present analysis was performed to gain economic arguments for the strategic positioning of regional anaesthesia procedures into clinical pathways. Surgical procedures, which in 2005 had a relevant caseload in Germany, were chosen in which regional anaesthesia procedures (alone or in combination with general anaesthesia) could routinely be used. The structure of costs and earnings for hospital services, split by types and centres of cost, as well as by underlying procedures are contained in the annually updated public accessible dataset (DRG browser) of the German Hospital Reimbursement Institute (InEK). For the year 2005 besides own data, national anaesthesia staffing costs are available from the German Society of Anaesthesiology (DGAI). The curve of earnings per DRG can be calculated from the 2005 InEK browser. This curve intersects by the cost curve at the point of national mean length of stay. The cost curve was calculated by process-oriented distribution of cost centres over the length of stay and allows benchmarking within the national competitive environment. For comparison of process times data from our local database were used. While the InEK browser lacks process times, the cost positions 5.1-5.3 (staffing costs anaesthesia) and the national structure adjusted anaesthesia staffing costs 2005 as published by the DGAI, were used to calculate nationwide mean available anaesthesia times which were compared with own process times. Within the portfolio diagram of lengths of stay for each DRG and process times most procedures are located in the economic lower left, in particular those with high case mix (length of stay and anaesthesia times below reimbursement relevant national mean). The driver of increased earnings is shortening length of stay. Our use of regional anaesthesia is 5 to 10-fold higher than national benchmarks and may contribute to our advantageous position in national competition. The annual increases in profit per DRG range between EUR 1,706 and EUR 467,359 and compensate by far the investment of regional anaesthesia derived pain management, besides the advantage of increased patient satisfaction and avoidance of complications. Regional anaesthesia is a considerable value driver in clinical pathways by shortening length of stay. The present analysis further demonstrates that time for regional block performance is covered by anaesthesia reimbursement within the DRG costing schedule.
    Der Anaesthesist 05/2009; 58(5):459-68. · 0.85 Impact Factor
  • Aktuelle Neurologie - AKTUEL NEUROL. 01/2008; 35.
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    ABSTRACT: The application of perfluorohexane (PFH) vapor led to an improvement of oxygenation and mechanical lung function in a model of oleic acid-induced ARDS in sheep. The aim of this study was to investigate the effects of PFH on gas exchange over an extended time period and to reduce the invasiveness of ventilation. ARDS was induced in sheep ( n=12) by injecting 0.1 ml/kg body weight oleic acid intravenously. Six sheep were treated for 30 min with 18 vol.% PFH (PFH-Tx) and followed up over a time period of 240 min while untreated sheep ( n=6) served as controls. Subsequently the F(I)O(2) was reduced to generate a p(a)O(2) between 100-140 mmHg. Gas exchange, respiratory and hemodynamic data were collected at regular intervals. Data were analysed using covariance analysis. PFH treatment led to an improvement in oxygenation ( p<0.01) and in mechanical lung function ( p<0.01). Furthermore, mean pulmonary artery pressure ( p<0.01) and shunt ( p<0.01) were lower in PFH-Tx. F(I)O(2) could be reduced in all PFH-treated animals ( p<0.01). Treatment of oleic acid-induced lung injury with PFH vapor improved oxygenation and mechanical lung function over a extended time period allowing a reduction in the invasiveness of ventilation.
    Der Anaesthesist 02/2004; 53(2):137-43. · 0.85 Impact Factor
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    ABSTRACT: FragestellungDie Inhalation von Perfluorhexan (PFH) fhrt im lsure-induzierten Lungenversagen am Schaf zu einer Verbesserung der Oxygenierung und der mechanischen Lungenfunktion. Ziel der Untersuchung war es, Effekte von PFH bei der Therapie eines experimentellen acute respiratory distress syndrome (ARDS) ber einen lngeren Beobachtungszeitraum (4h) zu untersuchen sowie die Mglichkeit einer schrittweisen Reduktion der inspiratorischen Sauerstofffraktion (FIO2) in der Behandlungsgruppe zu evaluieren.MethodikEin experimentelles ARDS wurde bei 12Schafen mit der intravensen Gabe von lsure induziert. Nach dessen Induktion erfolgte bei 6Tieren eine 30-mintige Therapie mit 18 Vol.-% PFH (PFH-Tx), gefolgt von einer 240-mintigen Beobachtungsphase. Im Anschluss wurde, wenn mglich, die FIO2 schrittweise reduziert mit dem Ziel eines paO2-Werts zwischen 100mmHg und 140mmHg. Kontrolltiere (n=6) blieben untherapiert. Blutgasanalysen, hmodynamische und respiratorische Parameter wurden in regelmigen Abstnden gemessen.ErgebnissePerfluorhexan fhrte zu einer Verbesserung der Oxygenierung (p<0,01) und der mechanischen Lungenfunktion (p<0,01) bezglich des Schdigungszeitpunkts. Gleichzeitig kam es zu einer Reduktion des mittleren pulmonalarteriellen Druckes (MPAP; p<0,01) und des Shunts (p<0,01) im Vergleich zur Kontrollgruppe. Zudem konnte die FIO2 in der PFH-Tx-Gruppe signifikant gesenkt werden (p<0,01).SchlussfolgerungDie Therapie eines lsure-induzierten ARDS mit 18 Vol.-% PFH fhrte zu einer signifikanten Verbesserung des Gasaustausches und der Lungenmechanik und erlaubte im Verlauf die Reduktion der inspiratorischen Sauerstofffraktion.IntroductionThe application of perfluorohexane (PFH) vapor led to an improvement of oxygenation and mechanical lung function in a model of oleic acid-induced ARDS in sheep. The aim of this study was to investigate the effects of PFH on gas exchange over an extended time period and to reduce the invasiveness of ventilation.MethodARDS was induced in sheep (n=12) by injecting 0.1ml/kg body weight oleic acid intravenously. Six sheep were treated for 30min with 18 vol.% PFH (PFH-Tx) and followed up over a time period of 240min while untreated sheep (n=6) served as controls. Subsequently the FIO2 was reduced to generate a paO2 between 100–140mmHg. Gas exchange, respiratory and hemodynamic data were collected at regular intervals. Data were analysed using covariance analysis.ResultsPFH treatment led to an improvement in oxygenation (p<0.01) and in mechanical lung function (p<0.01). Furthermore, mean pulmonary artery pressure (p<0.01) and shunt (p<0.01) were lower in PFH-Tx. FIO2 could be reduced in all PFH-treated animals (p<0.01).ConclusionTreatment of oleic acid-induced lung injury with PFH vapor improved oxygenation and mechanical lung function over a extended time period allowing a reduction in the invasiveness of ventilation.
    Der Anaesthesist 01/2004; 53(2):137-143. · 0.85 Impact Factor
  • Source
    M Hübler, R J Litz, R von Kummer, D M Albrecht
    Anaesthesia 04/2002; 57(3):307-8. · 3.49 Impact Factor
  • R J Litz, D M Albrecht
    Der Anaesthesist 01/2002; 50(12):954-6. · 0.85 Impact Factor
  • Source
    M Müller, R J Litz, M Hüler, D M Albrecht
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    ABSTRACT: We report a patient to whom ropivacaine 1.1 mg kg(-1) was administered for brachial plexus blockade and who developed grand mal convulsions because of inadvertent i.v. injection. No symptoms of cardiovascular toxicity occurred. Venous blood samples were taken 15, 45, 75 and 155 min after the injection. The measured total plasma concentrations of ropivacaine were 3.3, 1.6, 1.2 and 1.0 mg litre(-1) respectively. Initial plasma concentration after the end of the injection period was estimated at 5.75 mg litre(-1) using a two-compartment pharmacokinetic model.
    BJA British Journal of Anaesthesia 12/2001; 87(5):784-7. · 4.24 Impact Factor
  • M Ragaller, D M Albrecht
    ains · Anästhesiologie · Intensivmedizin 12/2001; 36 Suppl 2:S155-8. · 0.39 Impact Factor
  • R J Litz, M Hübler, T Koch, D M Albrecht
    Anesthesiology 11/2001; 95(4):1031-3. · 5.16 Impact Factor
  • R J Litz, I Kreinecker, M Hübler, D M Albrecht
    European Journal of Anaesthesiology 11/2001; 18(10):697-9. · 2.79 Impact Factor
  • M Hübler, R J Litz, D M Albrecht
    Anesthesia & Analgesia 08/2001; 93(1):241-2. · 3.30 Impact Factor
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    ABSTRACT: The aim of the present study was to compare and assess the quality of analgesia, the safety and the side-effects after the use of a continuous, thoracic epidural infusion of sufentanil (5 microg h(-1)), 0.25% bupivacaine (10 mL h(-1)), 0.2% ropivacaine (10 mL h(-1)) alone or in combination in patients who had undergone major urological surgery. This prospective, randomized, double-blinded study investigated the efficacy of thoracic epidural infusions after major urological surgery. Patients received a 72-h continuous infusion (10 mL h(-1)) of 0.25% bupivacaine (B), 0.2% ropivacaine (R), 0.25% bupivacaine with 0.5 microg mL(-1) sufentanil (BS), 0.2% ropivacaine with 0.5 microg mL(-1) sufentanil (RS) or 0.5 microg mL(-1) sufentanil only (S). The analysis included 109 patients. The mean visual analogue scale (VAS) scores for pain were highest in the groups R and S (P < 0.001). The PaCO2 values were significantly higher in the groups RS and S (P = 0.003). Motor block occurred more frequently in the groups B and BS than in the other groups (P < 0.001). Sedation, nausea and pruritus were more common in the groups that received sufentanil. A continuous, epidural infusion with these drugs was safe and effective in our patients. The combination of 0.2% ropivacaine plus sufentanil appeared preferable because of the low incidence of motor block.
    European Journal of Anaesthesiology 07/2001; 18(7):450-7. · 2.79 Impact Factor
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    ABSTRACT: A number of studies have demonstrated the effectiveness of liquid ventilation with perfluorocarbons in improving pulmonary function in acute respiratory distress syndrome. Although it is known that perfluorocarbon-associated gas exchange facilitates lung mechanics and oxygenation, the complete mechanism by which perfluorocarbons exert their beneficial effects in acute lung injury still remains unclear. Possibly, an influence of perfluorocarbons on proinflammatory and procoagulant features of monocytic cells present in the alveolar space, such as alveolar macrophages (AMs), may be involved. Therefore, we examined in an in vitro model the effects of perfluorocarbon on both activated mononuclear blood cells (MBCs) and AMs by monitoring the expression of interleukin (IL)-1 beta, tumor necrosis factor (TNF)alpha, and tissue factor (TF). Mononuclear blood cells, obtained from peripheral blood of healthy volunteers, or AMs from diagnostic bronchoalveolar lavage were stimulated by incubation with lipopolysaccharide in the presence of different amounts of perfluorohexane, which was devoid of cytotoxicity. Using both video-enhanced contrast and electron microscopy, the authors observed that perfluorohexane droplets were phagocytosed by activated monocytes as well as by in vitro--cultured AMs within 1--3 h. After lipopolysaccharide stimulation of monocytes or AMs, we observed a down-regulation of TF mRNA and a significant inhibition (P < 0.05) of cellular TF antigen by perfluorohexane. In addition, the concentration of both IL-1 beta and TNF alpha in the supernatant of lipopolysaccharide-stimulated MBC was significantly decreased (P < 0.01) by perfluorohexane compared with controls without perfluorohexane. By preincubation of lipopolysaccharide-containing medium with perfluorohexane, the authors could exclude that the inhibitory effect of perfluorohexane was caused by binding or sequestering limited amounts of lipopolysaccharide. Taken together, our results demonstrate an interference of perfluorohexane with the expression of the procoagulant protein TF on monocytes and AMs as well as with the release of proinflammatory cytokines by MBCs. These effects may contribute to the protective role of liquid ventilation with perfluorocarbons in injuries associated with local activation of inflammatory processes.
    Anesthesiology 02/2001; 94(1):101-9. · 5.16 Impact Factor
  • European Journal of Anaesthesiology 01/2001; 18. · 2.79 Impact Factor
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    ABSTRACT: To investigate the prevalence and distribution of comorbidity and its association with perioperative complications in patients undergoing radical prostatectomy (RPE). In 431 unselected RPE patients, the American Society of Anesthesiologists Physical Status classification (ASA-PS), the New York Heart Association classification of cardiac insufficiency (NYHA), the classification of angina pectoris of the Canadian Cardiovascular Society (CCS), height, weight, the body mass index (BMI), and the number of concomitant diseases (NCD) were assessed and related to perioperative cardiovascular complications. In RPE patients less than 70 years old, comorbidity rose nearly continuously with increasing age. However, after reaching an age of 70 years, the proportion of NYHA-0 patients increased (60-64 years, 86%; 65-69 years, 85%; >or=70 years, 87%). Furthermore, the severe comorbidities decreased in patients selected for RPE aged 70 or more years. There was a nonsignificant trend towards higher comorbidity in patients with perioperative cardiovascular complications. These data suggest that documentation of the distribution of ASA-PS, CCS, NYHA and of concomitant diseases might be helpful to characterize the general health status and the degree of selection of prostate cancer treatment populations especially in series with a high portion of patients aged 70 or more years. Concerning perioperative complications, the individual predictive value of comorbidity seems to be poor in the radical prostatectomy setting.
    Urologia Internationalis 01/2001; 67(4):283-8. · 1.07 Impact Factor
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    ABSTRACT: Background: A number of studies have demonstrated the effectiveness of liquid ventilation with perfluorocarbons in improving pulmonary function in acute respiratory distress syndrome. Although it is known that perfluorocarbon-associated gas exchange facilitates lung mechanics and oxygenation, the complete mechanism by which perfluorocarbons exert their beneficial effects in acute lung injury still remains unclear. Possibly, an influence of perfluorocarbons on proinflammatory and procoagulant features of monocytic cells present in the alveolar space, such as alveolar macrophages (AMs), may be involved. Therefore, we examined in an in vitro model the effects of perfluorocarbon on both activated mononuclear blood cells (MBCs) and AMs by monitoring the expression of interleukin (IL)-1β, tumor necrosis factor (TNF)α, and tissue factor (TF).
    Anesthesiology 12/2000; 94(1):101-109. · 5.16 Impact Factor
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    ABSTRACT: Patients requiring radical prostatectomy (rPE), including retroperitoneal lymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in terms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hospital were retrospectively reviewed. Patients were divided in those who received: 1. general anaesthesia (GA) alone, 2. a combination of lumbar epidural anaesthesia (LEA) + GA or, 3. thoracic epidural anaesthesia (TEA) + GA. General anaesthesia was performed as balanced anaesthesia, and epidural administered local anaesthetics were bupivacaine 0.25% or ropivacaine 0.2%, 8-12 ml/h. In terms of intra- and postoperative numbers of tachycardiac and hypertensive episodes, a reduced stress response was observed under epidural anaesthesia (EA). Moreover, the weaning duration was shorter under EA and onset of gastrointestinal motility was found earlier ([h] GA: 50.6 +/- 11.1/LEA: 39.3 +/- 13.6/TEA: 33.8 +/- 13.0). Furthermore, a trend to rarer phases of postoperative vomiting and a significant decrease of in hospital stay of about one day ([d] GA: 12.4 +/- 5.8/LEA: 11.1 +/- 3.1/TEA: 11.5 +/- 3.8) was observed. The duration of personnel binding in the OR did not differ significantly between GA and TEA ([min] GA: 222.9 +/- 43.5/LEA: 238.2 +/- 41.8/TEA: 227.0 +/- 46.2), but ICU stay was shortened under TEA. Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO2 and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.
    Der Anaesthesist 12/2000; 49(11):949-59. · 0.85 Impact Factor
  • M Hübler, D M Albrecht
    Der Anaesthesist 11/2000; 49(10):905-6. · 0.85 Impact Factor
  • M Ragaller, D M Albrecht
    ains · Anästhesiologie · Intensivmedizin 10/2000; 35(9):571-91. · 0.39 Impact Factor

Publication Stats

307 Citations
136.17 Total Impact Points

Institutions

  • 1997–2012
    • Technische Universität Dresden
      • Klinik und Poliklinik für Anästhesiologie und Intensivtherapie
      Dresden, Saxony, Germany
  • 1997–2009
    • Universitätsklinikum Dresden
      • Klinik und Poliklinik für Anästhesiologie und Intensivtherapie
      Dresden, Saxony, Germany
  • 1996–2004
    • Carl Gustav Carus-Institut
      Pforzheim, Baden-Württemberg, Germany
  • 1992–1996
    • Universität Heidelberg
      • • Faculty of Medicine Mannheim and Clinic Mannheim
      • • Department of Anesthesiology and Critical Care Medicine
      Heidelberg, Baden-Wuerttemberg, Germany