C Diefenbach

University of Rostock, Rostock, Mecklenburg-Vorpommern, Germany

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Publications (90)132.42 Total impact

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    ABSTRACT: To determine cardiovascular effects and neonatal outcome of ropivacaine 0.75% and bupivacaine 0.5% for elective epidural caesarean section. Healthy pregnant women, scheduled for elective caesarean section, were enrolled in this randomised, double-blind study. Epidural block was obtained with 20-30 ml of ropivacaine 0.75% (Group R) or bupivacaine 0.5% (Group B) and surgery did not commence until anaesthesia was achieved bilaterally to T6. Maternal heart rate and blood pressure were assessed before the main dose of local anaesthetic and at 5-min intervals until 35 min. Neonatal umbilical pH and Apgar scores were determined after delivery. Ten, twenty and thirty minutes after the main dose, sensory and motor block characteristics were determined. Quality of analgesia was assessed by the anaesthetist, surgeon and the patient. Adverse events were recorded. Sixty-two patients were enrolled and the data of 60 of them were eligible for analysis: 31 in Group R and 29 in Group B. The area under the curve (AUC) for maternal heart rate decreased significantly less in Group B than in Group R (p = 0.038). Twenty-five and thirty minutes after administration of the main local anaesthetic dose, heart rate decreased significantly less in Group B than in Group R (p = 0.006 and p = 0.007). There was no difference in AUC for maternal blood pressure (p = 0.32). Repeated measurement analysis showed no difference between groups in motor block (p = 0.78) and in spread of the sensory block (lower level: p = 0.83, upper level: p = 0.88). There was no statistical difference in neonatal umbilical pH (p = 0.22) and Apgar score (p = 0.59). Multiple linear regression analysis showed a significant influence of maternal body mass index on neonatal pH (p = 0.004), but not of maternal blood pressure (p = 0.323), nor of maternal heart rate (p = 0.12). The quality of analgesia and incidence of adverse events were similar in both groups. Both drugs produced equally satisfactory epidural block. Although ropivacaine 0.75% resulted in a greater decrease of maternal heart rate, this effect did not influence neonatal well-being. Both ropivacaine 0.75% and bupivacaine 0.5% can therefore be recommended for epidural anaesthesia in elective caesarean section.
    Current Medical Research and Opinion 02/2004; 20(1):7-12. · 2.37 Impact Factor
  • S Kampe, M Warm, S-M Kasper, C Diefenbach
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    ABSTRACT: Pedicled TRAM flap surgery is a complex procedure characterised by an extensive wound site. We present two patients with efficient postoperative pain relief by continuous wound instillation of ropivacaine 0.2% via two multilumen catheters. The catheters were placed subcutaneously before the wound closure through the umbilicus into the abdominal wound, and under the autologous flap into the breast. Each multilumen catheter provides even distribution for local anaesthetics over 12.5 cm. At the end of surgery, patients received a single shot dose of local anaesthetic via the pain catheters. After surgery the continuous infusion of ropivacaine 0.2% was commenced at a rate of 10 ml/h per catheter. Pain scores at rest and on coughing were low on the first postoperative day, and later zero. No medication for breakthrough pain was required throughout the recovery period, and the patients experienced no adverse events linked to the analgesia scene. Patient satisfaction was excellent, and quality of recovery score was superior.
    British Journal of Plastic Surgery 08/2003; 56(5):478-83. · 1.29 Impact Factor
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    ABSTRACT: The present study evaluates the use of muscle relaxants for rapid-sequence induction (RSI) and different application techniques (pre-curarisation, priming, timing) as a part of a nationwide survey in Germany. In 86.8% of anaesthesia departments succinylcholine is used for RSI and an average of 56.5% of respondents used only succinylcholine for RSI. Of all non-depolarising muscle relaxants rocuronium is the most frequently used alternative. Of the anaesthesia departments 2.6% use rocuronium regularly in patients with increased risk for aspiration of stomach contents; level one centres significantly more than others, 12.9% answered that pre-curarisation techniques were never used, whereas 45.6% use non-depolarising neuromuscular blocking drugs before giving succinylcholine in 80-100% of cases. Priming is not used by 64.4% of respondents, as opposed to 9.8% who utilise this technique regularly. The statements regarding timing are 71.1% and 5.4%, respectively. Alcuronium is used for RSI in departments in which the financial aspect is the primary decision criteria. Despite ist known side-effects and the on-going discussion over the past years, succinylcholine is still the most frequently used muscle relaxants for RSI. Priming is often declined by anaesthetists in Germany, most probably due to the absence of clear advantages and the possibility of severe complications. It is the opinion of the authors that timing but also drugs with a slow onset (e.g., alcuronium and Pancuronium) are obsolete in the context of RSI.
    Der Anaesthesist 07/2003; 52(6):516-21. · 0.85 Impact Factor
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    ABSTRACT: Hydroxyethyl starch (HES) 130/0.4 may impair blood coagulation less than other HES solutions and, thus, may be used at larger doses without increasing the risk of postoperative bleeding. This study tested the hypothesis that volume replacement with 6% HES 130/0.4 at a dose of up to 50 ml/kg does not increase blood loss and transfusion requirements in elective coronary artery bypass surgery compared with 6% HES 200/0.5 at a dose of up to 33 ml/kg. One hundred twenty adult patients scheduled for elective coronary artery bypass surgery were randomized to receive up to 50 ml/kg of 6% HES 130/0.4 or up to 33 ml/kg of 6% HES 200/0.5 for volume replacement during surgery and until 24 h thereafter. Volume requirements in excess of the respective maximum dose of HES were treated with gelatin. Colloid use was at the discretion of the attending physicians and not dictated by protocol. The primary outcome variable was chest tube drainage volume during the first 24 h after surgery. The data from 117 patients (HES 130/0.4, 59 patients; HES 200/0.5, 58 patients) who completed the study according to protocol were analyzed. The median volumes of HES administered were 49 and 33 ml/kg in the HES 130/0.4 and HES 200/0.5 groups, respectively (P < 0.001). Consequently, patients in the HES 130/0.4 group required less gelatin in addition to HES than those in the HES 200/0.5 group (medians: 7 ml/kg vs. 20 ml/kg, P < 0.001). The combined volumes of HES and gelatin were similar for both groups (P = 0.21). The 24-h chest tube drainage (medians: 660 ml vs. 705 ml, P = 0.60) did not differ significantly between the groups, nor did transfusion outcome. Six percent HES 130/0.4 at a median dose of 49 ml/kg did not increase blood loss and transfusion requirements in coronary artery bypass surgery compared with 6% HES 200/0.5 at a median dose of 33 ml/kg.
    Anesthesiology 07/2003; 99(1):42-7. · 5.16 Impact Factor
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    ABSTRACT: As there are no reliable epidemiological data for the use of muscle relaxants in Germany,we conducted a mailing study. The aim of the study was to compare the use of muscle relaxants between German anaesthesia departments. In the present part of the presentation we focused on neuromuscular monitoring (NMM) and management of residual paralysis. A total number of 2,996 questionnaires were sent to all registered anaesthesiological facilities in Germany and the return was 68.6% (2054 questionnaires). In 574 of the returned questionnaires (28%) the regular use of NMM was confirmed. Intraoperative monitoring of neuromuscular block and assessment of neuromuscular recovery were the most frequent applications of NMM, i.e. 25% and 18% of returned questionnaires, respectively. Clinical signs, however, are still the most popular way to estimate the degree of neuromuscular blockade. Moreover, routine reversal at the end of surgery with a neostigmin/atropine mixture was not practiced in 75% of the anaesthesia departments. This survey revealed that NMM is still very rarely used in daily clinical practice. Especially the seldom use of NMM to assess residual paralysis has to be improved.
    Der Anaesthesist 07/2003; 52(6):522-6. · 0.85 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the use and application of muscle relaxants and neuromuscular monitoring in Germany. A total of 2,996 questionnaires were sent out to the heads of German anaesthesia departments and private anaesthesia practices. The questions covered frequency of muscle relaxants used,how they were used, and neuromuscular monitoring. Influences on the way muscle relaxants were used could be derived from the desire for specific properties of a muscle relaxant, the desire for different monitoring conditions and from the size of the institution. We correlated these features with application practice using logistic regression analyses. Of the 2,996 questionnaires 2,058 could be analysed (68.6%). Amongst those were 102 level one hospitals (5%) and 903 private practices (44%). The replies from 350 (17%) departments were based on surveyed data, 1,613 (78.5%) were based on estimations. The desire for certain properties of muscle relaxants correlated with the use in practice, as were the desire for a non-depolarizing replacement for succinylcholine, the size of the department and the frequency of use of neuromuscular monitoring. Over 50% of all German anaesthesia departments limited the use of muscle relaxants to three. The use of laryngeal masks reduced the use of muscle relaxants. The survey regarding use of muscle relaxants in Germany could for the first time give an overview on the use of anaesthesia-specific substances in Germany. From the different frequencies of use and use modalities,conclusions could be drawn towards a standard of application for the year 2000. Changes in this standard would raise the need for further trend surveys. The methods of statistical analysis and survey evaluation can be used as a base for further surveys.
    Der Anaesthesist 06/2003; 52(5):427-34. · 0.85 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the use of muscle relaxants during induction of anesthesia in patients without risk of aspiration of stomach contents. Of the 2,996 questionnaires sent out, 2,054 (68.6%) could be analysed and the results show that succinylcholine is used regularly in 13.6% of anesthesia departments. The next most commonly used muscle relaxants are atracurium, vecuronium and mivacurium, followed by cis-atracrium, rocuronium and pancuronium. Alcuronium is the least frequently used muscle relaxant. During induction of an elective anesthesia procedure, a priming technique is used by 19% of anesthesiologists, 22% utilize precurarization, and a timing technique is performed in 7.1%. The use of muscle relaxants for on-going relaxation follows the same pattern as for induction of neuromuscular blockade and succinylcholine is used in 1.4% if further relaxation is needed. The desire for specific qualities of muscle relaxants is correlated with higher use of the specific substance: short onset time for rocuronium, good controllability with mivacurium, no side-effects with cisatracurium and economical aspects with alcuronium. Of the participants 76.6% voiced the desire for a non-depolarizing replacement for succinylcholine.Private practices use mivacurium more often than hospitals, level one hospitals use rocuronium and cisatracurium more often. This survey could not show a definite standard of use in terms of muscle relaxants for an elective case.Precurarization, priming and timing are used frequently in patients not at risk of aspiration. This should be reduced by on-going teaching.
    Der Anaesthesist 06/2003; 52(5):435-41. · 0.85 Impact Factor
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    ABSTRACT: Mit der vorliegenden Arbeit wurde der Einsatz von Muskelrelaxanzien zur Blitzintubation und zu verschiedenen Applikationstechniken (Präkurarisierung, Priming, Timing) als Teilergebnis einer Umfrage in Deutschland untersucht. In 86,8% aller befragten anästhesiologischen Einrichtungen wird Succinylcholin zur Blitzintubation eingesetzt. Durchschnittlich 56,5% aller Befragten gaben an, hierbei fast ausschließlich Succinylcholin anzuwenden. Von allen nichtdepolarisierenden Muskelrelaxanzien stellt Rocuronium die häufigste Alternative dar. Es verwenden 2,6% der Anästhesieabteilungen bei Patienten mit Aspirationsrisiko regelmäßig (81–100%) Rocuronium, Krankenhäuser der Maximalversorgung signifikant häufiger als andere. Von 12,9% wurde die Frage nach einer Präkurarisierung mit “nie” beantwortet, während 45,6% in 80–100% einen Nichtdepolarisationsblocker vor Succinylcholin applizierten. Das Priming wird von 64,4% der Befragten nie angewendet, gegenüber 9,8%, die diese Technik regelmäßig (81–100%) einsetzen. Die entsprechenden Angaben für das Timing liegen bei 71,1% bzw. 5,4%. Alcuronium wird in den Einrichtungen zur Blitzintubation verwendet, die ökonomische Aspekte als vorrangiges Auswahlkriterium angaben. Mit Succinylcholin wird trotz der bekannten Nebenwirkungen und der Diskussionen der vergangenen Jahre am häufigsten blitzintubiert. Priming wird von Deutschlands Anästhesisten häufig abgelehnt, vermutlich weil eindeutige Vorteile fehlen und schwer wiegende Komplikationen drohen. Das Timing sowie sehr langsam anschlagende Medikamente, wie Alcuronium und Pancuronium, sollten nach Auffassung der Autoren auch zur Blitzintubation nicht mehr eingesetzt werden. The present study evaluates the use of muscle relaxants for rapid-sequence induction (RSI) and different application techniques (pre-curarisation, priming, timing) as a part of a nationwide survey in Germany. In 86.8% of anaesthesia departments succinylcholine is used for RSI and an average of 56.5% of respondents used only succinylcholine for RSI. Of all non-depolarising muscle relaxants rocuronium is the most frequently used alternative. Of the anaesthesia departments 2.6% use rocuronium regularly in patients with increased risk for aspiration of stomach contents; level one centres significantly more than others, 12.9% answered that pre-curarisation techniques were never used, whereas 45.6% use non-depolarising neuromuscular blocking drugs before giving succinylcholine in 80–100% of cases. Priming is not used by 64.4% of respondents, as opposed to 9.8% who utilise this technique regularly. The statements regarding timing are 71.1% and 5.4%, respectively. Alcuronium is used for RSI in departments in which the financial aspect is the primary decision criteria. Despite ist known side-effects and the on-going discussion over the past years, succinylcholine is still the most frequently used muscle relaxants for RSI. Priming is often declined by anaesthetists in Germany, most probably due to the absence of clear advantages and the possibility of severe complications. It is the opinion of the authors that timing but also drugs with a slow onset (e.g., alcuronium and Pancuronium) are obsolete in the context of RSI.
    Der Anaesthesist 05/2003; 52(6):516-521. · 0.85 Impact Factor
  • Sandra Kampe, Christian Pietruck, Christoph Diefenbach
    Anesthesia & Analgesia 05/2003; 96(4):1234; author reply 1234-5. · 3.30 Impact Factor
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    ABSTRACT: Ziel. Ziel dieser Studie war es,Aufschluss über den Einsatz und die Art der Anwendung von Muskelrelaxanzien und das neuromuskuläre Monitoring in Deutschland zu geben. Methode. Es wurden 2.996 Fragebogen an die Leiter deutscher Anästhesieabteilungen und freier Anästhesiepraxen versendet. In diesen Fragebogen wurde nach den Häufigkeiten der verwendeten Muskelrelaxanzien, nach deren Anwendungsweise und nach dem neuromuskulären Monitoring gefragt. Einflüsse auf diese Anwendungsgewohnheiten könnten aus Wünschen nach bestimmten Eigenschaften der Muskelrelaxanzien, nach Wünschen für veränderte Monitoringbedingungen und aus der Größe der Einrichtungen abgeleitet werden.Wir korrelierten mit logistischen Regressionsanalysen solche Eigenschaften mit den Anwendungsgewohnheiten. Ergebnisse. Von 2.996 Fragebogen konnten 2.054 (68,6%) ausgewertet werden; darunter 102 Kliniken (5%) mit Maximalversorgungsauftrag und 903 niedergelassene Anästhesisten (44,0%).Auf der Basis erhobener Daten antworteten 350 (17%) Abteilungen, auf der Basis einer Schätzung 1.613 (78,5%). Wünsche an die Eigenschaften von Muskelrelaxanzien waren mit den Anwendungsgewohnheiten korreliert, ebenso der Wunsch nach einem nichtdepolarisierenden Succinylcholin-Ersatz, die Größe der Abteilung und die Häufigkeit, mit der das neuromuskuläre Monitoring genutzt wird. Mehr als die Hälfte aller deutschen Anästhesieeinrichtungen beschränken sich auf 3 Muskelrelaxanzien. Larynxmasken reduzieren den Verbrauch von Muskelrelaxanzien. Schlussfolgerung. Die Umfrage zur Anwendung von Muskelrelaxanzien in Deutschland erbrachte erstmals einen Überblick über die Anwendung Anästhesie-spezifischer Substanzen in Deutschland.Aus den unterschiedlichen Anwendungshäufigkeiten und Anwendungsarten kann auf einen Anwendungsstandard im Jahr 2000 geschlossen werden.Veränderungen des Anwendungsstandards erfordern jedoch weitere Verlaufsbeobachtungen. Die Methoden zur statistischen Auswertung und Bewertung der Umfrage sowie die Ergebnisse können als Grundlage weiterer Umfragen genutzt werden. Aim. The aim of this study was to evaluate the use and application of muscle relaxants and neuromuscular monitoring in Germany. Methods. A total of 2,996 questionnaires were sent out to the heads of German anaesthesia departments and private anaesthesia practices.The questions covered frequency of muscle relaxants used,how they were used, and neuromuscular monitoring. Influences on the way muscle relaxants were used could be derived from the desire for specific properties of a muscle relaxant, the desire for different monitoring conditions and from the size of the institution.We correlated these features with application practice using logistic regression analyses. Results. Of the 2,996 questionnaires 2,058 could be analysed (68.6%).Amongst those were 102 level one hospitals (5%) and 903 private practices (44%).The replies from 350 (17%) departments were based on surveyed data, 1,613 (78.5%) were based on estimations. The desire for certain properties of muscle relaxants correlated with the use in practice, as were the desire for a non-depolarizing replacement for succinylcholine, the size of the department and the frequency of use of neuromuscular monitoring.Over 50% of all German anaesthesia departments limited the use of muscle relaxants to three.The use of laryngeal masks reduced the use of muscle relaxants. Conclusions. The survey regarding use of muscle relaxants in Germany could for the first time give an overview on the use of anaesthesia-specific substances in Germany. From the different frequencies of use and use modalities,conclusions could be drawn towards a standard of application for the year 2000.Changes in this standard would raise the need for further trend surveys.The methods of statistical analysis and survey evaluation can be used as a base for further surveys.
    Der Anaesthesist 04/2003; 52(5):427-434. · 0.85 Impact Factor
  • Sandra Kampe, Jens W Krombach, Christoph Diefenbach
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    ABSTRACT: Studies on the toxic effects of muscle relaxants are difficult to design because of the need for mechanical ventilation and, consequently, concomitant administration of anaesthetic drugs which may influence the results. The following overview shows that muscle relaxants are weak toxic agents with regard to their teratogenicity, carcinogenicity and cytotoxic effects (including tissue- and organ-damaging effects). Moreover, this chapter presents other side-effects of muscle relaxants under the broad heading of toxicity: the succinylcholine-triggered cytotoxic effects on skeletal muscle cells with different aetiology, for example, or persistent muscle weakness after long-term administration of non-depolarizing muscle relaxants. Receptor stimulation in the central nervous system may cause acute excitement and seizures. Muscle relaxants and their metabolites may interact with muscarinic and nicotinic receptors in other organs and the ganglionic system, for example in the cardiovascular system. Direct stimulation of mast cells, with consequent release of histamine, after administration of muscle relaxants may clinically impose as toxic reactions.
    Baillière&#x27 s Best Practice and Research in Clinical Anaesthesiology 04/2003; 17(1):137-46.
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    ABSTRACT: Fragestellung. Ziel dieser Untersuchung war es die aktuellen Anwendungsgewohnheiten und die Arbeitsplatzverfügbarkeit des neuromuskulären Monitorings (NMM) in Deutschland zu untersuchen. Methodik. Dazu wurden 2.996 Fragebogen an die Leiter deutscher Anästhesieabteilungen und an freie Anästhesiepraxen versandt. Gefragt wurde nach der Arbeitsplatzausstattung mit NMM, welche Nervenstimulatoren verwendet werden und wozu sie verwendet werden. Darüber hinaus wurde untersucht,welche Faktoren den Einsatz des NMM begünstigen können. Ergebnisse. Von 2.054 Abteilungen gaben 574 (28%) an NMM regelmäßig zu verwenden. Das NMM wird signifikant häufiger regelmäßig zur intraoperativen Überwachung der neuromuskulären Blockade (25%) sowie zur Beurteilung der neuromuskulären Erholung (18%) angewendet als zum Festlegen des Intubationszeitpunktes (8%) bzw. postoperativ im Aufwachraum (p<0,01). Klinische Zeichen sind das mit Abstand häufigste Zeichen sowohl zur intraoperativen Nachrelaxierung als auch zur Indikationsstellung zur Antagonisation. Die Akzelerometer TOF-Guard® und TOF-Watch® werden signifikant häufiger eingesetzt als die “einfachen Nervenstimulatoren” (25% vs.10%; p<0,01). In Kliniken der Maximalversorgung waren häufiger NMM vorhanden als in anderen Krankenhäusern und in Anästhesiepraxen (p<0,01). Schlussfolgerungen. Nach wie vor wird NMM nur unregelmäßig eingesetzt. Insbesondere die seltene Verwendung zur Beurteilung der NM-Erholung gilt es im Interesse der Patienten zu verbessern. Aim. As there are no reliable epidemiological data for the use of muscle relaxants in Germany,we conducted a mailing study. The aim of the study was to compare the use of muscle relaxants between German anaesthesia departments. In the present part of the presentation we focused on neuromuscular monitoring (NMM) and management of residual paralysis. Methods. A total number of 2,996 questionnaires were sent to all registered anaesthesiological facilities in Germany and the return was 68.6% (2054 questionnaires). Results. In 574 of the returned questionnaires (28%) the regular use of NMM was confirmed. Intraoperative monitoring of neuromuscular block and assessment of neuromuscular recovery were the most frequent applications of NMM, i.e. 25% and 18% of returned questionnaires, respectively. Clinical signs, however, are still the most popular way to estimate the degree of neuromuscular blockade. Moreover, routine reversal at the end of surgery with a neostigmin/atropine mixture was not practiced in 75% of the anaesthesia departments. Conclusions. This survey revealed that NMM is still very rarely used in daily clinical practice. Especially the seldom use of NMM to assess residual paralysis has to be improved.
    Der Anaesthesist 01/2003; 52(6):522-526. · 0.85 Impact Factor
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    ABSTRACT: Ziel dieser Studie war es den Einsatz von Muskelrelaxanzien zur Narkoseeinleitung bei Patienten ohne Aspirationsgefahr darzustellen. Von 2.996 Fragebögen konnten 2.054 Fragebögen (68,6%) ausgewertet werden. Succinylcholin wird in 13,6% aller Abteilungen regelmäßig verwendet. Es folgt eine Dreiergruppe, bestehend aus Atracurium, Vecuronium und Mivacurium, mit der zweithäufigsten Anwendung und eine weitere Dreiergruppe, bestehend aus Cisatracurium, Rocuronium und Pancuronium, mit der dritthäufigsten Anwendung.Alcuronium wird am seltensten eingesetzt. In der elektiven Narkoseeinleitung wird regelmäßig von 19% der Befragten die Priming-Technik, von 22% eine Präkurarisierung und von 7,1% die Timing-Technik verwendet.Die Anwendungsgewohnheiten für Muskelrelaxanzien zur Nachrelaxierung gleichen denen zur Induktion der neuromuskulären Blockade.Mit Succinylcholin wird noch in 1,4% regelmäßig nachrelaxiert.Der Wunsch nach bestimmten Eigenschaften von Muskelrelaxanzien korrelierte mit häufigerer Verwendung der entsprechenden Substanzen: kurze Anschlagzeiten mit Rocuronium, gute Steuerbarkeit mit Mivacurium, fehlende Nebenwirkungen mit Cisatracurium sowie ökonomische Aspekte mit Alcuronium.Es wünschen sich 76,6% der Befragten einen nichtdepolarisierenden “Succinylcholin-Ersatz”. Praxen verwenden häufiger Mivacurium als Krankenhäuser, Kliniken der Maximalversorgung häufiger Rocuronium und Cisatracurium. Diese Erhebung lässt keinen eindeutigen Anwendungsstandard für die Routinenarkose erkennen.Präkurarisierung,Priming und Timing werden bei Patienten ohne Aspirationsgefahr sehr häufig verwendet.Durch Aus- und Weiterbildung sollte das vermindert werden. The aim of this study was to evaluate the use of muscle relaxants during induction of anesthesia in patients without risk of aspiration of stomach contents.Of the 2,996 questionnaires sent out, 2,054 (68.6%) could be analysed and the results show that succinylcholine is used regularly in 13.6% of anesthesia departments.The next most commonly used muscle relaxants are atracurium, vecuronium and mivacurium, followed by cis-atracrium, rocuronium and pancuronium. Alcuronium is the least frequently used muscle relaxant. During induction of an elective anesthesia procedure, a priming technique is used by 19% of anesthesiologists, 22% utilize precurarization, and a timing technique is performed in 7.1%.The use of muscle relaxants for on-going relaxation follows the same pattern as for induction of neuromuscular blockade and succinylcholine is used in 1.4% if further relaxation is needed.The desire for specific qualities of muscle relaxants is correlated with higher use of the specific substance: short onset time for rocuronium, good controlability with mivacurium, no side-effects with cisatracurium and economical aspects with alcuronium. Of the participants 76.6% voiced the desire for a non-depolarizing replacement for succinylcholine.Private practices use mivacurium more often than hospitals, level one hospitals use rocuronium and cisatracurium more often.This survey could not show a definite standard of use in terms of muscle relaxants for an elective case.Precurarization, priming and timing are used frequently in patients not at risk of aspiration. This should be reduced by on-going teaching.
    Der Anaesthesist 01/2003; 52(5):435-441. · 0.85 Impact Factor
  • S Kampe, H Nori, S M Kasper, C Diefenbach
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    ABSTRACT: In our hospital hyperbaric Carbostesin 0.5% (AstraZeneca) had been substituted by hyperbaric Bucain 0.5% (Curasan) and both drugs were believed to be identical in their actions.However, both local anaesthetics differ in the amount of glucose they contain. We report about three patients who underwent cesarian section under spinal anaesthesia. In two patients we observed an insufficient spread of spinal anaesthesia after administration of hyperbaric Bucain 0.5%. The third patient received the normally used combination of hyperbaric Carbostesin 0.5% and fentanyl and the subarachnoid block proceeded completely uneventfully. According to the literature the clinical efficacy of hyperbaric Carbostesin 0.5% and hyperbaric Bucain 0.5% should be identical and therefore a critical dilution of the Bucain should not have occurred because of the addition of fentanyl.
    Der Anaesthesist 01/2003; 51(12):993-5. · 0.85 Impact Factor
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    ABSTRACT: We surveyed current German practice in postoperative epidural analgesia (EA). Of 300 questionnaires sent anonymously, 147 (49%) were returned fully completed. A 24-h acute pain service (APS) was offered in 41% of German hospitals. Seventy percent of the large teaching hospitals (>1000 beds) offered an APS, whereas just 9% of the hospitals of <500 beds provided an APS. Small-size hospitals (<200 beds) preferred ropivacaine as the local anesthetic (LA) in contrast to large teaching hospitals using more bupivacaine than ropivacaine. In the general ward setting, 36% of the respondents used plain LA, and 64% combined the LA with an opioid. If ropivacaine was used, 0.2% was the most popular concentration (78%), combined with morphine (17%), fentanyl (14%), or sufentanil (75%). If bupivacaine was used, 0.25% was the preferred concentration (30%), combined with morphine (40%), fentanyl (8%), or sufentanil (60%). On wards, 58% of German anesthetic departments used continuous epidural infusion, 57% bolus doses, and 20% patient-controlled EA mode. We conclude that the availability of a 24-h APS (41%) in German hospitals corresponds favorably to international data. EA with the combination of LAs and opioids was the most common modality in the ward setting. IMPLICATIONS: We surveyed current German practice in postoperative epidural analgesia. We found that the availability of a 24-h acute pain service (41%) in German hospitals corresponds favorably to international practice. Epidural analgesia with the combination of local anesthetics and opioids was the most common modality in the ward setting.
    Anesthesia & Analgesia 01/2003; 95(6):1767-9, table of contents. · 3.30 Impact Factor
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    ABSTRACT: We assessed the analgesic efficacy of postoperative epidural infusions of ropivacaine 0.1 and 0.2% combined with sufentanil 1 microg mL(-1) in a prospective, randomized, double-blinded study. Twenty-two ASA I-III patients undergoing elective total-knee replacement were included. Lumbar epidural blockade using ropivacaine 0.75% was combined with either propofol sedation or general anaesthesia for surgery. After surgery, the epidural infusion was commenced. Eleven patients in each group received either an epidural infusion of ropivacaine 0.1% with 1 microg mL(-1) sufentanil (Group 1) or ropivacaine 0.2% with 1 microg mL(-1) sufentanil (Group 2) at a rate of 5-9 mL h(-1). All patients had access to intravenous pirinatrimide (piritramide) via a patient-controlled analgesia (PCA) device. Motor block was negligible for the study duration in both groups. There was no significant difference with the 100 mm visual analogue scale (VAS) scores, with the consumption of rescue analgesia or with patient satisfaction. Patients in Group 1 experienced significantly less nausea (P < 0.05) than those in Group 2. Both treatment regimens provided effective postoperative analgesia with only a minimal use of supplemental opioid PCA. We recommend the use of ropivacaine 0.1% with 1 microg mL(-1) sufentanil for postoperative analgesia after total knee replacement as it provides efficient pain relief with no motor block of the lower limbs. In addition, compared with 0.2% ropivacaine with sufentanil, the mixture reduces local anaesthetic consumption without compromise in patient satisfaction or VAS scores. Patients even experience less nausea.
    European Journal of Anaesthesiology 10/2002; 19(9):666-71. · 2.79 Impact Factor
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    ABSTRACT: It is common experience that virus transmission, particularly transmission of the human immunodeficiency virus (HIV), is a principal concern of patients and physicians regarding blood transfusion (1). Many physicians are probably unaware that transfusion-transmitted HIV infection is approximately 50 to 100 times less likely to occur than transfusion error (2-4). This misconception may have been encouraged by the scarcity of reports on transfusion error relative to the tremendous public attention focused on HIV infection. We present five cases illustrating how anesthesiologists, intensivists, and emergency physicians are particularly vulnerable to the risk of administering blood to the wrong recipient. All five cases were collected during a 4-yr period. Transfused units of packed red cells totaled approximately 50,000 U during this period in our department. IMPLICATIONS: Human error leading to the transfusion of blood to an unintended recipient is a major source of transfusion-related fatalities. We report five cases that highlight some specific areas in which transfusion error is likely to occur.
    Anesthesia & Analgesia 02/2002; 94(1):154-6, table of contents. · 3.30 Impact Factor
  • S. Kampe, H. Nori, S.M. Kasper, C. Diefenbach
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    ABSTRACT: In unserer Klinik war Carbostesin 0,5% hyperbar® (AstraZeneca) durch Bucain 0,5% hyperbar® (Curasan) ausgetauscht und als pharmakologisch gleichwertig angeboten worden.Die beiden Lokalanästhetika unterscheiden sich jedoch durch ihren Glukoseanteil. Wir berichten über 3 Patientinnen, die eine Spinalanästhesie zur Sectio caesarea erhielten. Bei 2 Patientinnen beobachteten wir nach Verwendung von Bucain 0,5% hyperbar® eine nur unzureichende Ausbreitung der Spinalanästhesie.Die dritte Patientin erhielt wieder die zuvor übliche Kombination von Carbostesin 0,5% hyperbar® mit Fentanyl und zeigte einen unauffälligen Verlauf. Nach Durchsicht der Literatur müsste die klinische Wirkung von Carbostesin 0,5% hyperbar® und Bucain 0,5% hyperbar® identisch sein. Es hätte nicht zu einer kritischen Verdünnung des Bucains durch den Fentanylzusatz kommen dürfen. In our hospital hyperbaric Carbostesin 0.5%® (AstraZeneca) had been substituted by hyperbaric Bucain 0.5%® (Curasan) and both drugs were believed to be identical in their actions.However, both local anaesthetics differ in the amount of glucose they contain. We report about three patients who underwent cesarian section under spinal anaesthesia. In two patients we observed an insufficient spread of spinal anaesthesia after administration of hyperbaric Bucain 0.5%®.The third patient received the normally used combination of hyperbaric Carbostesin 0.5%® and fentanyl and the subarachnoid block proceeded completely uneventfully. According to the literature the clinical efficacy of hyperbaric Carbostesin 0.5%® and hyperbaric Bucain 0.5%® should be identical and therefore a critical dilution of the Bucain should not have occurred because of the addition of fentanyl.
    Der Anaesthesist 01/2002; 51(12):993-995. · 0.85 Impact Factor
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    Critical Care 01/2002; 6:1-2. · 4.93 Impact Factor
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    ABSTRACT: We assessed the efficacy of an epidural infusion of ropivacaine 0.1% and sufentanil 1 microg x ml(-1), comparing it with intravenous patient-controlled analgesia using piritramide in this prospective, randomised, double-blind study of 24 ASA physical status I-III patients undergoing elective total hip replacement. Lumbar epidural block using ropivacaine 0.75% was combined with either propofol sedation or general anaesthesia for surgery. Epidural infusion and patient-controlled analgesia were started after surgery. Twelve patients received an epidural infusion of ropivacaine 0.1% and sufentanil 1 microg x ml(-1) at a rate of 5-9 ml x h(-1) and an intravenous patient-controlled analgesia device loaded with saline. Eleven patients received an epidural infusion of saline at the same rate and intravenous piritramide via the patient-controlled analgesia device. Motor block was negligible in both groups. The epidural ropivacaine group had significantly lower visual analogue pain scores at rest 4 h after surgery (p < 0.01), and on movement 4 h (p < 0.01) and 8 h (p < 0.05) after surgery, than the intravenous piritramide group. The piritramide group experienced significantly more adverse events than the epidural group (p < 0.001), especially hypotension (p < 0.01) and vomiting (p < 0.05). Patients in the epidural ropivacaine group were more satisfied with the pain management (p < 0.05). We conclude that the epidural infusion of ropivacaine 0.1% and sufentanil 1 microg x ml(-1) is superior to intravenous opioid by patient-controlled analgesia in preventing pain after total hip replacement, with fewer adverse effects and greater patient satisfaction.
    Anaesthesia 12/2001; 56(12):1189-93. · 3.49 Impact Factor

Publication Stats

792 Citations
132.42 Total Impact Points

Institutions

  • 2003
    • University of Rostock
      • Klinik und Poliklinik für Anästhesiologie und Intensivtherapie
      Rostock, Mecklenburg-Vorpommern, Germany
    • Philipps-Universität Marburg
      • Klinik für Anästhesie und Intensivtherapie (Marburg)
      Marburg an der Lahn, Hesse, Germany
    • Universität des Saarlandes
      • Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie
      Saarbrücken, Saarland, Germany
    • St. Katharinen-Hospital GmbH
      Frechen, North Rhine-Westphalia, Germany
  • 1970–2003
    • University of Cologne
      • • Department of Anaesthesiology and Intensive Care Medicine
      • • Division of Intensive Care Medicine
      • • Division of Anesthesiology
      Köln, North Rhine-Westphalia, Germany