K Taeger

Universität Regensburg, Ratisbon, Bavaria, Germany

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Publications (139)325.86 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Providing an acute pain service means accumulation of a large amount of data. The alleviation of data collection, improvement of data quality and data analysis plays a pivotal role. The electronic medical record (EMR) is gaining more and more importance in this context and is continuously spreading in clinical practice. Up to now only a few commercial softwares are available that specifically fit to the needs of an acute pain service. Here we report the development and implementation of such a program (Schmerzvisite, Medlinq, Hamburg, Germany) in the acute pain service of a University Hospital.
    ains · Anästhesiologie · Intensivmedizin 08/2009; 44(7-8):548-51. · 0.39 Impact Factor
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    ABSTRACT: Acid aspiration is a serious complication that can occur during general anesthesia. Studies show that beta-agonists have beneficial effects on lung injury. Therefore, we tested the effect of the nebulized beta-agonist fenoterol on lung variables in a rodent model of acid-induced lung injury. In a prospective, randomized, and controlled study, we evaluated the effects of fenoterol inhalation on lung oxygenation, inflammation, and pulmonary histology in a rat model of acid-induced lung injury. Sprague-Dawley rats underwent sevoflurane anesthesia with tracheotomy and carotid catheter insertion. Lung injury was induced by instillation of 0.4 mL/kg 0.1 M hydrochloric acid. The lungs were ventilated for 6 h and randomized to receive either fenoterol inhalation 10 microg or saline inhalation, both at 15 and 180 min after acid aspiration. Mean arterial blood pressures and peak airway pressures were documented, arterial blood gases were determined at 30, 90, 180, 270, and 360 min, and postmortem histology was subsequently examined. Additionally, fenoterol concentrations in bronchoalveolar lavage fluid (BALF) and plasma were determined by liquid chromatography/tandem mass spectroscopy. After 360 min tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 were determined in the BALF, and lungs were dried for determination of the wet/dry ratio. Inhalation treatment with 10 microg fenoterol significantly increased oxygenation after 270 and 360 min when compared with placebo. Fenoterol-treated rats showed a significant decrease in IL-6 and TNF-alpha levels and in the wet/dry weight ratio of the lungs. The histologic appearance showed significantly less interstitial edema and leukocyte infiltration in the fenoterol group. The concentration of fenoterol was 10.3 microg/L (median) in the BALF and <1 microg/L in the plasma. Fenoterol inhalation improved oxygenation after 270 and 360 min, attenuated the release of TNF-alpha and IL-6, and diminished the lung edema and infiltration of polymorphonuclear leukocytes.
    Anesthesia and analgesia 07/2009; 109(1):143-50. DOI:10.1213/ane.0b013e3181a2a85d · 3.42 Impact Factor
  • ains · Anästhesiologie · Intensivmedizin 07/2009; 44:548-551. DOI:10.1055/s-0029-1237110 · 0.34 Impact Factor
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    ABSTRACT: Pulmonary aspiration of gastric acid is a serious complication during anaesthesia and may cause aspiration pneumonitis and adult respiratory distress syndrome. The development of pulmonary hypertension may aggravate the initial course of the aspiration pneumonitis. The authors hypothesized that acid aspiration induces an acute increase in right ventricular pressure in the rat heart. Additionally, it was hypothesized as a secondary study that endothelin levels would be increased in this rat model. Male Sprague Dawley rats, anaesthetized with sevoflurane, underwent tracheostomy, and catheters were inserted into the carotid and right ventricle. Lung injury was induced by instillation of 0.4 ml kg(-1) 0.1 mol l(-1) HCl; a control group received the same volume of 0.9% NaCl. Rats were then ventilated for 6 hours. p(a)O2, mean arterial blood pressures and right ventricular systolic pressures were documented every 30 minutes, and arterial blood gases were measured at baseline, 30, 90, 180, 270 and 360 min. Wet/dry ratio was performed and additionally endothelin-1 levels were examined before and 180 and 360 min after aspiration. p(a)O2 values were lower, whereas right ventricular systolic pressures were significantly higher in the HCl group. Mortality rate was 50% after HCl aspiration, whereas 100% of the rats survived NaCl aspiration. Wet/dry ratio and endothelin-1 levels showed a significant increase after 180 and 360 min of HCl aspiration. Acid aspiration induces a significant increase in right ventricular systolic pressure and endothelin levels, and causes metabolic acidosis in this animal model.
    European Journal of Anaesthesiology 05/2009; 26(4):285-92. DOI:10.1097/EJA.0b013e32831ac614 · 2.79 Impact Factor
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    ABSTRACT: To investigate the accuracy of jugular bulb venous monitoring in detecting cerebral ischemia, we performed ipsilateral jugular bulb venous monitoring in 48 patients undergoing carotid surgery under regional anesthesia. Cerebral ischemia was assumed when neurologic deterioration occurred. During carotid clamping, the maximal arterial-jugular venous oxygen content difference [AJDO2 (max)], the minimal jugular venous oxygen saturation [SjO2 (min)], the maximal arterial-jugular venous lactate content difference [AJDL (max)], the maximal lactate oxygen index [LOI (max)], and the maximal modified LOI [mLOI (max)] were determined. To quantify the selectivity of each parameter, we performed receiver operating characteristic analysis and determined the area under the curve. The cutoff points providing the highest accuracy and the corresponding sensitivity (Se) and specificity (Spec) were determined. Neurologic deterioration occurred in 12 patients. All parameters, except AJDO2 (max), showed significant ability to distinguish between ischemic and nonischemic patients. The area under the curve for AJDL (max) was 0.840, for SjO2 (min) 0.766, for LOI 0.745, for mLOI 0.748, and for AJDO2 (max) 0.672. We found cutoff points of > or =0.16 mmol/L for AJDL (max) (Se=67%; Spec=86%) and < or =55% for SjO2 (Se=75%; Spec=83%). In conclusion, the present investigation shows that AJDL, SjO2, LOI, and mLOI provide the ability to detect cerebral hypoperfusion. The highest accuracy was found for AJDL. Neither the calculation of LOI nor of mLOI showed improved results.
    Journal of Neurosurgical Anesthesiology 02/2008; 20(1):8-14. DOI:10.1097/ANA.0b013e31814b1459 · 2.35 Impact Factor
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    ABSTRACT: This study compares the accuracy of cerebral monitoring systems in detecting cerebral ischemia during carotid endarterectomy. The authors compared transcranial Doppler sonography (TCD), near-infrared spectroscopy (NIRS), stump pressure (SP) measurement, and somatosensory evoked potentials (SEP) in 48 patients undergoing carotid surgery during regional anesthesia. Cerebral ischemia was assumed when neurologic deterioration occurred. During clamping, the minimum mean middle cerebral artery velocity (TCD(min)), its percentage change (TCD%), the minimum regional saturation of oxygen (NIRS(min)), its percentage change (NIRS%), the mean SP, and the changes of SEP amplitude were recorded. To analyze the corresponding sensitivity and specificity of each parameter, the authors performed receiver operating characteristic analysis. Neurologic deterioration occurred in 12 patients. SP and NIRS were successfully performed in all patients. TCD monitoring was not possible in 10 (21%); SEP was not possible in 2 patients (4%). All parameters provided the ability to distinguish between ischemic and nonischemic patients. TCD% and NIRS% showed significantly better discrimination than TCD(min) and NIRS(min) (P < 0.05). The highest area under the curve (AUC) was found for TCD% (AUC = 0.973), but there was no significant difference compared with NIRS% (AUC = 0.905) and SP (AUC = 0.925). The lowest AUC was found for SEP (AUC = 0.749), which was significantly lower than that for TCD%, NIRS%, and SP. TCD%, NIRS%, and SP measurement provide similar accuracy for the detection of cerebral ischemia during carotid surgery. Lower accuracy was found for SEP monitoring. Because of the high rate of technical difficulties (21%), TCD monitoring was the least practical of the investigated monitoring devices.
    Anesthesiology 10/2007; 107(4):563-9. DOI:10.1097/01.anes.0000281894.69422.ff · 6.17 Impact Factor
  • T Bein, M Ritzka, F Schmidt, K Taeger
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    ABSTRACT: The effects of a systematic change in a patient's position [prone position, continuous lateral rotational therapy (CLRT)] have been investigated in recent years in acute lung injury and have shown an improvement in oxygenation, but controversial results regarding duration of mechanical ventilation, intensive care treatment and mortality compared to conventionally treated patients. We were interested in the practice and acceptance of positioning therapy in German intensive care units (ICU) and performed a national postal survey with respect to evaluation of indications, preference of particular positions, observed complications and additional aspects (costs, influence on other intensive care measures etc.). A questionnaire (12 multiple choice items) was sent to 1,763 ICUs, which were identified from the "Deutsches Krankenhausadressbuch" (German hospital address book 2005). The analysis was performed anonymously. A total of 702 questionnaires (40.4%) were returned and analysed. The 135 degrees position (incomplete prone position) was most frequently used (50%), while the prone position (25%) and CLRT (18%) were less frequent. The improvement in oxygenation (95%) and the prevention of ventilator-associated complications (75.7%) were important indications for positioning therapy. Results of a blood gas analysis provided the necessary criteria for determining positional therapy. Supporters of the prone position advocated lower cost and better efficacy in comparison to CLRT. The frequency of complications during positioning therapy was reported to be high: hemodynamic instability (73.6%), accidental loss of tube/catheters (50.4%) and patient intolerance (40.7%) were often observed, and complication-free positioning therapy was reported in only 8.6%. The 135 degrees position (incomplete prone position) is the most frequently used positioning therapy in Germany for improvement of oxygenation in patients with acute lung injury. Prone position and CLRT are less frequently used, probably due to an increased frequency of (expected) complications. The authors assume that clear guidelines and algorithms are needed to establish a more routine, safe practical application and a reduction in the complication rate.
    Der Anaesthesist 04/2007; 56(3):226-31. · 0.74 Impact Factor
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    ABSTRACT: Der systematische Wechsel der Lagerung des Intensivpatienten [Bauchlage, kontinuierliche laterale Rotationstherapie (KLRT)] bewirkt bei Patienten mit akuter respiratorischer Insuffizienz eine Verbesserung des pulmonalen Gasaustausches. Der Einfluss dieser Maßnahmen auf andere Parameter (Dauer von Beatmung und Intensivbehandlung, Inzidenz beatmungsassoziierter Komplikationen, Letalität) wird hingegen in Studien kontrovers beurteilt. Es wurde eine deutschlandweite Befragung zum Stand des Einsatzes von Lagerungsmaßnahmen in der Intensivmedizin durchgeführt, um Indikationsstellungen, Vorzüge bestimmter Lagerungen, beobachtete Komplikationen und zusätzliche Aspekte (Kosten, Einfluss auf andere intensivtherapeutische Maßnahmen etc.) in Erfahrung zu bringen.Die Fragebogen (12 Fragen mit Möglichkeit zur Mehrfachantwort) wurden an alle Intensivstationen (n=1736) versandt, die im Deutschen Krankenhausadressbuch (2005) aufgeführt waren. Die Auswertung erfolgte anonymisiert.Es wurden 702 Fragebögen (40,4%) auswertbar beantwortet. Die 135°-Lagerung (inkomplette Bauchlagerung) kommt bei etwa 50% der teilnehmenden Intensivstationen häufig zum Einsatz, die Bauchlagerung bei 25%. Kontinuierliche laterale Rotationstherapie wird in 18% häufig angewandt. Wesentliche Indikationen zum Einsatz von Lagerungstherapie sind die Verbesserung der Oxygenierung (95%) und die Prophylaxe von beatmungsassoziierten Komplikationen (75,7%). Die Blutgasanalyse gilt als wichtiger Entscheidungsparameter. Die Befürworter der Bauchlagerung nennen die geringeren Kosten und den besseren Effekt als Argument gegenüber der KLRT. Komplikationen während einer Lagerungstherapie sind häufig: hämodynamische Instabilität (73,6%), Tubus-/Katheterdislokation (50,4%) und Intoleranz des Patienten (40,7%). Nur 8,6% der Anwender sehen die Maßnahme als komplikationsfrei an.Die 135°-Lagerung ist auf deutschen Intensivstationen die häufigste Lagerungsmethode zur Steigerung des Gasaustausches. Bauchlagerung und KLRT kommen seltener zum Einsatz. Die Lagerungstherapie ist mit einer hohen Komplikationsquote und erheblichen Anpassungen der übrigen Intensivtherapie verknüpft. Die Autoren nehmen an, dass die Formulierung klarer Leitlinien und praktischer Algorithmen zu mehr Routine, sicherer Anwendungspraxis und zur Reduktion von Komplikationen führt.
    Der Anaesthesist 01/2007; 56(3). DOI:10.1007/s00101-007-1134-8 · 0.74 Impact Factor
  • M Gruber, K.-P. Ittner, K Taeger
    01/2007: pages 57-67; LinguaMed., ISBN: 3928610503
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    ABSTRACT: Pump-driven extracorporeal gas exchange systems have been advocated in patients suffering from severe acute respiratory distress syndrome who are at risk for life-threatening hypoxemia and/or hypercapnia. This requires extended technical and staff support. We report retrospectively our experience with a new pumpless extracorporeal interventional lung assist (iLA) establishing an arteriovenous shunt as the driving pressure. University hospital. Ninety patients with acute respiratory distress syndrome. Interventional lung assist was inserted in 90 patients with acute respiratory distress syndrome. Oxygenation improvement, carbon dioxide elimination, hemodynamic variables, and the amount of vasopressor substitution were reported before, 2 hrs after, and 24 hrs after implementation of the system. Interventional lung assist led to an acute and moderate increase in arterial oxygenation (Pao2/Fio2 ratio 2 hrs after initiation of iLA [median and interquartile range], 82 mm Hg [64-103]) compared with pre-iLA (58 mm Hg [47-78], p < .05). Oxygenation continued to improve for 24 hrs after implementation (101 mm Hg [74-142], p < .05). Hypercapnia was promptly and markedly reversed by iLA within 2 hrs (Paco2, 36 mm Hg [30-44]) in comparison with before (60 mm Hg [48-80], p < .05], which allowed a less aggressive ventilation. For hemodynamic stability, all patients received continuous norepinephrine infusion. The incidence of complications was 24.4%, mostly due to ischemia in a lower limb. Thirty-seven of 90 patients survived, creating a lower mortality rate than expected from the Sequential Organ Failure Assessment score. Interventional lung assist might provide a sufficient rescue measure with easy handling properties and low cost in patients with severe acute respiratory distress syndrome and persistent hypoxia/hypercapnia.
    Critical Care Medicine 05/2006; 34(5):1372-7. DOI:10.1097/01.CCM.0000215111.85483.BD · 6.15 Impact Factor
  • S Moritz, P Kasprzak, K Taeger, C Metz
    Journal of Neurosurgical Anesthesiology 01/2006; 18(4). DOI:10.1097/00008506-200610000-00121 · 2.35 Impact Factor
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    ABSTRACT: To investigate whether urapidil (α1-adrenergic antagonist/5-HT1A agonist) enhances subcutaneous tissue oxygen tension (PsqO2) during convective rewarming, we performed a prospective, randomized, placebo-controlled animal study. Mild hypothermia was achieved by surface cooling. Protocol A: before rewarming : i.v. bolus of 1.0ml NaCl 0.9%/kg body weight; Protocol B: before rewarming: i.v. bolus of 5mg urapidil/kg body weight.Urapidil significantly reduced the rewarming time (placebo: 30.2±2.9min, urapidil: 24.2±2.3min, P=0.012) and the PsqO2 during rewarming was significantly enhanced (P=0.023, AUCPsqO2‐placebo versus AUCPsqO2‐urapidil).The α1-adrenergic antagonist/5-HT1A agonist urapidil accelerates convective rewarming and enhances PsqO2 during rewarming in mildly hypothermic rats. Obviously, urapidil therapy increased the shift of heat from the periphery to the core. It is known that -HT1A receptor agonists reduce thermoregulatory thresholds to cold. Therefore, a reduction in oxygen consumption with an increased oxygen delivery to subcutaneous tissues by urapidil is a further possible mechanism.
    Journal of Thermal Biology 01/2006; 31(1):144-148. DOI:10.1016/j.jtherbio.2005.11.017 · 1.54 Impact Factor
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    ABSTRACT: Background and objective: The electroencephalographic Narcotrend Index (NI) is a measure of the hypnotic component of general anaesthesia. The purpose of this study was to evaluate the impact of Narcotrend guidance on propofol consumption and emergence times in children receiving total intravenous anaesthesia with propofol and remifentanil. Methods: Thirty children, aged 1-11 yr, scheduled for paediatric urological surgery were enrolled. Remifentanil was given to all patients at a constant infusion rate of 0.3 microg kg [-1] min[-1] throughout anaesthesia. Patients were randomly allocated to receive a continuous propofol infusion adjusted either according to a conventional clinical practice (Group C: n=15) or guided by Narcotrend monitoring (Group NI: n=15; target NI 60+/-5). All patients were connected to the Narcotrend Monitor, but in Group C the anaesthetist was blinded to the screen of the monitor. Propofol consumption (mg kg[-1]h[-1]) and emergence times (min) were the primary and secondary outcome measures. Results: Propofol consumption (median [inter-quartile range]) was significantly lower in Group NI compared to Group C (NI: 7.0 [6.4--8.2] vs. C: 9.3 [8.3--11.0] mg kg[-1]h[-1]; P<0.001), whereas Log-Rank-analysis revealed no intergroup difference in emergence times (Group NI: mean [95% confidence interval (CI)] 12.8 [11.2--14.4] min; Group C: 16.4 [12.6--20.2] min; P=0.10). Haemodynamic variables remained stable within age-related limits, and there were no observations of adverse events, especially no clinical signs of intraoperative awareness in any patient. Conclusion: Narcotrend monitoring for guidance of propofol/remifentanil anaesthesia in children results in reduced propofol consumption compared to a conventional clinical practice.
    European Journal of Anaesthesiology 10/2005; 22(10):741-7. DOI:10.1017/S0265021505001237 · 3.01 Impact Factor
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    ABSTRACT: The clearance of moxifloxacin is reported to be unaltered in the presence of renal insufficiency. There is little information about the clearance of intravenous moxifloxacin in renal replacement therapies during intensive care. The aim of this study was to determine the clearance of moxifloxacin during continuous veno-venous haemofiltration (CVVHF) in vitro. The elimination of moxifloxacin (reservoir with 600 mL of washed human erythrocytes, 100 mL of NaHCO3 and various amounts of Ringer solution and human albumin to give a total volume of 1000 mL, pH 7.35 +/- 0.5; haematocrit 41 +/- 2) during CVVHF in vitro with two filter conditions (during priming, after priming), three protein concentrations (human albumin: 0 g/L, 20 g/L, 40 g/L) and two filtration velocities [(i) standard condition: blood flow at 100 mL/min and turnover of 2 L/h; (ii) blood flow at 50 mL/min and turnover of 1 L/h] were investigated. A new filter needs 20 min of priming before moxifloxacin reaches a steady relative filtration rate. The sieving coefficient with 0 g/L albumin was 1.07, with 20 g/L 0.90 and with 40 g/L 0.80. Under standard filtration conditions (i) the renal clearance was between 26.7 and 35.7 mL/min, and under the altered conditions (ii) it was 15.2 mL/min. During CVVHF in vitro we found filtration clearances of moxifloxacin of the same order as its renal clearance in healthy subjects. The high sieving coefficient, nearly independent of blood protein concentration, would suggest that moxifloxacin is filtered almost as freely as creatinine. These results do not indicate a need for dose adjustment under appropriate haemofiltration conditions and normal hepatic function.
    Journal of Antimicrobial Chemotherapy 09/2005; 56(2):360-4. DOI:10.1093/jac/dki205 · 5.44 Impact Factor
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    ABSTRACT: The Narcotrend Index (NI) of anesthetic depth is potentially a pharmacodynamic measure of the effects of sevoflurane on the brain. In this prospective observational study of 30 pediatric surgical patients (1-11 years), we investigated the correlation between nonsteady-state endtidal sevoflurane (eT(Sevo)), NI, mean arterial pressure (MAP), and heart rate (HR). The performance of the Narcotrend for differentiation between consciousness and unconsciousness was evaluated using prediction probability (P(K)). Spearman correlation analysis showed significant correlations (P < 0.01) between eT(Sevo) and NI (r = -0.85) and MAP (r = -0.43). P(K)-values for differentiation between consciousness and unconsciousness were 1.0 for NI and <0.85 for MAP and HR. During the surgical procedure, NI-values showed a constant rise with each 0.5% step of lowering eT(Sevo) (P < 0.03), whereas MAP remained unaltered and HR showed a constant decline (P < 0.03), except between 1.5 and 1%. In children, nonsteady-state eT(Sevo) concentrations are more closely related with NI than with MAP or HR. In this study, only NI reliably differentiated consciousness from unconsciousness.
    Pediatric Anesthesia 09/2005; 15(9):727-32. DOI:10.1111/j.1460-9592.2004.01546.x · 1.74 Impact Factor
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    ABSTRACT: The Narcotrend Index (NI) for assessment of depth of anesthesia by analysis of the electroencephalogram (EEG), is potentially a pharmacodynamic measure of the effects of desflurane on the brain. In this prospective study of 30 pediatric and adult patients (group 1: 3-6 years, n = 10; group 2: > 6 < 12 years; group 3: 12-40 years), undergoing ophthalmological surgery, we investigated the pharmacodynamic relationship between nonsteady state endtidal desflurane concentrations (eT(Des)), NI, classical EEG parameters (cEEG), heart rate (HR) and mean arterial pressure (MAP). The performance of the Narcotrend for differentiation between consciousness and unconsciousness was evaluated using prediction probability (P(K)). Spearman correlation analysis showed significant negative correlations (P < 0.001) between eT(Des) and NI (group 1: r = -0.93, group 2: r = -0.86, group 3: r = -0.66). Correlations between eT(Des) and MAP or HR were either only weak negative (r < -0.5) or not significant. Desflurane EC(50) (eT(Des) with half maximal effect on NI) was 7.18% for group 1, 7.34% for group 2, and 4.15% for group 3 (P < 0.001 Vs groups 1 and 2). Overall awake NI values (96.7 +/- 1.4) were significantly higher (P < 0.001) than at the moment of loss of consciousness (58.3 +/- 17.5), with no overlap (P(K) 1.0), whereas P(K) values for cEEG, MAP and HR were all <0.85. The pharmacodynamic relationship between eT(Des) and NI is age dependent with a significantly higher EC(50) in children than in adolescents and adults. The NI appears to be superior to cEEG, MAP and HR in differentiating consciousness from unconsciousness.
    Pediatric Anesthesia 05/2005; 15(5):378-84. DOI:10.1111/j.1460-9592.2005.01465.x · 1.74 Impact Factor
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    ABSTRACT: To evaluate the effect of pentoxifylline treatment on gas exchange and mortality immediately after bilateral instillation of hydrochloric acid. Randomized, prospective, placebo-controlled trial. Animal laboratory of a university hospital. Twenty-four, adult, male Sprague-Dawley rats. Sevoflurane-anesthetized rats (n = 12 in each group) underwent tracheostomy and insertion of a cannula into a hind paw vein and the left carotid artery. All animals received volume-controlled mechanical ventilation (zero positive end-expiratory pressure; fraction of inspired oxygen, 0.21). Acute lung injury was induced by instillation of 0.4 mL/kg 0.1 mol/L hydrochloric acid. The animals were randomized into two groups. The pentoxifylline group (n = 12) received a bolus of 20 mg/kg IV pentoxifylline after aspiration, followed by a continuous infusion of 6 mg/kg/h. The placebo group (n = 12) received an equivalent volume of saline solution. Arterial blood samples were collected for blood gas analysis 15 min and 0 min prior to aspiration and 30, 90, 180, 270, and 360 min after aspiration. Hemodynamic parameters, temperature, and ECG were recorded simultaneously. The primary end point was 6 h after aspiration. All surviving rats were killed by IV administration of pentobarbital. To assess morphologic changes due to lung injury, all animals underwent CT in inspiratory hold at the end of the experiment. No difference in baseline measurements was observed. In pentoxifylline-treated rats, Pao(2) was significantly increased (p < 0.05) at 30, 90, 180, 270, and 360 min. Mortality at 6 h was 17% in the pentoxifylline group vs 67% in the placebo group. Placebo-treated rats showed significant abnormalities in CT lung scans compared with the pentoxifylline group. Acid aspiration impairs gas exchange and induces hypotension. Pentoxifylline administration shortly after acid instillation results in significant alleviation of impaired oxygenation, stabilization of BP with higher heart rates, and improved survival after 6 h.
    Chest 03/2005; 127(2):613-21. DOI:10.1378/chest.127.2.613 · 7.13 Impact Factor
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    Canadian Journal of Anaesthesia 11/2004; 51(8):855-6. DOI:10.1007/BF03018471 · 2.50 Impact Factor
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    ABSTRACT: Ventilation in the prone position is carried out for improvement of pulmonary gas exchange in patients with acute respiratory distress syndrome (ARDS). We compared the effects of an incomplete prone position (IPP, 135( degrees )) with a complete prone position (CPP, 180( degrees )) in patients with ARDS. For this trial 59 patients with ARDS were randomly assigned and were positioned in a "cross-over" design: patients of group A were placed in IPP for 6 h and then immediately positioned in CPP for another 6 h. Patients in group B were positioned in reverse order. Blood gases, hemodynamic measurements, quasistatic respiratory compliance and assessments of side effects were performed before begin, 30 min and 6 h after first positioning, then 30 min and 6 h after second positioning and 2 after repositioning. Turning patients in IPP and CPP resulted in a significant increase in the arterial oxygenation index (p(a)O(2)/F(I)O(2)), but this effect was more pronounced in the CPP (before: 142+/-46 mm Hg, 6 h: 253+/-107 mm Hg) than in the IPP (before: 139+/-54 mm Hg, 6 h: 206+/-75 mm Hg), and compliance was improved only in CPP. The improvement in arterial oxygenation persisted 2 h after repositioning in the supine position in both groups. The oxygenation responder rate was lower during the IPP (70.3%) in comparison with the CPP (84.0%, p<0.05). The incidence of side effects tended to be increased during the CPP. Incomplete prone position improves oxygenation in ARDS patients, but less effectively than a "classic" CPP. In these patients the use of a CPP should be preferred.
    Der Anaesthesist 11/2004; 53(11):1054-60. DOI:10.1007/s00101-004-0754-5 · 0.74 Impact Factor
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    ABSTRACT: In a prospective, randomized, cross-over, placebo-controlled study in healthy male volunteers, we tested the effect of the 5-HT3 antagonist tropisetron on cold-induced oxygen consumption and shivering.Cooling was performed by intravenous infusion of isotonic salt solution at 4°C. Whole-body oxygen consumption (VO2) was measured with a metabolic monitor. Shivering was qualitatively assessed. When the shivering score evaluated “2” (intense shivering), 5mg tropisetron or NaCl 0.9% was injected and repeated if necessary, to completely stop shivering.The VO2 before shivering (178±9ml/min/m2) rose significantly during shivering (291±21ml/min/m2). 5mg of tropisetron in 2 volunteers and 10mg in 3 volunteers stopped shivering but it returned (grade 0–1). The VO2 decreased significantly (209±17ml/min/m2). Placebo had no effect.Tropisetron reduced cold-induced VO2 and intensity of hypothermic shivering. That an additional dose of tropisetron could not stop the shivering totally may indicate that the effect of tropisetron is not dose dependent.
    Journal of Thermal Biology 10/2004; 29(7):845-849. DOI:10.1016/j.jtherbio.2004.08.066 · 1.54 Impact Factor

Publication Stats

2k Citations
325.86 Total Impact Points

Institutions

  • 1998–2006
    • Universität Regensburg
      • Department of Anesthesiology
      Ratisbon, Bavaria, Germany
  • 1996–2004
    • University Hospital Regensburg
      • Klinik für Anästhesiologie
      Ratisbon, Bavaria, Germany
  • 1999
    • Ludwig-Maximilian-University of Munich
      • Department of Anesthesiology
      München, Bavaria, Germany