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ABSTRACT: BACKGROUND:Sleep disturbances after general surgery have been described. In this study, we assessed rapid eye movement (REM) sleep in patients undergoing knee replacement surgery using a regional anesthetic technique.METHODS:Ambulatory polysomnography (PSG) was performed on 3 nights: the night before surgery (PSG1), the first night after surgery (PSG2), and the fifth postoperative night (PSG3). Postoperative analgesia was maintained with peripheral nerve catheters for the first 3 days and with oral opioids thereafter. In addition, nonsteroidal antiinflammatory drugs were administered. Postoperative pain was monitored using a visual analog scale.RESULTS:PSG was performed in 12 patients, 6 men and 6 women, with a mean age of 61 (±12) years. REM sleep was reduced from PSG1 (median 16.4%) to PSG2 (median 6.3%; P = 0.02). The Hodges-Lehmann estimate for the median reduction is -7.8% (95% confidence interval -14.8% to -0.7%). During PSG3, significantly more REM sleep was detected (median 15.4%) compared with PSG2 (P = 0.01). The Hodges-Lehmann estimate for this median increase is 10.0% (95% confidence interval 1.7%-25.3%).CONCLUSION:Postoperative reduction of REM sleep also occurs after surgery and regional anesthesia.
Anesthesia and analgesia 03/2013; · 3.08 Impact Factor
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ABSTRACT: Oxygen is the best known and well accepted medication in emergency medicine. In most emergencies high doses of oxygen are an essential part of treatment and seemed to be nearly free of adverse effects. Studies of the last two decades show hints to possible adverse effects of hyperoxia during post-resuscitation-care and myocardial infarction. These results should be critically reviewed and may lead to a rational use of oxygen in emergency care.
ains · Anästhesiologie · Intensivmedizin 03/2013; 48(2):84-9. · 0.41 Impact Factor
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ABSTRACT: Up to the present day, pain management in the ICU (Intensive Care Units)is a unresolved clinical problem due to patient heterogeneity with complex variation inetiopathology and treatment of the underlying diseases. Therefore, therapeutic strategies in terms of standard operating procedure (SOP) are a necessary to improve the pain management for intensive care patients. Common guidelines for analgosedation are often inadequate to reflect the clinical situation. In particular, for an ICU setting without permanent presence of a physician a missing pain management SOP resulting in delayed pain therapy caused by a therapeutic uncertainty of the nurse staff.In addition to our pre-existing SOP for analgosedation we implemented a pain management SOP for our interdisciplinary, anaesthesiologic ICU. A exploratory survey among the nurse staff was conducted to assess the efficacy of the SOP. The results of the evaluation after a 6 month follow-up indicated a faster onset of pain management and good acceptance by the nursing staff.
ains · Anästhesiologie · Intensivmedizin 03/2013; 48(3):150-4. · 0.41 Impact Factor
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Journal of Emergency Medicine 01/2013; · 1.31 Impact Factor
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ABSTRACT: Nowadays almost all operating rooms are equipped with air conditioning (AC units). Their main purpose is climatization, like ventilation, moisturizing, cooling and also the warming of the room in large buildings. In operating rooms they have an additional function in the prevention of infections, especially the avoidance of postoperative wound infections. This is achieved by special filtration systems and by the creation of specific air currents. Since hypothermia is known to be an unambiguous factor for the development of postoperative wound infections, patients are often actively warmed intraoperatively using warm air blankets (forced-air warming units). In such cases it is frequently discussed whether such warm air blankets affect the performance of AC units by changing the air currents or whether, in contrast, have exactly the opposite effect. However, it has been demonstrated in numerous studies that warm air blankets do not have any relevant effect on the functioning of AC units. Also there are no indications that their use increases the rate of postoperative wound infections. By preventing the patient from experiencing hypothermia, the rate of postoperative wound infections can even be decreased thereby.
ains · Anästhesiologie · Intensivmedizin 01/2013; 48(1):36-7. · 0.41 Impact Factor
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ains · Anästhesiologie · Intensivmedizin 01/2013; 48(02):84-89. · 0.41 Impact Factor
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ABSTRACT: BACKGROUND:For nerve stimulator-guided regional anesthesia, one has to compromise between a presumed low success rate (using a high-current threshold) and a presumed increased risk of nerve damage (using a low-current threshold). We hypothesized that high-current thresholds in the range of 0.9 to 1.1 mA are not inferior with respect to the procedural and latency times compared with low threshold currents in the range of 0.3 to 0.5 mA for nerve stimulation in brachial plexus blocks.METHODS:Two hundred five patients scheduled for elective surgery were randomized to a low (0.3-0.5 mA, n = 103) or a high (0.9-1.1 mA, n = 102) stimulation current threshold for the axillary plexus block with 40 mL local anesthetic mixture (20 mL, each of prilocaine 1% and ropivacaine 0.75%). The primary end point was the time to complete sensory block. The secondary outcome measures were the time to readiness for surgery (defined as the time from the start of block procedure to complete sensory block) and the block performance time. The noninferiority margin was set at 5 minutes and was evaluated using the two-sided 95% bootstrap-confidence intervals ([CIs] 100,000 replications) for differences in means.RESULTS:The mean times to complete sensory block revealed a significant decrease with the low-current group (17.9 ± 12.1 (mean ± SD) versus 22.8 ± 12.4 minutes; 95% CI, 1.1 to 8.6; p = 0.012). The time to readiness for surgery was 30.3 ± 13.8 minutes in the low-current group and 31.7 ± 12.9 minutes in the high-current group (95% CI, -2.7 to 5.5; p = 0.49). The performance time was significantly shorter in the high-current threshold group (9.5 ± 4.7 versus 11.9 ± 5.7 minutes; 95% CI, -4 to 1.1; p = 0.001).CONCLUSION:Noninferiority for the high-current threshold technique could neither be confirmed for the primary end point nor for secondary end points. However, we consider a difference in mean times of approximately 8.5 minutes to achieve readiness for surgery acceptable for clinical practice.
Anesthesia and analgesia 12/2012; · 3.08 Impact Factor
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ABSTRACT: Objective: Guidelines recommend mechanical ventilation with Intermitted Positive Pressure Ventilation (IPPV) during resuscita-tion. Mechanisms of chest compression might influence mechanical ventilation. We investigated the gas exchange using Chest Com-pression Synchronized Ventilation (CCSV) compared with IPPV in a pig model. 1 Methods: After approval by local authorities 44 pigs underwent anaesthesia with intubation. After 3 min of ventricular fibrilla-tion continuous chest compressions followed for 24 min. Pigs were mechanical ventilated with IPPV (FiO 2 1.0, tidalvolumes 7 ml/kg, respiratoryrate 10 min, PEEP = 0mbar) or Chest Compres-sion Synchronized Ventilation (CCSV), a pressure–controlled and with each chest compression synchronized breathing pattern (FiO 2 1.0, Pinsp = 60 mbar, inspiratory time 265 ms)., p = 0.3; PaCO 2 39 mmHg (37–42) vs. 39 mmHg (36–41), p = 0.5; PaO 2 86 mmHg (81–94) vs. 92 mmHg (83–97), p = 0.3; SaO 2 98% (97,98) vs. 98% (97–99), p = 0.16. t:=;8 min pH 7.39 (7.34–7.43) vs. 7.28 (7.20–7.34), p < 0.0001; PaCO 2 44 mmHg (35–49) vs. 58 mmHg (53–66), p < 0.0001; PaO 2 317 mmHg (175–492) vs. 88 mmHg (55–122), p = 0.0002; SaO 2 100% (99.6–100) vs. 93% (78–98), p < 0.0001. t = 12 min pH 7.36 (7.31–7.44) vs. 7.21 (7.10–7.28), p < 0.0001; PaCO 2 41 mmHg (32–50) vs. 60 mmHg (52–75) p < 0.0001; PaO 2 383 mmHg (132–456) vs. 97 mmHg (68–155), p = 0.001; SaO 2 100% (98–100) vs. 97% (80–99), p = 0.001. Conclusions: Chest Compression Synchronized Ventilation (CCSV) increases oxygenation and avoids hypercarbia during resus-citation in a pig model compared to the recommended standard IPPV 2 . Purpose of the study: Despite considerable effort over the last decades a valid scoring system to assess patients survival after out of hospital cardiac arrest (OOHCA) is not available. Hence, health care professionals are required to base delicate decisions upon experience and gut feeling. Improvement of the predictability of patient's survival would be of major medical and socioeconomic interest and could save medical resources. The objective was there-fore to develop an improved outcome prediction tool for patients after OOHCA. Materials and methods: The current study was a retrospec-tive cohort-study based on a cardiac arrest-registry. Multivariate logistic regression was applied on a set of variables before restora-tion of spontaneous circulation deemed to have high predictive power (23 variables for witnessed OOHCA, 19 variables for non-witnessed OOHCA). To obtain reliable estimates of the classification performance as well as reliable confidence intervals a 10–fold cross-validation was done. The main performance parameter was the area under the ROC curve (AUC), classifying patients into survivors/non-survivors after 30–days. Results: Data of 1447 witnessed and 279 non-witnessed OOHCA patients were analysed. The average AUC was 0.806 [CI 0.784–0.829] for witnessed OOHCA and 0.6300 [CI 0.533–0.727] for non-witnessed OOHCA respectively. For witnessed OOHCA this was significantly better than the AUC for any single considered vari-able. For witnessed OOHCA, the single most predictive variable was "minutes to sustained ROSC" (AUC: 0.700 [CI 0.672 0.728]), for non-witnessed OOHCA it was "total doses of adrenaline" (AUC: 0.692 [CI 0.606 0.779]). Conclusions: The current results, although preliminary, are promising to increase prognostication accuracy and we are con-fident that they can serve as basis for a survival score in OOHCA-patients.
Resuscitation 10/2012; 4948:44-7. · 3.60 Impact Factor
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ABSTRACT: An ever occurring problem in the health-care services is the handling of patients who are carriers of multi-resistant pathogens (MRP). As a general rule, these patients must be isolated. Thus, the transport of these patients not only within but also outside of the hospital can be a problem. It is not just a matter of making the necessary transport of the afflicted patient, e.g., to examination suites or operating rooms, possible but also above all of protecting other patients and personnel from transmission and potential infection with the pathogen. As a rule, the measures of "standard hygiene" are sufficient for an adequate protection of patients and personnel. Above all, hand disinfection is of decisive importance.
ains · Anästhesiologie · Intensivmedizin 09/2012; 47(9):564-5. · 0.41 Impact Factor
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ABSTRACT: According to §6, section 3 of the German Protection against Infections Act [Infektionsschutzgesetz (IfSG)] an outbreak is defined as the occurrence in large numbers of nosocomial infections for which an epidemiological relationship is probable or can be assumed. About 2-10% of nosocomial infections in hospitals (about 5% in intensive care wards) occur within the framework of an outbreak. The heaped occurrence of nosocomial infections can be declared according to the prescribed surveillance of nosocomial infections (§23 IfSG) when, in the course of this assessment, a statistically significant increase in the rate of infections becomes apparent. On the other hand, the occurrence of an outbreak can also be recognized through the vigilance of all involved personnel and a general sensibilization towards this subject. The names of patients involved in outbreaks need not be reported to the responsible health authorities. As a consequence of the report the health authorities become involved in the investigation to determine the cause and its elimination, and to provide support and advice. The outbreak management should be oriented on the respective recommendations of the Robert Koch Institute.
ains · Anästhesiologie · Intensivmedizin 04/2012; 47(4):238-9. · 0.41 Impact Factor
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ABSTRACT: Artificial ventilation is one of the best known resuscitation procedures. It is generally accepted that there must be oxygen delivery to vital organs during cardiac arrest and resuscitation in order to prevent irreversible damage, but there is an increasing number of ventilation concepts for resuscitation. Traditional and alternative methods of ventilation are reviewed.
The need for positive-pressure ventilation during resuscitation as an essential gold standard might be overestimated at least in the first minutes of cardiopulmonary resuscitation (CPR). The co-founders of the concept of cardiocerebral resuscitation could show positive effects of a sole passive oxygenation at the beginning of advanced life support (ALS). Research was published on continuous positive airway pressure (CPAP) ventilation as well as on CPAP plus pressure support ventilation. In addition to positive-pressure ventilation, the use of an impedance threshold device, partly in addition with active compression-decompression CPR, was investigated in both experimental and clinical settings. None of these methods alone could be proven to improve the outcome of cardiac arrest. The role of high oxygen concentration during CPR also remains unclear.
Positive-pressure ventilation with pure oxygen remains, in clinical practice, the gold standard in ALS. Further research should focus on the role of passive oxygenation during early ALS. The concentration of oxygen needed during resuscitation has to be defined and alternative ventilation patterns, regarding the impact of CPR, should be investigated.
Current opinion in critical care 03/2012; 18(3):251-5. · 2.67 Impact Factor
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ABSTRACT: A 69-year-old woman reported that underwent endonasal frontal sinus surgery under general anesthesia. In her medical history the patient reports a multiple occurrence of angina pectoris attacks, especially in stressful situations. Coronary heart disease has so far been excluded. At preoperative presentation of this patient was in good general and nutritional state. Intraoperative hypotension had to be treated with norepinephrine. In the recovery room, the patient developed angina pectoris symptoms and the ECG showed T negativity. The patient was admitted on an ICU. Coronary angiography showed left ventricular apical ballooning with a transient akinesia typical of the left ventricle, as is seen in a Tako-Tsubo syndrome. The symptoms are similar to acute coronary artery disease, but without stenosis of coronary arteries. Physical or emotional stress is known to trigger Tako-Tsubo Syndrome, but the exact etiology or pathophysiology remains somewhat unclear.
ains · Anästhesiologie · Intensivmedizin 01/2012; 47(1):22-4. · 0.41 Impact Factor
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ABSTRACT: Invasive infections through to sepsis caused by fungi in intensive care units have increased markedly in the past few years. In the mean time almost every tenth case of sepsis in the intensive care unit is the result of an invasive fungal infection. Not only hemato-oncological or organ-transplanted patients are affected but increasingly also those patients who have been under intensive care for a considerable time and who exhibit particular risk factors. The lethality among the afflicted patients is high. The diagnosis of fungal infections is still difficult; unambiguous, highly sensitive and specific test procedures are still lacking. The decision for therapy must often be made empirically and as early as possible. In the past few years newly developed antimycotic agents have opened up new options for therapy.
ains · Anästhesiologie · Intensivmedizin 11/2011; 46(11-12):744-5. · 0.41 Impact Factor
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ABSTRACT: In 2009 the Commission for Hospital Hygiene and Prevention of Infections (CHHPI) at the Robert Koch Institute (RKI) published recommendations on the personnel and organisational prerequisites for the prevention of nosocomial infections. Emphasis was placed on the tasks of all members of professional groups who belong to or work closely with a team of hygiene specialists in an institution for outpatient or inpatient medical care. Since these recommendations have not yet been adequately implemented and because of the repeated occurrence of hygiene deficits in the health-care services the legislature has been forced to pass a new law on hospital hygiene. This law requires the managers of hospitals and other medical facilities to avoid nosocomial infections and to abide by the recommendations of CHHPI and RKI. The already existing shortage of hygiene specialists, and especially of hospital hygiene specialists, is thereby further intensified. Thus there are initiatives to provide physicians working in hospitals with further training in hygiene so that they can take over the functions of a hospital hygiene specialist.
ains · Anästhesiologie · Intensivmedizin 09/2011; 46(9):584-5. · 0.41 Impact Factor
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ains · Anästhesiologie · Intensivmedizin 07/2011; 46(7-8):538-9. · 0.41 Impact Factor
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ABSTRACT: The results of microbiological tests are the foundation for a targetted therapy and the basis for monitoring infections. The quality of each and every laboratory finding depends not only on an error-free analytical process. The pre-analysis handling procedures are of particular importance. They encompass all factors and influences prior to the actual analysis. These include the correct timepoint for sample taking, the packaging and the rapid transport of the material to be investigated. Errors in the pre-analytical processing are the most frequent reasons for inappropriate findings.
ains · Anästhesiologie · Intensivmedizin 05/2011; 46(5):330-1. · 0.41 Impact Factor
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ABSTRACT: In this study, we determined whether needle advancement during needle-nerve contact (forced needle-nerve contact) is associated with a higher risk of nerve injury compared with needle-nerve contact without needle advancement (nonforced needle-nerve contact).
In 8 anesthetized pigs, the brachial plexus nerves underwent forced (0.15 Newton) or nonforced (0.0 Newton) needle-nerve contact without nerve penetration. The grade of nerve injury was histologically assessed using an objective score ranging from 0 (no injury) to 4 (severe injury).
Sixty-nine nerves, including controls, were examined. Histology revealed a significant difference between forced and nonforced needle-nerve contact (median [interquartile range] 3 [2-4] vs 2 [1-2]; P = 0.004). Myelin damage and intraneural hematoma occurred only after forced needle-nerve contact.
The severity of structural nerve injury after needle-nerve contact was directly related to force exposure via needle advancement.
Anesthesia and analgesia 04/2011; 113(2):417-20. · 3.08 Impact Factor
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ABSTRACT: Local infiltration analgesia (LIA) is usually performed intraoperatively by the surgeon who injects 150 mL (300 mg Ropivacain, 30 mg Ketorolac and 0.5 mg adrenalin) into the bone, cartilage, ligament, musculature, or hyperdermis. A tight bandage and ice cooling for 4 - 6 hours lengthen the duration of analgesia, mobilisation can be undertaken about 5 hours after the operation. Besides large observation-in-use studies, there are 11 randomised studies in the fields of total hip and knee arthroplasty that report comparisons with systemic analgesia as well as with epidural or peripheral anaesthesia, all of which showed positive results for LIA. In addition LIA is safe, has favourable costs and does not require any special technical abilities in contrast to epidural and peripheral regional anaesthesia.
ains · Anästhesiologie · Intensivmedizin 02/2011; 46(2):84-6. · 0.41 Impact Factor
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ains · Anästhesiologie · Intensivmedizin 02/2011; 46(2):136-9. · 0.41 Impact Factor
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ABSTRACT: Outbreaks of gastroenteritis caused by noroviruses have become an increasing problem for institutions in the health-care system over the past years. Staff members are also afflicted by the outbreaks of infection due to the highly contagious nature of noroviruses and this can lead to bottlenecks in health-care management and to economic losses. An acute gastroenteritis due to norovirus usually begins with severe nausea, heavy often projectile vomiting and a pronounced feeling of unwellness. In addition, there can be diarrhoea and abdominal cramps. The incubation time amounts to around one day. As a rule the disease is self-limiting and clears up after 2 to 3 days. However, the clinical pictures for one and the same type of pathogen can vary markedly from mild to severe illness. Since there is no way to treat the cause of a noroviral infection, prophylactic hygiene measures, especially of standard hygiene, are of particular importance. The necessary hygiene measures (especially hand hygiene) are aimed at interrupting the faecal-oral transmission pathway.
ains · Anästhesiologie · Intensivmedizin 02/2011; 46(2):98-9. · 0.41 Impact Factor
