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Publications (3)9.11 Total impact

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    ABSTRACT: Video-assisted thoracoscopic surgery (VATS) has become a standard procedure in pediatric surgery. To facilitate surgical access, the dependent lung has to collapse using intrathoracic carbon dioxide insufflation and/or single-lung ventilation. These procedures can induce hemodynamic deteriorations in adults. The potential impacts of single-lung ventilation in combination with capnothorax on hemodynamics in infants have never been studied before. We conducted a randomized experimental study focusing on hemodynamic and respiratory changes during single-lung ventilation with or without capnothorax in a pediatric animal model. Twelve piglets were randomly assigned to receive single-lung ventilation with (SLV-CO(2) ) or without (SLV) capnothorax with an insufflation pressure of 5 mmHg for a period of two hours. Before, during, and after single-lung ventilation, hemodynamic and respiratory parameters were measured. Although mean arterial pressure remained stable during the course of the study and no critical incidents were monitored, cardiac index (CI) decreased significantly with SLV-CO(2) (baseline 3.6 ± 1.6 l · min(-1) · m(-2) vs 2.9 ± 1.1 l · min(-1) · m(-2) at 120 min, P < 0.05). Furthermore, global end-diastolic volume and intrathoracic blood volume (ITBV) decreased as well significantly with SLV-CO(2) , causing a significant between-group difference in ITBV (P < 0.05). Despite a decrease in CI and preload parameters, the combination of single-lung ventilation and low-pressure capnothorax was well tolerated in piglets and could justify further clinical studies to be performed in infants and children focusing on hemodynamic and respiratory changes during VATS.
    Pediatric Anesthesia 12/2011; 22(8):793-8. · 2.44 Impact Factor
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    ABSTRACT: Errors in fluid management can lead to significant morbidity in children. We conducted an experimental animal study to determine the margin of safety in accidental hyperinfusion of different glucose and electrolyte containing solutions. Fifteen piglets [bodyweight 12.1 (sd 2.0) kg] were randomly assigned to receive either 100 ml kg⁻¹ of balanced electrolyte solution with glucose 1% (BS-G1), hypotonic electrolyte solution with glucose 5% (HE-G5), or glucose 40% solution (G40) over 1 h. Blood electrolytes, glucose, and osmolality and intracranial pressure (ICP) were measured before, during, and after fluid administration. Hyperinfusion of BS-G1 led to moderate hyperglycaemia [baseline 3.4 (sd 1.3) mmol litre⁻¹, study end 12.6 (1.8) mmol litre⁻¹], but no other relevant pathophysiological alterations. Hyperinfusion of HE-G5 produced marked hyperglycaemia [baseline 3.9 (1.2) mmol litre⁻¹, study end 48.6 (4.3) mmol litre⁻¹, P < 0.05] and hyponatraemia [baseline 136.4 (1.3) mmol litre(-1), study end 119.6 (2.1) mmol litre⁻¹, P < 0.05], whereas osmolality remained stable during the course of the study. Hyperinfusion of G40 induced acute hyperglycaemic/hyperosmolar decompensation with an extreme decrease in serum electrolytes [e.g. sodium baseline 138 (1.1) mmol litre⁻¹, 30 min 87.8 (6.4) mmol litre⁻¹, P < 0.01], leading to cardiac arrest after infusion of 50-75 ml kg⁻¹. ICP remained within a physiological range in all groups. In an animal model of accidental hyperinfusion, BS-G1 showed the widest margin of safety and can therefore be expected to enhance patient safety in perioperative fluid management in children; HE-G5 proved significantly less safe; and G40 was found to be outright hazardous.
    BJA British Journal of Anaesthesia 11/2010; 105(5):635-9. · 4.24 Impact Factor
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    ABSTRACT: Background:  The recommendations for perioperative maintenance fluid in children have been adapted from hypotonic to isotonic electrolyte solutions with lower glucose concentrations (1–2.5% instead of 5%) to avoid hyponatremia or hyperglycemia.Objective:  The objective of this prospective animal study was to determine the margin of safety of a novel isotonic-balanced electrolyte solution with 1% glucose (BS-G1) in comparison with normal saline with 1% glucose (NS-G1) in the case of accidental hyperhydration with a focus on acid–base electrolyte balance, glucose concentration, osmolality and intracranial pressure in piglets.Methods:  Ten piglets (bodyweight 11.8 ± 1.8 kg) were randomly assigned to receive either 100 ml·kg−1 of BS-G1 or NS-G1 within one hour. Before, during and after fluid administration, electrolytes, lactate, hemoglobin, hematocrit, glucose, osmolality and acid–base parameters were measured.Results:  Unlike BS-G1, administration of NS-G1 produced mild hyperchloremic acidosis (base excess BS-G1 vs NS-G1, baseline 1.9 ± 1.7 vs 2.9 ± 0.9 mmol·l−1, study end 0.2 ± 1.7 vs −2.7 ± 0.5 mmol·l−1, P < 0.05, chloride BS-G1 vs NS-G1 baseline 102.4 ± 3.4 vs 102.0 ± 0.7 mmol·l−1, study end 103.4 ± 1.8 vs 109.0 ± 1.4 mmol·l−1P < 0.05). The addition of 1% glucose led to moderate hyperglycemia (P < 0.05) with a concomitant increase in serum osmolality in both groups (P < 0.05).Conclusion:  Both solutions showed a wide margin of safety in the case of accidental hyperhydration with less acid–base electrolyte changes when using BS-G1. This novel solution could therefore enhance patient’s safety within the scope of perioperative volume management.
    Pediatric Anesthesia 07/2010; 20(8):734 - 740. · 2.44 Impact Factor