Gottfried Bogusch

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (15)26.38 Total impact

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    ABSTRACT: Background. The oesophageal leak pressure is defined as the pressure which breaks the seal between the cuff of a supraglottic airway and the peri-cuff mucosa, allowing penetration of fluid into the pharynx and the oral cavity. As a consequence, a decrease in this variable increases the risk of reflux and can lead to pulmonary aspiration. The aim of this study was to analyse the effects of cuff overinflation and pressure on the neck on the oesophageal leak pressure of seven supraglottic airways. Methods. Three laryngeal masks, two laryngeal tubes, and two oesophageal–tracheal tubes were tested in an experimental setting. In five human cadavers, we simulated a sudden increase in oesophageal pressure. To measure baseline values (control), we used an intracuff pressure as recommended by the manufacturer. The first intervention included overinflation of the cuff by applying twice the amount of pressure recommended. A second intervention was defined as external pressure on the neck. Results. The oesophageal leak pressure was decreased for laryngeal masks (control, 28 cm H2O; overinflation, 9 cm H2O; pressure on the neck, 8 cm H2O; P<0.01) and for laryngeal tubes (control, 68 cm H2O; overinflation, 37 cm H2O; pressure on the neck, 39 cm H2O; P<0.01) and was unaffected for oesophageal–tracheal tubes (control, 126 cm H2O; overinflation/pressure on the neck, 130 cm H2O; n.s.). Conclusion. Cuff overinflation and pressure on the neck can enhance the risk of gastro-oesophageal reflux when using supraglottic airways. Therefore, both manoeuvres should be avoided in clinical practice.
    No preview · Article · Feb 2016 · BJA British Journal of Anaesthesia
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    W Schmidbauer · S Bercker · T Volk · G Bogusch · G Mager · T Kerner
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    ABSTRACT: Supraglottic airway devices are increasingly used in anaesthesia and emergency medicine. This study was designed to investigate the oesophageal seal of the novel supralaryngeal airway device, I-Gel (I-Gel), in comparison with two of the laryngeal mask airways, Classic (cLMA) and ProSeal (pLMA), in a model of elevated oesophageal pressure. The three supralaryngeal airway devices were inserted into eight unfixed cadaver models with exposed oesophagi that had been connected to a water column producing both a slow and a fast oesophageal pressure increase. The pressure applied until the loss of oesophageal seal during a slow and fast pressure increase was measured. During the slow increase of pressure, the pLMA withstood an oesophageal pressure up to a median of 58 cm H(2)O, while the cLMA was able to block the oesophagus up to a median of 37 cm H(2)O, and I-Gel already lost its seal at 13 cm H(2)O. One minute after maximum pressure had been applied, the pLMA withstood an oesophageal pressure of 59 cm H(2)O, the cLMA of 46 cm H(2)O, and I-Gel airway of 21 cm H(2)O. A fast release of oesophageal fluid was accomplished through the oesophageal lumen of both the pLMA and I-Gel. Both the pLMA and cLMA provided a better seal of the oesophagus than the novel I-Gel airway. The pLMA and I-Gel drain off gastrointestinal fluid fast through the oesophageal lumen. Thus, tracheal aspiration may be prevented with their use. Further study is necessary.
    Preview · Article · Nov 2008 · BJA British Journal of Anaesthesia
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    ABSTRACT: Purpose: Isolated fractures of the hamate hook can be treated by conservative or surgical means. Because nonoperative treatment is associated with high nonunion rates, surgical treatment with open reduction and internal fixation through a palmar approach is often preferred. The aim of this study was to refine surgical treatment of hamate hook fractures using a cannulated mini compression screw through a dorsal percutaneous approach. Methods: Artificial fractures of the hamate hook were created in five male cadaver hands under fluoroscopy. Using an ulnar approach, the hamate hook was fractured at the base (n = 3) and middle third (n = 2) of the hook using an osteotome. Each fracture was visualized by X-ray and computed tomography. Under fluoroscopy, the fracture was stabilized with a 1.1 mm K wire through a dorsal percutaneous approach which guided the introduction of a 3 mm diameter cannulated mini compression screw. The screw position was then controlled by X-ray and computed tomography. Results: Percutaneous fixation of the fractured hook through the dorsal approach was achieved in all cases. Regardless of the fracture location, all fragments were adapted into anatomically correct positions. No displacement or disruption of the cortex of the hook was observed with central screw positioning. Conclusion: Minimal invasive repair of isolated hamate hook fractures through a dorsal percutaneous approach is feasible. The special properties of the cannulated mini compression screw allow optimal screw positioning and stable fixation without risk of diplacement or disruption of the hook fragment.
    No preview · Article · Aug 2008 · European Journal of Trauma and Emergency Surgery
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    ABSTRACT: Supraglottic airway devices are increasingly important in clinical anesthesia and prehospital emergency medicine, but there are only few data to assess the risk for aspiration. We designed this study to compare the seal of seven supraglottic airway devices in a cadaver model of elevated esophageal pressure. The classic laryngeal mask airway, laryngeal mask airway ProSeal, intubating laryngeal mask airway Fastrach, laryngeal tube, laryngeal tube LTS II, Combitube, and Easytube were inserted into unfixed human cadavers with an exposed esophagus that had been connected to a water column of 130 cm height. Slow and fast increases of esophageal pressure were performed and the water pressure at which leakage appeared was registered. The Combitube, Easytube, and intubating laryngeal mask Fastrach withstood the water pressure up to more than 120 cm H2O. The laryngeal mask airway ProSeal, laryngeal tube, and laryngeal tube LTS II were able to block the esophagus until 72-82 cm H2O. The classic laryngeal mask airway showed leakage at 48 cm H2O, but only minor leakage was found in the trachea. Devices with an additional esophageal drain tube drained fluid sufficiently without pulmonary aspiration. Concerning the risk of aspiration, the use of devices with an additional esophageal drainage lumen might be superior for use in patients with an increased risk of aspiration. The Combitube, Easytube, and intubating laryngeal mask Fastrach showed the best capacity to withstand an increase of esophageal pressure.
    Full-text · Article · Mar 2008 · Anesthesia and analgesia
  • J Birnbaum · E Klotz · G Bogusch · T Volk
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    ABSTRACT: Despite the increasing use of ultrasound, electrical nerve stimulation is commonly used as the standard for both plexus and peripheral nerve blocks. Several recent randomized trials have contributed to a better understanding of physiological and clinical correlations. Traditionally used currents and impulse widths are better defined in relation to the distance between needle tip and nerves. Commercially available devices enable transcutaneous nerve stimulation and provide new opportunities for the detection of puncture sites and for training. The electrically ideal position of the needle usually is defined by motor responses which can not be interpreted without profound anatomical knowledge. For instance, interscalene blocks can be successful even after motor responses of deltoid or pectoral muscles. Infraclavicular blocks should be aimed at stimulation of the posterior fascicle (extension). In contrast to multiple single nerve blocks, axillary single-shot blocks more commonly result in incomplete anaesthesia. Blockade of the femoral nerve can be performed without any nerve stimulation if the fascia iliaca block is used. Independently of the various approaches to the sciatic nerve, inversion and plantar flexion are the best options for single-shot blocks. Further clinical trials are needed to define the advantages of stimulating catheters in continuous nerve blocks.
    No preview · Article · Dec 2007 · Der Anaesthesist
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    ABSTRACT: The Division of Evidence Based Medicine (dEBM), Clinic for Dermatology, Venerology and Allergology, Charité--Universitätsmedizin Berlin, offers on a regular basis workshops focusing on different areas of aesthetic medicine. Once a year a joint course is provided in cooperation with the Institute of Anatomy, offering the participants the possibility to improve their injection techniques as well as their knowledge on the facial anatomy. This course is focused on treatment with hyaluronic acids of different particle size. Besides the classical indications, it considers new indications such as correcting the shape of the nose or lacrimal groove. Thirteen physicians participated in the course, which was evaluated as very helpful as it improved not only the injection technique but also the knowledge of anatomy.
    No preview · Article · Apr 2007 · Journal der Deutschen Dermatologischen Gesellschaft

  • No preview · Article · Mar 2007 · Journal der Deutschen Dermatologischen Gesellschaft
  • J. Birnbaum · E. Klotz · G. Bogusch · T. Volk
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    ABSTRACT: Despite the increasing use of ultrasound, electrical nerve stimulation is commonly used as the standard for both plexus and peripheral nerve blocks. Several recent randomized trials have contributed to a better understanding of physiological and clinical correlations. Traditionally used currents and impulse widths are better defined in relation to the distance between needle tip and nerves. Commercially available devices enable transcutaneous nerve stimulation and provide new opportunities for the detection of puncture sites and for training. The electrically ideal position of the needle usually is defined by motor responses which can not be interpreted without profound anatomical knowledge. For instance, interscalene blocks can be successful even after motor responses of deltoid or pectoral muscles. Infraclavicular blocks should be aimed at stimulation of the posterior fascicle (extension). In contrast to multiple single nerve blocks, axillary single-shot blocks more commonly result in incomplete anaesthesia. Blockade of the femoral nerve can be performed without any nerve stimulation if the fascia iliaca block is used. Independently of the various approaches to the sciatic nerve, inversion and plantar flexion are the best options for single-shot blocks. Further clinical trials are needed to define the advantages of stimulating catheters in continuous nerve blocks.
    No preview · Article · Jan 2007 · Der Anaesthesist
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    ABSTRACT: Fractures of the hook of the hamate are a rare event. The fracture cannot always be detected clinically and standard radiographs do not always provide an overlap-free image of the hook of the hamate, so that fractures can easily be overlooked. The objective of the present study was to examine if the sensitivity of detecting hamulus ossis hamati fractures can further be improved by a modified conventional radiographic projection.After dissection of the hook of the hamate on 10 cadaver hands, a fracture was produced close to the base using a surgical chisel. Conventional radiographs were then performed in four different projections (dorso-palmar, lateral, carpal-tunnel and oblique view). The oblique view was obtained in a 45° supination position, slight extension and radial duction, with the tube tilted from distal to proximal by 30°. An axial spiral CT was used as a reference for detection of the fracture.The highest sensitivity of the conventional radiographs, with 8/10 identified fractures (80%), was achieved by the oblique view. The carpal-tunnel view with 4/10 (40%) and the dorso-palmar projection with 3/10 (30%) were much lower. All fractures were missed in the lateral projection. If all of the conventional radiographic projections are taken into account, the sensitivity is increased to 90%. All of the fractures were reliably detected in the axial CT-image.If a hamulus ossis hamati fracture is suspected clinically, in addition to the dorso-palmar and carpal-tunnel view, the special oblique view described here should be performed as a third projection plane, while the lateral view can be dispensed with. However, even if all projections are taken into account, a negative finding in the conventional radiographic imaging does not exclude a fracture with absolute certainty. In such cases, a CT or MRI should be performed to exclude a fracture.
    No preview · Article · May 2006 · Rontgenpraxis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fractures of the hook of the hamate are a rare event. The fracture cannot always be detected clinically and standard radiographs do not always provide an overlap-free image of the hook of the hamate, so that fractures can easily be overlooked. The objective of the present study was to examine if the sensitivity of detecting hamulus ossis hamati fractures can further be improved by a modified conventional radiographic projection. After dissection of the hook of the hamate on 10 cadaver hands, a fracture was produced close to the base using a surgical chisel. Conventional radiographs were then performed in four different projections (dorso-palmar, lateral, carpal-tunnel and oblique view). The oblique view was obtained in a 45 degrees supination position, slight extension and radial duction, with the tube tilted from distal to proximal by 30 degrees. An axial spiral CT was used as a reference for detection of the fracture. The highest sensitivity of the conventional radiographs, with 8/10 identified fractures (80%), was achieved by the oblique view. The carpal-tunnel view with 4/10 (40%) and the dorso-palmar projection with 3/10 (30%) were much lower. All fractures were missed in the lateral projection. If all of the conventional radiographic projections are taken into account, the sensitivity is increased to 90%. All of the fractures were reliably detected in the axial CT-image. If a hamulus ossis hamati fracture is suspected clinically, in addition to the dorso-palmar and carpal-tunnel view, the special oblique view described here should be performed as a third projection plane, while the lateral view can be dispensed with. However, even if all projections are taken into account, a negative finding in the conventional radiographic imaging does not exclude a fracture with absolute certainty. In such cases, a CT or MRI should be performed to exclude a fracture.
    No preview · Article · Feb 2006 · Rontgenpraxis
  • D.-H. Boack · G. Bogusch · Th. Mittlmeier · N. P. Haas
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    ABSTRACT: Summary An anatomical study was performed to develop a modified technique for an extended saphenofasciocutaneous sural flap for coverage of large combined soft tissue lesions at the lower leg and foot. Then a prospective clinical study was performed to investigate the clinical applicability of the new technique. From August 1999 to August 2002, 7 patients with 10 large combined soft tissue lesions with exposed tendon, bone and joint or compound infected wounds, with loss of bone and osteitis, were prospectively examined after an operative treatment using the extended saphenofasciocutaneous sural flap. All patients had a variety of additional risk factors or severe co-morbidity (traumatic ipsilateral vascular lesion of the major nutrient artery of the lower leg, ipsilateral deep vein thrombosis, diabetic polyneuropathy with arteriosclerotic vessels and severe occlusive vascular disease). The size of defect of the ten combined soft tissue lesions ranged from 80 to 180 cm2. The defects were located in the mid and hind foot and also the lower leg. A complete coverage of all defects was achieved in a single-stage procedure with a distally based modified saphenofasciocutaneous sural flap from the proximal lower leg. All flaps survived completely withhot any partial necrosis of the flap. The flap donor site was directly closed in 7 cases and a simultaneous skin graft was applied in 3 cases. All patients were repeatedly clinical examined and the mean duration of follow-up was 22 months. All flaps had complete success. Any secondary donor site morbidity was not registered. We did not observe formations of neuromas of the sural nerve. There was no need for secondary debulking. Venous congestion nor long lasting edema were not seen. All patients were satisfied with the functional and aesthetic results.
    No preview · Article · Dec 2005 · Fuß & Sprunggelenk
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    ABSTRACT: To examine the ability to image fractures of the body and hook of the hamate bone in conventional X-rays and high-resolution computed tomography (HR-CT). In an in vitro experiment using 18 cadaver hands, the hamate bone was fractured at different places. Before and after fracture, conventional X-rays were taken in different planes (anteroposterior, lateral, oblique, and carpal tunnel), and HR-CT was performed with 2-mm layer thickness in the axial, sagittal, and coronal plane. Taking into account all the conventional X-ray projections applied, the in vivo experiment revealed a sensitivity of 72.2%, a specificity of 88.8%, and an accuracy of 80.5%. For the HR-CT, the sensitivity was 100%, the specificity was 94.4%, and the accuracy was 97.2%. Fractures of the body and hook of the hamate cannot always be detected with certainty in the conventional X-ray image, even if different projectional planes are used. The HR-CT is the imaging procedure of choice for further clarification, and an axial or sagittal plane should be selected.
    Full-text · Article · Feb 1999 · Investigative Radiology
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    ABSTRACT: Examination of the ability to image fractures of the body and hook of the hamate bone in conventional X-rays and HR-CT. In an in vitro experiment on 18 cadaver hands, the hamate bone was fractured at different localisations. Before and after fracture, conventional x-rays were taken in different projectional planes: a.-p., lateral, oblique and carpal tunnel view, as well as an HR-CT with 2 mm layer thickness in the axial, sagittal and coronal plane. In addition, 15 clinically verified hamate bone fractures (two body and 13 hook of hamate fractures) were reviewed retrospectively to assess the value of the imaging procedures that led to diagnosis. Taking into account all conventional x-ray projections applied, the in vitro experiment yielded a sensitivity of 72.2%, a specificity of 88.8% and an accuracy of 80.5%. For CT, the sensitivity was 100%, the specificity 94.4% and the accuracy 97.2%. In retrospective clinical evaluation, 60% of the existing fractures were identified in the conventional x-ray images. The remaining fractures were detected by additional procedures like scintigraphy, conventional tomography and CT. For the diagnosis of fractures of the body and hook of the hamate HR-CT is the imaging procedure of choice, in which case an axial or sagittal plane should be chosen.
    Full-text · Article · Aug 1998 · RöFo - Fortschritte auf dem Gebiet der R

  • No preview · Article · Jul 1998 · RöFo - Fortschritte auf dem Gebiet der R
  • D.-H. Boack · G. Bogusch · Th. Mittlmeier · N. P. Haas

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Publication Stats

154 Citations
26.38 Total Impact Points

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Institutions

  • 2005-2008
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
  • 2006
    • Humboldt-Universität zu Berlin
      Berlín, Berlin, Germany
    • University of Rostock
      Rostock, Mecklenburg-Vorpommern, Germany