Hinnerk Wulf

Philipps University of Marburg, Marburg, Hesse, Germany

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Publications (159)295.12 Total impact

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    ABSTRACT: Introduction: Continuous femoral nerve blocks for total knee arthroplasty can cause motor weakness of the quadriceps muscle and thus prevent early mobilisation. Perioperative falls may result as an iatrogenic complication. In this randomised and blinded trial, we tested the hypothesis that a continuous adductor canal block is superior to continuous femoral nerve block regarding mobilisation ('timed up-and-go' test and other tests) after total knee arthroplasty under general anaesthesia. Methods: In our study, we included patients scheduled for unilateral knee arthroplasty under general anaesthesia into a blinded and randomised trial. Patients were allocated to a continuous adductor canal block (CACB) or a continuous femoral nerve block (CFNB) for three postoperative days (POD 1-3); with a bolus of 15 ml ropivacaine 0.375 %, followed by continuous infusion of ropivacaine 0.2 % and patient-controlled bolus administration. Both groups received an additional continuous sciatic nerve block as well as a multimodal systemic analgesic treatment. The primary outcome parameter was mobilisation capability, assessed by 'timed up-and-go' (TUG) test. Analgesic quality, need for opioid rescue and local anaesthetic consumption were also assessed. Results: Forty-two patients were included and analysed (21 patients per group). No significant difference was noted in respect to mobilisation at POD 3 (TUG [s]: CACB 45, CFNB 51). It is worth saying that pain scores (numeric rating scale, NRS) were similar in both groups at POD 3 {rest [median (interquartile range)]: CACB 0 (0-3), CFNB 1 (0-3); stress: CACB 4 (2-5), CFNB 3 (2-4)}. Conclusions: Concerning the mobilisation capability, we did not actually observe a superior effect of CACB compared with CFNB technique in our patients following total knee arthroplasty. Moreover, no difference was observed concerning analgesia quality.
    No preview · Article · Jan 2016 · Archives of Orthopaedic and Trauma Surgery

  • No preview · Article · Nov 2015 · Resuscitation
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    ABSTRACT: Stimulating catheters are widely used for continuous peripheral nerve block techniques in regional anesthesia. The incidence of reported complications is somewhat similar to that for non-stimulating catheters. However, as many stimulating catheters contain a coiled steel wire for optimal stimulation, they may cause specific complications. In this report, we present two cases of complicated removals of stimulating catheters. During both removals, a part of the metal wire was left "decoiled" next to the supraclavicular and interscalene plexus, respectively. The strategies used to determine steel wire localization and a description of the successful removal of these steel wires are included in this report. Catheter separation and problems with residual metal wire components of stimulating catheters seem to be a rare but specific problem during removal. Anesthesiologists should strictly avoid catheter shearing during insertion, adhere to the manufacturer's instructions, and take care during catheter removal. Manufacturers should focus on technical solutions to avoid rare but relevant complications such as catheter tip decoiling and separation of stimulating catheters during removal.
    Full-text · Article · Jun 2015 · Local and Regional Anesthesia
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    ABSTRACT: Guidelines recommend mechanical ventilation with Intermitted Positive Pressure Ventilation (IPPV) during resuscitation. The influence of the novel ventilator mode Chest Compression Synchronized Ventilation (CCSV) on gas exchange and arterial blood pressure compared with IPPV was investigated in a pig model. In 12 pigs (general anaesthesia/intubation) ventricular fibrillation was induced and continuous chest compressions were started after 3min. Pigs were mechanically ventilated in a cross-over setting with 5 ventilation periods of 4min each: Ventilation modes were during the first and last period IPPV (100% O2, tidalvolumes = 7ml/kgKG, respiratoryrate = 10/min), during the 2nd, 3rd and 4th period CCSV (100% O2), a pressure-controlled and with each chest compression synchronized breathing pattern with three different presets in randomized order. Presets: CCSVA: Pinsp = 60mbar, inspiratorytime = 205ms; CCSVB: Pinsp = 60mbar, inspiratorytime = 265ms; CCSVC: Pinsp = 45mbar, inspiratorytime = 265ms. Blood gas samples were drawn for each period, mean arterial (MAP) and centralvenous (CVP) blood pressures were continuously recorded. Results as median (25%/75%percentiles). Ventilation with each CCSV mode resulted in higher PaO2 than IPPV: PaO2: IPPVfirst: 19.6(13.9/36.2)kPa, IPPVlast: 22.7(5.4/36.9)kPa (p = 0.77 vs IPPVfirst), CCSVA: 48.9(29.0/58.2)kPa (p = 0.028 vs IPPVfirst, p = 0.0001 vs IPPVlast), CCSVB: 54.0 (43.8/64.1) (p = 0.001 vs IPPVfirst, p = 0.0001 vs IPPVlast), CCSVC: 46.0 (20.2/58.4) (p = 0.006 vs IPPVfirst, p = 0.0001 vs IPPVlast). Both the MAP and the difference MAP-CVP did not decrease during twelve minutes CPR with all three presets of CCSV and were higher than the pressures of the last IPPV period. All patterns of CCSV lead to a higher PaO2 and avoid an arterial blood pressure drop during resuscitation compared to IPPV in this pig model of cardiac arrest.
    Full-text · Article · May 2015 · PLoS ONE
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    ABSTRACT: Background. After shoulder surgery performed in patients with interscalene nerve block (without general anesthesia), fast track capability and postoperative pain management in the PACU are improved compared with general anesthesia alone. However, it is not known if these evidence-based benefits still exist when the interscalene block is combined with general anesthesia. Methods. We retrospectively analyzed a prospective cohort data set of 159 patients undergoing shoulder arthroscopy with general anesthesia alone (í µí±› = 60) or combined with an interscalene nerve block catheter (í µí±› = 99) for fast track capability time. Moreover, comparisons were made for VAS scores, analgesic consumption in the PACU, pain management, and lung function measurements. Results. The groups did not differ in mean time to fast track capability (22 versus 22 min). Opioid consumption in PACU was significantly less in the interscalene group, who had significantly better VAS scores during PACU stay. Patients receiving interscalene blockade had a significantly impaired lung function postoperatively, although this did not affect postoperative recovery and had no impact on PACU times. Conclusion. The addition of interscalene block to general anesthesia for shoulder arthroscopy did not enhance fast track capability. Pain management and VAS scores were improved in the interscalene nerve block group.
    Full-text · Article · Apr 2015 · BioMed Research International
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    ABSTRACT: Introduction: Bacterial colonization of catheter tips is common in regional anesthesia and is a suspected risk factor for infectious complications. This is the first study evaluating the effect of CHG-impregnated dressings on bacterial colonization of regional anesthesia catheters in a routine clinical setting. Methods: In this prospective study, regional anesthesia catheter infection rates were examined in two groups of patients with epidural and peripheral regional catheters. In the first group, regional anesthesia was dressed with a conventional draping. The second group of patients underwent catheter dressing using a CHG-impregnated draping. Removed catheters and the insertion sites were both screened for bacterial colonization. Results: A total of 337 catheters from 308 patients were analysed. There was no significant reduction of local infections in either epidural or peripheral regional anesthesia catheters in both CHG and conventional groups. In the conventional group, 21% of the catheter tips and 41% of the insertion sites showed positive culture results. In the CHG-group, however, only 3% of the catheter tips and 8% of the insertion sites were colonised. Conclusion: CHG dressings significantly reduce bacterial colonization of the tip and the insertion site of epidural and peripheral regional catheters. However, no reductions in rates of local infections were seen.
    Full-text · Article · Mar 2015 · BioMed Research International
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    Full-text · Article · Feb 2015 · Anasthesiologie und Intensivmedizin
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    Full-text · Article · Feb 2015 · Anasthesiologie und Intensivmedizin
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    ABSTRACT: Adequate pain management is essential for preventing hemodynamic instability which can affect the perfusion of vital organs during the perioperative period, particularly in geriatric patients. For hip arthroplasty, peripheral nerve block is frequently used, limiting the adverse effects of opioid and non-opioid analgesics. The aim was to survey the impact of a supplementary single shot femoral nerve block (FNB) on hemodynamic stability and pain level.METHODS: After registration at German Clinical Trial Register (DRKS-ID): DRKS00000752. and Ethics Committee approval (University Hospital of Marburg), 80 patients who underwent elective hip surgery were included. Half of them were randomly assigned to receive a FNB followed by general anesthesia; a control group received only general anesthesia as standard procedure (STD). Blood pressure and heart rate were measured and recorded every five minutes during surgery and stay at the postanesthesia care unit (PACU). Fifty-two patients were included for statistical analysis. The FNB group had significantly lower systolic blood pressures during and after surgery and lower diastolic blood pressure postoperatively, heart rate, as well as opioid and non-steroidal anti-inflammatory consumption. Femoral nerve block improved perioperative hemodynamic stability mostly likely attributable to an overall reduced sympathico adrenergic tone.
    No preview · Article · Feb 2015 · Technology and health care: official journal of the European Society for Engineering and Medicine
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    ABSTRACT: TASK-1 channels have emerged as promising drug targets against atrial fibrillation, the most common arrhythmia in the elderly. While TASK-3, the closest relative of TASK-1, was previously not described in cardiac tissue, we found a very prominent expression of TASK-3 in right human auricles. Transcriptional profiling revealed that TASK-3 in the human heart is also expressed at similar levels in the atria and sinoatrial node, while in the atrioventricular node and the ventricles TASK-3 expression levels were even more pronounced. Immunocytochemistry experiments of human right auricular cardiomyocytes showed that TASK-3 is primarily localized at the plasma membrane. Single-channel recordings of right human auricles in the cell-attached mode, using divalent-cation-free solutions, revealed a TASK-1-like channel with a single-channel conductance of about 30 pS. While homomeric TASK-3 channels were not found, we observed an intermediate single-channel conductance of about 55 pS, possibly reflecting the heteromeric channel formed by TASK-1 and TASK-3. Subsequent experiments with TASK-1/TASK-3 tandem channels or with co-expressed TASK-1 and TASK-3 channels in HEK293 cells or Xenopus oocytes, supported that the 55 pS channels observed in right auricles have electrophysiological characteristics of TASK-1/TASK-3 heteromers. In addition, co-expression experiments and single-channel recordings suggest that heteromeric TASK-1/TASK-3 channels have a predominant surface expression and a reduced affinity for TASK-1 blockers. In summary, the evidence for heteromeric TASK-1/TASK-3 channel complexes together with an altered pharmacologic response to TASK-1 blockers in vitro is likely to have further impact for studies isolating ITASK-1 from cardiomyocytes and for the development of drugs specifically targeting TASK-1 in atrial fibrillation treatment. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Feb 2015 · Journal of Molecular and Cellular Cardiology
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    ABSTRACT: Purulent destruction–complicated pneumonia is a rare and serious disease of multifactorial genesis. In many cases, the diagnosis cannot be established by microbiological analysis of bronchial aspirates or transbronchial biopsies. In our present case, isolation of the pathogen was only possible by collecting specimens via open surgical lung biopsy. A 57-year-old otherwise healthy man was transferred to our department from another hospital. He presented with progressive respiratory failure while computed tomographic scan showed severe bilateral necrotising pneumonia. With open surgical lung biopsy, we could prove evidence of Burkholderia cenocepacia as causative pathogen. As the patient’s pulmonary condition deteriorated and he developed septic multiorgan failure, we initiated extracorporeal membrane oxygenation (ECMO) and commenced aggressive treatment with 4 intravenous antibiotics, cyclosporine, and corticosteroids. With this therapy, the patient’s situation rapidly improved; and he was successfully weaned from ECMO and mechanical ventilation. Pneumonia caused by B cenocepacia without underlying pulmonary disease such as cystic fibrosis is an absolute rarity. According to the severity of cepacia syndrome, an interdisciplinary approach including ECMO aggressive antibiotic treatment and immunosuppression was decisive for a successful therapy.
    No preview · Article · Jan 2015 · Infectious Disease in Clinical Practice
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    ABSTRACT: Background and objectives: Perineural hematoma may occur during performance of peripheral nerve blocks. The aim of this study was to test the hypothesis that an iatrogenic hematoma in the immediate vicinity of a peripheral nerve may cause histologic evidence of nerve injury. Methods: Fifty milliliters of autologous blood was injected adjacent to the right sciatic nerve in 20 anesthetized female pigs. In order to discern between blood-related volume and immune effects, 50 mL of albumin was injected at the same location in an additional 22 pigs. Either blood or albumin was injected in random order. The left sciatic nerve served as a negative control in all animals, that is, either no needle placement or needle placement without injection. After 48 hours, the nerves were resected. The grade of nerve injury was scored from 0 (no injury) to 3 (severe injury) by histologic analysis of myelin tissue and inflammatory cells. Results: Eighty-two nerve specimens were examined. Injury scores were significantly (P < 0.01) higher in the blood injection (n = 20; median [interquartile range] 2 [2-2]) and albumin injection (n = 22, 1 [1-2]) conditions compared with the no needle placement (n = 22, 0 [0-1]) and "dry needle placement" (n = 20, 1 [0-1]) conditions. Widespread inflammatory changes were seen in the blood injection group, in which 15% of nerve specimens showed damage to myelin. Conclusions: Our data suggest that hematoma adjacent to nerve tissue may result in structural nerve injury and inflammatory changes.
    Full-text · Article · Oct 2014 · Regional Anesthesia and Pain Medicine
  • Klaus Kerwat · Hinnerk Wulf
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    ABSTRACT: Resistance against antibiotics is continuously increasing throughout the world and has become a very serious problem. For just this reason "Antibiotic Stewardship Programs" have been developed. These programs are intended to lead to a sustained improvement in the situation and to assure a rational practice for the prescription of anti-infective agents in medical facilities. The aim is to prescribe the correct antibiotic therapy to the right patient at the most appropriate point in time. An AWMF S3 guideline on this topic published by the German Society for Infectiology (S3-Leitlinie StrategienzurSicherungrationalerAntibiotika-AnwendungimKrankenhaus.AWMF-Registernummer 092/001 - S3 Guideline on Strategies for the Rational Use of Antibiotics in Hospitals. AWMF - Registry Number 092/001) has been available since the end of 2013. An essential aspect therein is the expert interdisciplinary cooperation of a team comprising a clinically experienced infectiologist, a hospital pharmacist and a consultant for microbiology.
    No preview · Article · Sep 2014 · ains · Anästhesiologie · Intensivmedizin
  • Caroline Rolfes · Timon Vassiliou · Hinnerk Wulf

    No preview · Article · Aug 2014 · ains · Anästhesiologie · Intensivmedizin
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    ABSTRACT: Ehlers-Danlos syndrome (EDS, ORPHA98249) comprises a group of clinically and genetically heterogeneous heritable connective tissue disorders, chiefly characterized by joint hypermobility and instability, skin texture anomalies, and vascular and soft tissue fragility. As many tissues can be involved, the underlying molecular defect can manifest itself in many organs and with varying degrees of severity, with widespread implications for anesthesia and perioperative management. This review focuses on issues relevant for anesthesia for elective and emergency surgery in EDS. We searched the literature for papers related to all EDS variants; at the moment most of the published data deals with the vascular subtype and, to a lesser extent, classic and hypermobility EDS. Knowledge is fragmented and consists mostly of case reports, small case series and expert opinion. Because EDS patients commonly require surgery, we have summarized some recommendations for general, obstetrical and regional anesthesia, as well as for hemostatic therapy.
    Full-text · Article · Jul 2014 · Orphanet Journal of Rare Diseases
  • Karl Hampl · Thorsten Steinfeldt · Hinnerk Wulf
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    ABSTRACT: Purpose of review: Neural toxicity of substances injected into the intrathecal space has been a matter of debate since the introduction of spinal anesthesia in clinical practice. In recent years, new local anesthetics and adjuvants have been proposed for intrathecal use, and new techniques such as the use of ultrasound have been propagated. The present review summarizes recent clinical and experimental data on the neurotoxic effects of drugs and substances used for or in conjunction with spinal anesthesia. Recent findings: Chloroprocaine has been demonstrated to be associated with a lower risk of transient neurologic symptoms compared with lidocaine. However, despite extensive research, the issue of chloroprocaine or bisulfite neurotoxicity has not yet been resolved.Recent experimental data have identified a smaller neurotoxic potential for ropivacaine compared to levobupivacaine, procaine and bupivacaine. The addition of epinephrine has not been shown to increase lidocaine neurotoxicity. In-vivo experimental data suggest that lidocaine and bupivacaine neurotoxicity is not enhanced in diabetic patients.Furthermore, intrathecal introduction of aqueous ultrasound gel has been demonstrated to cause a distinct neuroinflammatory reaction. Finally, a large cohort study did not find the use of chlorhexidine gluconate for skin disinfection before neuraxial block to be associated with the risk of adhesive arachnoiditis. Summary: Clinical data suggest a high safety profile for intrathecal drugs and substances used for or in conjunction with spinal anesthesia. Recent experimental models for toxicity have provided further insight into the mechanisms and demonstrated possible, albeit clinically small differences in the relative neurotoxic potential of intrathecal drugs. This may contribute to a further increase in the safe use of spinal anesthesia in the clinical setting.
    No preview · Article · Jul 2014 · Current Opinion in Anaesthesiology
  • Clemens Kill · Bernhard Schieffer · Hinnerk Wulf
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    ABSTRACT: The standards of treatment of patients suffering cardiac arrest is defined by international guidelines for cardiopulmonary resuscitation, that are updated every five years. Scientific knowledge is continuously increasing and recent studies should be considered and discussed to improve the results of daily emergency care. There are some leading topics of the ongoing discussion concerning airwaymanagement, mechanical ventilation, mechanical cpr-devices and extracorporal life support. The strategies of postresuscitation care are also in the focus of interest. This review presents and discusses the value of recent investigations on resuscitation science.
    No preview · Article · Jul 2014 · Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie

  • No preview · Article · May 2014 · Resuscitation
  • Klaus Kerwat · Marcel Goedecke · Hinnerk Wulf
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    ABSTRACT: Vaccinations are among the most efficient and important preventive medical procedures. Modern vaccines are well tolerated. In Germany there are no longer laws for mandatory vaccinations, either for the general public or for medical personnel. Vaccinations are now merely "officially recommended" by the top health authorities on the basis of recommendations from the Standing Committee on Vaccinations (STIKO) of the Robert Koch Institute (RKI) according to § 20 para 3 of the Protection against Infection law (IfSG). The management of vaccine damage due to officially recommended vaccinations is guaranteed by the Federal States. Whereas vaccinations in childhood are generally considered to be a matter of course, the willingness to accept them decreases markedly with increasing age. In the medical sector vaccinations against, for example, hepatitis B are well accepted while other vaccinations against, for example, whooping cough or influenza are not considered to be so important. The fact that vaccinations, besides offering protection for the medical personnel, may also serve to protect the patients entrusted to medical care from nosocomial infections is often ignored.
    No preview · Article · May 2014 · ains · Anästhesiologie · Intensivmedizin
  • Klaus Kerwat · Hinnerk Wulf

    No preview · Article · Apr 2014

Publication Stats

2k Citations
295.12 Total Impact Points

Institutions

  • 2001-2016
    • Philipps University of Marburg
      • Klinik für Anästhesie und Intensivtherapie (Marburg)
      Marburg, Hesse, Germany
  • 2008-2014
    • Universitätsklinikum Gießen und Marburg
      • • Klinik für Anästhesie und Intensivtherapie
      • • Klinik für Anästhesie und Operative Intensivmedizin
      Marburg, Hesse, Germany
    • Justus-Liebig-Universität Gießen
      Giessen, Hesse, Germany
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 2013
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 2002
    • University of Wuerzburg
      • Department of Anaesthesia and Critical Care
      Würzburg, Bavaria, Germany
  • 1994-2000
    • Christian-Albrechts-Universität zu Kiel
      • Klinik für Anästhesiologie und Operative Intensivmedizin
      Kiel, Schleswig-Holstein, Germany
  • 1998
    • University of Cologne
      Köln, North Rhine-Westphalia, Germany