[Show abstract][Hide abstract]ABSTRACT: ECT is a well-established treatment for severe depression. The available data on psychosis are limited, but reliable. Its therapeutic potential relies on the induction of a generalized seizure. Besides other narcotics, methohexital and etomidate are used for general anesthesia in ECT. Since prolonged seizures have been reported following the use of etomidate, it can be deduced that the substances might differ in their anticonvulsant properties, resulting in a lower increase in stimulus intensity during the course of treatment under etomidate. Besides this hypothesis, we aimed to investigate the differential effects of etomidate and methohexital on clinical features, ECT parameters and side effects of the treatment.
We performed a retrospective analysis of treatment data of patients with affective and psychotic diagnosis who received general anesthesia for ECT either with etomidate or with methohexital.
ECT with etomidate and methohexital was equally effective. During the course of therapies the administered electric charge increased significantly and equally in both treatment groups. In the methohexital group, but not in the etomidate group, electroencephalographic seizure duration had a declining trend during the course of therapies. We observed more side effects during and immediately after ECT in the methohexital group than in the etomidate group.
The limitations of this study are that the patients received various psychotropic co-medications, which influence ictal parameters differently, and, secondly, the study is based on a retrospective analysis.
The results of our analysis suggest that etomidate and methohexital affect ictal parameters to different extents. Longer seizure duration and fewer side effects are in favor of etomidate.
No preview · Article · May 2013 · Journal of Psychiatric Research
[Show abstract][Hide abstract]ABSTRACT: Die sichere Kurznarkose zur Durchführung der modifizierten EKT unter Muskelrelaxation verlangt entsprechende Voruntersuchungen, geschultes Personal, einen geeigneten Arbeitsplatz und eine gute interdisziplinäre Zusammenarbeit. Der Einsatz von Muskelrelaxantien und Hypnotika setzt zwingend die Beherrschung der Atemwegssicherung voraus. Die Auswahl der verwendeten Medikamente orientiert sich an den beiden Zielen, die Narkose sicher und den Krampfanfall therapeutisch wirksam zu gestalten. Deswegen sollten einige Medikamente der anästhesiologischen Routine nicht verwendet werden. Ein standardisiertes Protokoll hilft, diese Ziele zu erreichen und evtl. auftretende Komplikationen mit größtmöglicher Sicherheit zu beherrschen.
[Show abstract][Hide abstract]ABSTRACT: Teleconsultation from the scene of an emergency to an experienced physician including real-time transmission of monitoring, audio and visual information seems to be feasible. In preparation for bringing such a system into practice within the research project "Med-on-@ix", a simulation study has been conducted to investigate whether telemedical assistance (TMA) in Emergency Medical Services (EMS) has an impact on compatibility to guidelines and timing.
In a controlled simulation study 29 EMS teams (one EMS physician, two paramedics) ran through standardized scenarios (STEMI: ST-elevation myocardial infarction; MT: major trauma) on high-fidelity patient simulators with defined complications (treatable clearly following guidelines). Team assignments were randomized and each team had to complete one scenario with and another without TMA. Analysis was based on videotaped scenarios using pre-defined scoring items and measured time intervals for each scenario.
Adherence to treatment algorithms improved using TMA. STEMI: cathlab informed (9/14 vs. 15/15; p=0.0169); allergies checked prior to acetylsalicylic acid (5/14 vs. 13/15; p=0.0078); analgosedation prior to cardioversion (10/14 vs. 15/15; p=0.0421); synchronized shock (6/14 vs. 14/15; p=0.0052). MT: adequate medication for intubation (3/15 vs. 10/14; p=0.0092); mean time to inform trauma centre 547 vs. 189 s (p=0.0001). No significant impairment of performance was detected in TMA groups.
In simulated setting TMA was able to improve treatment and safety without decline in timing. Nevertheless, further research is necessary to optimize the system for medical, organizational and technical reasons prior to the evaluation of this system in routine EMS.
[Show abstract][Hide abstract]ABSTRACT: Hypocapnia through hyperventilation is a well-known procedure in electroconvulsive therapy (ECT) to enhance seizure activity. However, it has mostly been applied in an uncontrolled manner. Originally intended for a better management of the supraglottic airway, laryngeal masks are more suited to monitor levels of CO(2) during hyperventilation than face masks and thereby provide for the possibility of controlled hyperventilation (CHV). The impact of CHV was retrospectively studied in 114 consecutive patients; 65 of them had received ECT with CHV and 49 had received ECT with uncontrolled hyperventilation (UHV) directly prior to the time period when the laryneal mask was introduced to the ECT treatment procedure. The CO(2) level in the CHV group was aimed at 30 mmHg or below. CHV considerably enhanced the seizure activity leading to changes in clinically determined parameters of the treatment course: the necessity for increasing the electric charge, for re-stimulations (trend) and for bilateral stimulations was lower in the CHV group as compared to the UHV group. The improvement in the Global Assessment of Functioning Scores was not different in both groups. CHV was associated with a higher amount of prolonged seizures, with a reduced number of delirious symptoms after treatments and an attenuating effect on heart rate. Concluding, CHV can help to maintain the applied electric charge low without worsening the clinical outcome. Therefore, it is a helpful technical improvement. However, it should be used carefully with regard to prolonged seizures.
No preview · Article · Aug 2011 · European Archives of Psychiatry and Clinical Neuroscience
[Show abstract][Hide abstract]ABSTRACT: Physicians have to demonstrate non-technical skills, such as communication and team leading skills, while coping with critical incidents. These skills are not taught during medical education. A crisis resource management (CRM) training was established for 4th to 6th year medical students using a full-scale simulator mannikin (Emergency Care Simulator, ECS, METI).
The learning objectives of the course were defined according to the key points of Gaba's CRM concept. The training consisted of theoretical and practical parts (3 simulation scenarios with debriefing). Students' self-assessment before and after the training provided the data for evaluation of the training outcome.
A total of 65 students took part in the training. The course was well received in terms of overall course quality, debriefings and didactic presentation, the mean overall mark being 1.4 (1: best, 6: worst). After the course students felt significantly more confident when facing incidents in clinical practice. The main learning objectives were achieved.
The effectiveness of applying the widely used ECS full-scale simulator in interdisciplinary teaching has been demonstrated. The training exposes students to crisis resource management issues and motivates them to develop non-technical skills.
No preview · Article · Mar 2009 · Der Anaesthesist
[Show abstract][Hide abstract]ABSTRACT: Repeated use of emergency physicians might result in excessive costs and has discouraging effects on emergency department staff. To our knowledge, no data are available on the characteristic of repeated use of emergency physicians (EP) in the German emergency medical services. Accordingly, this retrospective survey focused on emergency cases on-the-scene, which necessitated EP intervention.
Following data from the local EMS computerised database (Medlinq, EASY, Hamburg, Germany) were retrospectively analysed for the period from January to December of 2002: total number of EP interventions, person who engaged the emergency call, number of repeat EP-users with two to three calls, number of frequent EP-users with more than three calls, their sex, age, NACA. Probably inappropriate repeat users were defined as patients with no apparent underlying distress on-the-scene, lack of preclinical findings which could explain the symptoms initially mentioned, and refuse of hospital referral by the patient. The rate of repeated inappropriate EP use was defined as the ratio of the number of repeated inappropriate use over the total number of EP-engagements in the year 2002.
6064 EP interventions were analysed. The rate of the repeated use was 15.5 % (939/6064) including 3.6 % (218/6064) frequent users. The main medical causes (80 %) of repeated EP use were cardiovascular, neurological, respiratory, and psychiatric. The rate of repeated inappropriate EP use was 0.2 % (11/6064).
The rate of repeated inappropriate EP use in this middle sized town was low. More than four fifths of all repeated calls were for cardiovascular, respiratory, neurological, and psychiatric distress.
No preview · Article · Oct 2006 · ains · Anästhesiologie · Intensivmedizin