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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  124. Kongress der Deutschen Gesellschaft für Chirurgie; 20070501-20070504; München; DOC07dgch6678 /20071001/
    Publication Date: 2007-10-02
    Keywords: ddc: 610
    Language: German
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC); 20070426-20070429; Leipzig; DOCP 007 /20070411/
    Publication Date: 2007-04-04
    Keywords: regional CBF ; hyperventilation ; head injury ; regionaler CBF ; Hyperventilation ; Hirntrauma ; ddc: 610
    Language: English
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  • 3
    ISSN: 0190-7409
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine , Education , Psychology
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  • 4
    ISSN: 1432-1238
    Keywords: Mucociliary clearance ; Ultrastructural ciliary alterations ; Cilia ; Electron microscopy ; Intubation ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The objective of this study was to investigate whether reduced bronchial mucus transport velocity (BTV) is associated with a loss of cilia or ultrastructural abnormalities of cilia in intubated patients. Design The patients were studied prospectively in a convenience sample trial. Setting The study took place in a university hospital. Patients and participants 29 orally intubated patients in a surgical ICU. Interventions BTV was measured with radiolabeled microspheres in the right and left primary bronchus. Following these measurements, biopsy samples were taken from the bronchi for scanning (SEM) and transmission (TEM) electron-microscopic investigations. Measurements and results SEM: Patients with normal or slight impaired BTV (group 1,n=14: BTV: 8.5 mm/min (3.8–11.5); median with range) showed more cilia on the luminal surface than patients with markedly depressed BTV (p〈0.05) (group 2,n=15: BTV: 0(0–2.1)). The difference was statistically significant. The BTV values correlated moderately with the number of cilia on the luminal surface (r=0.46;p=0.02). TEM: In group 1, 6.5% (3.9–14.9) of cilia were abnormal (median with range) vs 9.3% (4.9–13.7) in group 2; these differences were not statistically significant. Neither was there any significant correlation between BTV and the frequency of abnormal cilia. Conclusions Impaired mucociliary transport in intubated patients is associated with a loss of cilia rather than ultrastructural abnormalities of cilia, which are less relevant.
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  • 5
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Allgemeinnarkose – Ketamin – In-vitro-Fertilisations-Embryotransfer (IVF-ET) – Prolaktin –β-Endorphine ; Key words: General anaesthesia – Ketamine – In vitro fertilization-embryo transfer – Prolactin –β-endorphins
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. Different anaesthetic procedures that were used during an in vitro fertilisation and embryo transfer (IVF-ET) program have been analysed in order to determine their influence on plasma levels of estradiol, progesterone, prolactin, and β-endorphin and results of IVF-ET. Methods. Fifty-four patients awaiting transvaginal oocyte aspiration were randomised into three groups: (1) anaesthesia with ketamine as an induction agent and analgesic (n=20); (2) general intubation anaesthesia using thiopentone for induction and enflurane for maintenance (n=18); and (3) no anaesthesia (n=16). Estradiol, progesterone, prolactin, and β-endorphin were measured from day 3 to 14 referring to follicle aspiration. Differences between preoperative hormone levels and their intra- and postoperative peaks were analysed using the Kruskal-Wallis test (P〈0.03). The results were corrected using the Holms method (α=0.05). Results. No differences were observed in estradiol and progesterone levels (Figs. 1, 2). Prolactin levels were 1.4 times higher (P〈0.001) when ketamine was used and 2.2 times higher (P〈0.001) after short general anaesthesia than in the control group (Fig. 3). Similar results were observed with respect to β-endorphin: in comparison with the control group we found significant elevation by a factor of 2.1 when ketamine was used (P〈0.001). The discrepancy became even more marked with general anaesthesia: β-endorphin was 3.9 times higher compared to the controls (P〈0.001) (Fig. 4). Comparing the two groups who were given anaesthetics, prolactin and β-endorphin levels were also significantly different (P〈0.001). The IVF procedure itself did not appear to be affected by different anaesthetic procedures during oocyte aspiration (Table 2). Conclusions. The increased prolactin and β-endorphin plasma levels associated with ketamine and general anaesthesia reflect a significant alteration of the observed hormone levels. When anaesthesia is indicated, we try to avoid general intubation anaesthesia in favor of ketamine.
    Notes: Zusammenfassung. Im Rahmen der in-vitro-Fertilisations-Embryotransfer-(IVF-ET-)Behandlung werden bei der Oozytengewinnung u. a. systemische Kurznarkosen eingesetzt. Ihr Einfluß auf die Östradiol-, Progesteron-, Prolaktin- und β-Endorphin-Plasmaspiegel sowie auf die Ergebnisse der IVF-Verfahren wurde an 54 Patientinnen untersucht. Diese wurden vor einer geplanten transvaginalen Follikelpunktion zwischen einer Narkose mit Ketamin als Einleitungshypnotikum und Analgetikum (n=20), einer "Allgemeinnarkose" mit Thiopental als Einleitungs- und Enfluran als Inhalationsnarkotikum (n=18) und einer Kontrollgruppe ohne Anästhesie (n=16) randomisiert. Die Hormonspiegelbestimmungen erfolgten peri- und intraoperativ zwischen Tag −3 und +14. Die Differenzbeträge zum individuellen Vor- bzw. Nullwert wurden mittels Kruskal-Wallis-Test analysiert (p〈0,03) und nach dem Holm-Verfahren korrigiert (α=0,05). Der Prolaktinspiegel war unter Ketaminanästhesie 1,4fach und Allgemeinanästhesie 2,2fach gegenüber der Kontrollgruppe erhöht (jeweils p〈0,001). Auch die β-Endorphine stiegen um den Faktor 2,1 (p〈0,001) bzw. 3,9 (p〈0,001) signifikant an. Beim Vergleich der Narkoseformen untereinander waren Prolaktin- sowie Endorphinspiegel ebenfalls signifikant unterschiedlich (p〈0,001). Keine Unterschiede ergaben sich bezüglich der Östradiol- und Progesteronspiegel sowie in bezug auf die IVF-Durchführung und die klinischen Ergebnisse nach Embryotransfer. Wenngleich die klinischen Ergebnisse der IVF-Behandlung nicht durch den Einsatz der Narkoseverfahren beeinflußt wurden, sollte dennoch ein Anästhesieverfahren mit einer geringen Beeinflussung der Hormonspiegel gewählt werden. In unserer Untersuchung war dies die Ketaminnarkose ohne endotracheale Intubation.
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  • 6
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Raumluftbelastung ; Larynxmaske ; Doppelmaske ; Key words Atmospheric pollution ; Double mask ; Laryngeal mask
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Pollution of work areas by volatile anaesthetics and nitrous oxide occurs during general anaesthesia. Short anaesthesia procedures are often carried out in operating theatres that are not equipped with air-conditioning systems. Methods of lovering exposure during short procedures, where mask anaesthesia is the usual procedure, are double masks and the laryngeal mask. The aim of our investigation was to determine the possibility of lowering the pollution of the environment to below national and international thresholds in a non-air-conditioned work area and to find out which method of anaesthesia is the most effective in environmental protection, i.e. which has the lowest leakage rate. Methods. In our investigation, at two points of the work area the mean enflurane [2-chloro-1-(difluoromethoxy)-1,1,2-trifluoro-ethane] concentrations were measured under daily routine conditions in a non-ventilated anaesthesiological work area by gas chromatography. Anaesthesia with single masks, double masks, laryngeal masks or endotracheal intubation was carried out. Results. No differences were found in the mean concentration of enflurane during the anaesthesia procedures. The leakage rates of endotracheal intubation anaesthesia were the lowest. Discussion. In unventilated work areas, it was not possible to lower the exposure of the personnel by changing the method of anaesthesia. The application of procedures like double or laryngeal masks does not avoid the need for installation of air-conditioning systems in all work areas were anaesthesia is performed.
    Notes: Zusammenfassung Während Inhalationsnarkosen kommt es zu Raumluftkontaminationen durch volatile Anästhetika und Lachgas. Belastungssenkende Verfahren für Narkosen, die als Maskennarkosen durchgeführt werden, sind Doppelmasken und Larynxmasken. Ziel unserer Untersuchung, die in einem nichtklimatisierten Eingriffsraum stattfand, war es, die verfahrensbedingte Leckage im Vergleich zur Intubationsnarkose zu quantifizieren. Gleichzeitig wurde geprüft, ob sich durch die Einführung von Larynx- oder Doppelmasken die MAK-Werte in nichtbelüfteten Arbeitsplätzen einhalten lassen. Es wurden Narkosen mit Einfachmasken, Doppelmasken, Larynxmasken und Intubationsnarkosen durchgeführt. Dabei bestimmten wir während jeder Narkose die mittlere Enflurankonzentration gleichzeitig an zwei Punkten im Arbeitsbereich des Anästhesisten. Aus den gemessenen Werten und den Narkosezeiten wurde die verfahrensbedingte Leckage berechnet. Es wurden keine Unterschiede der mittleren Narkosegasbelastung festgestellt. Die Narkosegaseemission war bei Intubationsnarkosen niedriger als bei allen anderen Verfahren. Belastungssenkende Effekte von Larynx- und Doppelmasken werden in nichtbelüfteten Räumen durch andere Expositionsquellen überlagert. Die Installation von suffizienten Klimaanlagen muß weiter für alle anästhesiologischen Arbeitsplätze gefordert werden.
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  • 7
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Mukoziliäre Klärfunktion ; Kombinationsanästhesie ; Isofluran ; Fentanyl ; Key words Mucociliary clearance ; General anaesthesia ; Isoflurane ; Fentanyl
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The mucociliary escalator of the lung is an important protective transport system by means of which inhaled particles and microorganisms are removed from the tracheobronchial system. In general, it is assumed that anaesthetics inhibit mucociliary clearance [3, 5, 6, 19, 27]. In the present prospective study the effect of combination anaesthesia with isoflurane, fentanyl, vecuronium, and nitrous oxide-oxygen mixture on bronchial mucus transport velocity (BTV) was investigated. Patients and methods: 10 patients undergoing major abdominal surgery were included in the study. The study was approved by the ethics committee of our hospital. In all patients anaesthesia was induced with propofol (1–2 mg/kg), fentanyl (0,2–0,3 mg/kg) and vecuronium (0,1 mg/kg). After intubation anaesthesia was maintained with 1,5 MAC isoflurane and repeated doses of fentanyl (0,1–0,2 mg) and vecuronium. Ventilation was assisted with a 2:1 mixture of nitrous oxide and oxygen. The BTV was measured preoperatively in the conscious patients one day before surgery while they received local anaesthesia with 10 ml of 1 percent lidocaine and postoperatively while they received intubation anaesthesia. BTV was determined with a small volume of albumin microspheres labeled with technetium-99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope [15]. Results: Table 1 provides information about age, application of anaesthetics and duration of mechanical ventilation of the patients. The preoperative and postoperative BTV values showed no significant differences (Fig. 1). Conclusions: Combination anaesthesia with isoflurane, fentanyl, vecuronium, and O2:N2O does not influence BTV in patients with healthy lungs.
    Notes: Zusammenfassung Ziel: In der vorliegenden prospektiven Studie überprüften wir den Einfluß einer Kombinationsanästhesie mit Isofluran, Fentanyl, Vecuronium und Sauerstoff-Lachgas-Beatmung auf die bronchiale Schleimtransportgeschwindigkeit (BTG). Material und Methoden: Insgesamt wurden 10 Patienten untersucht, bei denen ein längerdauernder großer abdominalchirurgischer Eingriff vorgesehen war. Die Narkose wurde mit Propofol (1–2 mg/kg), Fentanyl (0,2–0,3 mg) und Vecuronium (0,1 mg/kg) eingeleitet und mit 1,5 MAC Isofluran unter repetitiven Dosen von Fentanyl und Vecuronium aufrechterhalten. Beatmet wurde mit einem Sauerstoff-Lachgas-Gemisch im Verhältnis von 2:1 im halbgeschlossenen System. Die BTG wurde einen Tag vor der Operation in Lokalanästhesie mit 1%igem Xylocain gemessen und nach Beendigung der Operation in Intubationsnarkose unter kontrollierter Beatmung. Zur Bestimmung der BTG wurden 2 MBq Technetium-99 makroaggregiertes Albumin auf die Schleimhautoberfläche der distalen Hauptbronchien mittels Fiberbronchoskopie appliziert und die Wanderungsgeschwindigkeit mit einer Gamma-Kamera erfaßt. Ergebnis: Statistisch signifikante Unterschiede zwischen den präoperativen und postoperativen BTG-Werten bestanden weder im rechten noch im linken Bronchialsystem. Zusammenfassend ergibt sich, daß eine Kombinationsanästhesie mit Isofluran, Fentanyl, Vecuronium und Sauerstoff-Lachgas-Beatmung keine nachteiligen Effekte auf den bronchialen Schleimtransport der Lunge hat.
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  • 8
    ISSN: 0942-0940
    Keywords: Keywords: Autologous bone graft; Cloward fusion; cervical spine; intervertebral; radiculopathy; myelopathy; myeloradiculopathy.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ The Cloward ventral interbody fusion is often employed for treatment of cervical degenerative disease. The present study was aimed at evaluating results and complications in this classical type of autologous bone graft procedure in a cohort of patients with radiculopathy (RP) or myeloradiculopathy (MRP). Indications for and limitations of the technique were investigated by retrospective data analysis in a series of 106 patients (30 females and 76 males). These underwent single or multiple level Cloward fusion in a total of 145 levels. Neuroradiological investigations included lateral and antero-posterior cervical spine X-rays, axial CT scans, and MRI. The presence of postoperative ossification and stable bony fusion in the fused segments was confirmed by X-rays and, when necessary, by CT. The median postoperative follow-up period was 6.5 years (range 4–10.5 years). Short term outcome in RP patients was good in 26 cases (92.9%) and fair in 2 cases (7.1%). A good short term outcome was seen in 55 MRP patients (70.5%), a fair outcome in 20 patients (25.6%), and a poor outcome in 3 patients (3.8%). Patients having myelopathy signs for less than 1 year had a significantly better outcome than those with clinical signs for more than 1 year (p〈0.05). MRP patients below the age of 40 years had a significantly better outcome than those above the age of 40 (p〈0.05). In the long term, radiculopathy was cured or significantly improved in 92.8% of cases, and myeloradiculopathy in 64%. One year after surgery, there were 139 stably fused segments (96%) and 6 segments showing osseous non-union (4%). Plain lateral radiographs demonstrated, besides the bony fusion in the respective segment, relatively frequent graft collapse with slight to severe correction losses and kyphotic deformity of the cervical spine. However, these findings did not necessarily correlate with the clinical outcome. Autologous bone graft harvesting caused a rather high short-term morbidity with donor site pain and/or wound haematoma in 33% of the cases. These surgery-related complications, however, were of a temporary nature, as long-term complications (cutaneous hypaesthesiae) were found in 2 patients (1.8%) only. In conclusion, Cloward anterior cervical fusion for degenerative spinal disease is a relatively simple and safe surgical procedure with favourable short and long term results. In our hands, graft donor site complications dominate the side effects of surgery, and the percentage of non-unions is rather low. Because of the relatively frequent bone graft collapse and the late loss of postural correction of the spine, we cannot recommend the Cloward type fusion for multisegmental procedures. In such cases, an instrumented plate fusion should be carried out in order to prevent graft collapse and non-union, and to allow for a shorter convalescence period.
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  • 9
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Mukoziliäre Klärfunktion ; Wärme- und Feuchtigkeitsaustauscher ; Befeuchtung ; Beatmungsfilter ; Filter ; Narkose ; Beatmung ; Key words Mucociliary clearance ; Heat and moisture exchanger ; HME ; Humidity ; Filter ; Semiclosed breathing system ; Artificial instrumentation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The administration of dry anaesthetic gases for ventilation leads to morphological changes of the tracheobronchial epithelium that may cause postoperative pulmonary complications. Therefore, additional humidification with a heat and moisture exchanger (HME) is suggested for ventilation during anaesthesia, particularly when using semi-open breathing systems. Recommendations concerning the use of a HME in the semi-closed system are controversial. There are no data in the literature as to whether a HME improves mucociliary transport under these conditions. We therefore studied bronchial mucus transport velocity (BTV) with and without the use of a HME in the semi-closed circle system in humans. Patients and methods. The study was approved by the ethics committee of our hospital. In a prospective, randomised trial a total of 22 patients undergoing major abdominal surgery were investigated. In all patients anaesthesia was induced and maintained with midazolam, fentanyl, and vecuronium. After intubation, a HME (BACT/VIRAL HME, Pharma Systems AB, Sweden) was inserted between the endotracheal tube and ventilation tubing in 11 patients; the other 11 were ventilated without a HME and served as controls. Ventilation was assisted with a fresh gas flow of 3 l in a semi-closed system (Dräger Sulla 808 V with an 8 ISO circle system and Ventilog 2 ventilator, Drägerwerk AG, Germany) and a 2:1 mixture of nitrous oxide and oxygen. The fresh gas passed through the soda lime canister. At the end of the operation BTV was measured with a small volume of albumin microspheres labeled with technetium Tc99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope [16]. Results. The two groups were comparable with regard to age, sex, preoperative lung function, duration of mechanical ventilation, and dose of anaesthetics (Table 1). There were no statistically significant differences in the BTVs (Fig. 1). Discussion. BTV does not improve with the use of a HME in the semi-closed circle system with a fresh gas flow of 3 l. With modern anaesthesia machines lower fresh gas flows should be administered, whereby the humidity and temperature of the inspired gases are further increased.
    Notes: Zusammenfassung In einer prospektiven randomisierten Studie wurde der Einfluß eines Wärme- und Feuchtigkeitsaustauschers (HME) auf die bronchiale Schleimtransportgeschwindigkeit während einer Narkosebeatmung im halbgeschlossenen Kreissystem untersucht. Bei 11 Patienten wurde sofort nach erfolgter Intubation ein HME (BACT/VIRAL HME, Pharma Systems AB, Schweden) zwischen Tubus und Beatmungsschläuchen plaziert, bei anderen 11 Patienten wurden die Beatmungsschläuche direkt am Tubus angeschlossen. Nach einer mehrstündigen Narkosebeatmung wurde die bronchiale Schleimtransportgeschwindigkeit (BTG) bestimmt. Zur Bestimmung der BTG wurden zwei MBq Technetium-99 makroaggregiertes Albumin auf die Schleimhautoberfläche der distalen Hauptbronchien mittels Fiberbronchoskopie appliziert und die Wanderungsgeschwindigkeit mit einer Gammakamera erfaßt. Die BTG war in der Filtergruppe sowohl im linken als auch im rechten Hauptbronchus gegenüber der Kontrollgruppe tendenziell höher (Medianwerte links 6,8 versus 5,8 mm/min; rechts 7,5 versus 6,4 mm/min), ein statistisch signikanter Unterschied ließ sich jedoch nicht nachweisen. Die vorliegende Studie zeigt, daß bei einer Narkosebeatmung im halbgeschlossenen System mit einer Frischgaseinleitung vor dem Atemkalk und einem Frischgasfluß von 3 l/min die bronchiale Schleimtransportgeschwindigkeit durch einen HME nicht verbessert wird.
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  • 10
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We studied 22 patients aged 53–78 years scheduled for cardiac surgery under cardiopulmonary bypass. Blood pressure, cardiac output, transcranial Doppler blood flow velocity, arterial blood gases, body temperature and protein S100B, as a marker for cerebral integrity, were evaluated in normotensive and hypertensive patients. Pre-operative mean (SD) arterial blood pressure was 93 (11) mmHg in the normotensive group compared with 116 (15) mmHg in the hypertensive group. We found an increase in protein S100B levels in both groups. Serum protein S100B concentrations in the hypertensive group were significantly higher than in the normotensive group (p 〈 0.001). The highest mean (SD) values were 2.04 (0.65) µmol.l−1 in the normotensive group and 7.02 (4.55) µmol.l−1 in the hypertensive group. These results suggest that cardiopulmonary bypass is associated with a significantly higher rate of cerebral injury in hypertensive patients than in normotensive patients. This may be due to altered autoregulation and insufficient cerebral perfusion. Modifications of cardiopulmonary bypass management for hypertensive patients might be made to decrease the risk of cerebral injury.
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