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1.
J Clin Monit Comput ; 37(2): 493-500, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36129642

RESUMO

The bedside Exhaled Drug MONitor - EDMON measures exhaled propofol in ppbv every minute based on multi-capillary column - ion mobility spectrometry (MCC-IMS). The MCC pre-separates gas samples, thereby reducing the influence of the high humidity in human breath. However, preliminary analyses identified substantial measurement deviations between dry and humid calibration standards. We therefore performed an analytical validation of the EDMON to evaluate the influence of humidity on measurement performance. A calibration gas generator was used to generate gaseous propofol standards measured by an EDMON device to assess linearity, precision, carry-over, resolution, and the influence of different levels of humidity at 100% and 1.7% (without additional) relative humidity (reference temperature: 37°C). EDMON measurements were roughly half the actual concentration without additional humidity and roughly halved again at 100% relative humidity. Standard concentrations and EDMON values correlated linearly at 100% relative humidity (R²=0.97). The measured values were stable over 100min with a variance ≤ 10% in over 96% of the measurements. Carry-over effects were low with 5% at 100% relative humidity after 5min of equilibration. EDMON measurement resolution at 100% relative humidity was 0.4 and 0.6 ppbv for standard concentrations of 3 ppbv and 41 ppbv. The influence of humidity on measurement performance was best described by a second-order polynomial function (R²≥0.99) with influence reaching a maximum at about 70% relative humidity. We conclude that EDMON measurements are strongly influenced by humidity and should therefore be corrected for sample humidity to obtain accurate estimates of exhaled propofol concentrations.


Assuntos
Propofol , Humanos , Umidade , Testes Respiratórios/métodos , Naftiridinas , Gases
2.
Anaesthesist ; 70(4): 298-307, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33170310

RESUMO

BACKGROUND: Sympathomimetic drugs are a therapeutic cornerstone for the management of hypotensive states like intraoperative hypotension (IOH). While cafedrine/theodrenaline (C/T) is widely used in Germany to restore blood pressure in patients with IOH, more research is required to compare its effectiveness with alternatives such as ephedrine (E) that are more commonly available internationally. METHODS: HYPOTENS (NCT02893241, DRKS00010740) was a prospective, national, multicenter, open-label, two-armed, non-interventional study that compared C/T with E for treatment of IOH. We describe a prospectively defined cohort of patients ≥50 years old with comorbidities undergoing general anesthesia induced with propofol and fentanyl. Primary objectives were to examine treatment precision, rapidity of onset and the ability to restore blood pressure without relevant increases in heart rate. Secondary endpoints were treatment satisfaction and the number of required additional boluses or other accompanying measures. RESULTS: A total of 1496 patients were included in the per protocol analysis. Overall, effective stabilization of blood pressure was achieved with both C/T and E. Post-hoc analysis showed that blood pressure increase from baseline was more pronounced with C/T. Fewer additional boluses or other accompanying measures were required in the C/T arm. The incidence of tachycardia was comparable between groups. Post-hoc analysis showed that E produced dose-dependent elevated heart rate values. By contrast, heart rate remained stable in patients treated with C/T. Physicians reported a higher level of treatment satisfaction with C/T, with a higher proportion of anesthetists rating treatment precision and rapidity of onset as good or very good when compared with E. CONCLUSION: Neither drug was superior in restoring blood pressure levels; however, post-hoc analyses suggested that treatment is more goal-orientated and easier to control with C/T. Heart rate was shown to be more stable with C/T and fewer additional interventions were required to restore blood pressure, which could have contributed to the increased treatment satisfaction reported by anesthetists using C/T.


Assuntos
Raquianestesia , Hipotensão , Pressão Sanguínea , Efedrina/uso terapêutico , Humanos , Hipotensão/induzido quimicamente , Hipotensão/tratamento farmacológico , Pessoa de Meia-Idade , Norepinefrina/análogos & derivados , Fenilpropanolamina/análogos & derivados , Estudos Prospectivos , Teofilina/análogos & derivados , Vasoconstritores/uso terapêutico
3.
Anaesthesist ; 66(1): 52-59, 2017 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-27942785

RESUMO

Factor XIII (FXIII) plays an important role in the field of blood coagulation. In the last decade, both congenital and acquired deficiencies have been investigated in clinical studies. FXIII is a versatile enzyme that leads to a covalent cross-linking of fibrin fibrils at the end of the clotting cascade and supports platelet adhesion to the damaged sub-endothelium with the result of a mechanically stable clot.Symptoms of FXIII deficiencies vary within a broad spectrum from superficial skin bleeding episodes to severe, sometimes life threatening hemorrhage, requiring prophylactic or therapeutic replacement therapy.Since 1993 purified plasma-derived FXIII concentrate has been available in Germany, large parts of Europe and in the USA and Canada. The administration is conducted intravenously, and FXIII is immediately available in the plasma. The dosage should be determined by measuring actual plasma FXIII-activity. Repetitive application is possible, especially with regard to the mean half-time of 7.9 days.Administration is considered to be safe and effective, but there are some case reports, as with other coagulation factors, describing the appearance of inhibitory antibodies.This summary seeks to provide an insight into the principle pharmacokinetic and pharmacodynamic characteristics of plasma-derived FXIII concentrate, reviewing the current literature. For detailed use in clinical settings, the application of FXIII concentrate or substitution therapy with fresh frozen plasma, we therefore refer to current guidelines and significant studies that have been recently published.


Assuntos
Fator XIII/farmacologia , Fator XIII/farmacocinética , Administração Intravenosa , Fator XIII/administração & dosagem , Fator XIII/efeitos adversos , Deficiência do Fator XIII/sangue , Deficiência do Fator XIII/terapia , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Humanos
5.
Anaesthesist ; 62(6): 464-72, 2013 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-23793973

RESUMO

During perioperative treatment of coagulopathic patients the so-called Point-of-Care (POC) analyses enable more rapidly available and more comprehensive hemostatic analyses compared to routinely performed conventional coagulation testing, such as activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen concentration and platelet count. In this review article a hemotherapy algorithm is presented which is based on viscoelastic and aggregometric POC measurements. The algorithm was designed double sided and consists of a general and a special part. The general part contains boxes and fields for sociodemographic data and gives general recommendations for coagulation management and therapy specifications for particular patient collectives and presents proposals for emergency reversal of anticoagulation therapy. The special part refers to basic physiological conditions for hemostasis and asks for measurement results of clot initiation, clot firmness, clot stability and platelet function analyses. Reference values were defined for each parameter and therapeutic options are presented. In cases of persistent coagulopathy despite algorithm-conform therapy, the algorithm could be run through once again. Finally, the algorithm presents therapeutic options for an ultima ratio therapy approach.


Assuntos
Algoritmos , Transtornos da Coagulação Sanguínea/terapia , Assistência Perioperatória/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Anticoagulantes/antagonistas & inibidores , Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Transtornos da Coagulação Sanguínea/sangue , Gasometria , Serviços Médicos de Emergência , Medicina Baseada em Evidências , Hemostasia , Hemostáticos/uso terapêutico , Humanos , Coeficiente Internacional Normatizado , Tempo de Tromboplastina Parcial , Testes de Função Plaquetária , Fatores Socioeconômicos
7.
Br J Anaesth ; 105(2): 172-8, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20587537

RESUMO

BACKGROUND: The patient state index (PSI) and the bispectral index (BIS) quantify anaesthetic depth based on the EEG using different algorithms. We compared both indices with regard to the prediction of the depth of propofol anaesthesia. METHODS: In 17 patients, propofol was infused until burst suppression occurred and stopped thereafter until BIS recovered to values above 60. This was repeated; afterwards, patients were intubated, for subsequent surgery. Without surgical stimulus, PSI and BIS were measured simultaneously and compared with the estimated effect-site concentrations of propofol. These were derived from simultaneous pharmacokinetic and -dynamic modelling in an individual two-stage and a population-based NONMEM approach. RESULTS: A close sigmoid relationship was observed between the propofol effect-site concentration and both PSI [coefficient of determination rho(2)=0.91 (sd 0.05)] and BIS [rho(2)=0.92 (0.03)], which was significantly steeper for PSI [gamma=2.2 (0.6)] than for BIS [gamma=1.8 (0.4)], and reached significantly lower values for PSI [E(max)=0.3 (1.1)] than for BIS [E(max)=5.3 (6.7)] at maximal propofol concentrations. A significantly smaller k(e0) was obtained for PSI [0.09 (0.03) min(-1)] compared with BIS [0.10 (0.02) min(-1)]. PSI and BIS correlated significantly with each other (rho(2)=0.866) and predicted propofol effect-site concentration with a comparable probability [P(K)=0.87 (0.05) and 0.86 (0.05), respectively]. NONMEM revealed E(0)=89.3 and 92.3, E(max)=1.9 and 8.6, C(e50)=1.38 and 1.92 microg ml(-1), gamma=1.6 and 1.48, and k(e0)=0.103 and 0.131 min(-1) as typical values for PSI and BIS, respectively. CONCLUSIONS: The PSI and the BIS monitors performed equally well in predicting depth of propofol anaesthesia. However, PSI was lower than BIS by approximately 10-15 points at high propofol concentrations.


Assuntos
Anestésicos Intravenosos/farmacologia , Eletroencefalografia/efeitos dos fármacos , Monitorização Intraoperatória/métodos , Propofol/farmacologia , Processamento de Sinais Assistido por Computador , Adolescente , Adulto , Idoso , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/sangue , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos , Propofol/administração & dosagem , Propofol/sangue , Reprodutibilidade dos Testes , Adulto Jovem
8.
Scand J Immunol ; 70(2): 101-5, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19630915

RESUMO

Transfusion of blood may contribute to immunomodulation. Leuco-depleted standard blood products are supposed to result in less immunomodulation compared with whole blood. To determine the influence of leuco-depleted blood products on the cytokine response, red blood cell concentrates (RBC), fresh frozen plasma (FFP) and platelet concentrates (PC) were investigated in an in vitro model of blood transfusion. Leuco-depleted standard blood bank RBC, FFP and PC were mixed in vitro with AB0 compatible venous blood from healthy volunteers in ratios of 3:1, 1:1 and 1:3. Specimens were incubated in presence or absence of lipopolysaccharide, 1 mug/ml. After 24 h of incubation cytokine release of tumour necrosis factor (TNF)-alpha and interleukin-10 (IL-10) was measured in cell culture supernatants by means of enzyme-linked immunsorbent assay. Addition of RBC, FFP and PC to venous blood from healthy volunteers led to a significant and dose-dependent increase in spontaneous TNF-alpha and IL-10 release. After endotoxin stimulation, RBC, FFP and PC significantly suppressed the TNF-alpha response, while the stimulated release of IL-10 tended to increase, reaching significance only after high doses of FFP. Addition of leuco-depleted blood products changed the spontaneous and stimulated cytokine response in an in vitro model of transfusion. These data may suggest a possible contribution of transfused FFP and PC to immunomodulation after transfusion similar to RBC.


Assuntos
Transfusão de Componentes Sanguíneos , Plaquetas/imunologia , Eritrócitos/imunologia , Plasma/imunologia , Plaquetas/metabolismo , Eritrócitos/metabolismo , Humanos , Interleucina-10/agonistas , Interleucina-10/sangue , Lipopolissacarídeos/farmacologia , Modelos Biológicos , Plasma/metabolismo , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/efeitos dos fármacos
9.
Anaesthesist ; 58(7): 708-15, 2009 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-19554270

RESUMO

Since its commercial introduction in 1996, target-controlled infusion (TCI) has become an established technique for administration of intravenous anaesthetics. Modern TCI systems, however, are characterized by an increasing number of additional options and features, such as the choice between different pharmacokinetic models and modes of application, which may confuse the less experienced user. This review describes the differences between pharmacokinetic models, modes of application and the effect of covariates as well as the consequences for dosing. The aim is to explicate for the user of modern TCI systems the underlying scientific concepts and the relevance for clinical practice.


Assuntos
Anestesia Intravenosa/métodos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacocinética , Infusões Intravenosas/métodos , Farmacocinética , Humanos , Modelos Estatísticos , Propofol/administração & dosagem , Propofol/farmacocinética
10.
Med Klin Intensivmed Notfmed ; 114(7): 655-660, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-30725273

RESUMO

BACKGROUND: Analysis of exhaled air is a risk-free option for bedside diagnostics. Modern breath analysis can detect very low concentrations of volatile components. Current research focuses on drug monitoring and diagnosis of various diseases. OBJECTIVES: Presentation and discussion of current breath research relevant to intensive care medicine. MATERIALS AND METHODS: The literature in PubMed was searched using the following terms: "breath analysis", "volatile organic compounds", "critically ill" combined with "drug monitoring", "propofol", "heart failure", "pneumonia", "ARDS", "renal failure", "liver failure", "sepsis" or "hemorrhage". RESULTS: Intravenously administered propofol can now be measured reliably in exhaled air. Functional impairments of the heart, lungs, kidneys and liver show characteristic influences on the exhaled air, which could serve as a new diagnostic tool in the future. Animal experiments already show promising results to detect sepsis, hemorrhage and ventilator-induced lung injury. CONCLUSIONS: In the future, modern breath analysis could enable non-invasive drug monitoring and diagnostics of medical conditions relevant to intensive care medicine.


Assuntos
Testes Respiratórios , Compostos Orgânicos Voláteis , Testes Respiratórios/métodos , Expiração/fisiologia , Humanos , Compostos Orgânicos Voláteis/análise
11.
J Breath Res ; 11(1): 016009, 2017 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-28049865

RESUMO

Propofol is an intravenous anesthetic. Currently, it is not possible to routinely measure blood concentration of the drug in real time. However, multi-capillary column ion-mobility spectrometry of exhaled gas can estimate blood propofol concentration. Unfortunately, adhesion of volatile propofol on plastic materials complicates measurements. Therefore, it is necessary to consider the extent to which volatile propofol adheres to various plastics used in sampling tubing. Perfluoralkoxy (PFA), polytetrafluorethylene (PTFE), polyurethane (PUR), silicone, and Tygon tubing were investigated in an experimental setting using a calibration gas generator (HovaCAL). Propofol gas was measured for one hour at 26 °C, 50 °C, and 90 °C tubing temperature. Test tubing segments were then flushed with N2 to quantify desorption. PUR and Tygon sample tubing absorbed all volatile propofol. The silicone tubing reached the maximum propofol concentration after 119 min which was 29 min after propofol gas exposure stopped. The use of PFA or PTFE tubing produced comparable and reasonably accurate propofol measurements. The desaturation time for the PFA was 10 min shorter at 26 °C than for PTFE. PFA tubing thus seems most suitable for measurement of volatile propofol, with PTFE as an alternative.


Assuntos
Plásticos/química , Propofol/análise , Adesividade , Anestésicos Intravenosos/análise , Área Sob a Curva , Calibragem , Processamento de Sinais Assistido por Computador , Temperatura , Fatores de Tempo , Volatilização
12.
J Breath Res ; 9(1): 016007, 2015 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-25749729

RESUMO

Long-term animal studies are needed to accomplish measurements of volatile organic compounds (VOCs) for medical diagnostics. In order to analyze the time course of VOCs, it is necessary to ventilate these animals. Therefore, a total of 10 male Sprague-Dawley rats were anaesthetized and ventilated with synthetic air via tracheotomy for 24 h. An ion mobility spectrometry coupled to multi-capillary columns (MCC-IMS) was used to analyze the expired air. To identify background contaminations produced by the respirator itself, six comparative measurements were conducted with ventilators only. Overall, a number of 37 peaks could be detected within the positive mode. According to the ratio peak intensity rat/ peak intensity ventilator blank, 22 peaks with a ratio >1.5 were defined as expired VOCs, 12 peaks with a ratio between 0.5 and 1.5 as unaffected VOCs, and three peaks with a ratio <0.5 as resorbed VOCs. The peak intensity of 12 expired VOCs changed significantly during the 24 h measurement. These results represent the basis for future intervention studies. Notably, online VOC analysis with MCC-IMS is possible over 24 h in ventilated rats and allows different experimental approaches.


Assuntos
Respiração Artificial , Compostos Orgânicos Voláteis/metabolismo , Animais , Expiração/fisiologia , Masculino , Modelos Animais , Ratos , Ratos Sprague-Dawley , Análise Espectral/métodos
13.
Sci Rep ; 4: 5423, 2014 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-24957852

RESUMO

Online measurement of drug concentrations in patient's breath is a promising approach for individualized dosage. A direct transfer from breath- to blood-concentrations is not possible. Measured exhaled concentrations are following the blood-concentration with a delay in non-steady-state situations. Therefore, it is necessary to integrate the breath-concentration into a pharmacological model. Two different approaches for pharmacokinetic modelling are presented. Usually a 3-compartment model is used for pharmacokinetic calculations of blood concentrations. This 3-compartment model is extended with a 2-compartment model based on the first compartment of the 3-compartment model and a new lung compartment. The second approach is to calculate a time delay of changes in the concentration of the first compartment to describe the lung-concentration. Exemplarily both approaches are used for modelling of exhaled propofol. Based on time series of exhaled propofol measurements using an ion-mobility-spectrometer every minute for 346 min a correlation of calculated plasma and the breath concentration was used for modelling to deliver R(2) = 0.99 interdependencies. Including the time delay modelling approach the new compartment coefficient k(e0lung) was calculated to k(e0lung) = 0.27 min(-1) with R(2) = 0.96. The described models are not limited to propofol. They could be used for any kind of drugs, which are measurable in patient's breath.


Assuntos
Expiração , Pulmão/metabolismo , Modelos Biológicos , Propofol/sangue , Propofol/farmacocinética , Algoritmos , Humanos , Hipnóticos e Sedativos/sangue , Hipnóticos e Sedativos/farmacocinética , Cinética , Fatores de Tempo
14.
J Breath Res ; 8(2): 027107, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24837657

RESUMO

In breath analysis, ambient air contaminations are ubiquitous and difficult to eliminate. This study was designed to investigate the reduction of ambient air background by a lung wash-out with synthetic air. The reduction of the initial ambient air volatile organic compound (VOC) intensity was investigated in the breath of 20 volunteers inhaling synthetic air via a sealed full face mask in comparison to inhaling ambient air. Over a period of 30 minutes, breath analysis was conducted using ion mobility spectrometry coupled to a multi-capillary column. A total of 68 VOCs were identified for inhaling ambient air or inhaling synthetic air. By treatment with synthetic air, 39 VOCs decreased in intensity, whereas 29 increased in comparison to inhaling ambient air. In total, seven VOCs were significantly reduced (P-value < 0.05). A complete wash-out of VOCs in this setting was not observed, whereby a statistically significant reduction up to 65% as for terpinolene was achieved. Our setting successfully demonstrated a reduction of ambient air contaminations from the airways by a lung wash-out with synthetic air.


Assuntos
Ar/análise , Testes Respiratórios/métodos , Adulto , Expiração , Feminino , Humanos , Íons , Masculino , Mentol/análise , Pessoa de Meia-Idade , Análise Espectral , Fatores de Tempo , Compostos Orgânicos Voláteis/análise , Adulto Jovem
15.
J Breath Res ; 8(1): 016006, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24566204

RESUMO

Rats are commonly used in medical research as they enable a high grade of standardization. The exhalome of ventilated rats has not as yet been investigated using an ion mobility spectrometer coupled with a multi-capillary column (MCC-IMS). As a first step, a rat model has to be established to measure potential biomarkers in the exhale with long-term settings, allowing constant and continuous analysis of exhaled air in time series. Therefore, eight animals were anaesthetized, prepared and ventilated for 1 h. A total of 73 peaks were directly detected with the IMS chromatogram. Thirty five of them were assigned to the ventilator system and 38 to the animals. Peak intensity varied within three measurements. The intensity of analytes of individual rats varied by a factor of up to 18. This new model will also enable continuous measurements of volatile organic compounds (VOCs) from rat's breath in long-term experiments. It is hoped that, in the future, variability and progression of VOCs can be monitored in different models of diseases using this set-up.


Assuntos
Testes Respiratórios/instrumentação , Testes Respiratórios/métodos , Modelos Teóricos , Respiração Artificial , Animais , Expiração/fisiologia , Estudos de Viabilidade , Hemodinâmica , Humanos , Íons , Masculino , Modelos Animais , Ratos , Ratos Sprague-Dawley , Processamento de Sinais Assistido por Computador , Fatores de Tempo
16.
Anaesthesist ; 57(3): 223-30, 2008 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-18322665

RESUMO

Over the last 10 years the technique of target-controlled infusion (TCI) has substantially influenced the development and practice of intravenous anaesthesia. It opened the possibility of many new and exciting applications of perioperative anaesthetic care. More recent and current developments, such as open TCI (target-controlled infusion) and the availability of generic anaesthetic agents combined with modern infusion pumps, means that TCI can become a standard procedure in anaesthesia and is no longer just a research tool for specialists and enthusiasts. This review explains the fundamentals and applications of intravenous drug delivery by TCI and gives practice guidelines to successfully implement the technique into clinical practice. The aim is to provide a comprehensive reference based on clinically proven evidence.


Assuntos
Anestesia Intravenosa/métodos , Anestésicos Intravenosos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Anestesia Intravenosa/instrumentação , Anestesia Intravenosa/tendências , Anestésicos Intravenosos/farmacocinética , Sedação Consciente/métodos , Eletroencefalografia/efeitos dos fármacos , Humanos , Bombas de Infusão , Monitorização Intraoperatória , Propofol/administração & dosagem , Propofol/farmacocinética
17.
Anaesthesist ; 56(2): 128-32, 2007 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-17235542

RESUMO

INTRODUCTION: After neurosurgery patients often need to be sedated and ventilated in the intensive care unit (ICU). However, rapid postoperative recovery and neurological examination are particularly important for the early recognition of complications. In this retrospective study two different strategies of anaesthesia technique and ICU sedation (fentanyl-midazolam versus remifentanil-propofol) were compared. METHODS: Intraoperatively, patients received continuous infusions of either fentanyl (0.2-1.0 mg/h) and midazolam (2-10 mg/h) or remifentanil (0.2-0.5 microg/kg body weight/min) and propofol (3-6 mg/kg body weight/h). After arrival in the ICU fentanyl (0.03-0.2 mg/h) and midazolam (2-12 mg/h) or remifentanil (0.1-0.2 microg/kg body weight/min) and propofol (0.5-3 mg/kg body weight/h) were infused to reach a Ramsay score of 4. The times between termination of infusion and extubation and the length of stay in the ICU were examined. RESULTS: A total of 60 patients (n=30 each group) undergoing supratentorial brain tumour surgery were enrolled. The groups were comparable for age, weight, ASA status (American Society of Anesthesiologists) and duration of drug administration (remifentanil-propofol 528+/-382 min versus fentanyl-midazolam 548+/-360 min). Extubation times were significantly shorter after remifentanil-propofol (47 min) than after fentanyl-midazolam (481 min), and the length of stay in the ICU was also significantly reduced (1.8 days versus 3.7 days). As a result of prolonged unconsciousness and impaired neurological assessability, a brain CT scan was necessary in 3 patients after fentanyl-midazolam to exclude neurosurgical complications. CONCLUSION: This retrospective study demonstrates that remifentanil-propofol anaesthesia and ICU sedation are superior to the combination of fentanyl and midazolam in terms of ventilation time and length of ICU stay. Moreover, the use of fentanyl-midazolam may lead to unnecessary CT scans.


Assuntos
Anestésicos Intravenosos , Sedação Consciente , Fentanila , Midazolam , Procedimentos Neurocirúrgicos , Piperidinas , Propofol , Cuidados Críticos , Bases de Dados Factuais , Tempo de Internação , Remifentanil , Respiração Artificial , Estudos Retrospectivos , Neoplasias Supratentoriais/cirurgia , Tomografia Computadorizada por Raios X
18.
Anaesthesist ; 56(8): 793-6, 2007 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-17520227

RESUMO

Placenta increta is a rare but potentially life-threatening risk constellation after a previous caesarean section. We present the case of a 29-year-old gravida 2 para 1 patient, who developed dramatic haemorrhaging caused by this abnormal placentation, which could only be resolved by a postpartal hysterectomy. This demonstrates that in the case of a combination of the two most common predisposing factors, repeat caesarean section and placenta praevia, the possibility of a placenta increta should be considered and suitable precautions should be taken.


Assuntos
Cesárea , Placenta Prévia/cirurgia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Parto/etiologia , Adulto , Anestesia Obstétrica , Raquianestesia , Feminino , Humanos , Histerectomia , Complicações Pós-Operatórias/fisiopatologia , Hemorragia Pós-Parto/fisiopatologia , Gravidez
19.
Anaesthesist ; 56(6): 538-56, 2007 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-17530207

RESUMO

Pharmacokinetic models can be differentiated into two groups: physiological-based models and empirical models. Traditionally the pharmacokinetics of volatile anaesthetics are described using physiological-based models together with the respective tissue-blood distribution coefficients. The compartments of the empirical model have no anatomical equivalents and are merely the product of the mathematical procedure for parameter estimation. The end expiratory concentration of volatile anaesthetics is approximately equal to the arterial concentration and, therefore, the description of the transition between plasma and effect site for volatile anaesthetics plays a central role. The most important parameter here is the k(e0) value which is a time constant and describes the time delay for the transition from the central compartment to the calculated effect compartment. The k(e0) values for sevoflurane and isoflurane are the same but the concentration balance between the end-tidal concentration and the effect compartment occurs twice as quickly with desflurane. In clinical practice volatile anaesthetics are normally combined with N(2)O and/or opioids. This results in an additive interaction between volatile anaesthetics and N(2)O but a synergistic interaction of volatile anaesthetics with opioids. However, there are relatively few investigations on the interactions between the clinically widely used combination of volatile anaesthetics, N(2)O and opioids.


Assuntos
Anestésicos Inalatórios/farmacologia , Anestésicos Inalatórios/farmacocinética , Algoritmos , Anestesia por Inalação , Eletroencefalografia/efeitos dos fármacos , Humanos , Modelos Biológicos , Modelos Estatísticos , Óxido Nitroso/administração & dosagem , Óxido Nitroso/farmacocinética
20.
Best Pract Res Clin Anaesthesiol ; 20(1): 111-9, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16634418

RESUMO

The Narcotrend (MonitorTechnik, Bad Bramstedt, Germany) is an EEG monitor designed to measure the depth of anaesthesia. It has been developed at the University Medical School of Hannover, Germany, has been commercially available for 5 years and has meanwhile received US Food and Drug Administration approval. The Narcotrend algorithm is based on pattern recognition of the raw electroencephalogram (EEG) and classifies the EEG traces into different stages from A (awake) to F (increasing burst suppression down to electrical silence). The newest Narcotrend software version includes a dimensionless Narcotrend index from 100 (awake) to 0 (electrical silence). The raw EEG signal can be recorded by standard electrocardiogram electrodes for single- and double-channel registration. The Narcotrend monitor provides a vast amount of information: the actual Narcotrend stage and index, the trend ('cerebrogram'), the raw EEG signal and a power spectrum and several derived EEG parameters. Multiple clinical and validation studies are available for the Narcotrend monitor, including comparisons with the BIS monitor (Aspect Medical Systems, Natick, USA).


Assuntos
Eletroencefalografia/instrumentação , Monitorização Intraoperatória/instrumentação , Algoritmos , Anestesia Geral/métodos , Estado de Consciência/efeitos dos fármacos , Estado de Consciência/fisiologia , Eletroencefalografia/métodos , Humanos , Monitorização Intraoperatória/métodos
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