[Leipzig fast-track protocol for cardio-anesthesia. Effective, safe and economical]. / Leipziger "Fast-track"-Protokoll in der Kardioanästhesie. Effektiv, sicher und ökonomisch sinnvoll.

BACKGROUND: In November 2005 a complex, multimodal anesthesia fast-track protocol (FTP) was introduced for elective cardiac surgery patients in the Cardiac Center of the University of Leipzig which included changing from an opioid regime to remifentanil and postoperative treatment in a special post-anesthesia recovery and care unit. The goal was to speed up recovery times while maintaining safety and improving costs. METHOD: A total of 421 patients who underwent the FTP and were treated in the special recovery room were analyzed retrospectively. These patients were compared with patients who had been treated by a standard protocol (SP) prior to instituting the FTP. Primary outcomes were time to extubation, length of stay in the intensive care unit (ICU) and treatment costs. RESULTS: The times to extubation were significantly shorter in the FTP group with 75 min (range 45-110 min) compared to 900 min (range 600-1140 min) in the SP group. Intensive care unit stay and hospital length of stay were also significantly shorter in the FTP group (p<0.01). The reduction of treatment costs of intensive care for FTP patients was 53.5% corresponding to savings of EUR 738 per patient in the FTP group compared with the SP group. CONCLUSIONS: The Leipzig fast-track protocol for cardio-anesthesia including the central elements of switching opiate therapy to remifentanil and switching patient recovery to a special post-anesthesia recovery and care unit, shortened therapy times, is safe and economically effective.

Dermal tolerance and effect on skin hydration of a new ethanol-based hand gel.

We studied the dermal tolerance (repetitive occlusive patch test; ROPT) and the skin hydrating properties of a new ethanol-based gel [85% (w/w)], Sterillium Gel. For the ROPT, 53 participants were studied. Gel was applied to one site on the back under an occlusive patch during an induction phase (nine applications over three weeks) and two weeks later to a virgin site on the back during a challenge phase (one application). Twenty-four hours after the removal of the patches (induction phase and challenge phase), then 48 and 72 h later (challenge phase) sites were graded for skin reactions using a standardized scale. In the induction phase none of the 53 participants had a skin reaction. In the challenge phase one participant had a barely perceptible skin reaction, and one had mild erythema at one time point. To evaluate skin hydrating properties of the gel, treated skin of 21 participants was compared to untreated skin. The gel was applied twice a day to the forearm for 14 days. Control corneometer values were taken before application of the gel (mean: 32.7 +/- 5.0) and after one (36.3 +/- 4.4) and two weeks (36.1 +/- 5.4). Relative skin hydration on treated skin in comparison with an untreated control field was significantly higher after one week by 6.85% (P = 0.0031; paired t -test for dependent samples) and after two weeks by 4.47% (P = 0.0153). Sterillium Gel did not demonstrate a clinically relevant potential for dermal irritation or sensitization, and significantly increased skin hydration after repetitive use, and so could enhance compliance with hand hygiene among healthcare workers.

Multicentre comparison of skin hydration in terms of physical-, physiological- and product-dependent parameters by the capacitive method (Corneometer CM 825).

A multicentre study for measuring skin hydration with 349 volunteers was carried out in six different laboratories. The purpose of the study was to investigate physical-, physiological- and product-dependent parameters of three test emulsions (base, base + moisturizer and base + moisturizer + lipids) in a double-blind study. A comparison between analogous and digital sensor technology of the Corneometer CM825 was examined. Here, a clear relationship between both sensor types could be highlighted. A vital point of the study was the division of the test subjects according to their skin type. To get more objective limits for three different skin types - very dry, dry and normal skin - visual expert evaluation, self-assessment and hydration measurements were analysed by means of statistical methods. The moisture-related skin types were determined as follows: very dry skin was characterized with corneometer units below 30, dry skin between 30 and 40 and normal skin higher than 40 a.u. (arbitrary units). The efficacy of the three test emulsions was examined in relation to the mentioned skin types. Analysing the measured data of all test centres, a clear dependency of skin physiology (skin type) and product efficacy became evident. The drier the skin, the higher the increase of hydration. The product performance of the three test emulsions compared to the untreated control resulted in a significant increase of skin hydration in all measuring centres. The evaluation of a product ranking showed a good differentiation between the basic emulsion and the two other products. An increase of efficacy by adding lipids could be observed in four of six centres. The important influence of the skin type of the volunteers on the degree of product performance, as demonstrated in this study, should be especially considered when drawing up guidelines for efficacy testing.