Wolfgang Ummenhofer - Academia.edu (original) (raw)
Papers by Wolfgang Ummenhofer
Der Anaesthesist
A 53-year-old woman diagnosed as having hereditary motor-sensory neuropathy Charcot-Marie-Tooth (... more A 53-year-old woman diagnosed as having hereditary motor-sensory neuropathy Charcot-Marie-Tooth (CMT) disease Type 2, underwent inguinal hernia surgery. In this patient CMT disease was manifested as distal muscle weakness and wasting. Anaesthetic experience with patients who have CMT disease is limited. Association to malignant hyperthermia is very unlikely although there is one case report that shows that there could be a relationship. We describe a total intravenous anaesthesia (TIVA) protocol with propofol and alfentanil without any muscle relaxants after fiberoptic intubation. The patient made an uneventful recovery and was discharged from the hospital on the fourth postoperative day. TIVA was a safe technique in this patient and should be considered as an alternative for patients presenting with CMT disease.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or... more Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers' professional background. Tracheal cuff pressures in patients intubated before arrival of a helicopter-based rescue team were prospectively recorded during a 12-month period. Information about the method used for initial cuff pressure assessment, profession of provider and time since intubation was collected by interview during patient handover. Indications for helicopter missions were either Intensive Care Unit (ICU) transports or emergency transfers. ICU transports were between ICUs of two hospitals. Emergency transfers were either evacuation from the scene or transfer from an eme...
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2006
Scandinavian journal of trauma, resuscitation and emergency medicine, 2013
Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or... more Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers' professional background. Tracheal cuff pressures in patients intubated before arrival of a helicopter-based rescue team were prospectively recorded during a 12-month period. Information about the method used for initial cuff pressure assessment, profession of provider and time since intubation was collected by interview during patient handover. Indications for helicopter missions were either Intensive Care Unit (ICU) transports or emergency transfers. ICU transports were between ICUs of two hospitals. Emergency transfers were either evacuation from the scene or transfer from an eme...
Resuscitation, 2003
Objective: Early defibrillation using automated external defibrillators (AEDs) has been advocated... more Objective: Early defibrillation using automated external defibrillators (AEDs) has been advocated to improve survival in witnessed out-of-hospital cardiac arrest (OHCA) due to pulseless ventricular tachycardia (VT) and ventricular fibrillation (VF). However, when VT/VF is untreated and prolonged for more than a few minutes, defibrillation using AEDs may fail. Methods : This retrospective study reviewed the charts from local emergency medical service (EMS) between the years 1993 to 2001 to evaluate the value of the AED after its introduction into our EMS. All witnessed OHCA due to VT/VF were analysed; cases of collapse witnessed by EMS were excluded. The primary endpoint was defined as survival to hospital discharge and at 1-year follow-up, and the secondary endpoint as survival without major neurological deficit. A total of 76 patients were treated for witnessed VT/VF before the implementation of the AED and 92 patients after its implementation. Results: Before the introduction of paramedic AED defibrillation, physician defibrillation was performed at 15.6 min (9/5.5, S.D.). After the introduction of AED defibrillation, paramedic defibrillation was performed at 5.7 min (9/2.4, S.D.); the mean response interval from the call to defibrillation was shortened significantly (P B/0.001). At the same time, survival to hospital discharge decreased from 23.7% (18/76 patients) to 14.1% (13/92) (P0/0.112) and at 1-year follow-up from 17.1% (13/76) to 9.8% (9/92) (P 0/0.161). Favourable neurological outcome at 1year follow-up also decreased from 14.5% (11/76) to 8.7% (8/92) (P0/0.239). Conclusion : Implementation of the AED did not improve survival or a favourable neurological outcome in patients with OHCA due to VF/VT. However, with 5.7 min time to defibrillation, our EMS did not meet the criteria for early defibrillation. For prolonged periods of VT/VF, initial basic life support (BLS) may be superior to immediate AED. If response times of B/4 min cannot be attained by the emergency systems, reconsidering of resuscitation algorithms seems to be advisable. #
Resuscitation, 2001
In-hospital emergency medicine in central Europe relies on inter-disciplinary co-operation. To im... more In-hospital emergency medicine in central Europe relies on inter-disciplinary co-operation. To improve team performance in the emergency room (ER), a questionnaire for assessment of attitudes and judgements in resuscitation procedures was developed. A total of 43 items were evaluated according to a five-point Likert scale. With a response rate of 81%, 143 questionnaires were evaluated. Assessment of data was performed with regard to professional speciality and level in the medical hierarchy. Factorial analysis identified four main factors: Assessment of 'quality of performance' (F1), 'importance of structure' (F2), 'quality of team culture' (F3), and 'importance of hierarchy' (F4). Influences from the categories 'speciality' and 'hierarchy' and from the covariate 'gender' on these main factors were evaluated by two-factorial analysis of variance. For all four factors, 'speciality' produced significant differences. Surgeons accorded high values to F1 and low values to F2, whereas anaesthesiologists accorded low values to F1 and high values to F2. F3 showed a low ranking from within the ER nursing staff and the residents in internal medicine, whereas F4 received high scores by medical residents and staff members. For F1 and F3, there was a tendency towards hierarchy dependency, whereas no factor was influenced by gender. In conclusion, team performance in the ER is mainly influenced by different perceptions and attitudes of the different disciplines involved in the resuscitation process.
Pediatric Anesthesia, 2005
In infants with a Norwood stage I reconstruction, the respiratory management to direct pulmonary ... more In infants with a Norwood stage I reconstruction, the respiratory management to direct pulmonary to systemic blood flow ratio is of critical importance. Disturbance of this delicate blood-flow balance can occur causing rapid deterioration of the infant's condition requiring urgent interventions. However, the emergency staff personnel that are generally the first to be called may not be familiar with these patients' complex pathophysiology. We report on the resuscitation of an infant with a Norwood circulation who developed deep central cyanosis in an out-of-hospital environment. The infant deteriorated because of stenoses in both the neoaortic arch and the aortopulmonary shunt. Emergency therapy, especially for out-of-hospital treatment, can only consist of basic measures, which are discussed.
The Journal of Emergency Medicine, 2007
ABSTRACT
European Journal of Pediatric Surgery, 1997
Malignant Hyperthermia (MH) remains a life-threatening event in anaesthetic practice. In paediatr... more Malignant Hyperthermia (MH) remains a life-threatening event in anaesthetic practice. In paediatric patients, triggering agents such as volatile anaesthetics and other succinylcholine are widely used. For children with a positive family history or previous clinical signs of MH, muscle biopsy for the halothane and caffeine in vitro muscle contracture tests is the only reliable procedure for diagnosis of MH susceptibility. Here we investigated outcome and compliance of patients and parents involved in the test. Twenty-four children between 6 and 14 yrs of age were admitted to hospital for biopsy. Muscle withdrawal was performed at the upper leg from lateral vastus muscle using regional or trigger-free general anaesthesia. Outcome and compliance were controlled by a telephone interview or direct physical re-evaluation. Seventeen patients out of 24 were diagnosed as clinically MH-susceptible according to the protocol of the European MH Group. Seven children were excluded as MH-negative by the test. Twenty-one children were evaluated postoperatively. Minor side effects of wound healing occurred, but none of the patients showed any abnormalities of muscle contracture or movement performance. Considering the high risk of fatal complications in the presence of MH-susceptibility, muscle biopsy of the upper leg for in-vitro diagnosis is a justified procedure that is acceptable to children and their parents.
Der Anaesthesist, 2001
ABSTRACT
Critical Care Medicine, 2005
Atrial fibrillation is the most common arrhythmia after cardiac surgery. Amiodarone can effective... more Atrial fibrillation is the most common arrhythmia after cardiac surgery. Amiodarone can effectively prevent and control postoperative atrial and ventricular fibrillation. Acute hepatic damage after intravenous amiodarone, which can be fatal, is not well recognized. We describe three cases of acute hepatocellular injury after intravenous amiodarone administration in critically ill patients. Another 25 published cases and six cases reported to the Swiss Pharmacovigilance Center (Swissmedic) are discussed. This study consisted of a series of three case reports and review of the literature. : This study was conducted at an operative critical care unit at the University Hospital Basel, Switzerland. Three hemodynamically compromised patients after open heart surgery developed significant increases of transaminases (up to more than 100-fold of the upper limit of normal) shortly after the introduction of intravenous amiodarone. INTERVENTIONS AND MEASUREMENT: Cessation of intravenous amiodarone and of other potentially hepatotoxic drugs. Liver parameters significantly improved or returned to normal in all three patients, even after start of oral amiodarone in two patients. Amiodarone is a highly effective antiarrhythmic agent for the treatment and prevention of atrial and ventricular arrhythmias. Acute liver damage after intravenous amiodarone, possibly induced by the solubilizer polysorbate 80, is rare but potentially harmful. Amiodarone loading should therefore be adapted to the necessity of an immediate effect of the drug, and liver function should be monitored closely in critically ill patients. Oral maintenance therapy with amiodarone is possible, even in patients who developed liver disease during intravenous loading.
Canadian Journal of Anaesthesia, 1998
Canadian Journal of Anaesthesia, 1995
Interruption of daily caffeine consumption can cause caffeine withdrawal headache. As headache ra... more Interruption of daily caffeine consumption can cause caffeine withdrawal headache. As headache ranks among the most frequent minor postoperative sequelae, the impact of perioperatire substitution of caffeine on the incidence of postoperative headache was evaluated. Forty patients undergoing minor surgical procedures with general anaesthesia were randomly allocated to receive either placebo or caffeine tablets at a dosage equal to their individual average daily caffeine consumption. Daily dietary intake was calculated based on an average weekday consumption using conversion factors from previously published sources. The patients were instructed at the preoperative visit to abstain from all external sources of caffeine. Compliance with these dietary restrictions was verified by blood samples obtained immediately before the surgical procedure and on postoperative day L lhe patients were assessed for headache using a standardised checklist immediately before induction of anaesthesia, on the evening of the day of surgery and on the morning of postoperative day L Ten patients 00%) who received placebo reported headaches, which persisted in seven patients (35%) until the next day. No patient receiving caffeine substitution therapy reported headache following surgery, and only one complained of headache on postoperative day L We suggest that the prophylactic administration of caffeine tablets might be considered for surgical patients who are accustomed to a high daily intake of caffeine. L'interruption de I'ingestion quotidienne de caf~ine peut provoquer de la cdphal~e par suppression. Comme la c$phal$e constitue une s$quelle postopdratoire tr~s fr~quente, i~mpact
Brain Injury, 2009
Patients with brain injuries are assessed using the Glasgow Coma Scale (GCS). This review evaluat... more Patients with brain injuries are assessed using the Glasgow Coma Scale (GCS). This review evaluates the use of GCS scoring in medical literature and identifies the reasons for inaccuracy. LITERATURE SELECTION AND CRITICAL APPRAISAL: Pubmed and ISI Web of Knowledge SM were searched using specific keywords. The authors critically appraised the current state of GCS scoring, GCS definitions, the time and frequency of assessment, confounders, GCS reporting and GCS assessment schemes. More than 90% of the publications using GCS scoring cite the 14-item GCS rather than the 15-item GCS. The timing of the initial GCS assessment is inconstant. GCS components are seldom utilized, contributing to the loss of information. Confounders are often not reported and, if they are, not in a standardized manner. The order of the GCS components is not consistent. The current inconsistent and inappropriate use of GCS diminishes its reliability in both a clinical and a scientific context. A consensus statement is needed to correct this situation. Citing the correct references, early and repeated GCS assessments at defined intervals, standardized reporting of confounders and GCS component plus sum scores, and the utilization of a uniform assessment scheme are recommended.
Annals of Emergency Medicine, 2010
Annals of Emergency Medicine, 2010
Study objective: We evaluate changes in endotracheal tube intracuff pressures among intubated pat... more Study objective: We evaluate changes in endotracheal tube intracuff pressures among intubated patients during aeromedical transport. We determine whether intracuff pressures exceed 30 cm H 2 O during aeromedical transport.
Anesthesiology, 2000
Despite widespread use, little is known about the comparative pharmacokinetics of intrathecally a... more Despite widespread use, little is known about the comparative pharmacokinetics of intrathecally administered opioids. The present study was designed to characterize the rate and extent of opioid distribution within cerebrospinal fluid, spinal cord, epidural space, and systemic circulation after intrathecal injection. Equal doses of morphine and alfentanil, fentanyl, or sufentanil were administered intrathecally (L3) to anesthetized pigs. Microdialysis probes were used to sample cerebrospinal fluid at L2, T11, T7, T3, and the epidural space at L2 every 5-10 min for 4 h. At the end of the experiment, spinal cord and epidural fat tissue were sampled, and each probe's recovery was determined in vitro. Using SAAM II pharmacokinetic modeling software (SAAM Institute, University of Washington, Seattle, WA), the data were fit to a 16-compartment model that was divided into four spinal levels, each of which consisted of a caternary arrangement of four compartments representing the spinal cord, cerebrospinal fluid, epidural space, and epidural fat. Model simulations revealed that the integral exposure (area under the curve divided by dose) of the spinal cord (i.e., effect compartment) to the opioids was highest for morphine because of its low spinal cord distribution volume and slow clearance into plasma The integral exposure of the spinal cord to the other opioids was relatively low, but for different reasons: alfentanil has a high clearance from spinal cord into plasma, fentanyl distributes rapidly into the epidural space and fat, and sufentanil has a high spinal cord volume of distribution. The four opioids studied demonstrate markedly different pharmacokinetic behavior, which correlates well with their pharmacodynamic behavior.
Anesthesiology, 1994
Postoperative nausea and vomiting (PONV) is a commonly observed adverse effect of general anesthe... more Postoperative nausea and vomiting (PONV) is a commonly observed adverse effect of general anesthesia. Recently, ondansetron, a new serotonin3 (5-hydroxytryptamine3) receptor antagonist was shown to be effective in the prophylaxis and prevention of chemotherapy-induced nausea and vomiting in children and adults as well as of PONV in adults. The aim of the current study was to evaluate the capacity of ondansetron to prevent PONV in pediatric patients. Two hundred children (132 boys and 68 girls) 2-10 yr of age received general inhalational anesthesia for surgical procedures (the extremities; ear, nose, and throat; inguinal hernia and phimosis; and dentistry) of an expected duration of less than 90 min. This study was divided into two phases: prophylaxis and rescue treatment. For prophylaxis, patients were randomly assigned to two groups: one group received an intravenous injection of 0.1 mg/kg ondansetron, and the other group received a placebo before surgical incision under double-blind conditions. For rescue treatment, only placebo patients were included; as a rescue medication they received an intravenous injection of 0.1 mg/kg ondansetron or 0.02 mg/kg droperidol according to a prestudy randomization under double-blind conditions. Incidence and severity of PONV (PONV score 0 = no nausea and no retching; 1 = complaining of sickness and retching; 2 = vomiting one or two time in 30 min; 3 = vomiting more than two times in 30 min) was recorded over a 4-h period in the postanesthesia care unit. Within 72 h of the procedure, a follow-up nurse interviewed the parents for late-onset nausea in the children. With regard to prophylaxis, 10% of patients receiving ondansetron had PONV during the 4-h observation period versus 40% of those receiving placebo (P < 0.001). The incidence of vomiting alone (PONV score > or = 2) was 5% and 25%, respectively (P < 0.001). There were no significant differences between ondansetron and droperidol in the treatment of PONV. However, at the end of the 4-h period, ondansetron patients were less sedated than were patients who had received droperidol (P < 0.01). Interviews with parents could be performed for 143 of 200 children (76 ondansetron and 67 placebo). Twenty-four children (15 ondansetron and 9 placebo) showed late-onset PONV after the 4-h observation period but within 24 h of the procedure (19.7% vs. 13.4%; P not significant). Ondansetron is effective in the prevention of PONV in pediatric patients for the first 4 h after general anesthesia. Lower sedation scores with ondansetron compared with droperidol may be an advantage, especially in ambulatory surgery. However, the incidence of late-onset PONV (> 4-24 h) was not influenced by prophylactic treatment with one dose of ondansetron preoperatively.
Anesthesiology, 2003
Background: The ability of epinephrine to improve the efficacy of epidurally administered drugs i... more Background: The ability of epinephrine to improve the efficacy of epidurally administered drugs is assumed to result from local vasoconstriction and a consequent decrease in drug clearance. However, because drug concentration in the epidural space has never been measured, our understanding of the effect of epinephrine on epidural pharmacokinetics is incomplete. This study was designed to characterize the effect of epinephrine on the epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidurally administered opioids.
Der Anaesthesist
A 53-year-old woman diagnosed as having hereditary motor-sensory neuropathy Charcot-Marie-Tooth (... more A 53-year-old woman diagnosed as having hereditary motor-sensory neuropathy Charcot-Marie-Tooth (CMT) disease Type 2, underwent inguinal hernia surgery. In this patient CMT disease was manifested as distal muscle weakness and wasting. Anaesthetic experience with patients who have CMT disease is limited. Association to malignant hyperthermia is very unlikely although there is one case report that shows that there could be a relationship. We describe a total intravenous anaesthesia (TIVA) protocol with propofol and alfentanil without any muscle relaxants after fiberoptic intubation. The patient made an uneventful recovery and was discharged from the hospital on the fourth postoperative day. TIVA was a safe technique in this patient and should be considered as an alternative for patients presenting with CMT disease.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or... more Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers' professional background. Tracheal cuff pressures in patients intubated before arrival of a helicopter-based rescue team were prospectively recorded during a 12-month period. Information about the method used for initial cuff pressure assessment, profession of provider and time since intubation was collected by interview during patient handover. Indications for helicopter missions were either Intensive Care Unit (ICU) transports or emergency transfers. ICU transports were between ICUs of two hospitals. Emergency transfers were either evacuation from the scene or transfer from an eme...
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2006
Scandinavian journal of trauma, resuscitation and emergency medicine, 2013
Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or... more Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers' professional background. Tracheal cuff pressures in patients intubated before arrival of a helicopter-based rescue team were prospectively recorded during a 12-month period. Information about the method used for initial cuff pressure assessment, profession of provider and time since intubation was collected by interview during patient handover. Indications for helicopter missions were either Intensive Care Unit (ICU) transports or emergency transfers. ICU transports were between ICUs of two hospitals. Emergency transfers were either evacuation from the scene or transfer from an eme...
Resuscitation, 2003
Objective: Early defibrillation using automated external defibrillators (AEDs) has been advocated... more Objective: Early defibrillation using automated external defibrillators (AEDs) has been advocated to improve survival in witnessed out-of-hospital cardiac arrest (OHCA) due to pulseless ventricular tachycardia (VT) and ventricular fibrillation (VF). However, when VT/VF is untreated and prolonged for more than a few minutes, defibrillation using AEDs may fail. Methods : This retrospective study reviewed the charts from local emergency medical service (EMS) between the years 1993 to 2001 to evaluate the value of the AED after its introduction into our EMS. All witnessed OHCA due to VT/VF were analysed; cases of collapse witnessed by EMS were excluded. The primary endpoint was defined as survival to hospital discharge and at 1-year follow-up, and the secondary endpoint as survival without major neurological deficit. A total of 76 patients were treated for witnessed VT/VF before the implementation of the AED and 92 patients after its implementation. Results: Before the introduction of paramedic AED defibrillation, physician defibrillation was performed at 15.6 min (9/5.5, S.D.). After the introduction of AED defibrillation, paramedic defibrillation was performed at 5.7 min (9/2.4, S.D.); the mean response interval from the call to defibrillation was shortened significantly (P B/0.001). At the same time, survival to hospital discharge decreased from 23.7% (18/76 patients) to 14.1% (13/92) (P0/0.112) and at 1-year follow-up from 17.1% (13/76) to 9.8% (9/92) (P 0/0.161). Favourable neurological outcome at 1year follow-up also decreased from 14.5% (11/76) to 8.7% (8/92) (P0/0.239). Conclusion : Implementation of the AED did not improve survival or a favourable neurological outcome in patients with OHCA due to VF/VT. However, with 5.7 min time to defibrillation, our EMS did not meet the criteria for early defibrillation. For prolonged periods of VT/VF, initial basic life support (BLS) may be superior to immediate AED. If response times of B/4 min cannot be attained by the emergency systems, reconsidering of resuscitation algorithms seems to be advisable. #
Resuscitation, 2001
In-hospital emergency medicine in central Europe relies on inter-disciplinary co-operation. To im... more In-hospital emergency medicine in central Europe relies on inter-disciplinary co-operation. To improve team performance in the emergency room (ER), a questionnaire for assessment of attitudes and judgements in resuscitation procedures was developed. A total of 43 items were evaluated according to a five-point Likert scale. With a response rate of 81%, 143 questionnaires were evaluated. Assessment of data was performed with regard to professional speciality and level in the medical hierarchy. Factorial analysis identified four main factors: Assessment of 'quality of performance' (F1), 'importance of structure' (F2), 'quality of team culture' (F3), and 'importance of hierarchy' (F4). Influences from the categories 'speciality' and 'hierarchy' and from the covariate 'gender' on these main factors were evaluated by two-factorial analysis of variance. For all four factors, 'speciality' produced significant differences. Surgeons accorded high values to F1 and low values to F2, whereas anaesthesiologists accorded low values to F1 and high values to F2. F3 showed a low ranking from within the ER nursing staff and the residents in internal medicine, whereas F4 received high scores by medical residents and staff members. For F1 and F3, there was a tendency towards hierarchy dependency, whereas no factor was influenced by gender. In conclusion, team performance in the ER is mainly influenced by different perceptions and attitudes of the different disciplines involved in the resuscitation process.
Pediatric Anesthesia, 2005
In infants with a Norwood stage I reconstruction, the respiratory management to direct pulmonary ... more In infants with a Norwood stage I reconstruction, the respiratory management to direct pulmonary to systemic blood flow ratio is of critical importance. Disturbance of this delicate blood-flow balance can occur causing rapid deterioration of the infant&amp;amp;amp;#39;s condition requiring urgent interventions. However, the emergency staff personnel that are generally the first to be called may not be familiar with these patients&amp;amp;amp;#39; complex pathophysiology. We report on the resuscitation of an infant with a Norwood circulation who developed deep central cyanosis in an out-of-hospital environment. The infant deteriorated because of stenoses in both the neoaortic arch and the aortopulmonary shunt. Emergency therapy, especially for out-of-hospital treatment, can only consist of basic measures, which are discussed.
The Journal of Emergency Medicine, 2007
ABSTRACT
European Journal of Pediatric Surgery, 1997
Malignant Hyperthermia (MH) remains a life-threatening event in anaesthetic practice. In paediatr... more Malignant Hyperthermia (MH) remains a life-threatening event in anaesthetic practice. In paediatric patients, triggering agents such as volatile anaesthetics and other succinylcholine are widely used. For children with a positive family history or previous clinical signs of MH, muscle biopsy for the halothane and caffeine in vitro muscle contracture tests is the only reliable procedure for diagnosis of MH susceptibility. Here we investigated outcome and compliance of patients and parents involved in the test. Twenty-four children between 6 and 14 yrs of age were admitted to hospital for biopsy. Muscle withdrawal was performed at the upper leg from lateral vastus muscle using regional or trigger-free general anaesthesia. Outcome and compliance were controlled by a telephone interview or direct physical re-evaluation. Seventeen patients out of 24 were diagnosed as clinically MH-susceptible according to the protocol of the European MH Group. Seven children were excluded as MH-negative by the test. Twenty-one children were evaluated postoperatively. Minor side effects of wound healing occurred, but none of the patients showed any abnormalities of muscle contracture or movement performance. Considering the high risk of fatal complications in the presence of MH-susceptibility, muscle biopsy of the upper leg for in-vitro diagnosis is a justified procedure that is acceptable to children and their parents.
Der Anaesthesist, 2001
ABSTRACT
Critical Care Medicine, 2005
Atrial fibrillation is the most common arrhythmia after cardiac surgery. Amiodarone can effective... more Atrial fibrillation is the most common arrhythmia after cardiac surgery. Amiodarone can effectively prevent and control postoperative atrial and ventricular fibrillation. Acute hepatic damage after intravenous amiodarone, which can be fatal, is not well recognized. We describe three cases of acute hepatocellular injury after intravenous amiodarone administration in critically ill patients. Another 25 published cases and six cases reported to the Swiss Pharmacovigilance Center (Swissmedic) are discussed. This study consisted of a series of three case reports and review of the literature. : This study was conducted at an operative critical care unit at the University Hospital Basel, Switzerland. Three hemodynamically compromised patients after open heart surgery developed significant increases of transaminases (up to more than 100-fold of the upper limit of normal) shortly after the introduction of intravenous amiodarone. INTERVENTIONS AND MEASUREMENT: Cessation of intravenous amiodarone and of other potentially hepatotoxic drugs. Liver parameters significantly improved or returned to normal in all three patients, even after start of oral amiodarone in two patients. Amiodarone is a highly effective antiarrhythmic agent for the treatment and prevention of atrial and ventricular arrhythmias. Acute liver damage after intravenous amiodarone, possibly induced by the solubilizer polysorbate 80, is rare but potentially harmful. Amiodarone loading should therefore be adapted to the necessity of an immediate effect of the drug, and liver function should be monitored closely in critically ill patients. Oral maintenance therapy with amiodarone is possible, even in patients who developed liver disease during intravenous loading.
Canadian Journal of Anaesthesia, 1998
Canadian Journal of Anaesthesia, 1995
Interruption of daily caffeine consumption can cause caffeine withdrawal headache. As headache ra... more Interruption of daily caffeine consumption can cause caffeine withdrawal headache. As headache ranks among the most frequent minor postoperative sequelae, the impact of perioperatire substitution of caffeine on the incidence of postoperative headache was evaluated. Forty patients undergoing minor surgical procedures with general anaesthesia were randomly allocated to receive either placebo or caffeine tablets at a dosage equal to their individual average daily caffeine consumption. Daily dietary intake was calculated based on an average weekday consumption using conversion factors from previously published sources. The patients were instructed at the preoperative visit to abstain from all external sources of caffeine. Compliance with these dietary restrictions was verified by blood samples obtained immediately before the surgical procedure and on postoperative day L lhe patients were assessed for headache using a standardised checklist immediately before induction of anaesthesia, on the evening of the day of surgery and on the morning of postoperative day L Ten patients 00%) who received placebo reported headaches, which persisted in seven patients (35%) until the next day. No patient receiving caffeine substitution therapy reported headache following surgery, and only one complained of headache on postoperative day L We suggest that the prophylactic administration of caffeine tablets might be considered for surgical patients who are accustomed to a high daily intake of caffeine. L'interruption de I'ingestion quotidienne de caf~ine peut provoquer de la cdphal~e par suppression. Comme la c$phal$e constitue une s$quelle postopdratoire tr~s fr~quente, i~mpact
Brain Injury, 2009
Patients with brain injuries are assessed using the Glasgow Coma Scale (GCS). This review evaluat... more Patients with brain injuries are assessed using the Glasgow Coma Scale (GCS). This review evaluates the use of GCS scoring in medical literature and identifies the reasons for inaccuracy. LITERATURE SELECTION AND CRITICAL APPRAISAL: Pubmed and ISI Web of Knowledge SM were searched using specific keywords. The authors critically appraised the current state of GCS scoring, GCS definitions, the time and frequency of assessment, confounders, GCS reporting and GCS assessment schemes. More than 90% of the publications using GCS scoring cite the 14-item GCS rather than the 15-item GCS. The timing of the initial GCS assessment is inconstant. GCS components are seldom utilized, contributing to the loss of information. Confounders are often not reported and, if they are, not in a standardized manner. The order of the GCS components is not consistent. The current inconsistent and inappropriate use of GCS diminishes its reliability in both a clinical and a scientific context. A consensus statement is needed to correct this situation. Citing the correct references, early and repeated GCS assessments at defined intervals, standardized reporting of confounders and GCS component plus sum scores, and the utilization of a uniform assessment scheme are recommended.
Annals of Emergency Medicine, 2010
Annals of Emergency Medicine, 2010
Study objective: We evaluate changes in endotracheal tube intracuff pressures among intubated pat... more Study objective: We evaluate changes in endotracheal tube intracuff pressures among intubated patients during aeromedical transport. We determine whether intracuff pressures exceed 30 cm H 2 O during aeromedical transport.
Anesthesiology, 2000
Despite widespread use, little is known about the comparative pharmacokinetics of intrathecally a... more Despite widespread use, little is known about the comparative pharmacokinetics of intrathecally administered opioids. The present study was designed to characterize the rate and extent of opioid distribution within cerebrospinal fluid, spinal cord, epidural space, and systemic circulation after intrathecal injection. Equal doses of morphine and alfentanil, fentanyl, or sufentanil were administered intrathecally (L3) to anesthetized pigs. Microdialysis probes were used to sample cerebrospinal fluid at L2, T11, T7, T3, and the epidural space at L2 every 5-10 min for 4 h. At the end of the experiment, spinal cord and epidural fat tissue were sampled, and each probe's recovery was determined in vitro. Using SAAM II pharmacokinetic modeling software (SAAM Institute, University of Washington, Seattle, WA), the data were fit to a 16-compartment model that was divided into four spinal levels, each of which consisted of a caternary arrangement of four compartments representing the spinal cord, cerebrospinal fluid, epidural space, and epidural fat. Model simulations revealed that the integral exposure (area under the curve divided by dose) of the spinal cord (i.e., effect compartment) to the opioids was highest for morphine because of its low spinal cord distribution volume and slow clearance into plasma The integral exposure of the spinal cord to the other opioids was relatively low, but for different reasons: alfentanil has a high clearance from spinal cord into plasma, fentanyl distributes rapidly into the epidural space and fat, and sufentanil has a high spinal cord volume of distribution. The four opioids studied demonstrate markedly different pharmacokinetic behavior, which correlates well with their pharmacodynamic behavior.
Anesthesiology, 1994
Postoperative nausea and vomiting (PONV) is a commonly observed adverse effect of general anesthe... more Postoperative nausea and vomiting (PONV) is a commonly observed adverse effect of general anesthesia. Recently, ondansetron, a new serotonin3 (5-hydroxytryptamine3) receptor antagonist was shown to be effective in the prophylaxis and prevention of chemotherapy-induced nausea and vomiting in children and adults as well as of PONV in adults. The aim of the current study was to evaluate the capacity of ondansetron to prevent PONV in pediatric patients. Two hundred children (132 boys and 68 girls) 2-10 yr of age received general inhalational anesthesia for surgical procedures (the extremities; ear, nose, and throat; inguinal hernia and phimosis; and dentistry) of an expected duration of less than 90 min. This study was divided into two phases: prophylaxis and rescue treatment. For prophylaxis, patients were randomly assigned to two groups: one group received an intravenous injection of 0.1 mg/kg ondansetron, and the other group received a placebo before surgical incision under double-blind conditions. For rescue treatment, only placebo patients were included; as a rescue medication they received an intravenous injection of 0.1 mg/kg ondansetron or 0.02 mg/kg droperidol according to a prestudy randomization under double-blind conditions. Incidence and severity of PONV (PONV score 0 = no nausea and no retching; 1 = complaining of sickness and retching; 2 = vomiting one or two time in 30 min; 3 = vomiting more than two times in 30 min) was recorded over a 4-h period in the postanesthesia care unit. Within 72 h of the procedure, a follow-up nurse interviewed the parents for late-onset nausea in the children. With regard to prophylaxis, 10% of patients receiving ondansetron had PONV during the 4-h observation period versus 40% of those receiving placebo (P < 0.001). The incidence of vomiting alone (PONV score > or = 2) was 5% and 25%, respectively (P < 0.001). There were no significant differences between ondansetron and droperidol in the treatment of PONV. However, at the end of the 4-h period, ondansetron patients were less sedated than were patients who had received droperidol (P < 0.01). Interviews with parents could be performed for 143 of 200 children (76 ondansetron and 67 placebo). Twenty-four children (15 ondansetron and 9 placebo) showed late-onset PONV after the 4-h observation period but within 24 h of the procedure (19.7% vs. 13.4%; P not significant). Ondansetron is effective in the prevention of PONV in pediatric patients for the first 4 h after general anesthesia. Lower sedation scores with ondansetron compared with droperidol may be an advantage, especially in ambulatory surgery. However, the incidence of late-onset PONV (> 4-24 h) was not influenced by prophylactic treatment with one dose of ondansetron preoperatively.
Anesthesiology, 2003
Background: The ability of epinephrine to improve the efficacy of epidurally administered drugs i... more Background: The ability of epinephrine to improve the efficacy of epidurally administered drugs is assumed to result from local vasoconstriction and a consequent decrease in drug clearance. However, because drug concentration in the epidural space has never been measured, our understanding of the effect of epinephrine on epidural pharmacokinetics is incomplete. This study was designed to characterize the effect of epinephrine on the epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidurally administered opioids.