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Eberhart L, Seegan P, McGuire J, Hu H, Tripuraneni BR, Miller MJ. Attributes of Provider Referrals for Digital Mental Health Applications in an Integrated Health System, 2019-2021. Psychiatr Serv 2024; 75:6-16. [PMID: 37494117 DOI: 10.1176/appi.ps.20220401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This article describes trends and attributes associated with digital mental health application (DMHA) referrals from December 2019 through December 2021. METHODS In total, 43,842 DMHA referrals for 25,213 unique patients were extracted from the electronic health record of a large, diverse, integrated health system. DMHAs were aggregated by type (cognitive-behavioral therapy [CBT] or mindfulness and meditation [MM]). Monthly referral patterns were described and categorized into mutually exclusive clusters (MM, CBT, or MM and CBT). Multinomial logistic regression and post hoc predicted probabilities were used to profile patient, clinical, and encounter attributes among referral clusters. RESULTS DMHA referrals increased, reached equilibrium, and then began to decline over the 25-month observation period. Compared with the referral cluster average, MM-alone referrals were more likely to occur for patients who were ages ≥65, who were Hispanic or Asian, whose reason for visit concerned mental health, and who had a primary diagnosis of other anxiety disorders. CBT-alone referrals were more likely to occur for patients with a primary diagnosis of depression and less likely to occur for Hispanic patients. Combined MM and CBT referrals were more likely to occur for patients who were ages 18-30, whose reason for visit was "other," and who had a primary diagnosis of depression and were less likely to occur for Hispanic patients and those ages ≥65. CONCLUSIONS Although this study demonstrates readiness to integrate DMHA referral into clinical workflows, observed variations in attributes of referral clusters support the need to further investigate provider decision making and whether referral patterns are optimal and sustainable.
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Affiliation(s)
- Lindsay Eberhart
- Mid-Atlantic Permanente Research Institute (Eberhart, Hu, Miller) and Medical Group (Eberhart, Hu, Tripuraneni, Miller), Rockville, Maryland; Johns Hopkins University School of Medicine, Baltimore (Seegan, McGuire)
| | - Paige Seegan
- Mid-Atlantic Permanente Research Institute (Eberhart, Hu, Miller) and Medical Group (Eberhart, Hu, Tripuraneni, Miller), Rockville, Maryland; Johns Hopkins University School of Medicine, Baltimore (Seegan, McGuire)
| | - Joseph McGuire
- Mid-Atlantic Permanente Research Institute (Eberhart, Hu, Miller) and Medical Group (Eberhart, Hu, Tripuraneni, Miller), Rockville, Maryland; Johns Hopkins University School of Medicine, Baltimore (Seegan, McGuire)
| | - Haihong Hu
- Mid-Atlantic Permanente Research Institute (Eberhart, Hu, Miller) and Medical Group (Eberhart, Hu, Tripuraneni, Miller), Rockville, Maryland; Johns Hopkins University School of Medicine, Baltimore (Seegan, McGuire)
| | - Bhaskara R Tripuraneni
- Mid-Atlantic Permanente Research Institute (Eberhart, Hu, Miller) and Medical Group (Eberhart, Hu, Tripuraneni, Miller), Rockville, Maryland; Johns Hopkins University School of Medicine, Baltimore (Seegan, McGuire)
| | - Michael J Miller
- Mid-Atlantic Permanente Research Institute (Eberhart, Hu, Miller) and Medical Group (Eberhart, Hu, Tripuraneni, Miller), Rockville, Maryland; Johns Hopkins University School of Medicine, Baltimore (Seegan, McGuire)
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Horberg M, Eberhart L, Bhatia M, Jonas C, Cherico-Hsii S, Tamrat Y, Bhandari B, Kadlecik P, Gahunia MK. Patient Demographics and the Utilization of a Novel 3-Anatomic-Site Testing Panel Including Rectal Self-Collection as Compared With Usual Care Testing. Sex Transm Dis 2022; 49:268-273. [PMID: 34813580 DOI: 10.1097/olq.0000000000001585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND At Kaiser Permanente Mid-Atlantic States, we designed a 3-anatomic-site panel (urine, oropharynx, and rectum) with a self-collect feature for rectal sites. We compared the proportion tested at each anatomic site, demographic factors, and HIV status between those who received the 3-site panel versus usual care. METHODS Patients entered our laboratories without a prior appointment and underwent urine (usual care [patient collected]), oropharynx (laboratory technician collected), and rectal site (patient collected) testing. Providers recommended the panel to their patients. Patients then had the choice to accept or to reject the panel. Multivariate and logistic regressions were conducted to explore the relationship of age, sex, race, and HIV status with Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) test results as well as the type of testing (3-site panel vs. usual care testing) received. RESULTS A total of 145,854 patients received usual care testing as compared with 9227 who received the panel. For those who underwent usual care testing, 4.0% tested positive for CT and 0.85% for GC. For those who received the panel, 9.1% tested positive for CT and 6.4% for GC. Those who received the 3-site panel were more likely to test positive for CT (odds ratio [OR], 2.70; confidence interval [CI], 2.46-2.97) and GC (OR, 4.00; CI, 3.59-4.64). White patients were the most likely to receive the panel compared with Black patients (OR, 3.14; CI, 2.96-3.33). Patients with HIV had greater odds of undergoing the panel (OR, 15.62; CI, 14.67-16.64) and of testing positive for CT (OR, 1.27; CI, 1.07-1.51) and GC (OR, 1.39; CI, 1.14-1.68). CONCLUSIONS Patients who received the panel had higher odds of testing positive for CT and GC compared with patients with usual testing. Physician training may address the racial and sex differences observed in the panel enrollment and increase utilization. Self-collection for rectal sites should lead to higher detection of CT and GC.
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Affiliation(s)
| | | | | | | | | | - Yonas Tamrat
- Kaiser Permanente Mid-Atlantic Permanente Medical Group
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Eberhart L, Geldner G, Kowark A, Zucker TP, Kreuer S, Przemeck M, Huljic S, Koch T, Keller T, Weber S, Kranke P. Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine : A prospective, national, multicenter, non-interventional study-the HYPOTENS trial. Anaesthesist 2021; 70:298-307. [PMID: 33170310 PMCID: PMC8026467 DOI: 10.1007/s00101-020-00877-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- L Eberhart
- Department of Anesthesiology & Intensive Care, Philipps University Marburg, Baldingerstraße 1, 35033, Marburg, Germany.
| | - G Geldner
- Clinic for Intensive Care, Emergency Medicine and Pain Therapy, Hospital Ludwigsburg, Ludwigsburg, Germany
| | - A Kowark
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - T-P Zucker
- Department of Anesthesiology, Intensive Care and Pain Therapy, Academic Teaching Hospital Traunstein, Traunstein, Germany
| | - S Kreuer
- Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital Saarland, Homburg, Germany
| | - M Przemeck
- Department of Anesthesiology and Intensive Care, DIAKOVERE Annastift, Hannover, Germany
| | | | - T Koch
- Department of Anesthesiology & Intensive Care, Philipps University Marburg, Baldingerstraße 1, 35033, Marburg, Germany
| | - T Keller
- ACOMED Statistik, Leipzig, Germany
| | - S Weber
- ACOMED Statistik, Leipzig, Germany
| | - P Kranke
- Department of Anesthesia and Critical Care, University Hospital Würzburg, Würzburg, Germany
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Dobbs LK, Kaplan AR, Bock R, Phamluong K, Shin JH, Bocarsly ME, Eberhart L, Ron D, Alvarez VA. D1 receptor hypersensitivity in mice with low striatal D2 receptors facilitates select cocaine behaviors. Neuropsychopharmacology 2019; 44:805-816. [PMID: 30504927 PMCID: PMC6372593 DOI: 10.1038/s41386-018-0286-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/16/2018] [Accepted: 11/23/2018] [Indexed: 11/17/2022]
Abstract
Vulnerability for cocaine abuse in humans is associated with low dopamine D2 receptor (D2R) availability in the striatum. The mechanisms driving this vulnerability are poorly understood. In this study, we found that downregulating D2R expression selectively in striatal indirect-pathway neurons triggers a multitude of changes in D1 receptor (D1R)-expressing direct-pathway neurons, which comprise the other main subpopulation of striatal projection neurons. These changes include a leftward shift in the dose-response to a D1-like agonist that indicates a behavioral D1R hypersensitivity, a shift from PKA to ERK intracellular signaling cascades upon D1R activation, and a reduction in the density of bridging collaterals from D1R-expressing neurons to pallidal areas. We hypothesize that the D1R hypersensitivity underlies abuse vulnerability by facilitating the behavioral responses to repeated cocaine, such as locomotor sensitization and drug self-administration. We found evidence that littermate control mice develop D1R hypersensitivity after they are sensitized to cocaine. Indeed, D1-like agonist and cocaine cross-sensitize in control littermates and this effect was potentiated in mice lacking striatal D2Rs from indirect-pathway neurons. To our surprise, mice with low striatal D2Rs acquired cocaine self-administration similarly to littermate controls and showed no significant change in motivation to take cocaine but lower seeking. These findings indicate that downregulation of striatal D2Rs triggers D1R hypersensitivity to facilitate cocaine locomotor sensitization, which by itself was not associated with greater cocaine taking or seeking under the conditions tested.
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Affiliation(s)
- Lauren K Dobbs
- Laboratory on the Neurobiology of Compulsive Behaviors, National Institute on Alcohol Abuse and Alcoholism, Intramural Research Program, NIH, Bethesda, MD, USA
- Center on Compulsive Behaviors, Intramural Research Program, NIH, Bethesda, MD, USA
| | - Alanna R Kaplan
- Laboratory on the Neurobiology of Compulsive Behaviors, National Institute on Alcohol Abuse and Alcoholism, Intramural Research Program, NIH, Bethesda, MD, USA
| | - Roland Bock
- Laboratory on the Neurobiology of Compulsive Behaviors, National Institute on Alcohol Abuse and Alcoholism, Intramural Research Program, NIH, Bethesda, MD, USA
- Center on Compulsive Behaviors, Intramural Research Program, NIH, Bethesda, MD, USA
| | - Khanhky Phamluong
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - J Hoon Shin
- Laboratory on the Neurobiology of Compulsive Behaviors, National Institute on Alcohol Abuse and Alcoholism, Intramural Research Program, NIH, Bethesda, MD, USA
| | - Miriam E Bocarsly
- Laboratory on the Neurobiology of Compulsive Behaviors, National Institute on Alcohol Abuse and Alcoholism, Intramural Research Program, NIH, Bethesda, MD, USA
- Postdoctoral Research Associate Program, National Institute of General Medical Sciences, NIH, Bethesda, MD, USA
| | - Lindsay Eberhart
- Laboratory on the Neurobiology of Compulsive Behaviors, National Institute on Alcohol Abuse and Alcoholism, Intramural Research Program, NIH, Bethesda, MD, USA
| | - Dorit Ron
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Veronica A Alvarez
- Laboratory on the Neurobiology of Compulsive Behaviors, National Institute on Alcohol Abuse and Alcoholism, Intramural Research Program, NIH, Bethesda, MD, USA.
- Center on Compulsive Behaviors, Intramural Research Program, NIH, Bethesda, MD, USA.
- National Institute on Drug Abuse, Intramural Research Program, NIH, Baltimore, MD, USA.
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Smyla N, Eberhart L, Weibel S, Kranke P. Amisulpride for the prevention and treatment of postoperative nausea and vomiting: A quantitative systematic review (meta-analysis). DRUG FUTURE 2019. [DOI: 10.1358/dof.2019.44.6.2973350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aust H, Eberhart L, Sturm T, Schuster M, Nestoriuc Y, Brehm F, Rüsch D. A cross-sectional study on preoperative anxiety in adults. J Psychosom Res 2018; 111:133-139. [PMID: 29935747 DOI: 10.1016/j.jpsychores.2018.05.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The main objective of this study was a detailed comparison of the level of anxiety about surgery and anesthesia. Other objectives included the assessment of the prevalence and intensity of preoperative anxiety. METHODS This cross-sectional single-center survey used the validated Amsterdam anxiety and information scale (APAIS) and a modified numeric rating scale (mNRS) to assess preoperative anxiety, anxiety about surgery and anxiety about anesthesia. Prevalences and intensities of anxieties were predominantly analyzed descriptively. RESULTS 3200 patients were enrolled and 3087 (57% females) were analyzed. 92.6% reported preoperative anxiety according to APAIS scores. The average total APAIS anxiety score (APAIS-A-T) was 9.9 (SD 3.6). 40.5% reported high anxiety (defined as APAIS-A-T > 10). Mean anxiety about surgery (APAIS-A-Su) was higher than mean anxiety about anesthesia (APAIS-A-An): 5.5 (SD 2.1) vs. 4.3 (SD 1.9), p < 0.0001. Accordingly, more patients were substantially more afraid (score difference > 2) of surgery (642, 20.8%, 95% CI 19.4-22.3) than of anesthesia (48, 1.6%, 95% CI 1.2-2.1). CONCLUSION Preoperative anxiety is still very common among adult patients scheduled to undergo an elective procedure. Therefore, it should be evaluated routinely. Anxiety about surgery and anxiety about anesthesia differ in many patients. For this reason, anxiety about surgery and anxiety about anesthesia should be assessed separately. This would allow providing a more individualized support of patients to cope with their anxiety and could require particular attention by the surgeon or the anesthetist.
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Affiliation(s)
- H Aust
- University Hospital Giessen-Marburg, Department of Anesthesia and Intensive Care, Marburg Campus, Baldingerstrasse, 35033 Marburg, Germany
| | - L Eberhart
- University Hospital Giessen-Marburg, Department of Anesthesia and Intensive Care, Marburg Campus, Baldingerstrasse, 35033 Marburg, Germany
| | - T Sturm
- Philipps-University Marburg, Biegenstraße 10, 35037 Marburg, Germany
| | - M Schuster
- Philipps-University Marburg, Biegenstraße 10, 35037 Marburg, Germany
| | - Y Nestoriuc
- Institute and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Schön Clinic Hamburg-Eilbek, Dehnheide120, 20081 Hamburg, Germany
| | - F Brehm
- Philipps-University Marburg, Biegenstraße 10, 35037 Marburg, Germany
| | - D Rüsch
- University Hospital Giessen-Marburg, Department of Anesthesia and Intensive Care, Marburg Campus, Baldingerstrasse, 35033 Marburg, Germany.
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Colpitts M, Malinowski M, Phillion R, Coleman R, Mitchell L, Malone A, Eberhart L, Sanders R, Langholz D. Echocardiographic imaging options in ovine research subjects. J Vet Cardiol 2017; 19:502-513. [PMID: 29097107 DOI: 10.1016/j.jvc.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/13/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine the feasibility of acquiring quality transesophageal (TEE), epicardial (EE), and intracardiac (ICE) echocardiographic images in ovine subjects and to discuss the merits of each technique with a focus on ICE image acquisition. ANIMALS Eleven male castrated Dorset adult sheep. METHODS Transesophageal echocardiography was performed under general anesthesia. Epicardial echocardiography was performed as part of an open chest (thoracotomy or sternotomy) experiment. Subjects were recovered with permanent jugular vein indwelling catheter and ICE from this approach was described. Feasibility of each technique was qualitatively assessed based on subjective image quality from three images for each image plane in each sheep. RESULTS Transesophageal echocardiography was technically challenging and did not provide adequate image quality for consistent interpretation. Epicardial echocardiography and ICE had more favorable results with ICE demonstrating unique benefits for post-operative serial monitoring. CONCLUSIONS Epicardial echocardiography and ICE were effective imaging techniques. Epicardial echocardiography required the least specialized training but was considered to have limited feasibility due to its requirement for an open chest procedure. Even with the necessity for permanent indwelling jugular cannulation, ICE was the least invasive of the three imaging techniques and potentially the most practical approach for chronic studies by minimizing post-operative stress. Transesophageal echocardiography was not a feasible technique in this study.
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Affiliation(s)
- M Colpitts
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA.
| | - M Malinowski
- Division of Cardiothoracic Surgery, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA; Medical University of Silesia, Department of Cardiac Surgery, Ziolowa 47, 40-635, Katowice, Poland
| | - R Phillion
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - R Coleman
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - L Mitchell
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - A Malone
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - L Eberhart
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - R Sanders
- Michigan State University - College of Veterinary Medicine, Department of Cardiology, 736 Wilson Road, East Lansing, MI 48823, USA
| | - D Langholz
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
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Malinowski M, Wilton P, Khaghani A, Brown M, Karia D, Langholz D, Hooker V, Eberhart L, Hooker B, Timek T. Effect of Left Ventricular Assist Device on Ovine Tricuspid Annular 3D Geometry. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Aust H, Veltum B, Wächtershäuser T, Wulf H, Eberhart L. [Premedication visits in departments of anesthesiology in Hessen. Compilation of organizational and performance portfolios]. Anaesthesist 2014; 63:105-13. [PMID: 24499960 DOI: 10.1007/s00101-013-2287-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 11/13/2013] [Accepted: 11/20/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many anesthesia departments operate a pre-anesthesia assessment clinic (PAAC). Data regarding organization, equipment and structure of such clinics are not yet available. Information about modern anesthesiology techniques and procedures contributes to a reduction in emotional stress of the patients but such modern techniques often require additional technical hardware and costs and are not equally available. AIM This survey examined the current structures of PAAC in the state of Hessen, demonstrated current concepts and associated these with the performance and the portfolio of procedures in these departments. MATERIAL AND METHODS An online survey was carried out. Data on structure, equipment, organization and available methods were compiled. In addition, anesthesia department personnel were asked to give individual subjective attitudes toward the premedication work. RESULTS Of the anesthesia departments in Hessen 84 % participated in the survey of which 91 % operated a PAAC. A preoperative contact with the anesthesiologist who would perform anesthesia existed in only 19 % of the departments. Multimedia processing concepts for informed consent in a PAAC setting were in general rare. Many modern procedures and anesthesia techniques were broadly established independent of the hospital size. Regarding the individual and subjective attitudes of anesthetists towards the work, the psychological and medical importance of the pre-medication visit was considered to be very high. CONCLUSION The PAACs are now well established. This may make economic sense but is accompanied by an anonymization of care in anesthesiology. The high quality, safety and availability of modern anesthesiology procedures and monitoring concepts should be communicated to patients all the more as an expression of trust and high patient safety. These factors can be facilitated in particular by multimedia tools which have as yet only been sparsely implemented in PAACs.
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Affiliation(s)
- H Aust
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstr., 35033, Marburg, Deutschland,
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Kranke P, Eberhart L, Motsch J, Chassard D, Wallenborn J, Diemunsch P, Liu N, Keh D, Bouaziz H, Bergis M, Fox G, Gan T. I.V. APD421 (amisulpride) prevents postoperative nausea and vomiting: a randomized, double-blind, placebo-controlled, multicentre trial. Br J Anaesth 2013; 111:938-45. [DOI: 10.1093/bja/aet251] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Aust H, Veltum B, Wächtershäuser T, Eberhart L, Wulf H, Rüsch D. Zur präoperativen Risikoevaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen. Anaesthesist 2013; 62:365-79. [DOI: 10.1007/s00101-013-2168-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/06/2013] [Accepted: 03/20/2013] [Indexed: 12/27/2022]
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Zoremba M, Dette F, Hunecke T, Eberhart L, Braunecker S, Wulf H. A comparison of desflurane versus propofol: the effects on early postoperative lung function in overweight patients. Anesth Analg 2010; 113:63-9. [PMID: 20966444 DOI: 10.1213/ane.0b013e3181fdf5d4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In this study, we evaluated the influence of propofol versus desflurane anesthesia in overweight patients on postoperative lung function and pulse oximetry values. METHODS We prospectively studied 134 patients with body mass indices of 25 to 35 kg/m(2) undergoing minor peripheral surgery lasting 40 to 120 minutes. Patients were randomly assigned to receive propofol (total IV anesthesia) or desflurane anesthesia via a tracheal tube targeting bispectral index values of 40 to 60. Premedication, adjuvant drug usage, and ventilation were standardized. We measured oxyhemoglobin saturation and lung function preoperatively (baseline), and at 10 minutes, 0.5 hour, 2 hours, and 24 hours after tracheal extubation. All values were measured with the patient supine, in a 30° head-up position. Changes from preoperative baseline values were first analyzed for the impact of body mass index and type of anesthesia using univariate methods, followed by linear regression and multivariate analysis of variance. RESULTS Within the first 2 hours after surgery, the propofol group displayed lower oxyhemoglobin saturation (at 2 hours, mean ± SD, 93.8% ± 2.0% vs 94.6% ± 2.1%; P < 0.007) and lung function (forced vital capacity, forced expiratory volume exhaled in 1 second [FEV(1)], peak expiratory flow, midexpiratory flow [MEF], forced inspiratory vital capacity, and peak inspiratory flow; between 11% and 20% larger reduction from baseline in the propofol group, all P < 0.001) compared with the desflurane group. Even 24 hours after surgery, FEV(1), peak expiratory flow, MEF, forced inspiratory vital capacity, and peak inspiratory flow were reduced more in the propofol group (all P < 0.01). At 2 hours after extubation, increasing obesity was associated with decreasing FEV(1) and MEF in patients anesthetized with propofol but not desflurane (P < 0.01). CONCLUSION We conclude that, for superficial surgical procedures of up to 120 minutes, maintenance of anesthesia with propofol impairs early postoperative lung function and pulse oximetry values more than with desflurane. Furthermore, increasing obesity decreases pulmonary function at 2 hours after propofol anesthesia but not after desflurane anesthesia.
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Affiliation(s)
- M Zoremba
- Department of Anaesthesia and Intensive Care, University of Marburg, Baldingerstraße, Marburg, Germany.
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Steinfeldt T, Nimphius W, Wurps M, Eberhart L, Vassiliou T, Kill C, Wulf H, Graf J. Nerve perforation with pencil point or short bevelled needles: histological outcome. Acta Anaesthesiol Scand 2010; 54:993-9. [PMID: 20701598 DOI: 10.1111/j.1399-6576.2010.02279.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the case of needle nerve contact during peripheral blocks, pencil point needles are considered less traumatic compared with bevelled needles. However, there are not enough data to prove this notion. Therefore, the aim of this study was to challenge the hypothesis that nerve perforation with short bevelled needles is associated with major nerve damage compared with pencil point needles. METHODS In five anaesthetised pigs, the brachial plexus was exposed bilaterally. Up to eight nerves underwent needle nerve perforation using a pencil point needles cannula or an short bevelled needle. After 48 h, the nerves were resected. The specimens were processed for visual examination and the detection of inflammatory cells (haematoxylin-eosin, i.e. CD68-immunohistochemistry to detect macrophages), myelin damage (Kluver-Barrera staining) and intraneural haematoma. The grade of nerve injury was characterised by an objective score ranging from 0 (no injury) to 4 (severe injury). RESULTS Fifty nerves were examined. According to the injury score applied, there was no significant difference between the pencil point needles [median (inter-quartile range) 2.0 (2.0-2.0)] and the short bevelled-needle group [median 2.0 (2.0-2.0) P=0.23]. No myelin damage was observed. Signs of post-traumatic inflammation were equally distributed among both groups. CONCLUSIONS In the present study, the magnitude of nerve injury after needle nerve perforation was not related to one of the applied needle types. Post-traumatic inflammation rather than structural damage of nerve tissue is the only notable sign of nerve injury after needle nerve perforation with either needle type. However, neither the pencil point- nor the short bevelled needle can be designated a less traumatic device.
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Affiliation(s)
- T Steinfeldt
- Department of Anaesthesiology and Intensive Care Therapy, Philipps University Marburg, Marburg, Germany.
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14
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Abstract
BACKGROUND Obesity is a well-established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period. METHODS We prospectively studied 134 moderately obese patients (BMI 30) undergoing minor peripheral surgery. They were randomly assigned to orotracheal intubation or LMA during general anaesthesia with mechanical ventilation. Premedication, general anaesthesia and respiratory settings were standardized. While breathing air, we measured arterial oxygen saturation by pulse oximetry. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t-test analysis. Statistical significance was considered to be P<0.05. RESULTS Postoperative pulmonary mechanical function was significantly reduced in both groups compared with preoperative values. However, within the first 24 h, lung function tests and oxygen saturation were significantly better in the LMA group (P<0.001; ANOVA). CONCLUSIONS In moderately obese patients undergoing minor surgery, use of the LMA may be preferable to orotracheal intubation with respect to postoperative saturation and lung function.
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Affiliation(s)
- M Zoremba
- Department of Anaesthesia, University of Marburg, Baldingerstrasse, Marburg, Germany.
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15
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Bonnet F, Eberhart L, Wennberg E, Dodds SJ, Van Bellinghen L, Annemans L, Kavanagh S, Choe Y. Fentanyl HCl iontophoretic transdermal system versus morphine IV-PCA for postoperative pain management: survey of healthcare provider opinion. Curr Med Res Opin 2009; 25:293-301. [PMID: 19192974 DOI: 10.1185/03007990802631321] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This survey estimated differences in staff time requirements between fentanyl HCl iontophoretic transdermal system (fentanyl ITS) and intravenous patient-controlled analgesia (IV-PCA) in post-operative pain management. RESEARCH DESIGN AND METHODS European Delphi panels of nurses and anaesthesiologists, who had practical experience with both fentanyl ITS and IV-PCA, were provided a task list, developed from a previous clinical trial, associated with each modality. The panellists were asked to estimate time spent on each task. Estimates were calculated by multiplying the estimated patient proportion for whom the task was performed by the expected frequency of task performance, by the estimated task time. RESULTS Data is presented as mean minutes (standard deviation). Fentanyl ITS use was estimated to save an average of 68.7 min total staff time per patient per treatment period compared to IV-PCA (86.5 (20.3)) vs. 156.4 (55.2); respectively; p < 0.001), the largest amount of savings being in the 'Setup' category (19.4 (6.7) vs. 47.8 (17.5), respectively; p < 0.001), and mostly due to IV-PCA task elimination. Significant time savings were estimated using fentanyl ITS over IV-PCA in the 'Discontinuation' category (4.8 (2.4) vs. 20.6 (3.3), respectively; p < 0.001). Panellists agreed that fentanyl ITS use would decrease staff assistance time required for helping patients during self-care routines and it may also decrease the patient's time to ambulation. Survey limitations included: possible recall bias due to the observational nature of the data; task list descriptions resulting in possible double-counting of data; no sensitivity analyses; and the declarative nature of the responses possibly leading to a dilution of survey findings. CONCLUSIONS Fentanyl ITS use was estimated, by expert opinion, to require 44% less staff time than IV-PCA use.
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Affiliation(s)
- F Bonnet
- Université Pierre & Marie Curie, Paris, France.
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16
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Zoremba M, Morin A, Engel S, Eberhart L, Wulf H. 277. Day Case Surgery and Incidence of Transient Neurological Symptoms After Spinal Anaesthesia With Prilocaine. Reg Anesth Pain Med 2008. [DOI: 10.1136/rapm-00115550-200809001-00075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Putzke C, Hanley PJ, Schlichthörl G, Preisig-Müller R, Rinné S, Anetseder M, Eckenhoff R, Berkowitz C, Vassiliou T, Wulf H, Eberhart L. Differential effects of volatile and intravenous anesthetics on the activity of human TASK-1. Am J Physiol Cell Physiol 2007; 293:C1319-26. [PMID: 17699638 DOI: 10.1152/ajpcell.00100.2007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Volatile anesthetics have been shown to activate various two-pore (2P) domain K(+) (K(2P)) channels such as TASK-1 and TREK-1 (TWIK-related acid-sensitive K(+) channel), and mice deficient in these channels are resistant to halothane-induced anesthesia. Here, we investigated whether K(2P) channels were also potentially important targets of intravenous anesthetics. Whole cell patch-clamp techniques were used to determine the effects of the commonly used intravenous anesthetics etomidate and propofol on the acid-sensitive K(+) current in rat ventricular myocytes (which strongly express TASK-1) and selected human K(2P) channels expressed in Xenopus laevis oocytes. In myocytes, etomidate decreased both inward rectifier K(+) (K(ir)) current (I(K1)) and acid-sensitive outward K(+) current at positive potentials, suggesting that this drug may inhibit TASK channels. Indeed, in addition to inhibiting guinea pig Kir2.1 expressed in oocytes, etomidate inhibited human TASK-1 (and TASK-3) in a concentration-dependent fashion. Propofol had no effect on human TASK-1 (or TASK-3) expressed in oocytes. Moreover, we showed that, similar to the known effect of halothane, sevoflurane and the purified R-(-)- and S-(+)-enantiomers of isoflurane, without stereoselectivity, activated human TASK-1. We conclude that intravenous and volatile anesthetics have dissimilar effects on K(2P) channels. Human TASK-1 (and TASK-3) are insensitive to propofol but are inhibited by supraclinical concentrations of etomidate. In contrast, stimulatory effects of sevoflurane and enantiomeric isoflurane on human TASK-1 can be observed at clinically relevant concentrations.
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MESH Headings
- Anesthetics, Inhalation/pharmacology
- Anesthetics, Intravenous/pharmacology
- Animals
- Arachidonic Acids/pharmacology
- Cells, Cultured
- Dose-Response Relationship, Drug
- Etomidate/pharmacology
- Halothane/pharmacology
- Humans
- Hydrogen-Ion Concentration
- Isoflurane/pharmacology
- Membrane Potentials/drug effects
- Methyl Ethers/pharmacology
- Myocytes, Cardiac/cytology
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/physiology
- Nerve Tissue Proteins/genetics
- Nerve Tissue Proteins/physiology
- Oocytes/drug effects
- Oocytes/metabolism
- Oocytes/physiology
- Patch-Clamp Techniques
- Potassium/metabolism
- Potassium Channel Blockers/pharmacology
- Potassium Channels, Tandem Pore Domain/genetics
- Potassium Channels, Tandem Pore Domain/physiology
- Propofol/pharmacology
- RNA, Complementary/genetics
- Rats
- Sevoflurane
- Xenopus laevis
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Affiliation(s)
- C Putzke
- Department of Anesthesiology and Critical Care Medicine, Philipps-University Marburg, Baldingerstrasse 1, 35043, Marburg, Germany.
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18
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Lattermann R, Wykes L, Detschman E, Eberhart L, Meterissian S, Schricker T. Anabolic effects of preoperative hypocaloric nutrition. Can J Anaesth 2007. [DOI: 10.1007/bf03019904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Diemunsch P, Gan TJ, Philip BK, Girao MJ, Eberhart L, Irwin MG, Pueyo J, Chelly JE, Carides AD, Reiss T, Evans JK, Lawson FC. Single-dose aprepitant vs ondansetron for the prevention of postoperative nausea and vomiting: a randomized, double-blind phase III trial in patients undergoing open abdominal surgery. Br J Anaesth 2007; 99:202-11. [PMID: 17540667 DOI: 10.1093/bja/aem133] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The neurokinin(1) antagonist aprepitant is effective for prevention of chemotherapy-induced nausea and vomiting. We compared aprepitant with ondansetron for prevention of postoperative nausea and vomiting. METHODS Nine hundred and twenty-two patients receiving general anaesthesia for major abdominal surgery were assigned to receive a single preoperative dose of oral aprepitant 40 mg, oral aprepitant 125 mg, or i.v. ondansetron 4 mg in a randomized, double-blind trial. Vomiting episodes, use of rescue therapy, and nausea severity (verbal rating scale) were documented for 48 h after surgery. Primary efficacy endpoints were complete response (no vomiting and no use of rescue therapy) 0-24 h after surgery and no vomiting 0-24 h after surgery. The secondary endpoint was no vomiting 0-48 h after surgery. RESULTS Aprepitant at both doses was non-inferior to ondansetron for complete response 0-24 h after surgery (64% for aprepitant 40 mg, 63% for aprepitant 125 mg, and 55% for ondansetron, lower bound of 1-sided 95% CI > 0.65), superior to ondansetron for no vomiting 0-24 h after surgery (84% for aprepitant 40 mg, 86% for aprepitant 125 mg, and 71% for ondansetron; P < 0.001), and superior for no vomiting 0-48 h after surgery (82% for aprepitant, 40 mg, 85% for aprepitant, 125 mg, and 66% for ondansetron; P < 0.001). The distribution of peak nausea scores was lower in both aprepitant groups vs ondansetron (P < 0.05). CONCLUSIONS Aprepitant was non-inferior to ondansetron in achieving complete response for 24 h after surgery. Aprepitant was significantly more effective than ondansetron for preventing vomiting at 24 and 48 h after surgery, and in reducing nausea severity in the first 48 h after surgery. Aprepitant was generally well tolerated.
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Affiliation(s)
- P Diemunsch
- Services d'Anesthesiologie-Reanimation Chirurgicale, CHU, Hôpital de Hautepierre, 1 Avenue de Moliere, Strasbourg 67000, France.
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20
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Maybauer DM, Geldner G, Blobner M, Pühringer F, Hofmockel R, Rex C, Wulf HF, Eberhart L, Arndt C, Eikermann M. Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium. Anaesthesia 2007; 62:12-7. [PMID: 17156221 DOI: 10.1111/j.1365-2044.2006.04862.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a randomised, controlled, double-blind, multicentre trial in 338 patients, we assessed the incidence of residual paralysis following administration of cisatracurium or rocuronium. The incidence at the end of surgery was significantly lower in patients treated with rocuronium (62 of 142 patients, 44%) than in those given cisatracurium (99 of 175 patients, 57%) (p < 0.05). In contrast, with rocuronium the mean (SD) time between skin closure and extubation was 28 (28) min vs 18 (19) min for cisatracurium, and the duration 0.9 (time from administration of last top-up dose to recovery of the train-of-four ratio to 0.9) was significantly longer and more variable for rocuronium than for cisatracurium. Thus, after repeated administration, the duration and variability of duration of action are greater with rocuronium compared with cisatracurium. These pharmacodynamic differences do not necessarily translate into a higher incidence of residual paralysis, because clinicians compensate for the longer duration of action and variability of rocuronium by terminating administration of the neuromuscular blocking earlier.
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Affiliation(s)
- D M Maybauer
- Klinik für Anästhesiologie und Intensivmedizin, Philipps-Universität Marburg, Germany
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21
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Schricker T, Wykes L, Eberhart L, Carli F, Meterissian S. Randomized clinical trial of the anabolic effect of hypocaloric parenteral nutrition after abdominal surgery. Br J Surg 2005; 92:947-53. [PMID: 16034820 DOI: 10.1002/bjs.5105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The observed failure of hypocaloric nutrition to establish an anabolic state after surgery may reflect inadequate control for the type and quality of analgesia in the studies performed. This study was designed to test the hypothesis that hypocaloric nutrition induces anabolism in patients who receive effective segmental pain relief using perioperative epidural analgesia. METHODS Sixteen patients who underwent colorectal surgery and received epidural analgesia were randomly assigned to receive intravenous glucose either without (glucose only) or with amino acids (nutrition). Feeding was administered over 48 h from surgical skin incision until the second day after operation. Glucose provided 50 per cent of the patient's resting energy expenditure (REE). Amino acids were infused at rates that provided 20 per cent of REE. Leucine rate of appearance (Ra), leucine oxidation and non-oxidative leucine disposal (NOLD) were assessed by measuring L-[1-13C]leucine kinetics. A positive leucine balance, that is the difference between NOLD and leucine Ra, indicated anabolism. RESULTS After surgery, leucine Ra in the nutrition group was lower than that in the glucose only group (mean(s.d.) 88(25) versus 131(22) micromol per kg per h). The leucine balance remained negative in the glucose only group, whereas it became positive in the nutrition group (mean(s.d.) -24(3) versus 38(12) micromol per kg per h; P < 0.001). CONCLUSION Patients who receive hypocaloric parenteral nutrition can be rendered anabolic after colorectal surgery in the presence of epidural analgesia.
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Affiliation(s)
- T Schricker
- Department of Anaesthesia, Montreal, Quebec, Canada.
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22
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Torossian A, Ruehlmann S, Eberhart L, Middeke M, Wulf H, Bauhofer A. Pre-treatment with ozonized oxygen (O3) aggravates inflammation in septic rats. Inflamm Res 2004; 53 Suppl 2:S122-5. [PMID: 15338062 DOI: 10.1007/s00011-004-0352-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE AND DESIGN Ozone is produced by neutrophils during bacterial killing. Its application was found to be beneficial in peritonitis patients. Therefore, we measured survival and cytokines after ozone pre-treatment in septic rats. SUBJECTS AND TREATMENT With approval, 40 male Wistar-rats were allocated to 1) ozone pre-treatment for five days before intra-abdominal sepsis, or 2) no pre-treatment. METHODS The primary endpoint was mortality at 120 h. Secondary endpoints were plasma cytokine levels. RESULTS In the control group mortality was 50% (10/20 rats). After ozone pre-treatment, survival was only 35% (7/20 rats, Log-Rank test: P = 0.10). Ozone increased TNF-alpha and MIP-2 after infection: 127 +/- 23 pg/ml and 94 +/- 19 pg/ml (control group: 398 pg/ml and 369 pg/ml; P < 0.002 and P < 0.01). IL-6 levels were similar in both groups. CONCLUSIONS Ozone pre-treatment was pro-inflammatory in sepsis with a trend to reduced survival. Therefore, its effects in sepsis should be further evaluated in animal trials.
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Affiliation(s)
- A Torossian
- Department of Anaesthesia and Critical Care, University of Marburg, Baldingerstrasse 1, 35033, Marburg, Germany.
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23
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Lang C, Behnke H, Bittersohl J, Eberhart L, Walthers E, Sommer F, Wulf H, Geldner G. [Special features of intensive care of toxic shock syndrome. Review and case report of a TSST-1 associated toxic-shock syndrome with adult respiratory distress syndrome and multiple organ failure from a staphylococcal panaritium]. Anaesthesist 2003; 52:805-13. [PMID: 14504808 DOI: 10.1007/s00101-003-0552-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Toxic-shock-syndrome (TSS) is an acute febrile, exanthematous illness caused by toxins such as toxic-shock-syndrome-toxine-1 (TSST-1) and other endotoxines from staphylococcus aureus with an incidence of 0,5 per 100.000 inhabitants. Patients with menstrual toxic-shock-syndrome (menstrual-TSS) usually have TSS associated with menstruation and use of a vaginal device such as tampons. Other patients with non-menstrual toxic-shock-syndrome (non-menstrual-TSS) have a focus of staphylococcal infection such as a surgical wound infection or soft tissue abscess. TSS usually presents with fever, pharyngitis, diarrhoea, vomiting, myalgia and may progress rapidly (within hours) to signs of hypovolaemic hypotension and shock. In some cases TSS is associated with multisystem failure including shock, renal failure, myocardial failure and adult respiratory distress syndrome. In its acute phase the diagnosis of TSS is often uncertain because of its initial symptoms are non-specific and numerous conditions need to be considered in the differential diagnosis. But obviously less incidence, the signs and symptoms of toxic-shock-syndrome should be recognised early to permit successful therapy. The site of infection should be adequately drained and treated with antimicrobial therapy. Possible complications including ARDS and myocardial failure require a thorough understanding of its underlying pathophysiology to ensure appropriate intensive-care treatment. Only if appropriate therapy is instituted as early as possible, most of patients will be able to survive their toxic-shock-syndrome. In other cases TSS can be a rapidly progressive and perhaps lethal ending disease because of possible multiple organe failure such as ARDS.
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Affiliation(s)
- C Lang
- Klinik für Anästhesie und Intensivtherapie, Interdisziplinäres Medizinisches Zentrum, Klinikum der Philipps-Universität, Marburg, Germany.
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