1
|
Mencke T, Zitzmann A, Reuter DA. [New aspects of rapid sequence induction including treatment of pulmonary aspiration]. Anaesthesist 2021; 70:171-184. [PMID: 33410921 DOI: 10.1007/s00101-020-00901-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pulmonary aspiration of solid components leads to displacement of the tracheobronchial tree, the aspiration of acidic gastric juices to chemical pneumonitis (Mendelson's syndrome) and the aspiration of oropharyngeal secretions or gastrointestinal pathogens to aspiration pneumonia. Principally, pulmonary aspiration can occur at any stage of anesthesia. In the clinical routine the aim must therefore be to identify those patients who have an increased risk of aspiration. When this is successful, measures can be taken to reduce the risk; these can be regional anaesthesia or the performance of general anaesthesia as rapid sequence induction (RSI). If severe pulmonary aspiration occurs despite all preventive measures, mostly during induction of anaesthesia, extensive experience and rapid action are necessary. This can only be achieved if the induction to RSI is performed by three persons with supervision of the trainee anaesthetist by a consultant anaesthetist.
Collapse
Affiliation(s)
- T Mencke
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - A Zitzmann
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - D A Reuter
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| |
Collapse
|
2
|
Mencke T, Zitzmann A, Reuter DA. [56-year-old male with mechanical ileus after cystectomy : Preparation for the medical specialist examination: Part 15]. Anaesthesist 2019; 68:146-149. [PMID: 30989304 DOI: 10.1007/s00101-019-0548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Mencke
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - A Zitzmann
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - D A Reuter
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| |
Collapse
|
3
|
Sauer M, Haubner C, Richter G, Ehler J, Mencke T, Mitzner S, Margraf S, Altrichter J, Doß S, Nöldge-Schomburg G. Impaired Cell Viability and Functionality of Hepatocytes After Incubation With Septic Plasma-Results of a Second Prospective Biosensor Study. Front Immunol 2018; 9:1448. [PMID: 29988573 PMCID: PMC6026797 DOI: 10.3389/fimmu.2018.01448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022] Open
Abstract
Liver dysfunction (LD) and liver failure are associated with poor outcome in critically ill patients. In patients with severe sepsis or septic shock, LD occurred in nearly 19% of patients. An early diagnosis of LD at time of initial damage of the liver can lead to a better prognosis of these patients because an early start of therapy is possible. We performed a second prospective study with septic patients to test a new cell-based cytotoxicity device (biosensor) to evaluate clinical relevance for early diagnosis of LD and prognostic capacity. In the clinical study, 99 intensive care unit patients were included in two groups. From the patients of the septic group (n = 51, SG), and the control (non-septic) group [n = 49, control group (CG)] were drawn 20 ml blood at inclusion, after 3, and 7 days for testing with the biosensor. Patients’ data were recorded for hospital survival, organ function, and demographic data, illness severity [acute physiology and chronic health evaluation (APACHE) II-, sepsis-related organ failure assessment (SOFA) scores], cytokines, circulating-free deoxyribonucleic acid/neutrophil-derived extracellular traps (cf-DNA/NETs), microbiological results, and pre-morbidity. For the developed cytotoxicity test, the human liver cell line HepG2/C3A was used. Patients’ plasma was incubated in a microtiter plate assay with the test cells and after 6 days incubation the viability (trypan blue staining, XTT-test) and functionality (synthesis of albumin, cytochrome 1A2 activity) was analyzed. An impairment of viability and functionality of test cells was only seen in the SG compared with the CG. The plasma of non-survivors in the SG led to a more pronounced impairment of test cells than the plasma of survivors at inclusion. In addition, the levels of cf-DNA/NETs were significantly higher in the SG at inclusion, after 3, and after 7 days compared with the CG. The SG showed an in-hospital mortality of 24% and the values of bilirubin, APACHE II-, and SOFA scores were markedly higher at inclusion than in the CG. Hepatotoxicity of septic plasma was already detected with the liver cell-based biosensor at inclusion and also in the course of disease. The biosensor may be a tool for early diagnosis of LD in septic patients and may have prognostic relevance.
Collapse
Affiliation(s)
- Martin Sauer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany.,Extracorporeal Immunomodulation (EXIM), Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Cristof Haubner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Georg Richter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Thomas Mencke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Steffen Mitzner
- Extracorporeal Immunomodulation (EXIM), Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany.,Division of Nephrology, Department of Medicine, University Hospital of Rostock, Rostock, Germany
| | - Stefan Margraf
- Extracorporeal Immunomodulation (EXIM), Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Jens Altrichter
- Division of Nephrology, Department of Medicine, University Hospital of Rostock, Rostock, Germany
| | - Sandra Doß
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Gabriele Nöldge-Schomburg
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| |
Collapse
|
4
|
Funcke S, Saugel B, Koch C, Schulte D, Zajonz T, Sander M, Gratarola A, Ball L, Pelosi P, Spadaro S, Ragazzi R, Volta CA, Mencke T, Zitzmann A, Neukirch B, Azparren G, Giné M, Moral V, Pinnschmidt HO, Díaz-Cambronero O, Estelles MJA, Velez ME, Montañes MV, Belda J, Soro M, Puig J, Reuter DA, Haas SA. Individualized, perioperative, hemodynamic goal-directed therapy in major abdominal surgery (iPEGASUS trial): study protocol for a randomized controlled trial. Trials 2018; 19:273. [PMID: 29743101 PMCID: PMC5944092 DOI: 10.1186/s13063-018-2620-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/28/2018] [Indexed: 01/04/2023] Open
Abstract
Background Postoperative morbidity and mortality in patients undergoing surgery is high, especially in patients who are at risk of complications and undergoing major surgery. We hypothesize that perioperative, algorithm-driven, hemodynamic therapy based on individualized fluid status and cardiac output optimization is able to reduce mortality and postoperative moderate and severe complications as a major determinant of the patients’ postoperative quality of life, as well as health care costs. Methods/design This is a multi-center, international, prospective, randomized trial in 380 patients undergoing major abdominal surgery including visceral, urological, and gynecological operations. Eligible patients will be randomly allocated to two treatment arms within the participating centers. Patients of the intervention group will be treated perioperatively following a specific hemodynamic therapy algorithm based on pulse-pressure variation (PPV) and individualized optimization of cardiac output assessed by pulse-contour analysis (ProAQT© device; Pulsion Medical Systems, Feldkirchen, Germany). Patients in the control group will be treated according to standard local care based on established basic hemodynamic treatment. The primary endpoint is a composite comprising the occurrence of moderate or severe postoperative complications or death within 28 days post surgery. Secondary endpoints are: (1) the number of moderate and severe postoperative complications in total, per patient and for each individual complication; (2) the occurrence of at least one of these complications on days 1, 3, 5, 7, and 28 in total and for every complication; (3) the days alive and free of mechanical ventilation, vasopressor therapy and renal replacement therapy, length of intensive care unit, and hospital stay at day 7 and day 28; and (4) mortality and quality of life, assessed by the EQ-5D-5L™ questionnaire, after 6 months. Discussion This is a large, international randomized controlled study evaluating the effect of perioperative, individualized, algorithm-driven ,hemodynamic optimization on postoperative morbidity and mortality. Trial registration Trial registration: NCT03021525. Registered on 12 January 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2620-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sandra Funcke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Koch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Dagmar Schulte
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Thomas Zajonz
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Angelo Gratarola
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Savino Spadaro
- Department of Anesthesia and Intensive Care, University of Ferrara, Sant Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Riccardo Ragazzi
- Department of Anesthesia and Intensive Care, University of Ferrara, Sant Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Carlo Alberto Volta
- Department of Anesthesia and Intensive Care, University of Ferrara, Sant Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Thomas Mencke
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Amelie Zitzmann
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Benedikt Neukirch
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Gonzalo Azparren
- Department of Anesthesiology, Hospital Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | - Marta Giné
- Department of Anesthesiology, Hospital Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | - Vicky Moral
- Department of Anesthesiology, Hospital Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | - Hans Otto Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Oscar Díaz-Cambronero
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Maria Jose Alberola Estelles
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Marisol Echeverri Velez
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Maria Vila Montañes
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Javier Belda
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Marina Soro
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Jaume Puig
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Daniel Arnulf Reuter
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Sebastian Alois Haas
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
| |
Collapse
|
5
|
|
6
|
Sauer M, Richter G, Altrichter J, Wild T, Doß F, Mencke T, Ehler J, Doß S, Koch S, Schubert A, Nöldge-Schomburg G, Mitzner SR. Effects of Bioreactor-Oxygenation During Extracorporeal Granulocytes Treatment in Septic Patients. Ther Apher Dial 2018; 22:389-398. [PMID: 29418067 DOI: 10.1111/1744-9987.12657] [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: 08/20/2017] [Revised: 11/03/2017] [Accepted: 11/09/2017] [Indexed: 11/30/2022]
Abstract
A granulocyte bioreactor for the extracorporeal treatment was developed to enhance the immune cell function in patients with severe sepsis. The influence of oxygenation on the used cells was tested in a prospective clinical study. Ten patients with severe sepsis were treated twice with the granulocyte bioreactor. The used cells were screened for functionality; values of blood gases, glucose and lactate were obtained from the recirculating bioreactor circuit. Five patients were treated with an oxygenator setup (Oxy group), five without oxygenator (Non-Oxy group). The overall in-hospital mortality was 50%. Significantly lower values of oxygen saturation, partial oxygen pressure, lactate, oxyburst and phagocytosis were seen in the Non-Oxy group compared with the Oxy group in the bioreactor circuit. Further studies with this approach are encouraged and should focus on the influence of oxygenation on production of reactive oxygen species and cytokines of used cells.
Collapse
Affiliation(s)
- Martin Sauer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany.,Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Georg Richter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | | | - Thomas Wild
- Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Fanny Doß
- Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Thomas Mencke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Sandra Doß
- Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Stephanie Koch
- Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Anton Schubert
- Department of Surgery, University Hospital of Rostock, Rostock, Germany
| | - Gabriele Nöldge-Schomburg
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Steffen R Mitzner
- Department of Medicine (Division of Nephrology), University Hospital of Rostock, Rostock, Germany.,Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| |
Collapse
|
7
|
Soltesz S, Stark C, Noé KG, Anapolski M, Mencke T. Comparison of the trapezius and the adductor pollicis muscle as predictor of good intubating conditions: a randomized controlled trial. BMC Anesthesiol 2017; 17:106. [PMID: 28818054 PMCID: PMC5561588 DOI: 10.1186/s12871-017-0401-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022] Open
Abstract
Background Adequate muscle relaxation is important for ensuring optimal conditions for intubation. Although acceleromyography of the adductor pollicis muscle is commonly used to assess conditions for intubation, we hypothesized that acceleromyography of the trapezius is more indicative of optimal intubating conditions. The primary outcome was the difference between both measurement sites with regard to prediction of good or acceptable intubating conditions. Methods Neuromuscular blockade after injection of rocuronium 0.3 mg/kg IV was measured simultaneously with acceleromyography of the adductor pollicis muscle and the trapezius muscle in sixty female patients, American Society of Anesthesiologists physical status I to III, undergoing general anesthesia for gynecologic surgery. Exclusion criteria were: expected difficult tracheal intubation (e.g. history of difficult intubation, reduced mouth opening (< 2 cm) and/or Mallampati Score 4), increased risk of pulmonary aspiration (e.g. gastroesophageal reflux or delayed gastric emptying) allergies to drugs used during the study, pregnancy, neuromuscular diseases, medication with potential to influence neuromuscular function (e.g. furosemide, magnesium, cephalosporins) and hepatic or renal insufficiency (serum bilirubin >26 μmol/L, serum creatinine >90 μmol/l). Patients were randomized to 2 groups: group A (n = 30): endotracheal intubation after onset of the neuromuscular block at the adductor pollicis muscle. Group B (n = 30): endotracheal intubation after onset at the trapezius muscle. Intubating conditions were compared between both groups by means of a standardised score (the Copenhagen score) with Fisher’s exact test. Results Onset of the block after rocuronium injection was observed at the adductor pollicis muscle compared to the trapezius with 2.8 (1.1) versus 2.5 (1.1) min (mean ± SD; P = 0.006). Intubating conditions were poor in 2 patients (7%) of group A, and in 1 patient (3%) of group T. They were acceptable (either excellent or good) in 28 patients (93%) in group A, and in 1 patient (97%) in group T (P = 0.82). Conclusions Performing acceleromyography at the trapezius muscle reduced the time between injection of neuromuscular blocking agents and intubation by 18 s (11%). Thus, trapezius muscle acceleromyography is an acceptable alternative to adductor pollicis muscle acceleromyography in predicting acceptable intubating conditions, which allows for earlier indication of adequate intubating conditions. Trial registration ClinicalTrial.gov Identifier: NCT01849198. Registered April 29, 2013.
Collapse
Affiliation(s)
- Stefan Soltesz
- Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, Dormagen, Germany. .,Klinik für Anästhesie, Intensiv- und Notfallmedizin, Kreiskrankenhaus Dormagen, D-41540, Dormagen, Germany.
| | - Christian Stark
- Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, Dormagen, Germany
| | - Karl G Noé
- Department Ob/Gyn, University of Witten-Herdecke, KKH Dormagen, Dormagen, Germany
| | - Michael Anapolski
- Department Ob/Gyn, University of Witten-Herdecke, KKH Dormagen, Dormagen, Germany
| | - Thomas Mencke
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Rostock, Germany
| |
Collapse
|
8
|
Ovari A, Bicker I, Machmueller S, Schuldt T, Sauer M, Soltesz S, Noeldge-Schomburg G, Mlynski R, Mencke T. Sevoflurane at 1.0 MAC together with remifentanil and propofol produces clinically acceptable intubation conditions at the vocal cords: A prospective randomized study. J Int Med Res 2017; 45:1098-1108. [PMID: 28449630 PMCID: PMC5536408 DOI: 10.1177/0300060517701355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective The overall intubation conditions after tracheal intubation with remifentanil, propofol, and sevoflurane at 1.0 minimum alveolar concentration (MAC) are worse than with rocuronium at 0.45 mg/kg. Therefore, we compared the intubation conditions and laryngeal morbidity (vocal cord injuries, hoarseness, and sore throat) with sevoflurane at 1.2 and 1.4 MAC versus 1.0 MAC. Methods In this prospective clinical trial, 90 patients were randomized to 3 groups: the sevoflurane 1.0, 1.2, and 1.4 MAC groups. At 3 min, tracheal intubation was performed and the patients’ intubation conditions were assessed. The vocal cords were examined for injury by videolaryngoscopy. Additionally, the incidence and severity of laryngeal morbidity were compared between women and men. Results Acceptable intubation conditions were seen in 72% of the patients without significant differences between the groups. Overall, vocal cord injuries (oedema) occurred in three (4%) patients. Women reported sore throat more often than men (51% vs. 21%, respectively). Conclusions Intubation conditions were not improved with higher sevoflurane concentrations. The incidence and severity of sore throat were greater in women than men. Trial registration: ClinicalTrials.Gov: NCT 01896245
Collapse
Affiliation(s)
- Attila Ovari
- 1 Department of Otorhinolaryngology, Rostock Medical University Center, Rostock, Germany
| | - Ilona Bicker
- 2 Department of Anaesthesia and Intensive Care Medicine, Rostock Medical University Center, Rostock, Germany
| | - Susann Machmueller
- 2 Department of Anaesthesia and Intensive Care Medicine, Rostock Medical University Center, Rostock, Germany
| | - Tobias Schuldt
- 1 Department of Otorhinolaryngology, Rostock Medical University Center, Rostock, Germany
| | - Martin Sauer
- 2 Department of Anaesthesia and Intensive Care Medicine, Rostock Medical University Center, Rostock, Germany
| | - Stefan Soltesz
- 3 Department of Anaesthesia and Intensive Care Medicine, KKH Dormagen, Dormagen, Germany
| | - Gabriele Noeldge-Schomburg
- 2 Department of Anaesthesia and Intensive Care Medicine, Rostock Medical University Center, Rostock, Germany
| | - Robert Mlynski
- 1 Department of Otorhinolaryngology, Rostock Medical University Center, Rostock, Germany
| | - Thomas Mencke
- 2 Department of Anaesthesia and Intensive Care Medicine, Rostock Medical University Center, Rostock, Germany
| |
Collapse
|
9
|
Soltesz S, Stark C, Noé KG, Anapolski M, Mencke T. In reply: Monitoring recovery from neuromuscular block using acceleromyography at the trapezius muscle: problems that must be considered. Can J Anaesth 2016; 63:1380. [PMID: 27506897 DOI: 10.1007/s12630-016-0716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/02/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Stefan Soltesz
- Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, Dormagen, Germany.
| | - Christian Stark
- Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, Dormagen, Germany
| | - Karl G Noé
- Department Obstetrics and Gynecology, KKH Dormagen, Dormagen, Germany
| | | | - Thomas Mencke
- Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, Dormagen, Germany
| |
Collapse
|
10
|
Soltesz S, Stark C, Noé KG, Anapolski M, Mencke T. Monitoring recovery from rocuronium-induced neuromuscular block using acceleromyography at the trapezius versus the adductor pollicis muscle: an observational trial. Can J Anaesth 2016; 63:709-17. [PMID: 26864194 DOI: 10.1007/s12630-016-0609-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 05/29/2015] [Revised: 01/14/2016] [Accepted: 02/02/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Positioning for surgery can restrict access to the patient's hand, thereby limiting assessment of the response at the adductor pollicis muscle to ulnar nerve stimulation. We evaluated a novel site to assess neuromuscular block by stimulating the accessory nerve and measuring the acceleromyographic response at the trapezius muscle. METHODS In this prospective non-blinded observational study, we assessed neuromuscular transmission in anesthetized adult female patients undergoing elective laparoscopic gynecological surgery. We performed the assessment by simultaneous recording acceleromyographic responses with the TOF-Watch(®) SX monitor at both the right adductor pollicis and left trapezius muscles. The neuromuscular block was achieved using rocuronium 0.3 mg·kg(-1), and the repeatability, time course, and limits of agreement (Bland-Altman) of responses were compared at the two recording sites. The primary endpoint was the 90% train-of-four (TOF) recovery time with other endpoints included the onset time of the block, maximum T1 depression, time to 25% T1 recovery, and recovery time course of the T1 response and TOF ratio. RESULTS Thirty-six patients were enrolled with responses obtained from 27 subjects. The variability of baseline responses recorded at the trapezius muscle was larger than that recorded at the adductor pollicis muscle, as determined by their mean (SD) repeatability coefficients [twitch height T1, 6.1 (1.9)% and 4.2 (1.6)%, respectively; P = 0.001; TOF ratio, 6.2 (2.1)% and 4.3 (1.7)%, respectively; P = 0.001]. The recorded responses showed relatively narrow limits of agreement. The onset time of the block was 0.3 min earlier at the trapezius muscle than at the adductor pollicis muscle [2.3 (0.8) min and 2.6 (0.7) min, respectively; P = 0.007], with limits of agreement ranging from 1.6 min earlier to 1.0 min later. The time to 25% T1 recovery was 1.8 min earlier at the trapezius muscle than at the adductor pollicis muscle [18.2 (5.7) min and 20.0 (5.2) min, respectively; P = 0.039], with limits of agreement ranging from 11.1 min earlier to 7.5 min later. Additionally, the time to achieve 90% TOF ratio was 4.4 min earlier at the trapezius muscle than at the adductor pollicis muscle [32.6 (7.9) min and 37 (9.1) min, respectively; P = 0.004], with limits of agreement ranging from 18.4 min earlier to 9.7 min later. CONCLUSIONS We conclude that recording evoked acceleromyographic responses at the trapezius muscle is an acceptable alternative when monitoring from the adductor pollicis muscle is compromised. Nevertheless, we caution that recording a 90% TOF response at the trapezius muscle may overestimate functional recovery from the neuromuscular blockade. This trial was registered at ClinicalTrials.gov identifier, NCT01849198.
Collapse
Affiliation(s)
- Stefan Soltesz
- Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, 41540, Dormagen, Germany.
| | - Christian Stark
- Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, 41540, Dormagen, Germany
| | - Karl G Noé
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, KKH Dormagen, Dormagen, Germany
| | | | - Thomas Mencke
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Rostock, Germany
| |
Collapse
|
11
|
Mencke T, Soltész S. General anaesthesia vs. spinal anaesthesia for total hip arthroplasty. Acta Anaesthesiol Scand 2015; 59:541-2. [PMID: 25790313 DOI: 10.1111/aas.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Soltész S, Mencke T. Reply to: Intravenous bolus injection of dexamethasone and transient excruciating perineal pain. Eur J Anaesthesiol 2015; 32:68. [PMID: 25387305 DOI: 10.1097/eja.0000000000000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Stefan Soltész
- From the Department of Anaesthesia and Intensive Care (SS) and the Department of Anaesthesia and Intensive Care Medicine (TM), University of Rostock, Rostock, Germany
| | | |
Collapse
|
13
|
Ovári A, Just T, Dommerich S, Hingst V, Böttcher A, Schuldt T, Guder E, Mencke T, Pau HW. Conservative management of post-intubation tracheal tears-report of three cases. J Thorac Dis 2014; 6:E85-91. [PMID: 24977034 DOI: 10.3978/j.issn.2072-1439.2014.03.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/05/2014] [Indexed: 12/11/2022]
Abstract
Iatrogenic tracheal rupture is a rare complication after intubation. We present three patients with tracheal tears. In all of these patients, a common finding was a lesion of the posterior tracheal wall with postoperative subcutaneous and emphysema as the first clinical sign of the rupture. Diagnosis and follow-up were based on clinical and endoscopic findings and chest computed tomography (CT) scans. In our cases with progressive subcutaneous and mediastinal emphysema or dyspnea, we performed a tracheotomy and bypassed the lesion with a tracheostomy tube to avoid an increase in air leakage into the mediastinum. Under broad-spectrum antibiotic therapy, no mediastinitis occurred and all patients survived without sequelae. Closure of tracheostomy was scheduled for 1-2 months after tracheal injury. Analysis of surgical and anesthesiological procedures revealed no abnormalities and the accumulation of tracheal injuries was considered as accidental. We found that in clinically stable patients with spontaneous breathing and with no mediastinitis, a conservative management of tracheal tears is a safe procedure.
Collapse
Affiliation(s)
- Attila Ovári
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Tino Just
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Steffen Dommerich
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Volker Hingst
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Arne Böttcher
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Tobias Schuldt
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Ellen Guder
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Thomas Mencke
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Hans-Wilhelm Pau
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| |
Collapse
|
14
|
Mencke T, Jacobs RM, Machmueller S, Sauer M, Heidecke C, Kallert A, Pau HW, Noeldge-Schomburg G, Ovari A. Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial. BMC Anesthesiol 2014; 14:39. [PMID: 24860256 PMCID: PMC4032635 DOI: 10.1186/1471-2253-14-39] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/30/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Tracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg(-1) and propofol 2.0-3.0 mg·kg(-1) or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil. METHODS Eighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg(-1), remifentanil 0.30 μg kg min(-1) and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg(-1). We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery. RESULTS ACCEPTABLE INTUBATING CONDITIONS WERE SEEN MORE FREQUENTLY WITH ROCURONIUM THAN WITH SEVOFLURANE: 97% versus 82%; p = 0.03; the subscore for vocal cords was comparable: 100% versus 98%. MAP before intubation decreased significantly compared with the MAP at baseline to the same extent in both groups; ephedrine IV was given in 15 (SEVO) versus 16 (MR) patients; p = 0.93. BIS at tracheal intubation was 27 (13-65) in the SEVO group, 29 (14-62) in the MR group; p = 0.07. Vocal cord injuries (oedema, haematoma) were similar: 4 patients in each group. CONCLUSIONS Overall intubating conditions were better when rocuronium was used; the subscore for vocal cords was comparable. The incidence of side effects was the same in the two groups. TRIAL REGISTRATION ClinicalTrials.Gov: NCT 01591031.
Collapse
Affiliation(s)
- Thomas Mencke
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany
| | - Refa Maria Jacobs
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany
| | - Susann Machmueller
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany
| | - Martin Sauer
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany
| | - Christine Heidecke
- Department of Otorhinolaryngology, University of Rostock, Rostock, Germany
| | - Anja Kallert
- Department of Otorhinolaryngology, University of Rostock, Rostock, Germany
| | - Hans Wilhelm Pau
- Department of Otorhinolaryngology, University of Rostock, Rostock, Germany
| | - Gabriele Noeldge-Schomburg
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany
| | - Attila Ovari
- Department of Otorhinolaryngology, University of Rostock, Rostock, Germany
| |
Collapse
|
15
|
Sauer M, Altrichter J, Mencke T, Klöhr S, Thomsen M, Kreutzer HJ, Nöldge-Schomburg G, Mitzner SR. Role of Different Replacement Fluids During Extracorporeal Treatment in a Pig Model of Sepsis. Ther Apher Dial 2012; 17:84-92. [DOI: 10.1111/j.1744-9987.2012.01103.x] [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] [Indexed: 01/08/2023]
|
16
|
Sauer M, Altrichter J, Mencke T, Klöhr S, Thomsen M, Kreutzer HJ, Nöldge-Schomburg G, Mitzner SR. Plasma Separation by Centrifugation and Subsequent Plasma Filtration: Impact on Survival in a Pig Model of Sepsis. Ther Apher Dial 2012; 16:205-12. [DOI: 10.1111/j.1744-9987.2011.01055.x] [Citation(s) in RCA: 4] [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] [Indexed: 11/30/2022]
|
17
|
Sauer M, Haubner C, Mencke T, Nöldge-Schomburg G, Mitzner S, Altrichter J, Stange J. Impaired cell functions of hepatocytes incubated with plasma of septic patients. Inflamm Res 2012; 61:609-16. [PMID: 22370970 DOI: 10.1007/s00011-012-0451-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 02/09/2012] [Accepted: 02/12/2012] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE AND DESIGN The development of liver failure is a major problem in septic patients. In this prospective clinical experimental study the hepatotoxicity of plasma from septic and non-septic patients was tested. METHODS AND SUBJECTS The basic test components consist of human liver cells (HepG2/C3A) used in a standardized microtiter plate assay. After incubation with patient's plasma viability of cells (XTT-test), the cytochrome 1A2 activity and synthesis of micro albumin were measured. Subjects (28) enrolled comprise the septic shock group (SSG, n=10), the non-septic group (NSG, n=5) and the healthy volunteers group (HVG, n=13). RESULTS The 28-day mortality was 30% in the SSG. The APACHE II-, SOFA-, and SAPS-scores and the values of bilirubin and prothrombin time as INR were significantly higher in the SSG than in the NSG. The cytochrome 1A2 activity and the release of albumin were significantly reduced in HepG2/C3A cells incubated with plasma of the SSG (p<0.05). The cytochrome 1A2 activities were higher in survivors compared to non-survivors at the time point 0 and were increasing in survivors and decreasing in non-survivors within 54 h in the SSG. In the SSG there was a significant decrease in IL-10 and IL-8 between inclusion and 54 h. Values of IL-6, TNF alpha and IL-10 were significantly lower in the NSG compared with the values of the SSG at inclusion and after 54 h. CONCLUSION The plasma of patients with septic shock impaired cellular functions of HepG2/C3A cells.
Collapse
Affiliation(s)
- Martin Sauer
- Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18055, Rostock, Germany.
| | | | | | | | | | | | | |
Collapse
|
18
|
Echternach M, Mencke T, Richter B, Reber A. Laryngeale Veränderungen nach endotrachealer Intubation und Anwendung der Larynxmaske. HNO 2011; 59:485-98. [DOI: 10.1007/s00106-011-2293-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
19
|
|
20
|
Soltész S, Mencke T, Stunz M, Diefenbach C, Ziegeler S, Molter GP. Attenuation of a rocuronium-induced neuromuscular block in patients receiving prednisolone. Acta Anaesthesiol Scand 2009; 53:443-8. [PMID: 19317861 DOI: 10.1111/j.1399-6576.2009.01908.x] [Citation(s) in RCA: 15] [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: 11/30/2022]
Abstract
BACKGROUND This study tested the influence of continuous medication (more than 4 weeks) with prednisolone on a rocuronium-induced neuromuscular block. METHODS The time course of a rocuronium-induced neuromuscular blockade (0.3 mg/kg) was investigated in 40 patients with chronic inflammatory bowel disease undergoing elective abdominal surgery. The primary end point was the time from the start of injection of rocuronium until recovery of the TOF ratio to 0.9. Twenty patients received continuous medication with prednisolone (group A), and 20 were without glucocorticoid medication (group B). Additionally, another 20 patients without inflammatory bowel disease and without glucocorticoid medication served as control (group C). RESULTS The onset time was prolonged in group A [253 (51.2) s] compared with group B [187 (61.3) s]. Twitch height at the onset of the block was higher in group A [16.5 (0-61)%] than that in group B [5.0 (0-33)%]. The duration to 25% twitch height was shorter in group A [12.6 (0-20.7) min] compared with group B [16.7 (0-25.3) min] and group C [16.9 (0-29.3) min]. The recovery to a train-of-four ratio of 0.9 was reduced in group A [25.7 (23-34.3) min] compared with group B [34.7 (32.7-44.2) min] and group C [36.5 (31.7-42.3) min]. CONCLUSIONS Prednisolone treatment in patients with inflammatory bowel disease is associated with a delayed onset and a shorter duration of action of rocuronium. The presence of an inflammatory bowel disease did not influence the neuromuscular block.
Collapse
Affiliation(s)
- S Soltész
- Department of Anaesthesia and Intensive Care, Hospital Leverkusen, Am Gesundheitspark 11, Leverkusen, Germany.
| | | | | | | | | | | |
Collapse
|
21
|
Mencke T, Soltesz S, Sauer M, Menzebach A, Silomon M, Nöldge-Schomburg G. Are women more sensitive to a pre-curarization dose of rocuronium than men? Acta Anaesthesiol Scand 2008; 52:1051-5. [PMID: 18840103 DOI: 10.1111/j.1399-6576.2008.01701.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 11/28/2022]
Abstract
BACKGROUND There is increasing evidence that there are gender-related differences in the pharmacodynamics of neuromuscular blocking drugs. However, it is not known whether gender influences the pharmacodynamics of a pre-curarizing dose. METHODS In the first part, we measured the neuromuscular blockade after administration of rocuronium 0.03 mg/kg (10% of ED(95)) after induction of anaesthesia in 20 patients (10 female and 10 male patients) by electromyography. In the second part, 40 female and 40 male patients were observed for signs and symptoms of muscle weakness 2.5 min after injection of rocuronium 0.03 mg/kg before loss of consciousness. Succinylcholine-associated post-operative myalgia (POM) was also assessed. RESULTS Median twitch heights were comparable between the two groups: 95.5 (range: 85-97; female) vs. 96.0 (range: 85-99; male), (NS). Train-of-four ratios were 97.5 (range: 64-100; female) vs. 99.0 (range: 52-100; male) (NS). Signs and symptoms of muscle weakness were observed in 64 (80%) patients, but there were no gender-related differences. The incidence and severity of POM did not differ significantly between the study groups. CONCLUSIONS Pre-curarization with rocuronium 0.03 mg/kg affected men and women equally. Nor was the incidence and the severity of muscle weakness affected by gender.
Collapse
Affiliation(s)
- T Mencke
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Rostock, Germany.
| | | | | | | | | | | |
Collapse
|
22
|
Soltész S, Mencke T, Mey C, Röhrig S, Diefenbach C, Molter GP. Influence of a continuous prednisolone medication on the time course of neuromuscular block of atracurium in patients with chronic inflammatory bowel disease. Br J Anaesth 2008; 100:798-802. [PMID: 18400809 DOI: 10.1093/bja/aen084] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 11/14/2022] Open
Abstract
BACKGROUND Corticosteroids interact with neuromuscular blocking agents. However, experimental data are contradictory: enhancement and attenuation of the neuromuscular block has been observed. This study tested the influence of long-term medication with prednisolone on atracurium-induced neuromuscular block. METHODS Sixty patients with chronic inflammatory bowel disease undergoing elective abdominal surgery were investigated. Thirty patients received a long-term medication with prednisolone (Group A) and 30 were without corticoid medication (Group B). Additionally, another 30 patients without inflammatory bowel disease and without corticoid medication served as control (Group C). The following parameters of an atracurium-induced neuromuscular block (0.25 mg kg(-1)) were measured: onset time, maximum block, recovery to 25% first twitch height, recovery index (time from 25% until 75% recovery of first twitch), duration to recovery to a train-of-four (TOF) rate of 0.7 and 0.9. RESULTS The groups did not differ with regard to onset time, maximum block, and recovery index. The duration to 25% twitch height was significantly lower in Group A [18.1 (0-30.7) min] compared with Group B [23.5 (0-36.7) min; P<0.05]. Duration to a TOF rate of 0.7 and 0.9, respectively, were significantly reduced in Group A [36.1 (7.9) and 40.9 (9.0 min)] compared with Group B [47.9 (7.6) and 53.4 (9.2) min; P<0.001]. CONCLUSIONS Long-term medication with prednisolone resulted in a shorter duration of an atracurium-induced neuromuscular block in patients with Crohn's disease or ulcerative colitis. The presence of the inflammatory bowel disease did not influence the time course of the neuromuscular block.
Collapse
Affiliation(s)
- S Soltész
- Department of Anaesthesia and Intensive Care, Hospital Leverkusen, Am Gesundheitspark 11, D-51375 Leverkusen, Germany.
| | | | | | | | | | | |
Collapse
|
23
|
Morgenthaler K, Bauer C, Ziegeler S, Mencke T, Werth M, Seil R, Dienst M, Soltész S, Silomon M. Intraartikuläre Bupivacaingabe bei Hüftgelenkarthroskopie. Anaesthesist 2007; 56:1128-32. [PMID: 17764003 DOI: 10.1007/s00101-007-1250-5] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The effect of intra-articular bupivacaine on postoperative pain following arthroscopy has been intensively studied for the knee joint but no data are currently available for the hip joint. The aim of the present prospective, randomized and double-blind study was to evaluate a possible effect of intra-articular bupivacaine on postoperative pain intensity following hip arthroscopy. A total of 26 patients were included: 13 received 20 ml of 0.25% bupivacaine through the trocar at the end of surgery and 13 patients received 20 ml of 0.9% NaCl as placebo. Postoperative pain intensity was assessed using a visual analogue scale (VAS) at 0.5 h, 4 h, 8 h, 12 h, 16 h and 20 h, at rest and during movement of the joint and on the basis of additional piritramide requirements. Furthermore, a mean VAS was calculated as the arithmetic mean of all VAS scores assessed over the whole study period. In the bupivacaine group, a significantly lower mean VAS was recorded at rest (17.5 vs 27.5, p=0.05) and during movement of the hip joint (23 vs. 46, p=0.001). The additional piritramide consumption tended to be higher in the placebo group. In conclusion, intra-articular bupivacaine following arthroscopic hip surgery reduces pain in the postoperative period mainly during movement and thus may possibly allow earlier mobilization.
Collapse
Affiliation(s)
- K Morgenthaler
- Klinik für Anaesthesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Soltész S, Silomon M, Gräf G, Mencke T, Boulaadass S, Molter GP. Effect of a 0.5% Dilution of Propofol on Pain on Injection during Induction of Anesthesia in Children. Anesthesiology 2007; 106:80-4. [PMID: 17197848 DOI: 10.1097/00000542-200701000-00015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [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: 11/26/2022]
Abstract
Background
Pain on injection of propofol in children has been reported to be as high as 30-80%. The reason for the pain is assumed to be the aqueous phase of the propofol emulsion. Therefore, for the first time, this study tested the hypothesis that dilution of propofol to a 0.5% emulsion might reduce the incidence of pain during propofol injection.
Methods
The study design was prospective, monocenter, double-blind, and randomized. Sixty-four children aged 2-6 yr were scheduled to receive 0.5% or 1.0% propofol in a medium-chain-triglyceride/long-chain-triglyceride emulsion. Incidence and intensity of pain were assessed by spontaneous expressions of pain and withdrawal of the arm. In a subgroup of 21 children, serum triglyceride levels were measured before and 3 and 20 min after induction. Adverse events were recorded.
Results
Amounts of propofol required until loss of eyelash reflex were 4.40+/-1.01 mg/kg for 0.5% propofol and 4.31+/-0.86 mg/kg for 1.0% propofol. Percentages of children who showed at least one pain reaction were 23.3% in the 0.5% propofol group and 70.0% in the 1.0% propofol group (P<0.001). Serum triglycerides were higher in the 0.5% propofol group 3 and 20 min after injection (251.7 vs. 148.8 mg/dl; P=0.001 and 135.5 vs. 75.5 mg/dl; P=0.03). Adverse events or complications did not occur.
Conclusions
Dilution of propofol to a 0.5% medium-chain-triglyceride/long-chain-triglyceride emulsion reduced pain effectively during injection in children aged 2-6 yr. Cumulative doses until 4-5 mg/kg propofol led to moderate increases of triglyceride levels and did not result in significant adverse events.
Collapse
Affiliation(s)
- Stefan Soltész
- Department of Anesthesia and Intensive Care Medicine, Hospital Leverkusen, and University of Rostock, Rostock, Germany.
| | | | | | | | | | | |
Collapse
|
25
|
Mencke T, Noeldge-Schomburg G, Knoll H. Airway Injury with Low-Dose Rocuronium Versus Succinylcholine for Rapid-Sequence Induction: Relevance and Ethics. Anesth Analg 2007. [DOI: 10.1213/01.ane.0000247687.21705.a5] [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: 11/05/2022]
|
26
|
Mencke T, Noeldge-Schomburg G, Silomon M. Rapid-Sequence Induction: Rocuronium or Suxamethonium? Anesth Analg 2006. [DOI: 10.1213/01.ane.0000246265.84935.1f] [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: 11/05/2022]
|
27
|
Meyer S, Shamdeen MG, Kegel B, Mencke T, Gottschling S, Gortner L, Grundmann U. Effect of propofol on seizure-like phenomena and electroencephalographic activity in children with epilepsy vs children with learning difficulties. Anaesthesia 2006; 61:1040-7. [PMID: 17042840 DOI: 10.1111/j.1365-2044.2006.04782.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [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: 10/24/2022]
Abstract
There is an ongoing debate as to whether propofol exhibits pro- or anticonvulsant effects, and whether it should be used in patients with epilepsy. We prospectively assessed the occurrence of seizure-like phenomena and the effects of intravenous propofol on the electroencephalogram (EEG) in 25 children with epilepsy (mean (SD) age: 101 (49) months) and 25 children with learning difficulties (mean (SD) age: 52 (40) months) undergoing elective sedation for MRI studies of the brain. No child demonstrated seizure-like phenomena of epileptic origin during and after propofol sedation. Immediately after stopping propofol, characteristic EEG changes in the epilepsy group consisted of increased beta wave activity (23/25 children), and suppression of pre-existing theta rhythms (11/16 children). In addition, 16 of 18 children with epilepsy and documented EEG seizure activity demonstrated suppression of spike-wave patterns after propofol sedation. In all 25 children with learning difficulties an increase in beta wave activity was seen. Suppression of theta rhythms occurred in 11 of 12 children at the end of the MRI study. In no child of either group was a primary occurrence or an increase in spike-wave patterns seen following propofol administration. The occurrence of beta wave activity (children with learning difficulties and epilepsy group) and suppression of spike-wave patterns (epilepsy group) were transient, and disappeared after 4 h. This study demonstrates characteristic, time-dependent EEG patterns induced by propofol in children with epilepsy and learning difficulties. Our data support the concept of propofol being a sedative-hypnotic agent with anticonvulsant properties as shown by depression of spike-wave patterns in children with epilepsy and by the absence of seizure-like phenomena of epileptic origin.
Collapse
Affiliation(s)
- S Meyer
- Department of Paediatrics and Paediatric Intensive Care Medicine, University Hospital of Saarland, Homburg, Germany
| | | | | | | | | | | | | |
Collapse
|
28
|
Knoll H, Ziegeler S, Schreiber JU, Buchinger H, Bialas P, Semyonov K, Graeter T, Mencke T. Airway Injuries after One-lung Ventilation: A Comparison between Double-lumen Tube and Endobronchial Blocker. Anesthesiology 2006; 105:471-7. [PMID: 16931978 DOI: 10.1097/00000542-200609000-00009] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.7] [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: 12/11/2022]
Abstract
Background
Vocal cord injuries, postoperative hoarseness, and sore throat are common complications after general anesthesia. One-lung ventilation can be achieved via two techniques: double-lumen endotracheal tube or endobronchial blocker such as the Arndt blocker. The current study was designed to assess the impact of these techniques for one-lung ventilation on the incidence and severity of postoperative hoarseness, vocal cord lesions, and sore throat.
Methods
In this prospective trial, 60 patients were randomly assigned to two groups. One-lung ventilation was achieved with either an endobronchial blocker (blocker group) or a double-lumen-tube (double-lumen group). Postoperative hoarseness and sore throat were assessed at 24, 48, and 72 h after surgery. Bronchial injuries and vocal cord lesions were examined by bronchoscopy immediately after surgery.
Results
In 56 included patients, postoperative hoarseness occurred significantly more frequently in the double-lumen group compared with the blocker group: 44% versus 17%, respectively (P = 0.046). Similar findings were observed for vocal cord lesions: 44% versus 17%, respectively (P = 0.046). The incidence of bronchial injuries was comparable between groups (P = 0.540). Cumulative number of days with hoarseness and sore throat were significantly increased in the double-lumen group compared with the blocker group (P < 0.01). No major complications such as bronchial ruptures were observed.
Conclusions
Clinicians should be aware of an increased incidence of minor airway injuries that may impair patient satisfaction when using a double-lumen tube instead of an endobronchial blocker for one-lung ventilation.
Collapse
Affiliation(s)
- Heike Knoll
- Department of Anesthesiology and Critical Care Medicine, University Hospital of the Saarland, Germany
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Mencke T, Kleinschmidt S, Fuchs-Buder T. Tracheal intubation with and without muscular relaxation. Eur J Anaesthesiol 2006; 23:354-5; author reply 355-6. [PMID: 16519860 DOI: 10.1017/s0265021506240584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2005] [Indexed: 11/05/2022]
|
30
|
Mencke T, Knoll H, Schreiber JU, Echternach M, Klein S, Noeldge-Schomburg G, Silomon M. Rocuronium Is Not Associated with More Vocal Cord Injuries than Succinylcholine After Rapid-Sequence Induction: A Randomized, Prospective, Controlled Trial. Anesth Analg 2006; 102:943-9. [PMID: 16492856 DOI: 10.1213/01.ane.0000194509.03916.02] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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: 11/05/2022]
Abstract
Postoperative hoarseness (PH), sore throat (ST), and vocal cord injuries (VCI) are common complications after general anesthesia. Excellent endotracheal intubating conditions are associated with less laryngeal morbidity than good or poor intubating conditions. Thus, we tested the hypothesis that a rapid-sequence induction (RSI) with succinylcholine would lead to less PH and VCI than with rocuronium. In this prospective trial, 160 patients were randomized in 2 groups to receive thiopental 5.0 mg/kg, fentanyl 3.0 microg/kg, succinylcholine 1.0 mg/kg, or rocuronium 0.6 mg/kg during RSI. PH and ST were assessed at 24, 48, and 72 h after surgery, VCI were examined by stroboscopy in those patients who had PH >3 days. Excellent and clinically acceptable intubating conditions were significantly increased in the succinylcholine group compared with the rocuronium group: 57% versus 21% and 89% versus 59%, respectively (P < 0.001). The incidence and severity of PH, and VCI between the succinylcholine and the rocuronium groups did not differ significantly: PH: 50% versus 51% (P = 0.99) and VCI: 3% versus 1% (P = 0.98), respectively. Similar findings were found for ST, 39% versus 28% (P = 0.22), and postoperative myalgia, 39% versus 29% (P = 0.25), respectively. Intubating conditions were significantly better in the succinylcholine group compared with the rocuronium group. The incidence and severity of ST and myalgia were not increased in the patients receiving succinylcholine. However, the rate of PH and VCI was similar to the rocuronium group.
Collapse
Affiliation(s)
- Thomas Mencke
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Rostock Germany.
| | | | | | | | | | | | | |
Collapse
|
31
|
Schreiber JU, Mencke T, Pradarutti S, Jeblick S, Fuchs-Buder T. Does preoperatively administered parecoxib prevent succinylcholine-associated myalgia? A randomized, placebo-controlled trial. Eur J Anaesthesiol 2006; 23:332-7. [PMID: 16438751 DOI: 10.1017/s026502150600007x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2005] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Data from several studies implicate that pre-treatment with non-selective cyclooxygenase inhibitors such as aspirin or diclofenac may decrease the incidence of postoperative succinycholine-related myalgia. We tested the influence of a preoperatively administered selective cyclooxygenase 2 inhibitor, parecoxib, on postoperative myalgia. METHODS After Ethics Committee approval, 68 patients were randomized into two groups (n = 34 each). Group 1 received parecoxib 40 mg intravenously 3 min before induction of anaesthesia, and Group 2 received saline (in a double-blinded manner). Incidence and severity of myalgia was evaluated systematically with a standardized questionnaire 24, 48 and 72 h after anaesthesia. We also the assessed the number of patients who felt limited in their activity due to myalgia. RESULTS Seven patients in the parecoxib-treated group complained of myalgia compared with 11 in the control group (not significant). No significant difference in the severity of myalgia or in the limitation of patients activity was found between the groups. CONCLUSION Intravenous parecoxib 40 mg, when administered before induction of anaesthesia, did not reduce incidence and severity of postoperative myalgia and did not improve activity in those who suffered from myalgia.
Collapse
Affiliation(s)
- J-U Schreiber
- University Hospital of the Saarland, Department of Anaesthesia and Critical Care Medicine, Homburg, Germany.
| | | | | | | | | |
Collapse
|
32
|
Mencke T, Echternach M, Plinkert PK, Johann U, Afan N, Rensing H, Noeldge-Schomburg G, Knoll H, Larsen R. Does the Timing of Tracheal Intubation Based on Neuromuscular Monitoring Decrease Laryngeal Injury? A Randomized, Prospective, Controlled Trial. Anesth Analg 2006; 102:306-12. [PMID: 16368848 DOI: 10.1213/01.ane.0000181290.37527.ce] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [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: 11/05/2022]
Abstract
Vocal cord injuries (VCI) and postoperative hoarseness (PH) are common complications after general anesthesia. Poor muscle relaxation at the moment of tracheal intubation may result in VCI. There is a large interindividual variation in neuromuscular depression after administration of neuromuscular blocking drugs. Therefore, the optimal individual timing of tracheal intubation based on neuromuscular monitoring (monitoring) may decrease VCI. In this prospective trial, 60 patients were randomized into 2 groups: Monitoring group: tracheal intubation at maximum block based on monitoring after atracurium 0.5 mg/kg and 2-min group: tracheal intubation 2 min after injection of atracurium 0.5 mg/kg. Intubating conditions were evaluated with the Copenhagen score. VCI were examined by stroboscopy before and 24 and 72 h after surgery. PH was assessed at 24, 48, and 72 h after surgery by a standardized interview. Excellent intubating conditions were significantly increased in the monitoring group compared with the 2-min group: 8 versus 2 patients, respectively (P = 0.036). The incidence of PH between the study groups was comparable: 7 (monitoring) versus 8 patients (2-min) (P = 0.860). Similar findings were observed for VCI: 9 versus 5 patients; respectively (P = 0.268); type of VCI: thickening of the vocal cords: 8 (monitoring) versus 5 (2-min) patients (P = 0.423), hematomas: 2 patients in each group (not significant). The present study demonstrated that neuromuscular monitoring improved endotracheal intubating conditions. However, tracheal intubation at maximum intensity of neuromuscular block was not associated with a decrease in vocal cord injuries.
Collapse
Affiliation(s)
- Thomas Mencke
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Rostock, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
PURPOSE There is increasing evidence for gender differences in the pharmacokinetics and pharmacodynamics of anaesthetic drugs and neuromuscular blocking agents, e.g. rocuronium (Roc). Females require 30% less Roc than males to achieve the same degree of neuromuscular block and onset times are shorter. However, whether this leads to an improvement of the intubation conditions in females is unclear. METHODS After approval of the ethics committee 60 female and 60 male patients were each randomised into 2 groups to receive 0.6 mg/kg body weight Roc or 1.0 mg/kg succinylcholine (Sux; control group). Induction: thiopentone (5 mg/kg), fentanyl (3 microg/kg) then Roc (Roc groups) or Sux (Sux groups) and tracheal intubation after 60 s. Time to intubation, glottic exposure and intubating conditions were assessed. RESULTS Men were significantly larger and heavier (p<0.001) than women, but the body mass index was comparable (ns). Number of attempts, time to intubation, and Cormack grades were comparable (ns). However, the rate of clinically acceptable intubation conditions was significantly higher in the female compared to the male Roc group: 80% vs 47%, p<0.05. The incidence of clinically acceptable intubation conditions in the female Roc and Sux groups were similar (80%). CONCLUSION The intubation conditions after Roc were significantly better in women than in men. The differences were Roc-related and did not occur in the control groups.
Collapse
Affiliation(s)
- T Mencke
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Rostock, Schillingallee 35, 18057 Rostock, Germany.
| | | | | | | | | | | |
Collapse
|
34
|
Mencke T, Schreiber JU, Knoll H, Stracke C, Kleinschmidt S, Rensing H, Silomon M. Women report more pain on injection of a precurarization dose of rocuronium: a randomized, prospective, placebo-controlled trial. Acta Anaesthesiol Scand 2004; 48:1245-8. [PMID: 15504183 DOI: 10.1111/j.1399-6576.2004.00506.x] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether gender influences the perception of pain on injection of rocuronium. METHODS In this prospective, placebo-controlled trial 120 patients were randomized into four groups to receive rocuronium 0.03 mg kg(-1) (40 female and 40 male patients) or saline (20 female and 20 male patients). The incidence and severity of the injection pain after administration of the study drug was compared between female and male patients using a numerical rating scale (0-10). Signs of local irritation, i.e. erythema and thrombophlebitis, were assessed up to 48 h after surgery. RESULTS In 26 (32.5%) of the 80 patients receiving rocuronium, pain on injection was observed. This occurred significantly more frequently in the female compared with male patients: 18 (45%) vs. eight (20%), respectively (P = 0.032). The severity was more pronounced in the women than in the men (P = 0.020). The incidence of the rocuronium-associated pain was significantly increased compared with the Saline groups (P < 0.001). After surgery no patient complained of any residual pain and no local signs were observed in any patient during the study period. CONCLUSIONS Women experienced more pain on injection of rocuronium than men, moreover this is an additional evidence for gender-related differences in pain perception. When rocuronium is used as a precurarization agent, an analgesic pretreatment (e.g. opioids) should be considered, especially for female patients.
Collapse
Affiliation(s)
- T Mencke
- Department of Anaesthesia and Intensive Care Medicine, University of the Saarland, Homburg/Saar, Germany.
| | | | | | | | | | | | | |
Collapse
|
35
|
Mencke T. Die optimale Dosierung von Succinylcholin neu bestimmt. Anaesthesist 2004. [DOI: 10.1007/s00101-004-0659-3] [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: 10/26/2022]
|
36
|
Schreiber JU, Mencke T, Biedler A, Fürst O, Kleinschmidt S, Buchinger H, Fuchs-Buder T. Postoperative myalgia after succinylcholine: no evidence for an inflammatory origin. Anesth Analg 2003; 96:1640-1644. [PMID: 12760988 DOI: 10.1213/01.ane.0000061220.70623.70] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/05/2022]
Abstract
UNLABELLED A common side effect associated with succinylcholine is postoperative myalgia. The pathogenesis of this myalgia is still unclear; inflammation has been suggested but without convincing evidence. We designed the present study to investigate whether an inflammatory reaction contributes to this myalgia. The incidence and severity of succinylcholine-associated myalgia was determined in 64 patients pretreated with saline or dexamethasone before succinylcholine (n = 32 for each). Incidence and severity of myalgia did not differ significantly between the two groups: 15 patients in the dexamethasone group complained of myalgia compared with 18 patients in the saline group, and severe myalgia was reported by five patients and three patients, respectively (not significant). At 48 h after surgery, 12 patients in both groups still suffered from myalgia (not significant). In addition, interleukin-6 (IL-6) as an early marker of inflammation was assessed in a subgroup of 10 patients pretreated with saline. We found an increase of IL-6 for only three patients, but only one patient reported myalgia; no relationship between myalgia and the increase of IL-6 was found. In conclusion, there is no evidence for an inflammatory origin of succinylcholine-associated myalgia. IMPLICATIONS Administration of dexamethasone before succinylcholine was not effective in decreasing the incidence or the severity of succinylcholine-induced postoperative myalgia. Furthermore, there was no significant relationship between postoperative myalgia and time course of interleukin-6 concentrations, a marker of inflammation. Pretreatment with dexamethasone is not justified to prevent postoperative myalgia after succinylcholine.
Collapse
Affiliation(s)
- Jan-Uwe Schreiber
- *Department of Anesthesia and Critical Care Medicine, University of the Saarland, Homburg, Germany; and †Department of Anesthesia, DAR CHU Brabois, Universite[Combining Acute Accent] Henri Poincare[Combining Acute Accent], Nancy 1, France
| | | | | | | | | | | | | |
Collapse
|
37
|
Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, Fuchs-Buder T. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology 2003; 98:1049-56. [PMID: 12717124 DOI: 10.1097/00000542-200305000-00005] [Citation(s) in RCA: 268] [Impact Index Per Article: 12.8] [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: 11/26/2022]
Abstract
BACKGROUND Vocal cord sequelae and postoperative hoarseness during general anesthesia are a significant source of morbidity for patients and a source of liability for anesthesiologists. Several risk factors leading to laryngeal injury have been identified in the past. However, whether the quality of tracheal intubation affects their incidence or severity is still unclear. METHODS Eighty patients were randomized in two groups (n = 40 for each) to receive a propofol-fentanyl induction regimen with or without atracurium. Intubation conditions were evaluated with the Copenhagen Score; postoperative hoarseness was assessed at 24, 48, and 72 h by a standardized interview; and vocal cords were examined by stroboscopy before and 24 and 72 h after surgery. If postoperative hoarseness or vocal cord sequelae persisted, follow-up examination was performed until complete restitution. RESULTS Without atracurium, postoperative hoarseness occurred more often (16 vs. 6 patients; P = 0.02). The number of days with postoperative hoarseness was higher when atracurium was omitted (25 vs. 6 patients; P < 0.001). Similar findings were observed for vocal cord sequelae (incidence of vocal cord sequelae: 15 vs. 3 patients, respectively, P = 0.002; days with vocal cord sequelae: 50 vs. 5 patients, respectively, P < 0.001). Excellent intubating conditions were less frequently associated with postoperative hoarseness compared to good or poor conditions (11, 29, and 57% of patients, respectively; excellent vs. poor: P = 0.008). Similar findings were observed for vocal cord sequelae (11, 22, and 50% of patients, respectively; excellent vs. poor: P = 0.02). CONCLUSIONS The quality of tracheal intubation contributes to laryngeal morbidity, and excellent conditions are less frequently associated with postoperative hoarseness and vocal cord sequelae. Adding atracurium to a propofol-fentanyl induction regimen significantly improved the quality of tracheal intubation and decreased postoperative hoarseness and vocal cord sequelae.
Collapse
Affiliation(s)
- Thomas Mencke
- Department of Anesthesia and Critical Care, University of the Saarland, Homburg/Saar, Germany
| | | | | | | | | | | | | |
Collapse
|
38
|
Mencke T, Becker C, Schreiber J, Bolte M, Fuchs-Buder T. [Precurarization of succinylcholine with cisatracurium: the influence of the precurarization interval]. Anaesthesist 2002; 51:721-5. [PMID: 12232643 DOI: 10.1007/s00101-002-0358-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 10/27/2022]
Abstract
PURPOSE To determine the influence of two different pretreatment intervals, i.e. 3 and 6 min, on the efficacy of 0.01 mg/kg cisatracurium in preventing succinylcholine-induced fasciculations and myalgia. METHODS A total of 60 adult patients were randomized and received either 0.01 mg/kg cisatracurium (0.2*ED(95)) i.v. (Cis 3 group: pretreatment interval 3 min, Cis 6 group: pretreatment interval 6 min) or normal saline i.v. (placebo group) prior to injection of succinylcholine. The incidence and severity of fasciculations and myalgia and side-effects of precurarization were assessed. RESULTS The incidence of muscle fasciculations was only reduced in the Cis 6 group (45%) compared with the Placebo group (85%), p<0.05. Cisatracurium was associated with a higher incidence of paralytic symptoms in both pretreatment groups (Cis 3: 75%, Cis 6: 80%) compared with the Placebo group (30%), p<0.05. CONCLUSION Cisatracurium is only effective in preventing succinylcholine-induced fasciculations when a longer pretreatment interval, i.e. 6 min instead of 3 min, is chosen. Precurarization led to signs of paralysis in both pretreatment groups in the majority (75-80%) of patients without reducing the incidence or severity of postoperative myalgia.
Collapse
Affiliation(s)
- T Mencke
- Klinik für Anästhesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg/Saar, Germany.
| | | | | | | | | |
Collapse
|
39
|
Mencke T, Becker C, Schreiber JU, Fuchs-Buder T. A longer pretreatment interval does not improve cisatracurium precurarization. Can J Anaesth 2002; 49:640-1. [PMID: 12067887 DOI: 10.1007/bf03017402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
40
|
Soltész S, Silomon M, Mencke T, Schlaich N, Fuchs-Buder T. [Neuromuscular blockade with cisatracurium in infants andchildren. Its course under sevoflurane anesthesia]. Anaesthesist 2002; 51:374-7. [PMID: 12125308 DOI: 10.1007/s00101-002-0304-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 10/27/2022]
Abstract
OBJECTIVE To compare the onset, duration and maximum effect of 0.1 mg/kg cisatracurium during balanced anesthesia with sevoflurane and remifentanil between infants and children. METHODS We measured the time course of the neuromuscular blockade in 15 infants and 15 children by electromyography. Anesthesia was induced with propofol/remifentanil and maintained with sevoflurane (constant 2% endtidal) and remifentanil according to the patients individual requirements. After injection of 0.1 mg/kg cisatracurium we measured the following parameters: onset time: time between the beginning of injection of cisatracurium and maximum T1 depression, clinical duration: time between injection of the drug and recovery of T1 to 25%, recovery index: time between recovery of T1 from 25% to 75%. TOFR 0.9: time between injection of cisatracurium and recovery of the train-of-four ratio to 90%. In addition, we determined the maximum neuromuscular blockade Tmax after 0.1 mg/kg cistracurium. RESULTS Both groups differed significantly with regard to onset time and clinical duration. In the infants, the onset time was shorter (74 s vs. 198 s) and the clinical duration longer (55 min vs. 41 min) compared to the older children. The TOFR 0.9 was 73 min (range 56-86 min) in the group of the infants and 59 min (range 43-72 min) in the group of the older children (p < 0.001). Tmax was 100% (range 97-100%) in the infants and 98% (range 92-100%) in the children (p < 0.01). However, the recovery index was comparable in both groups (21 vs. 16 min). CONCLUSIONS Infants are substantially more sensitive to cisatracurium than children, which can be demonstrated in a significantly shorter onset time, a prolonged clinical duration and a delayed neuromuscular recovery. As there exist large interindividual differences, we recommend the use of neuromuscular monitoring in the routine practice of pediatric anesthesia.
Collapse
Affiliation(s)
- S Soltész
- Klinik für Anästhesie und operative Intensivmedizin, Klinikum Leverkusen gGmbH, Dhünnberg 60, 51375 Leverkusen.
| | | | | | | | | |
Collapse
|
41
|
Fuchs-Buder T, Mencke T. Use of reversal agents in day care procedures (with special reference to postoperative nausea and vomiting). Eur J Anaesthesiol Suppl 2002; 23:53-9. [PMID: 11766248] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
There is some confusion about the contribution of reversal of residual paralysis to the occurrence of postoperative nausea and vomiting. The aim of this review is to discuss whether antagonism of residual paralysis is a cause of postoperative nausea and vomiting, and to assess the risk of residual paralysis if the reversal is omitted. Data from a meta-analysis published before 1998 were considered, along with trials published after that date to assess the influence of reversal of residual paralysis on postoperative nausea and vomiting, and the likelihood of harm when antagonism was omitted. Moreover, an overview of pathophysiological consequences, incidence and clinical consequences of residual paralysis is given and the actual criteria of the adequacy of neuromuscular recovery presented. When emetic outcomes are combined across all trials and all different neostigmine doses, there is no beneficial effect from omitting neostigmine on postoperative nausea and vomiting, but there is some evidence of a dose-responsiveness with neostigmine; higher doses may have emetic properties. However, omitting reversal introduces a non-negligent risk of residual paralysis. An improved understanding of the pathological consequences of residual paralysis (i.e. impaired laryngeal and pharyngeal muscle function, alterations in hypoxic ventilatory control, reduced margin of safety) led to establishment of more rigorous criteria for defining adequacy of neuromuscular recovery. A train-of-four ratio of > or = 0.9 is now accepted as the index of adequate recovery of neuromuscular function. Applying this new definition, residual paralysis becomes a frequent adverse side-effect. Neuromuscular recovery should therefore be routinely monitored in ambulatory patients and residual paralysis prevented by reversing neuromuscular block.
Collapse
Affiliation(s)
- T Fuchs-Buder
- Department of Anaesthesia and Critical Care, University of the Saarland, D-66421 Homburg/Saar, Germany.
| | | |
Collapse
|
42
|
Abstract
IMPLICATIONS This study demonstrated that pretreatment of succinylcholine with rocuronium failed to decrease the incidence or the severity of postoperative myalgia. However, in most patients, pretreatment was associated with muscle weakness before loss of consciousness. Thus, there is no convincing evidence supporting routine pretreatment with succinylcholine.
Collapse
Affiliation(s)
- Thomas Mencke
- Department of Anesthesia and Critical Care Medicine, University of the Saarland, Saar, Germany
| | | | | | | | | |
Collapse
|
43
|
Mencke T, Beerhalter U, Fuchs-Buder T. Spontaneous movements, local reactions and pain on injection of rocuronium. A comparison between female and male patients. Acta Anaesthesiol Scand 2001; 45:1002-5. [PMID: 11576052 DOI: 10.1034/j.1399-6576.2001.450813.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [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: 11/23/2022]
Abstract
BACKGROUND We investigated the incidence of withdrawal, local reactions and pain on injection of rocuronium in 120 adult ASA I-II patients undergoing general anaesthesia (group A: 60 male patients, group B: 60 female patients). METHODS After induction of anaesthesia with propofol and remifentanil, rocuronium 0.6 mg kg(-1) was injected in a separate intravenous cannula on the opposite arm. The patient's response to the injection of rocuronium was graded using a four-point scale. The appearance of local signs (i.e. erythema, venous sequelae) on the arm where rocuronium had been injected was recorded at the end of the injection as well as 1 h and 24 h after recovery from anaesthesia. Moreover, patients were asked 24 h after recovery from anaesthesia whether they had recall of pain or movements in this arm during induction of anaesthesia. RESULTS In 26 of the 120 patients (22%) included, withdrawal reactions after injection of rocuronium were observed. Of these 26 patients, 16 (13%) had severe movements. The overall incidence of withdrawal reactions after rocuronium as well as the incidence of severe reactions was significantly higher in female patients compared to male patients (overall incidence: 18 females (30%) vs. 8 males (13%), P<0.05; severe reaction: 13 females (22%) vs. 3 males (5%), P<0.05). No local reactions were observed and no patient remembered any pain or movements during induction of anaesthesia. CONCLUSION The incidence and the degree of withdrawal reactions in response to the injection of rocuronium were significantly higher in women than in men. This was not associated with adverse clinical consequences for the patient's outcome.
Collapse
Affiliation(s)
- T Mencke
- Department of Anaesthesia and Critical Care, University of the Saarland, Homburg/Saar, Germany
| | | | | |
Collapse
|
44
|
Affiliation(s)
- T Fuchs-Buder
- Klinik für Anaesthesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, 66421 Homburg/Saar
| | | |
Collapse
|
45
|
Solt??sz S, Mencke T, Schlaich N, Fuchs-Buder T. Co-Induction of Anaesthesia with Desflurane Improves Intubating Conditions after Low-Dose Rocuronium. Clin Drug Investig 2001. [DOI: 10.2165/00044011-200121060-00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
46
|
Grundmann U, Mencke T, Soltesz S, Fuchs-Buder T. Onset Properties of Rocuronium during Co-Induction of Anaesthesia with Desflurane and Isoflurane or Total Intravenous Anaesthesia. Clin Drug Investig 2000. [DOI: 10.2165/00044011-200020050-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
47
|
Mencke T, Soltész S, Grundmann U, Bauer M, Schlaich N, Larsen R, Fuchs-Buder T. [Time course of neuromuscular blockade after rocuronium. A comparison between women and men]. Anaesthesist 2000; 49:609-12. [PMID: 10969386 DOI: 10.1007/s001010070077] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 10/27/2022]
Abstract
BACKGROUND We studied 40 patients (20 female and 20 male) undergoing elective surgery under general anaesthesia to evaluate the effect of gender on the pharmacodynamics of rocuronium. METHODS Using electromyography (EMG) we determined the maximal neuromuscular block and time course of action of 0.45 mg/kg rocuronium (1.5 x ED95). RESULTS Age and body mass index were comparable between females and males (38 (+/- 8) vs. 37 (+/- 10) years and 24.2 (+/- 2.9) vs. 25.2 (+/- 1.7) kg/m2. However, significant differences in weight and height were found between females and males (65.7 +/- 9.3 kg vs. 77.5 +/- 5.5 kg; p < 0.01 and 178 +/- 6.8 cm vs. 164 +/- 6.7 cm; p < 0.01). Onset time was shorter in females (168 +/- 65 s vs. 211 +/- 56 s; p < 0.05). Maximal neuromuscular blockade after 0.45 mg/kg rocuronium was 94 (+/- 3) % in females and 89 (+/- 6) % in males; p < 0.01. Clinical duration was increased in females (23 +/- 5 min vs. 17 +/- 5 min; p < 0.05), while the recovery index was comparable between both groups (9 +/- 4 min in females and 9 +/- 3 min in males; n.s.). CONCLUSION Compared to men neuromuscular blockade after 0.45 mg/kg rocuronium was more pronounced in women. The onset time was shortened and the clinical duration increased in female patients.
Collapse
Affiliation(s)
- T Mencke
- Klinik für Anaesthesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg/Saar
| | | | | | | | | | | | | |
Collapse
|
48
|
Stober HD, Mencke T. [General anesthesia or spinal anesthesia for hip prosthesis replacement? Studies of acceptance of both procedures by patients]. Anaesthesiol Reanim 2000; 24:151-6. [PMID: 10675955] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Patients undergoing total hip replacement are given general anaesthesia or spinal anaesthesia. The aim of this study was to investigate the experiences of patients before, during and after general anaesthesia (68 patients) or spinal anaesthesia (77 patients). Our investigation revealed that with regard to complications (nausea and vomiting, headache and back pains), no differences between the two methods occurred. Between 25 and 30% of the patients in both groups had these complications, although there were differences between both groups regarding their concomitant diseases and medication. Patients with spinal anaesthesia had a three times higher incidence of cardiac concomitant diseases and received corresponding drugs more frequently. We found that the time of postoperative analgesia after spinal anaesthesia (210 minutes) was significantly longer than after general anaesthesia (90 minutes). The majority of the patients in both groups (approximately 90%) were satisfied with the chosen method of anaesthesia and with the postoperative pain therapy. These findings make it possible to conclude that with the exception of differences in the postoperative analgesia time, there are no differences between general anaesthesia and spinal anaesthesia regarding complications and satisfaction of the patients with both methods of anaesthesia.
Collapse
Affiliation(s)
- H D Stober
- Abteilung für Anästhesie, Intensivtherapie und Schmerztherapie, Krankenhausbetriebes von Berlin-Hellersdorf
| | | |
Collapse
|