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Gude P, Geldermann N, Georgevici AI, Herzog‐Niescery J, Weber TP, Vogelsang H, Dazert S, van Ackeren K, Volkenstein S. Pain in children undergoing tonsillotomy with alternating ibuprofen and paracetamol - a prospective observational study. Acta Anaesthesiol Scand 2021; 65:1374-1380. [PMID: 34310700 DOI: 10.1111/aas.13959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal pain therapy for children undergoing tonsillotomy remains unknown. Our aim was to evaluate a standard pain therapy including the alternating application of ibuprofen and paracetamol. METHODS Pain intensity of 81 in-patients after tonsillotomy aged 2-12 years was evaluated three times daily (mean observation 3.85 days) using the Children's and Infants' Postoperative Pain Scale (CHIPPS) in children <5 years, or with the Faces Pain Scale-Revised (FPS-R) in older children. Parents completed the Parents' Postoperative Pain Measure (PPPM-D) in addition. Exceeding the cut-off value in one of the scores implied the indication for an opioid rescue medication (RM). Endpoints were number of children with indication for the RM, course of pain, concordance between pain scales, and adverse events. RESULTS Overall, 45.7% of children needed the RM either in the recovery room or on the ward. The rate of children having an indication for RM on the ward was 30.9%. The highest proportion of affected children was identified on the day of surgery (32.1%). Most indications were detected with the PPPM-D only. A comparison with an earlier study showed less affected children compared to ibuprofen monotherapy on the day of surgery and the first postoperative day. Eleven children (13.6%) developed fever. CONCLUSION Although our pain therapy concept was effective from postoperative day 1 onwards, it needs improvement for the day of surgery. The overall concordance between the PPPM-D and CHIPPS or FPS-R was low. Fever might be a confounder for the pain intensity measurement with the PPPM-D.
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Affiliation(s)
- Philipp Gude
- Department of Anesthesiology Ruhr‐University BochumSt. Josef‐ and St. Elisabeth‐Hospital Bochum Germany
| | - Niclas Geldermann
- Department of Anesthesiology Ruhr‐University BochumSt. Josef‐ and St. Elisabeth‐Hospital Bochum Germany
| | - Adrian I. Georgevici
- Department of Anesthesiology Ruhr‐University BochumSt. Josef‐ and St. Elisabeth‐Hospital Bochum Germany
| | - Jennifer Herzog‐Niescery
- Department of Anesthesiology Ruhr‐University BochumSt. Josef‐ and St. Elisabeth‐Hospital Bochum Germany
| | - Thomas Peter Weber
- Department of Anesthesiology Ruhr‐University BochumSt. Josef‐ and St. Elisabeth‐Hospital Bochum Germany
| | - Heike Vogelsang
- Department of Anesthesiology Ruhr‐University BochumSt. Josef‐ and St. Elisabeth‐Hospital Bochum Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head & Neck Surgery Ruhr‐University BochumSt. Elisabeth‐Hospital Bochum Germany
| | - Konstantin van Ackeren
- Department of Otorhinolaryngology, Head & Neck Surgery Ruhr‐University BochumSt. Elisabeth‐Hospital Bochum Germany
| | - Stefan Volkenstein
- Department of Otorhinolaryngology, Head & Neck Surgery Ruhr‐University BochumSt. Elisabeth‐Hospital Bochum Germany
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Meiser A, Volk T, Wallenborn J, Guenther U, Becher T, Bracht H, Schwarzkopf K, Knafelj R, Faltlhauser A, Thal SC, Soukup J, Kellner P, Drüner M, Vogelsang H, Bellgardt M, Sackey P. Inhaled isoflurane via the anaesthetic conserving device versus propofol for sedation of invasively ventilated patients in intensive care units in Germany and Slovenia: an open-label, phase 3, randomised controlled, non-inferiority trial. Lancet Respir Med 2021; 9:1231-1240. [PMID: 34454654 DOI: 10.1016/s2213-2600(21)00323-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies indicate that isoflurane could be useful for the sedation of patients in the intensive care unit (ICU), but prospective studies evaluating isoflurane's efficacy have been small. The aim of this study was to test whether the sedation with isoflurane was non-inferior to sedation with propofol. METHODS This phase 3, randomised, controlled, open-label non-inferiority trial evaluated the efficacy and safety of up to 54 h of isoflurane compared with propofol in adults (aged ≥18 years) who were invasively ventilated in ICUs in Germany (21 sites) and Slovenia (three sites). Patients were randomly assigned (1:1) to isoflurane inhalation via the Sedaconda anaesthetic conserving device (ACD; Sedana Medical AB, Danderyd, Sweden; ACD-L [dead space 100 mL] or ACD-S [dead space 50 mL]) or intravenous propofol infusion (20 mg/mL) for 48 h (range 42-54) using permuted block randomisation with a centralised electronic randomisation system. The primary endpoint was percentage of time in Richmond Agitation-Sedation Scale (RASS) range -1 to -4, assessed in eligible participants with at least 12 h sedation (the per-protocol population), five or more RASS measurements, and no major protocol violations, with a non-inferiority margin of 15%. Key secondary endpoints were opioid requirements, spontaneous breathing, time to wake-up and extubation, and adverse events. Safety was assessed in all patients who received at least one dose. The trial is complete and registered with EudraCT, 2016-004551-67. FINDINGS Between July 2, 2017, and Jan 12, 2020, 338 patients were enrolled and 301 (89%) were randomly assigned to isoflurane (n=150) or propofol (n=151). 146 patients (97%) in each group completed the 24-h follow-up. 146 (97%) patients in the isoflurane group and 148 (98%) of patients in the propofol group were included in the per-protocol analysis of the primary endpoint. Least-squares mean percentage of time in RASS target range was 90·7% (95% CI 86·8-94·6) for isoflurane and 91·1% (87·2-95·1) for propofol. With isoflurane sedation, opioid dose intensity was 29% lower than with propofol for the overall sedation period (0·22 [0·12-0·34] vs 0·32 [0·21-0·42] mg/kg per h morphine equivalent dose, p=0·0036) and spontaneous breathing was more frequent on day 1 (odds ratio [OR] 1·72 [1·12-2·64], generalised mixed linear model p=0·013, with estimated rates of 50% of observations with isoflurane vs 37% with propofol). Extubation times were short and median wake-up was significantly faster after isoflurane on day 2 (20 min [IQR 10-30] vs 30 min [11-120]; Cox regression p=0·0011). The most common adverse events by treatment group (isoflurane vs propofol) were: hypertension (ten [7%] of 150 vs two [1%] of 151), delirium (eight [5%] vs seven [5%]), oliguria (seven [5%] vs six [4%]), and atrial fibrillation (five [3%] vs four [3%]). INTERPRETATION These results support the use of isoflurane in invasively ventilated patients who have a clinical need for sedation. FUNDING Sedana Medical AB.
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Affiliation(s)
- Andreas Meiser
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Jan Wallenborn
- Department of Anesthesiology and Intensive Care Medicine, Helios Klinikum Aue, Aue, Germany
| | - Ulf Guenther
- University Clinic of Anaesthesiology, Intensive Care, Emergency Medicine, Pain Therapy, Klinikum Oldenburg, Oldenburg, Germany
| | - Tobias Becher
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hendrik Bracht
- Department of Emergency Medicine, and Department of Anesthesiology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - Konrad Schwarzkopf
- Department of Anesthesia and Intensive Care, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Rihard Knafelj
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | - Serge C Thal
- Helios University Hospital Wuppertal, University of Witten-Herdecke, Department of Anesthesiology, Wuppertal, Germany; University Medical Center of the Johannes Gutenberg-University Mainz, Department of Anesthesiology, Mainz, Germany
| | - Jens Soukup
- Department of Anaesthesiology, Intensive Care Medicine and Palliative Care Medicine, Carl-Thiem-Hospital, Cottbus, Germany
| | - Patrick Kellner
- Department of Anesthesiology and Intensive Care, University of Lübeck, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Matthias Drüner
- Department of Anaesthesiology and Intensive Care Medicine, Emden Hospital, Emden, Germany
| | - Heike Vogelsang
- St Josef-Hospital Bochum, Department of Anaesthesiology and Intensive Care Medicine, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Martin Bellgardt
- St Josef-Hospital Bochum, Department of Anaesthesiology and Intensive Care Medicine, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Peter Sackey
- Department of Physiology and Pharmacology, Unit of Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden
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Wetterkamp M, Meiser A, Weber TP, Vogelsang H, Lange T, Trost M, Bellgardt M. Spontaneous breathing for managing analgesia during balanced anesthesia with remifentanil and desflurane: a prospective, single center randomized controlled trial. Med Gas Res 2021; 11:94-99. [PMID: 33942778 PMCID: PMC8174411 DOI: 10.4103/2045-9912.310606] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The main goal of anesthesiology is to achieve the best level of analgesia and a fast recovery of consciousness following anesthesia. The preservation of spontaneous breathing during general anesthesia with anesthetic gases is practiced by many anesthetists. However, very few studies have dealt with these positive properties of volatile anesthetics such as sevoflurane or desflurane. Remifentanil is a very short half-life opiate that combines sufficient intra-operative analgesia with a fast post-operative recovery time. We tested the hypothesis that spontaneous breathing can reduce overdosing with remifentanil during desflurane anesthesia. In this prospective, single center, multiple anesthetist study, 30 patients were randomized into two groups (volume-controlled ventilation mode and spontaneous breathing). The spontaneous breathing group showed a significantly lower post-operative pain level than the volume-controlled ventilation mode group. Furthermore, less remifentanil as well as less piritramide was needed in the spontaneous breathing group compared with volume-controlled ventilation mode. It was possible to achieve spontaneous breathing in all patients with 0.6 minimum alveolar concentration desflurane, in order to control the remifentanil rate and prevent an overdose. All spontaneous breathing patients had low intra- and post-operative pain levels and the need for analgesics was equal to or lower than that in the volume-controlled ventilation mode group. By reducing the intra-operative amount of opiates, both the post-operative pain and the amount of post-operative analgesia required can be reduced. A balanced anesthesia with spontaneous intra-operative breathing is needed to determine the required amount of opiates. This study was approved by the Ethic Committee of the Ruhr-University of Bochum (approval No. 2435) in September, 2004.
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Affiliation(s)
- Mark Wetterkamp
- Department of Orthopedics and Traumatology, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Andreas Meiser
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Peter Weber
- Department of Anesthesiology and Intensive Care Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Heike Vogelsang
- Department of Anesthesiology and Intensive Care Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Tobias Lange
- Department of Orthopedics and Traumatology, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Matthias Trost
- Department of Orthopedics and Traumatology, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Martin Bellgardt
- Department of Anesthesiology and Intensive Care Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
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Wolters A, Reuther J, Gude P, Weber T, Theiss C, Vogelsang H, Matschke V. Teriflunomide provides protective properties after oxygen-glucose-deprivation in hippocampal and cerebellar slice cultures. Neural Regen Res 2021; 16:2243-2249. [PMID: 33818508 PMCID: PMC8354112 DOI: 10.4103/1673-5374.310689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
One of the major challenges in emergency medicine is out-of-hospital cardiac arrest (OHCA). Every year, about 53-62/100 000 people worldwide suffer an out-of-hospital cardiac arrest with serious consequences, whereas persistent brain injury is a major cause of morbidity and mortality of those surviving a cardiac arrest. Today, only few and insufficient strategies are known to limit neurological damage of ischemia and reperfusion injury. The aim of the present study was to investigate whether teriflunomide, an approved drug for treatment of relapsing-remitting-multiple-sclerosis, exerts a protective effect on brain cells in an in vitro model of ischemia. Therefore, organotypic slice cultures from rat hippocampus and cerebellum were exposed to oxygen-glucose-deprivation and subsequently treated with teriflunomide. The administration of teriflunomide in the reperfusion time on both hippocampal and cerebellar slice cultures significantly decreased the amount of detectable propidium iodide signal compared with an untreated culture, indicating that more cells survive after oxygen-glucose-deprivation. However, hippocampal slice cultures showed a higher vulnerability to ischemic conditions and a more sensitive response to teriflunomide compared with cerebellar slice cultures. Our study suggests that teriflunomide, applied as a post-treatment after an oxygen-glucose-deprivation, has a protective effect on hippocampal and cerebellar cells in organotypic slice cultures of rats. All procedures were conducted under established standards of the German federal state of North Rhine Westphalia, in accordance with the European Communities Council Directive 2010/63/EU on the protection of animals used for scientific purposes.
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Affiliation(s)
- Anna Wolters
- Institute of Anatomy, Department of Cytology, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Judith Reuther
- Institute of Anatomy, Department of Cytology, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Philipp Gude
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr University Bochum, St. Josef Hospital, Bochum, Germany
| | - Thomas Weber
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr University Bochum, St. Josef Hospital, Bochum, Germany
| | - Carsten Theiss
- Institute of Anatomy, Department of Cytology, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Heike Vogelsang
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr University Bochum, St. Josef Hospital, Bochum, Germany
| | - Veronika Matschke
- Institute of Anatomy, Department of Cytology, Medical Faculty, Ruhr University Bochum, Bochum, Germany
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Nikolic M, Stift A, Reinisch W, Vogelsang H, Matic A, Müller C, von Strauss Und Torney M, Riss S. Allogeneic expanded adipose-derived stem cells in the treatment of rectovaginal fistulas in Crohn's disease. Colorectal Dis 2021; 23:153-158. [PMID: 32810356 PMCID: PMC7891611 DOI: 10.1111/codi.15324] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
AIM Crohn's disease (CD)-related rectovaginal fistulas (RVFs) are rare, challenging to treat and associated with a high morbidity. Due to a significant lack of data, we aimed to analyse the safety and feasibility of allogeneic adipose-derived stem cells (ASCs) in the treatment of CD-related RVF. METHOD Four consecutive patients with CD-related RVF underwent treatment with expanded allogeneic ASCs extracted from a healthy donor in a tertiary referral centre in 2019. None of the patients had an intestinal diversion at the time of the treatment. Follow-up was performed 6 months postoperatively. RESULTS The median operation time was 45 min with a median hospital stay of 3 days. No intra-operative complications occurred. Three patients (75%) developed recurrent RVF after a median follow-up of 19 days. Two patients required surgical treatment including loose seton drainage due to discharge and pain. One patient developed recurrence of symptoms after 10 days, but refused further surgical therapy. Only one patient (25%) showed healing of the RVF, with re-epithelialization of both the vaginal and rectal opening and absence of clinical symptoms. CONCLUSION Expanded allogeneic ASC therapy represents a novel safe treatment option for CD-associated RVF. Although efficacy appears limited, further controlled studies are required to draw robust conclusions.
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Affiliation(s)
- M Nikolic
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - A Stift
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - W Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - H Vogelsang
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - A Matic
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - C Müller
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - M von Strauss Und Torney
- Department of Visceral Surgery, St Clara Hospital and University Hospital Basel, Clarunis University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - S Riss
- Department of Surgery, Medical University of Vienna, Vienna, Austria
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Gude P, Kaci CSB, Sieker M, Vogelsang H, Bellgardt M, Herzog-Niescery J, Weber TP, Weber J, Teubner S, Kern P. The influence of labor epidural analgesia on maternal, uteroplacental and fetoplacental hemodynamics in normotensive parturients: a prospective observational study. Int J Obstet Anesth 2020; 45:83-89. [PMID: 33298344 DOI: 10.1016/j.ijoa.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epidural analgesia provides sufficient analgesia during labor but can cause hypotension despite various prophylactic measures. We studied its effects on pre-placental, fetoplacental, and fetal hemodynamics using Doppler ultrasound. The primary endpoint was the pulsatility index of the umbilical artery at 30 min after establishing epidural analgesia. Secondary endpoints included maternal blood pressures and neonatal outcome data. METHODS We included healthy parturients at a cervical dilation ≥2 cm, with or without a request for epidural analgesia (n=32 per group). Ultrasound studies of the uterine arteries, umbilical artery and fetal middle cerebral artery were performed before insertion of the epidural catheter, and 30, 60 and 90 min after; the same time-points were assessed in the non-epidural control group. Maternal blood pressure was measured by a continuous non-invasive arterial pressure monitor. RESULTS Ultrasound studies detected no significant differences in pulsatility indices over time in any blood vessel. In contrast to the control group, maternal blood pressures were significantly lower for all measures after the onset of analgesia compared with baseline values (mean systolic pressure decreased from 132.7 ± 15.9 mmHg to 123.1 ± 14.4 mmHg at 30 min, P=0.003). The mean pH value of the umbilical arterial blood was 7.29 (±0.06) in the epidural group versus 7.31 (±0.08) in the control group (P=0.33). The median Apgar score at 5 min was 10 in both groups. CONCLUSIONS Pre-placental, fetoplacental and fetal hemodynamics remained stable despite a statistically significant decrease in maternal blood pressure in laboring parturients receiving epidural analgesia.
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Affiliation(s)
- P Gude
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany.
| | - C S B Kaci
- Department of Obstetrics and Gynaecology, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - M Sieker
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - H Vogelsang
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - M Bellgardt
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - J Herzog-Niescery
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - T P Weber
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - J Weber
- Department of Obstetrics and Gynaecology, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - S Teubner
- Department of Obstetrics and Gynaecology, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - P Kern
- Department of Obstetrics and Gynaecology, Ruhr-University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
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Vogelsang H, Lang A, Cevik B, Botteck NM, Weber TP, Herzog‐Niescery J. Incidence of infection in non-tunnelled thoracic epidural catheters after major abdominal surgery. Acta Anaesthesiol Scand 2020; 64:1312-1318. [PMID: 32521043 DOI: 10.1111/aas.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/07/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Thoracic epidural analgesia is beneficial after major abdominal surgery, though side-effects and complications are rare but potentially devastating. The incidence of catheter-related infection is approximately 5.5%. Several guidelines have been recommended to prevent complications during thoracic epidural catheterization. Tunnelling is often recommended to reduce the incidence of infections and dislocations. METHODS A retrospective, single-centre analysis of our acute pain service database was performed between 2010 and 2018. The hygiene measures of the German Society of Anaesthesiology have been incorporated in our standard operating protocol since 2009. The procedure remained constant, but the skin disinfectant was changed from propan-2-ol to propan-2-ol with octenidine in 2014. Tunnelling of catheters was not performed. We analysed the incidence of catheter-related infections (primary endpoint) and effect of the used disinfectant (secondary endpoint). RESULTS A total of 2755 patients underwent elective major abdominal surgery with thoracic epidural catheterization. Sixteen patients (0.6%) showed symptoms of mild catheter-related infection. Moderate or severe infections were not observed in any patient. The type of disinfectant did not show any significant effect on the incidence of infection. CONCLUSION The incidence of catheter-related infections was low, and only mild signs of infection were observed. Non-tunnelling could be an alternative to tunnelling, especially if hygiene protocols are followed, and the duration of catheter use is short. A comprehensive database and regular examinations by trained staff are essential for early detection of abnormalities and immediate removal of the catheter, if required.
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Affiliation(s)
- Heike Vogelsang
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Alexander Lang
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Bilal Cevik
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Nikolaj M. Botteck
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Thomas P. Weber
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Jennifer Herzog‐Niescery
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
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Herzog-Niescery J, Seipp HM, Bellgardt M, Herzog T, Belyaev O, Uhl W, Gude P, Weber TP, Vogelsang H. Comparison of 3 Methods to Assess Occupational Sevoflurane Exposure in Abdominal Surgeons: A Single-Center Observational Pilot Study. Anesth Analg 2020; 131:537-543. [PMID: 31295179 DOI: 10.1213/ane.0000000000004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Studies demonstrated that operating room personnel are exposed to anesthetic gases such as sevoflurane (SEVO). Measuring the gas burden is essential to assess the exposure objectively. Air pollution measurements and the biological monitoring of urinary SEVO and its metabolite hexafluoroisopropanol (HFIP) are possible approaches. Calculating the mass of inhaled SEVO is an alternative, but its predictive power has not been evaluated. We investigated the SEVO burdens of abdominal surgeons and hypothesized that inhaled mass calculations would be better suited than pollution measurements in their breathing zones (25 cm around nose and mouth) to estimate urinary SEVO and HFIP concentrations. The effects of potentially influencing factors were considered. METHODS SEVO pollution was continuously measured by photoacoustic gas monitoring. Urinary SEVO and HFIP samples, which were collected before and after surgery, were analyzed by a blinded environmental toxicologist using the headspace gas chromatography-mass spectrometry method. The mass of inhaled SEVO was calculated according to the formula mVA = cVA·(Equation is included in full-text article.)·t·ρ VA aer. (mVA: inhaled mass; cVA: volume concentration; (Equation is included in full-text article.): respiratory minute volume; t: exposure time; and ρ VA aer.: gaseous density of SEVO). A linear multilevel mixed model was used for data analysis and comparisons of the different approaches. RESULTS Eight surgeons performed 22 pancreatic resections. Mean (standard deviation [SD]) SEVO pollution was 0.32 ppm (0.09 ppm). Urinary SEVO concentrations were below the detection limit in all samples, whereas HFIP was detectable in 82% of the preoperative samples in a mean (SD) concentration of 8.53 µg·L (15.53 µg·L; median: 2.11 µg·L, interquartile range [IQR]: 4.58 µg·L) and in all postoperative samples (25.42 µg·L [21.39 µg·L]). The mean (SD) inhaled SEVO mass was 5.67 mg (2.55 mg). The postoperative HFIP concentrations correlated linearly to the SEVO concentrations in the surgeons' breathing zones (β = 216.89; P < .001) and to the calculated masses of inhaled SEVO (β = 4.17; P = .018). The surgeon's body mass index (BMI), age, and the frequency of surgeries within the last 24 hours before study entry did not influence the relation between HFIP concentration and air pollution or inhaled mass, respectively. CONCLUSIONS The biological SEVO burden, expressed as urinary HFIP concentration, can be estimated by monitoring SEVO pollution in the personnel's individual breathing zone. Urinary SEVO was not an appropriate biomarker in this setting.
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Affiliation(s)
- Jennifer Herzog-Niescery
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Hans-Martin Seipp
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Martin Bellgardt
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Torsten Herzog
- Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Orlin Belyaev
- Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Waldemar Uhl
- Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Philipp Gude
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Thomas P Weber
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Heike Vogelsang
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
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Gude P, Gustedt F, Bellgardt M, Vogelsang H, Herzog-Niescery J, Dazert S, Weber TP, Volkenstein S. High dose ibuprofen as a monotherapy on an around-the-clock basis fails to control pain in children undergoing tonsil surgery: a prospective observational cohort study. Eur Arch Otorhinolaryngol 2020; 277:2115-2124. [DOI: 10.1007/s00405-020-05929-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/16/2020] [Indexed: 12/14/2022]
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Bellgardt M, Georgevici AI, Klutzny M, Drees D, Meiser A, Gude P, Vogelsang H, Weber TP, Herzog-Niescery J. Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial. Ann Intensive Care 2019; 9:118. [PMID: 31620921 PMCID: PMC6795651 DOI: 10.1186/s13613-019-0594-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/30/2019] [Accepted: 10/05/2019] [Indexed: 12/22/2022] Open
Abstract
Background The MIRUS™ (TIM, Koblenz, Germany) is an electronical gas delivery system, which offers an automated MAC (minimal alveolar concentration)-driven application of isoflurane, sevoflurane, or desflurane, and can be used for sedation in the intensive care unit. We investigated its consumption of volatile anesthetics at 0.5 MAC (primary endpoint) and the corresponding costs. Secondary endpoints were the technical feasibility to reach and control the MAC automatically, the depth of sedation at 0.5 MAC, and awakening times. Mechanically ventilated and sedated patients after major surgery were enrolled. Upon arrival in the intensive care unit, patients obtained intravenous propofol sedation for at least 1 h to collect ventilation and blood gas parameters, before they were switched to inhalational sedation using MIRUS™ with isoflurane, sevoflurane, or desflurane. After a minimum of 2 h, inhalational sedation was stopped, and awakening times were recorded. A multivariate electroencephalogram and the Richmond Agitation Sedation Scale (RASS) were used to assess the depth of sedation. Vital signs, ventilation parameters, gas consumption, MAC, and expiratory gas concentrations were continuously recorded. Results Thirty patients obtained inhalational sedation for 18:08 [14:46–21:34] [median 1st–3rd quartiles] hours. The MAC was 0.58 [0.50–0.64], resulting in a Narcotrend Index of 37.1 [30.9–42.4] and a RASS of − 3.0 [− 4.0 to (− 3.0)]. The median gas consumption was significantly lowest for isoflurane ([ml h−1]: isoflurane: 3.97 [3.61–5.70]; sevoflurane: 8.91 [6.32–13.76]; and desflurane: 25.88 [20.38–30.82]; p < 0.001). This corresponds to average costs of 0.39 € h−1 for isoflurane, 2.14 € h−1 for sevoflurane, and 7.54 € h−1 for desflurane. Awakening times (eye opening [min]: isoflurane: 9:48 [4:15–20:18]; sevoflurane: 3:45 [0:30–6:30]; desflurane: 2:00 [1:00–6:30]; p = 0.043) and time to extubation ([min]: isoflurane: 10:10 [8:00–20:30]; sevoflurane: 7:30 [4:37–14:22]; desflurane: 3:00 [3:00–6:00]; p = 0.007) were significantly shortest for desflurane. Conclusions A target-controlled, MAC-driven automated application of volatile anesthetics is technically feasible and enables an adequate depth of sedation. Gas consumption was highest for desflurane, which is also the most expensive volatile anesthetic. Although awakening times were shortest, the actual time saving of a few minutes might be negligible for most patients in the intensive care unit. Thus, using desflurane seems not rational from an economic perspective. Trial registration Clinical Trials Registry (ref.: NCT03860129). Registered 24 September 2018—Retrospectively registered.
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Affiliation(s)
- Martin Bellgardt
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.
| | - Adrian Iustin Georgevici
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Mitja Klutzny
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Dominik Drees
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Andreas Meiser
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Philipp Gude
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Heike Vogelsang
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Thomas Peter Weber
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Jennifer Herzog-Niescery
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
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Herzog-Niescery J, Steffens T, Bellgardt M, Breuer-Kaiser A, Gude P, Vogelsang H, Weber TP, Seipp HM. Photoacoustic gas monitoring for anesthetic gas pollution measurements and its cross-sensitivity to alcoholic disinfectants. BMC Anesthesiol 2019; 19:148. [PMID: 31399025 PMCID: PMC6689173 DOI: 10.1186/s12871-019-0822-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/10/2019] [Accepted: 08/06/2019] [Indexed: 11/14/2022] Open
Abstract
Background Real-time photoacoustic gas monitoring is used for personnel exposure and environmental monitoring, but its accuracy varies when organic solvents such as alcohol contaminate measurements. This is problematic for anesthetic gas measurements in hospitals, because most disinfectants contain alcohol, which could lead to false-high gas concentrations. We investigated the cross-sensitivities of the photoacoustic gas monitor Innova 1412 (AirTech Instruments, LumaSense, Denmark) against alcohols and alcoholic disinfectants while measuring sevoflurane, desflurane and isoflurane in a laboratory and in hospital during surgery. Methods 25 mL ethyl alcohol was distributed on a hotplate. An optical filter for isoflurane was used and the gas monitor measured the ‘isoflurane’ concentration for five minutes with the measuring probe fixed 30 cm above the hotplate. Then, 5 mL isoflurane was added vaporized via an Anesthetic Conserving Device (Sedana Medical, Uppsala, Sweden). After one-hour measurement, 25 mL isopropyl alcohol, N-propanol, and two alcoholic disinfectants were subsequently added, each in combination with 5 mL isoflurane. The same experiment was in turn performed for sevoflurane and desflurane. The practical impact of the cross-sensitivity was investigated on abdominal surgeons who were exposed intraoperatively to sevoflurane. A new approach to overcome the gas monitor’s cross-sensitivity is presented. Results Cross-sensitivity was observed for all alcohols and its strength characteristic for the tested agent. Simultaneous uses of anesthetic gases and alcohols increased the concentrations and the recovery times significantly, especially while sevoflurane was utilized. Intraoperative measurements revealed mean and maximum sevoflurane concentrations of 0.61 ± 0.26 ppm and 15.27 ± 14.62 ppm. We replaced the cross-sensitivity peaks with the 10th percentile baseline of the anesthetic gas concentration. This reduced mean and maximum concentrations significantly by 37% (p < 0.001) and 86% (p < 0.001), respectively. Conclusion Photoacoustic gas monitoring is useful to detect lowest anesthetic gases concentrations, but cross-sensitivity caused one third falsely high measured mean gas concentration. One possibility to eliminate these peaks is the recovery time-based baseline approach. Caution should be taken while measuring sevoflurane, since marked cross-sensitivity peaks are to be expected.
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Affiliation(s)
- Jennifer Herzog-Niescery
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.
| | - Thomas Steffens
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Martin Bellgardt
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Andreas Breuer-Kaiser
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Philipp Gude
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Heike Vogelsang
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Thomas Peter Weber
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Hans-Martin Seipp
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
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Herzog-Niescery J, Bartz H, Vogelsang H, Bunse J, Maier-Hasselmann A, Bellgardt M, Gude P, Weber TP, Seipp HM. Kinetics of isoflurane and sevoflurane in a unidirectional displacement flow and the relevance to anesthetic gas exposure by operating room personnel. J Occup Environ Hyg 2019; 16:294-301. [PMID: 30852983 DOI: 10.1080/15459624.2019.1577965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
International guidelines recommend the use of ventilation systems in operating rooms to reduce the concentration of potentially hazardous substances such as anesthetic gases. The exhaust air grilles of these systems are typically located in the lower corners of the operating room and pick up two-thirds of the air volume, whereas the final third is taken from near the ceiling, which guarantees an optimal perfusion of the operating room with a sterile filtered air supply. However, this setup is also employed because anesthetic gases have a higher molecular weight than the components of air and should pool on the floor if movement is kept to a minimum and if a ventilation system with a unidirectional displacement flow is employed. However, this anticipated pooling of volatile anesthetics at the floor level has never been proven. Thus, we herein investigated the flow behaviors of isoflurane, sevoflurane, and carbon dioxide (for comparison) in a measuring chamber sized 2.46 × 1.85 × 5.40 m with a velocity of 0.3 m/sec and a degree of turbulence <20%. Gas concentrations were measured at 1,728 measuring positions throughout the measuring chamber, and the flow behaviors of isoflurane and sevoflurane were found to be similar, with an overlap of 90%. The largest spread of both gases was 55 cm at 5.4 m from the emission source. Interestingly, neither isoflurane nor sevoflurane was detected at floor level, but a continuous cone-like spreading was observed due to gravity. In contrast, carbon dioxide accumulated at floor level in the form of a gas cloud. Thus, floor level exhaust ventilation systems are likely unsuitable for the collection and removal of anesthetic gases from operating rooms.
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Affiliation(s)
- Jennifer Herzog-Niescery
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Horst Bartz
- b Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
| | - Heike Vogelsang
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Jörg Bunse
- c Department of Surgery , Sana Hospital Lichtenberg , Berlin , Germany
| | | | - Martin Bellgardt
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Philipp Gude
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Thomas P Weber
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Hans-Martin Seipp
- b Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
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Herzog-Niescery J, Vogelsang H, Bellgardt M, Seipp HM, Weber TP, Gude P. The Personnel's Sevoflurane Exposure in the Postanesthesia Care Unit Measured by Photoacoustic Gas Monitoring and Hexafluoroisopropanol Biomonitoring. J Perianesth Nurs 2019; 34:606-613. [PMID: 30665744 DOI: 10.1016/j.jopan.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Room ventilation in the postanesthesia care unit (PACU) is often poor, although patients exhale anesthetic gases. We investigated the PACU personnel's environmental and biological sevoflurane (SEVO) burden during patient care. DESIGN Prospective, observational study. METHODS Air pollution was measured by photoacoustic gas monitoring in the middle of the PACU, above the patient's face, and on the PACU corridor. Urinary SEVO and hexafluoroisopropanol concentrations were determined. FINDINGS Mean air pollution was 0.34 ± 0.07 ppm in the middle of the PACU, 0.56 ± 0.17 ppm above the patient's face, and 0.47 ± 0.06 ppm on the corridor. Biological preshift exposure levels were 0.13 ± 0.03 mcg/L (SEVO) and 4.72 ± 5.41 mcg/L (hexafluoroisopropanol). Postshift concentrations increased significantly to 0.20 ± 0.06 mcg/L (P = .004) and 42.18 ± 27.82 mcg/L (P < .001). CONCLUSIONS PACU personnel were environmentally and biologically exposed to SEVO, but exposure levels were minimal according to current recommendations.
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Herzog-Niescery J, Vogelsang H, Gude P, Seipp HM, Uhl W, Weber TP, Bellgardt M. Environmental safety: Air pollution while using MIRUS™ for short-term sedation in the ICU. Acta Anaesthesiol Scand 2019; 63:86-92. [PMID: 30088264 DOI: 10.1111/aas.13222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/19/2018] [Revised: 06/16/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND MIRUS™ is a device for target-controlled inhalational sedation in the ICU in combination with use of isoflurane, or sevoflurane, or desflurane. The feasibility of this device has recently been proven; however, ICU staff exposure may restrict its application. We investigated ICU ambient room pollution during daily work to estimate ICU personnel exposure while using MIRUS™. METHODS This observational study assessed pollution levels around 15 adult surgical patients who received volatile anaesthetics-based sedation for a median of 11 hours. Measurements were performed by photoacoustic gas monitoring in real-time at different positions near the patient and in the personnel's breathing zone. Additionally, the impact of the Clean Air™ open reservoir scavenging system on volatile agent pollution was evaluated. RESULTS Baseline concentrations [ppm] during intervention and rest periods were isoflurane c ¯ mean = 0.58 ± 0.49, c ¯ max = 5.72; sevoflurane c ¯ mean = 0.22 ± 0.20, c ¯ max = 7.93; and desflurane c ¯ mean = 0.65 ± 0.57, c ¯ max = 6.65. Refilling MIRUS™ with liquid anaesthetic yielded gas concentrations of c ¯ mean = 2.18 ± 1.48 ppm and c ¯ max = 13.03 ± 9.37 ppm in the personnel's breathing zone. Air pollution in the patient's room was approximately five times higher without a scavenging system. CONCLUSION Ambient room pollution was minimal in most cases, and the measured values were within or below the recommended exposure limits. Caution should be taken during refilling of the MIRUS™ system, as this was accompanied by higher pollution levels. The combined use of air-conditioning and gas scavenging systems is strongly recommended.
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Affiliation(s)
| | - Heike Vogelsang
- Department of Anaesthesiology; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
| | - Philipp Gude
- Department of Anaesthesiology; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
| | - Hans-Martin Seipp
- Department of Life Science Engineering; University of Applied Sciences; Giessen Germany
| | - Waldemar Uhl
- Department of Surgery; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
| | - Thomas P. Weber
- Department of Anaesthesiology; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
| | - Martin Bellgardt
- Department of Anaesthesiology; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
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Vogelsang H, Botteck NM, Herzog-Niescery J, Kirov J, Litschko D, Weber TP, Gude P. Übertragung einer „Cockpit-Strategie“ in die Anästhesie. Anaesthesist 2018; 68:30-38. [DOI: 10.1007/s00101-018-0511-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/26/2018] [Accepted: 10/21/2018] [Indexed: 12/19/2022]
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Neubauer H, Wellmann M, Herzog-Niescery J, Wutzler A, Weber TP, Mügge A, Vogelsang H. Comparison of perioperative strategies in ICD patients: The perioperative ICD management study (PIM study). Pacing Clin Electrophysiol 2018; 41:1536-1542. [PMID: 30264871 DOI: 10.1111/pace.13514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 09/01/2018] [Accepted: 09/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of patients with implanted cardioverter defibrillators (ICDs) and the frequency of surgery on these patients are steadily on the rise. Guidelines recommend preoperative ICD reprogramming, although this is sometimes difficult in clinical practice. Placing a magnet on the ICD is a practical alternative and even no inactivation is possible in selected cases. METHODS In this prospective observational study, we compared different perioperative ICD management strategies depending on the location of the surgery and the type of electrocautery used. Patients undergoing surgery above the umbilicus with monopolar electrocautery had their ICD therapy inactivated by reprogramming. When surgery below the navel or surgery above the navel with bipolar electrocautery was completed, ICD inactivation was performed using a magnet. No inactivation was performed on patients undergoing lower extremity surgery with bipolar electrocautery. Only ICD patients who were not pacemaker dependent were enrolled. After surgery, the ICDs were assessed regarding documented arrhythmias and parameters. RESULTS Out of 101 patients included in this study, the ICD was preoperatively reprogrammed in 42 patients (41.6%), a magnet was used on 45 patients (44.5%), and ICDs were not deactivated at all in 14 patients (13.9%). No intraoperative electromagnetic interference was detected. Postoperative ICD analysis demonstrated no changes of preset parameters. CONCLUSIONS All three tested ICD management strategies were proved safe in this study. Keeping the location of surgery and the type of electrocautery in mind, an intraoperative magnet or even no ICD deactivation at all could be feasible alternatives in surgery on patients with ICDs.
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Affiliation(s)
- Horst Neubauer
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Malte Wellmann
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Jennifer Herzog-Niescery
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Alexander Wutzler
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Thomas Peter Weber
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Andreas Mügge
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Heike Vogelsang
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
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Gude P, Rieckert C, Bissantz N, Weber TP, Vogelsang H, Dazert S, Thomas JP. Analgetikabedarf bei Kindern im Alter zwischen 2 und 12 Jahren nach Tonsillenoperationen. Laryngorhinootologie 2018; 97:465-473. [DOI: 10.1055/a-0596-7675] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Hintergrund Mandeloperationen bei Kindern zählen zu den schmerzhaftesten Eingriffen. Altersgerechte Schmerzskalen sind die Kindliche Unbehagens- und
Schmerzskala (KUSS), die Faces Pain Scale–Revised (FPS-R) und der kaum bekannte PPPM-D-Fragebogen. Ziel war Evaluation der Analgesie bei durch Eltern
angeforderter Nichtopioid-Medikation (NOM) mit Ibuprofen (IBU) und Paracetamol (PCM) nach intrakapsulärer Tonsillektomie (TO) oder extrakapsulärer
Tonsillektomie (TE). Als Rescue-Medikation (RM) wurde nach Prüfung der Schmerzskalen Piritramid appliziert. Endpunkte waren Anteil der Patienten (PAT), der die
RM benötigte, Menge applizierter NOM, Übereinstimmung der Indikation in verschiedenen Schmerzskalen, Korrelation von Schmerzen mit Prämedikation und
Eingriffsdauer.
Material/Methoden Postoperativ erfolgten 3 Messungen täglich mit KUSS bei PAT ≤ 4 Jahre bzw. FPS-R ≥ 5 Jahre. Eltern füllten den PPPM-D aus. Bei einem
Wert ≥ 4 bei KUSS bzw. FPS-R oder ≥ 6 im PPPM-D wurde die RM indiziert.
Ergebnisse 68 PAT wurden in eine Zwischenauswertung eingeschlossen. Durchschnittliche tägliche NOM in den ersten 3 Tagen: nach TE 14,1–16,3 mg/Kg IBU und
4,2–12,4 mg/Kg PCM bzw. nach TO 10,8–14,7 mg/Kg IBU und 5,2–8,8 mg/Kg PCM. Bei 212 Visiten wurde die RM indiziert, davon 121 Mal nur durch den PPPM-D. Nach
Ausschluss eventuell falsch-positiver Indikationen benötigten 67 % der PAT nach TE und 48 % der PAT nach TO mindestens einmal die RM. Die Studie wurde wegen des
hohen RM-Bedarfs abgebrochen.
Schlussfolgerungen Der Bedarf an NOM wurde unterschätzt. Der PPPM-D kombiniert mit etablierten Skalen kann die postoperative Schmerztherapie
verbessern.
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Affiliation(s)
- Philipp Gude
- Katholisches Klinikum Bochum Klinik für Anästhesiologie und Intensivmedizin
| | - Claudia Rieckert
- Katholisches Klinikum Bochum Klinik für Anästhesiologie und Intensivmedizin
| | - Nicolai Bissantz
- Ruhr-Universität Bochum Fakultät für Mathematik, Lehrstuhl für Stochastik
| | - Thomas Peter Weber
- Katholisches Klinikum Bochum Klinik für Anästhesiologie und Intensivmedizin
| | - Heike Vogelsang
- Katholisches Klinikum Bochum Klinik für Anästhesiologie und Intensivmedizin
| | - Stefan Dazert
- HNO-Klinik der Ruhr-Universität Bochum, St. Elisabeth-Hospital, Bochum
| | - Jan Peter Thomas
- HNO-Klinik der Ruhr-Universität Bochum, St. Elisabeth-Hospital, Bochum
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Herzog-Niescery J, Vogelsang H, Bellgardt M, Botteck NM, Seipp HM, Bartz H, Weber TP, Gude P. The child's behavior during inhalational induction and its impact on the anesthesiologist's sevoflurane exposure. Paediatr Anaesth 2017; 27:1247-1252. [PMID: 29071770 DOI: 10.1111/pan.13269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sevoflurane is commonly used for inhalational inductions in children, but the personnel's exposure to it is potentially harmful. Guidance to reduce gas pollution refers mainly to technical aspects, but the impact of the child's behavior has not yet been studied. AIMS The purpose of this study was to determine how child behavior, according to the Frankl Behavioral Scale, affects the amount of waste sevoflurane in anesthesiologists' breathing zones. METHODS Sixty-eight children aged 36-96 months undergoing elective ENT surgery were recruited for this prospective, observational investigation. After oral midazolam premedication (0.5 mg/kg body weight), patients obtained sevoflurane using a facemask with an inspiratory concentration of 8 Vol.% in 100% oxygen (flow 10 L/min). Ventilation was manually supported and a venous catheter was placed. The inspiratory sevoflurane concentration was reduced, and remifentanil and propofol were administered before the facemask was removed and a cuffed tracheal tube inserted. The child's behavior toward the operating room personnel during induction was evaluated by the anesthesiologist (Frankl Behavioral Scale: 1-2 = negative behavior, 3-4 = positive behavior). During induction mean (c¯mean) and maximum (c¯max), sevoflurane concentrations were determined in the anesthesiologist's breathing zone by continuous photoacoustic gas monitoring. RESULTS Mean and maximum sevoflurane concentrations were c¯mean = 4.38 ± 4.02 p.p.m and c¯max = 70.06 ± 61.08 p.p.m in patients with positive behaviors and sufficient premedications and c¯mean = 12.63 ± 8.66 p.p.m and c¯max = 242.86 ± 139.91 p.p.m in children with negative behaviors and insufficient premedications (c¯mean: P < .001; c¯max: P < .001). CONCLUSION Negative behavior was accompanied by significantly higher mean and maximum sevoflurane concentrations in the anesthesiologist's breathing zone compared with children with positive attitudes. Consequently, the status of premedication influences the amount of sevoflurane pollution in the air of operating rooms.
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Affiliation(s)
- Jennifer Herzog-Niescery
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Heike Vogelsang
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Martin Bellgardt
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Nikolaj Matthias Botteck
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Hans-Martin Seipp
- Department of life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Horst Bartz
- Department of life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Thomas Peter Weber
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Philipp Gude
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
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Herzog-Niescery J, Vogelsang H, Gude P, Seipp HM, Bartz H, Uhl W, Weber TP, Bellgardt M. The impact of the anesthetic conserving device on occupational exposure to isoflurane among intensive care healthcare professionals. Minerva Anestesiol 2017. [PMID: 28631452 DOI: 10.23736/s0375-9393.17.11770-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Use of anesthetic conserving devices (ACD) for inhalational isoflurane sedation in Intensive Care Units (ICU) has grown in recent years, and healthcare professionals are concerned about isoflurane pollution and exposure-related health risks. Real-time measurements to determine isoflurane exposure in ICU personnel during short-term patient care procedures and ACD handling have not yet been performed. METHODS Isoflurane concentrations in the breathing zones of ICU staff (25 cm around the nose and mouth) were measured, by photoacoustic gas monitoring, during daily practice including tracheal suctioning, oral hygiene, body care, and patient positioning. Isoflurane pollution was further determined during ACD replacement, syringe filling, and after isoflurane spillages. RESULTS The average mean isoflurane concentration 25 cm above patients' tracheostoma was 0.3 ppm. Mean (cmean) and maximum (cmax) isoflurane exposure in personnel's breathing zones during patient care ranged from 0.4 to 1.9 ppm and 0.7 to 6.6 ppm, respectively. Isoflurane exposure during ACD replacement was cmean 0.5 to 17.4 ppm and cmax 0.8 to 114.3 ppm. Isoflurane concentrations during ACD syringe filling ranged from 2.4 to 9.1 ppm. The maximum isoflurane concentrations after spillage were dose-dependent. CONCLUSIONS Use of ACDs and patient physical manipulation are accompanied by isoflurane pollution. Baseline concentrations did not exceed long-term exposure limits, but short-term limits were occasionally exceeded during patient care procedures and ACD handling. Spillages should be avoided, especially when air-conditioning and scavenging systems are unavailable.
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Affiliation(s)
| | - Heike Vogelsang
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Philipp Gude
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Hans-Martin Seipp
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Horst Bartz
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Waldemar Uhl
- Department of Surgery, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Thomas P Weber
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Martin Bellgardt
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
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Halilbasic E, Fuerst E, Heiden D, Japtok L, Diesner S, Hillebrand P, Vogelsang H, Trauner M, Kulu A, Jaksch P, Klepetko W, Kleuser B, Kazemi-Shirazi L, Untersmayr E. EPS3.3 Plasma levels of the bioactive sphingolipid S1P are reduced in cystic fibrosis patients after lung transplantation depending on CFTR mutation. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30294-1] [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: 10/19/2022]
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21
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Halilbasic E, Katharina S, Schmid D, Brichta A, Jaksch P, Klepetko W, Vogelsang H, Trauner M, Kazemi-Shirazi L. EPS3.6 Lack of association between markers of intestinal inflammation and hepatobiliary alterations in adult cystic fibrosis patients after lung transplantation. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30297-7] [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: 10/19/2022]
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22
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Eigner W, Vogelsang H. Letter: refractory coeliac disease and coeliac-specific serology status - authors' reply. Aliment Pharmacol Ther 2017; 45:862-863. [PMID: 28211626 DOI: 10.1111/apt.13966] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- W Eigner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital of Vienna, Vienna, Austria
| | - H Vogelsang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital of Vienna, Vienna, Austria
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Eigner W, Bashir K, Primas C, Kazemi-Shirazi L, Wrba F, Trauner M, Vogelsang H. Dynamics of occurrence of refractory coeliac disease and associated complications over 25 years. Aliment Pharmacol Ther 2017; 45:364-372. [PMID: 27885681 DOI: 10.1111/apt.13867] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 06/08/2016] [Accepted: 10/27/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Refractory coeliac disease, enteropathy associated T-cell lymphoma and small bowel adenocarcinoma are rare but prognostically important complications in coeliac disease. AIM To analyse potential changes in occurrence of complicated coeliac disease over the last 25 years. METHODS One thousand one hundred and thirty eight patients were included and evaluated based on their time of first presentation at the Medical University of Vienna, Austria. Occurrences of refractory coeliac disease and associated malignancies were evaluated for 5-year intervals from January 1990 until December 2014 and were compared over time. RESULTS 2.6% (n = 29) were diagnosed with refractory coeliac disease (females 65.6%, mean age at diagnosis 62.8 years). The proportion of those patients was 2.6%, 3.1%, 3.3%, 2.7% and 0.5% for the 5 year intervals from 1990 onwards. Thus, the number of refractory cases has been decreasing since 2000 (P = 0.024). The number of patients presenting with lymphoma (n = 7) was 0.6%, 0.4%, 1.1%, 0.8% and 0% from 1990 to 2014. Similarly the number of patients with adenocarcinoma (n = 4) decreased to 0% until 2014. Overall mortality in patients suffering from refractory disease was 48%. Of all patients diagnosed with lymphoma 71.4% died with a 5-year survival rate of 28.6%. CONCLUSIONS Over the past 15 years the occurrence of complicated coeliac disease has been decreasing. This possibly reflects a higher awareness of coeliac disease and optimised diagnosis and treatment with avoidance of long-term immunological disease activity. Symptomatic disease and a delay in diagnosis are risk factors for refractory coeliac disease and related cancer.
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Affiliation(s)
- W Eigner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital of Vienna, Vienna, Austria
| | - K Bashir
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital of Vienna, Vienna, Austria
| | - C Primas
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital of Vienna, Vienna, Austria
| | - L Kazemi-Shirazi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital of Vienna, Vienna, Austria
| | - F Wrba
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - M Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital of Vienna, Vienna, Austria
| | - H Vogelsang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital of Vienna, Vienna, Austria
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Dasch B, Blum K, Vogelsang H, Bausewein C. [Epidemiological study on place of death for cancer patients Autoren]. Dtsch Med Wochenschr 2016; 141:e158-65. [PMID: 27557075 DOI: 10.1055/s-0042-111296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background | In Germany, place of death is recorded on death certificates, but is not analyzed further. In consequence, only little is known about the place of death among cancer patients at the population level. The aim of the study was to describe the changes of places of death in cancer patients over a time period of 10 years. Material and methods | This study examined death certificates from 2001 and 2011 of selected regions of Westphalia-Lippe (Germany). Cancer patients were identified on the basis of cause of death. Description of frequencies of place of death and subgroup analyses by tumor entity (ICD-10, C00-C96) were performed. Results | A total of 24 009 death certificates were analyzed (2001: 11,585; 2011: 12,424). Cancer was the underlying or contributory cause of death in 34.0%. For the years 2001 and 2011, respectively, the following distributions of place of death were observed: home, 24.1% vs. 24.7% (p=0.553); hospital, 62.8% vs. 51.4% (p=0.001); palliative care unit, 0.0% vs. 2.2%; hospice, 5.5% vs. 12.5% (p=0.001); nursing home, 7.4% vs. 10.9% (p=0.001); other, 0.1% vs. 0.3% (p=0.063); no data, 0.1% vs. 0.3% (p=0.015). Patients with brain tumours had a higher probability of dying in a hospice (2011: female 23.5%; male 27.7%). A higher risk of death in hospital was observed among cancer patients with an underlying hematological malignancy (2011: female 63.7%; male 68.4%). Conclusion | Cancer patients mainly die in institutions, with hospitals being the most frequent location. Only one in four deaths occurs in the home setting. The trend over time shows a shift in place of death away from hospitals towards hospices, palliative care units, and nursing homes.
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Narula N, Kainz S, Petritsch W, Haas T, Feichtenschlager T, Novacek G, Eser A, Vogelsang H, Reinisch W, Papay P. The efficacy and safety of either infliximab or adalimumab in 362 patients with anti-TNF-α naïve Crohn's disease. Aliment Pharmacol Ther 2016; 44:170-80. [PMID: 27226407 DOI: 10.1111/apt.13671] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/23/2015] [Accepted: 04/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND TNFα antagonists, including infliximab (IFX) and adalimumab (ADA), have revolutionised treatment for Crohn's disease. Studies comparing efficacy in patients with Crohn's disease naïve to TNFα antagonists are lacking. METHODS Consecutive TNFα antagonist-naïve patients with luminal or perianal Crohn's disease from four tertiary centres in Austria were assessed prospectively for induction and maintenance efficacy, and safety, of either IFX or ADA. RESULTS In a total of 362 patients, 251 (69.3%) started IFX and 111 (30.7%) started ADA. At baseline, the median Harvey-Bradshaw Index (HBI) score was 8 (range 5-29) and 8 (5-36), and the median C-reactive protein (CRP) was 1.07 (interquartile range (IQR) 1.36) mg/dL and 1.16 (IQR 1.23) mg/dL for IFX and ADA, respectively. At week 12, there was no difference between IFX and ADA among patients with luminal Crohn's disease in clinical remission (IFX 128/204; 62.7% vs. ADA 68/107; 63.6%, P = 0.47), clinical response (IFX 154/204; 75.5% vs. ADA 82/107; 76.6%, P = 0.82) and steroid-free remission (IFX 110/204; 53.9% vs. ADA 61/107; 57%, P = 0.60). At 12 months, there were similar numbers of patients treated with IFX and ADA who maintained clinical remission (IFX 77/154; 50.4% vs. ADA 47/82; 57.3%, P = 0.48) and steroid-free remission (IFX 68/154; 44.3% vs. ADA 44/82; 53.7%, P = 0.16). Baseline CRP >0.7 mg/dL (OR 0.24; 95% CI 0.07-0.77, P = 0.01) was the only predictor of clinical remission at 12 months in patients who did not have escalation of anti-TNFα therapy. CONCLUSION IFX and ADA appear comparable in clinical outcomes for patients with Crohn's disease who are naïve to TNFα antagonists.
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Affiliation(s)
- N Narula
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - S Kainz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - W Petritsch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - T Haas
- Department of Internal Medicine 1, Paracelsus Private Medical University, Salzburg, Austria
| | - T Feichtenschlager
- Department of Internal Medicine 4, Hospital Rudolfstifung, Vienna, Austria
| | - G Novacek
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - A Eser
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - H Vogelsang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - W Reinisch
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - P Papay
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Herzog-Niescery J, Gude P, Gahlen F, Seipp HM, Bartz H, Botteck NM, Bellgardt M, Dazert S, Weber TP, Vogelsang H. Surgeons' exposure to sevoflurane during paediatric adenoidectomy: a comparison of three airway devices. Anaesthesia 2016; 71:915-20. [DOI: 10.1111/anae.13515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
- J. Herzog-Niescery
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - P. Gude
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - F. Gahlen
- Department of Otorhinolaryngology; Head and Neck Surgery; St. Elisabeth Hospital; Ruhr-University Bochum; Bochum Germany
| | - H.-M. Seipp
- Department of Life Science Engineering; University of Applied Sciences; Giessen Germany
| | - H. Bartz
- Department of Life Science Engineering; University of Applied Sciences; Giessen Germany
| | - N. M. Botteck
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - M. Bellgardt
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - S. Dazert
- Department of Otorhinolaryngology; Head and Neck Surgery; St. Elisabeth Hospital; Ruhr-University Bochum; Bochum Germany
| | - T. P. Weber
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - H. Vogelsang
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
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27
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Novacek G, Dejaco C, Gröchenig H, Högenauer C, Knoflach P, Miehsler W, Moschen A, Petritsch W, Vogelsang H, Tilg H. Vedolizumab in der Behandlung der Colitis ulcerosa und des Morbus Crohn – ein Konsensus der Arbeitsgruppe „Chronisch Entzündliche Darmerkrankungen“ der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie. Z Gastroenterol 2016; 54:456-67. [DOI: 10.1055/s-0042-103694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- G. Novacek
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Wien, Austria
| | - C. Dejaco
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Wien, Austria
| | - H. Gröchenig
- Abteilung für Innere Medizin, Krankenhaus der Barmherzige Brüder, St. Veit an der Glan, Austria
| | - C. Högenauer
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Graz, Austria
| | - P. Knoflach
- 1. Interne Abteilung, Klinikum Wels, Austria
| | - W. Miehsler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Austria
| | - A. Moschen
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Austria
| | - W. Petritsch
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Graz, Austria
| | - H. Vogelsang
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Wien, Austria
| | - H. Tilg
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Austria
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Herzog-Niescery J, Botteck NM, Vogelsang H, Gude P, Bartz H, Weber TP, Seipp HM. Occupational Chronic Sevoflurane Exposure in the Everyday Reality of the Anesthesia Workplace. Anesth Analg 2016; 121:1519-28. [PMID: 26579657 DOI: 10.1213/ane.0000000000001015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although sevoflurane is one of the most commonly used volatile anesthetics in clinical practice, anesthesiologists are hardly aware of their individual occupational chronic sevoflurane exposure. Therefore, we studied sevoflurane concentrations in the anesthesiologists' breathing zones, depending on the kind of induction for general anesthesia, the used airway device, and the type of airflow system in the operating room. Furthermore, sevoflurane baselines and typical peaks during general anesthesia were determined. METHODS Measurements were performed with the LumaSense Photoacoustic Gas Monitor. As we detected the gas monitor's cross-sensitivity reactions between sevoflurane and disinfectants, regression lines for customarily used disinfectants during surgery (Cutasept®, Octeniderm®) and their alcoholic components were initially analyzed. Hospital sevoflurane concentrations were thereafter measured during elective surgery in 119 patients. The amount of inhaled sevoflurane by anesthesiologists was estimated according to mVA = cVA × V × t × ρVA aer. RESULTS Induction of general anesthesia stopped after tracheal intubation with the patient's expiratory sevoflurane concentration of 1.5%. Thereby, inhalational inductions (INH) caused higher sevoflurane concentrations than IV inductions (mean [SD]: (Equation is included in full-text article.)[ppm] INH 2.43 ± 1.91 versus IV 0.62 ± 0.33, P < 0.001; mVA [mg] INH 1.95 ± 1.54 versus IV 0.30 ± 0.22, P < 0.001). The use of laryngeal mask airway (LMA™) led to generally higher sevoflurane concentrations in the anesthesiologists' breathing zones than tracheal tubes ((Equation is included in full-text article.)[ppm] tube 0.37 ± 0.16 versus LMA™ 0.79 ± 0.53, P = 0.009; (Equation is included in full-text article.)[ppm] tube 1.91 ± 0.91 versus LMA™ 2.91 ± 1.81, P = 0.057; mVA [mg] tube 1.47 ± 0.64 versus LMA™ 2.73 ± 1.81, P = 0.019). Sevoflurane concentrations were trended higher during surgery in operating rooms with turbulent flow (TF) air-conditioning systems compared with laminar flow (LF) air-conditioning systems ((Equation is included in full-text article.)[ppm] TF 0.29 ± 0.12 versus LF 0.13 ± 0.06, P = 0.012; mVA [mg/h] TF 1.16 ± 0.50 versus LF 0.51 ± 0.25, P = 0.007). CONCLUSIONS Anesthesiologists are chronically exposed to trace concentrations of sevoflurane during work. Inhalational inductions, LMA™, and TF air-conditioning systems in particular are associated with higher sevoflurane exposure. However, the amount of inhaled sevoflurane per day was lower than expected, perhaps because concentrations in previous measurements could be overestimated (10%-15%) because of the cross-sensitivity reaction.
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Affiliation(s)
- Jennifer Herzog-Niescery
- From the *Department of Anesthesiology, Katholisches Klinikum Bochum, St. Josef- and St. Elisabeth Hospital, Ruhr-University of Bochum, Bochum, Germany; and †Department of Hygiene, Environmental Engineering and Biotechnology, University of Applied Sciences, Giessen, Germany
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Vinnikov V, Drees D, Herzog-Niescery J, Gude P, Vogelsang H, Cevik B, Weber T, Bellgardt M. Automated control of end-tidal volatile anaesthetic concentration using the MIRUS™ system: a comparison of isoflurane, sevoflurane and desflurane in anaesthesia. Crit Care 2015. [PMCID: PMC4472681 DOI: 10.1186/cc14575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hupfauf S, Lambertz H, Stahl J, Schober J, Rothe M, Vogelsang H. Ergebnisse kolorektaler Lungenmetastasenchirurgie eines peripheren zertifizierten onkologischen Zentrums. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389364] [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: 10/24/2022]
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Fuchssteiner H, Nigl K, Mayer A, Kristensen B, Platzer R, Brunner B, Weiß I, Haas T, Benedikt M, Gröchenig HP, Eisenberger A, Hillebrand P, Reinisch W, Vogelsang H. [Nutrition and IBD-Consensus of the Austrian Working Group of IBD (Inflammatory Bowel Diseases) of the ÖGGH]. Z Gastroenterol 2014; 52:376-86. [PMID: 24718944 DOI: 10.1055/s-0034-1366252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This is a consensus of the Austrian working group of IBD (inflammatory bowel diseases) of the ÖGGH on nutrition in IBD. Malnutrition should be assessed in case of IBD (in 20 - 70 % of Crohn's patients) and weight loss(> 5 % within 3 months) or nutritional deficiencies or after extensive bowel resection and afterwards also treated. Malnutrition should be treated with medical therapy of IBD and also adequate - as far as possible - with oral nutritional therapy particularly because of reduced life quality, risk of opportunistic infections, osteopenia/osteoporosis, longer hospitalisations and higher mortality. Iron homeostasis, serum levels of Vitamin B12- and folic acid, 25-hydroxyvitamin D and zinc should be checked. Therapy with enteral liquid diets is only indicated as therapy of first choice in children and adolescents, but only in rare situations in adults with IBD. There is - up to now - no proven oral diet for maintenance of remission in IBD. Probiotics as E. coli Nissle could be used as alternative to mesalazine for maintenance of remission in patients with ulcerative colitis. A specific dietary counselling is mandatory in patients with ileostoma or short bowel syndrome. Malnutrition of short bowel patients is particularly dependent on the function and length of the remaining bowel, therefore the most effective medical therapy should be administered.
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Affiliation(s)
- H Fuchssteiner
- Krankenhaus der Elisabethinen Linz GmbH, Interne Medizin 4
| | - K Nigl
- Fachhochschule Gesundheitsberufe OÖ GmbH, Studiengang Diätologie, Linz
| | - A Mayer
- Landesklinikum St. Pölten, 2. Medizin
| | - B Kristensen
- Fachhochschule St. Pölten, Studiengang Diätologie
| | - R Platzer
- Landesklinikum Wiener Neustadt, 1. Interne Abteilung
| | - B Brunner
- Landesklinikum Wiener Neustadt, 1. Interne Abteilung
| | - I Weiß
- Allgemeines Krankenhaus Wien, Univ.-Klinik Innere Medizin III
| | - T Haas
- Salzburger Landeskliniken, 1. Medizin
| | - M Benedikt
- Salzburger Landeskliniken, Ernährungsmedizinische Beratung
| | - H P Gröchenig
- Krankenhaus Barmherzige Brüder, St. Veit/Glan, Innere Medizin
| | - A Eisenberger
- LKH Univ.-Klinikum Graz, Ernährungsmedizinischer Dienst
| | - P Hillebrand
- Allgemeines Krankenhaus Wien, Univ.-Klinik Innere Medizin III
| | - W Reinisch
- Medizinische Universität Wien, Univ.-Klinik Innere Medizin III, Abt. Gastroenterologie und Hepatologie
| | - H Vogelsang
- Medizinische Universität Wien, Univ.-Klinik Innere Medizin III, Abt. Gastroenterologie und Hepatologie
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Novacek G, Dejaco C, Knoflach P, Moschen A, Petritsch W, Vogelsang H, Reinisch W. [Adalimumab for the treatment of ulcerative colitis--a consensus report by the working group inflammatory bowel diseases of the Austrian Society of Gastroenterology and Hepatology]. Z Gastroenterol 2014; 52:204-211. [PMID: 24488763 DOI: 10.1055/s-0033-1355818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
TNF alpha antibodies have clearly improved the outcome of moderately to severely active ulcerative colitis. Adalimumab is the first fully human, monoclonal TNF alpha antibody, which is administered subcutaneously. Since April 2012 adalimumab is approved for the treatment of moderately to severely active ulcerative colitis in patients who have not responded despite a full and adequate course of therapy with a corticosteroid and an immunosuppressant or who are intolerant to or have medical contraindications for such therapies. Adalimumab can induce and maintain clinical remission and mucosal healing compared to placebo in moderately to severely active ulcerative colitis, can reduce the rate of ulcerative colitis related hospitalisations and improve health-related quality of life. The response can be observed after two weeks of treatment. The safety profile of adalimumab is comparable to those of other TNF alpha inhibitors. Studies on the treatment of ulcerative colitis with adalimumab did not reveal new safety aspects. The present consensus report by the Working Group Inflammatory Bowel Diseases of the Austrian Society of Gastroenterology and Hepatology presents the existing evidence of adalimumab for the treatment of ulcerative colitis and is aimed to assist as code of its practice.
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Affiliation(s)
- G Novacek
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Österreich
| | - C Dejaco
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Österreich
| | - P Knoflach
- Klinikum Wels, 1. Interne Abteilung, Wels, Österreich
| | - A Moschen
- Medizinische Universität Innsbruck, Universitätsklinik für Innere Medizin I, Innsbruck, Österreich
| | - W Petritsch
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Graz, Österreich
| | - H Vogelsang
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Österreich
| | - W Reinisch
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Österreich
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Vogelsang H. Angioma Racemosum Arteriale Demonstrated by Serial Angiography. Acta Radiol 2013. [DOI: 10.1177/028418516205700308] [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: 11/16/2022]
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Novacek G, Haas T, Knoflach P, Petritsch W, Tilg H, Vogelsang H, Reinisch W. [Adalimumab for the treatment of adult Crohn's disease--update of a consensus report by the Working Group Inflammatory Bowel Disease of the Austrian Society of Gastroenterology and Hepatology]. Z Gastroenterol 2013; 51:1101-9. [PMID: 23996653 DOI: 10.1055/s-0033-1350165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
TNF alpha antibodies have clearly improved the outcome of moderate to severe Crohn's disease. Adalimumab is the first fully human, monoclonal TNF alpha antibody, which can be self-administered subcutaneously. Since August 2012 adalimumab is approved for the treatment of moderately to severely active Crohn's disease, in patients who have not responded despite a full and adequate course of therapy with a corticosteroid and/or an immunosuppressant or who are intolerant to or have medical contraindications for such therapies. Compared to placebo adalimumab can induce significantly more often steroid-free remission and mucosal healing in patients with moderate to severe Crohn's disease, reduce the rate of Crohn's disease-related hospitalisations and surgery and improve health-related quality of life. Adalimumab is clinically efficacious both in patients with Crohn's disease naïve to previous exposure to TNF-alpha antibodies and in those previously exposed with a rapid onset of action within days and confirmed maintenance performance over 3 years. The safety profile of adalimumab is comparable to those of other TNF alpha inhibitors. Due to its low immunogenicity allergic reactions are rare. The update of a consensus report by the Working Group Inflammatory Bowel Disease of the Austrian Society of Gastroenterology and Hepatology presents the existing evidence on adalimumab for the treatment of Crohn's disease and is aimed to assist as a code of practice in its applications.
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Affiliation(s)
- G Novacek
- Klinische Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Österreich
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Niescery J, Huhmann N, Dasch B, Bullmann V, Weber TP, Bellgardt M, Vogelsang H. Effects of liberal vs. conventional volume regimen on pulmonary function in posterior scoliosis surgery. Middle East J Anaesthesiol 2013; 22:165-171. [PMID: 24180165] [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: 06/02/2023]
Abstract
BACKGROUND We observed an increased rate of pulmonary complications (hypoxemia, pulmonary edema, re-intubation) in some patients after posterior spinal fusion, though standardized intraoperative volume regimens for major surgery were used. Therefore, we focused on the effects of two different standardized fluid regimens (liberal vs. conventional) as well as on two different types of postoperative pain management (thoracic epidural catheter vs. intravenous analgesia) concerning pulmonary function in patients undergoing posterior spinal fusion. METHODS 23 patients received a conventional intraoperative fluid management (crystalloids 5.5 ml/kg/h), whereas 22 patients obtained a liberal regimen (crystalloids approximately 11 ml/kg/h) during surgery. After surgery a thoracic epidural catheter was used in 29 patients, whereas 16 patients got a conventional intravenous analgesia. Regarding pulmonary outcome, the re-intubation rate, the postoperative oxygen saturations as well as delivery volumes and retention times of pleural drainages were evaluated. RESULTS Patients with conventional intraoperative fluid management had a less frequent reintubation rate (p = 0.015), better postoperative oxygen saturations (p = 0.043) and lower delivery volumes of pleural drainages (p = 0.027) compared to those patients with liberal volume regimen. Patients with thoracic epidural catheter had improved oxygen saturations on pulse oximetry at the first day after surgery (p < 0.001) and lower delivery volumes of pleural drainages than patients with intravenous analgesia (p = 0.008). CONCLUSIONS The combination of a more restrictive fluid management (better pulmonary oxygen uptake and ventilation, less pulmonary edema) and a thoracic epidural catheter (sympatholysis, pain management) in posterior spinal fusion may be advantageous as both factors can improve pulmonary outcome.
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Affiliation(s)
- Jennifer Niescery
- Department of Anesthesiology, St. Josef-Hospital, Ruhr-University Bochum, Germany.
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Staufer K, Halilbasic E, Harm S, Niculescu A, Jaksch P, Muraközy G, Hielle-Wittmann E, Lichtenberger C, Vogelsang H, Klepetko W, Trauner M, Kazemi-Shirazi L. 176 Prevalence of autoimmune antibodies in patients with cystic fibrosis after lung transplantation. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60317-3] [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: 11/30/2022]
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Angelberger S, Campregher C, Fuchssteiner H, Gasche C, Gröchenig HP, Haas T, Kazemi-Shirazi L, Mayer A, Miehsler W, Platzer R, Reinisch W, Steiner P, Tilg H, Tillinger W, Vogelsang H, Novacek G. [Colorectal cancer: screening and surveillance in inflammatory bowel diseases - consensus of the working group for inflammatory bowel diseases of the Austrian Society of Gastroenterology and Hepatology]. Z Gastroenterol 2013; 51:450-7. [PMID: 23681899 DOI: 10.1055/s-0033-1335252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patients with ulcerative colitis and Crohn's colitis are at increased risk of colorectal cancer (CRC). This risk is dependent on the duration and extent of disease, inflammatory activity and possible additional risk factors. Thus, the aim is to reduce this risk and to detect dysplastic and malignant lesions at an early stage. The working group for Inflammatory Bowel Diseases (IBD) of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) has developed consensus statements on the following topics: risk of colorectal cancer, screening and surveillance, procedure of surveillance colonoscopy, dysplasia and its management, and chemoprevention. This consensus is intended to increase awareness of the increased risk of CRC in IBD and to support a standardised approach in cancer prevention.
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Affiliation(s)
- S Angelberger
- Medizinische Universität Wien, Innere Medizin III, Abt. für Gastroenterologie und Hepatologie, Wien, Österreich
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Papay P, Primas C, Eser A, Novacek G, Winkler S, Frantal S, Angelberger S, Mikulits A, Dejaco C, Kazemi-Shirazi L, Vogelsang H, Reinisch W. Retesting for latent tuberculosis in patients with inflammatory bowel disease treated with TNF-α inhibitors. Aliment Pharmacol Ther 2012; 36:858-65. [PMID: 22978645 DOI: 10.1111/apt.12037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/26/2012] [Accepted: 08/17/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients treated with TNF-α inhibitors (TNFi) are at high risk of reactivation of latent tuberculosis (LTB). Prospective studies on monitoring of TB reactivation and/or infection in this risk group are lacking. AIM To test the conversion and reversion rate of screening tests for latent TB serial tuberculin skin test (TST) and interferon-γ release assay (IGRA) under ongoing TNFi therapy. METHODS We retested consecutive patients with IBD receiving TNFi therapy for a minimum of 5 months for LTB using IGRA and TST. A detailed patient history and concomitant therapy were recorded for each subject. RESULTS After a median of 34.9 weeks (20.7–177.7), IGRA was retested in 184/227 patients (81.1%; Crohn's disease n = 139, ulcerative colitis n = 45) still under index TNFi. TST was available in 144/184 subjects (78.2%). The majority of patients were TNFi naïve (147/184, 79.9%). In a subgroup of patients who received isoniazid due to diagnosis of latent TB at baseline (n = 32), 6/13 patients (46.2%) with baseline positive IGRA and 3/22 patients (13.6%) with baseline positive TST reverted to negative at retesting. In patients without diagnosis of LTB at baseline no permanent IGRA conversion was observed, but there were 6/144 (4.2%) TST conversions from negative to positive. No single case of TB reactivation or infection was recorded during the observation period. CONCLUSIONS During treatment TNF-α inhibitors conversion was observed for tuberculin skin test, but not interferon-γ release assay. As compared with tuberculin skin test, interferon-γ release assay reverted in nearly half of isoniazid-treated patients for latent tuberculosis. However, the fact that patients in whom the interferon-γ release assay test result remained positive did not develop active tuberculosis during follow-up questions the utility of interferon-γ release assay as a monitoring tool during chemoprevention.
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Affiliation(s)
- P Papay
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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Eser A, Papay P, Primas C, Pernicka E, Harrer M, Dejaco C, Novacek G, Lichtenberger C, Angelberger S, Kazemi L, Mikulits A, Vogelsang H, Reinisch W. The impact of intestinal resection on serum levels of anti-Saccharomyces cerevisiae antibodies (ASCA) in patients with Crohn's disease. Aliment Pharmacol Ther 2012; 35:292-9. [PMID: 22146122 DOI: 10.1111/j.1365-2036.2011.04932.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Antibodies to Saccharomyces cerevisiae (ASCA) are highly prevalent in sera of patients with Crohn's disease and have been proposed to identify subgroups of patients with a disabling disease course. AIM To investigate the impact of intestinal resection on serum levels of ASCA in patients with Crohn's disease and the predictive value of ASCA levels on surgical recurrence. METHODS Sera from 60 patients who underwent 'curative' intestinal resection due to stricturing and/or penetrating complications were collected preoperatively and during post-operative follow-up (week 2, months 4, 8 and 11 ± 1). Measurement of ASCA IgG and IgA isotypes were performed using ELISA. Re-operation rate was associated with ASCA status and serum levels. RESULTS At baseline 44/60 (73%) of patients were rated as positive for ASCA IgG, 45/60 (75%) for ASCA IgA and 52/60 (87%) as positive for at least one of both. ASCA serum levels remained stable during first year from resection. After a median of 106 months 10 of 40 (25%) patients with long-term follow-up underwent one or more intestinal re-operations. Neither ASCA positivity nor absolute ASCA serum levels were predictive of surgical recurrence. CONCLUSIONS Serum ASCA levels remain stable after curative intestinal resection in Crohn's disease. This indicates the persistence of both stimulus and immunological mechanism operative in the production of ASCA even after complete surgical resection of macroscopically inflamed intestinal tissue. After intestinal resection, neither ASCA positivity nor ASCA serum levels predict the risk of surgical recurrence during long-term follow-up.
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Affiliation(s)
- A Eser
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria
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Abstract
BACKGROUND The pathophysiology of functional dyspepsia is poorly understood. Visceral hypersensitivity may play a key role. We studied a previously validated test to assess chemical hypersensitivity in functional dyspepsia by applying an oral capsaicin load. METHODS A total of 116 outpatients with upper gastrointestinal (GI) symptoms participated in this double-blind, placebo-controlled trial of which 73 patients received a final diagnosis of functional dyspepsia. Patients swallowed a capsule containing 0.75 mg capsaicin or placebo. A graded questionnaire evaluated the severity of nine upper GI symptoms before and after capsule ingestion and an aggregate symptom score was calculated. A final score of >9 was considered as a positive test. KEY RESULTS In functional dyspepsia, median perception scores were 10.8 (interquartile range: 4.5-18.8) after ingestion of capsaicin and 0.5 (0.0-2.5) after placebo (P < 0.001). Thirty-seven functional dyspepsia patients (54%) had a positive test after capsaicin ingestion, whereas only four (11%) patients with upper GI symptoms but without functional dyspepsia were capsaicin positive [median perception score: 1.5 (0.0-5.0)]. After placebo, symptom scores were low and not significantly different among patient groups (P > 0.05). Clinical characteristics, age, and gender distribution was similar in capsaicin positive and capsaicin negative functional dyspepsia patients (P > 0.05). The value of patient blinding was good. CONCLUSIONS & INFERENCES Half of functional dyspepsia patients had chemical hypersensitivity, determined with an oral capsaicin load. Placebo response was negligible. The results of the capsaicin test were not associated with specific dyspepsia symptoms or Rome subgroups.
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Affiliation(s)
- M Führer
- Abteilung für Gastroenterologie und Hepatologie, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
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Hochwallner H, Schulmeister U, Swoboda I, Twaroch TE, Vogelsang H, Kazemi-Shirazi L, Kundi M, Balic N, Quirce S, Rumpold H, Fröschl R, Horak F, Tichatschek B, Stefanescu CL, Szépfalusi Z, Papadopoulos NG, Mari A, Ebner C, Pauli G, Valenta R, Spitzauer S. Patients suffering from non-IgE-mediated cow's milk protein intolerance cannot be diagnosed based on IgG subclass or IgA responses to milk allergens. Allergy 2011; 66:1201-7. [PMID: 21575008 DOI: 10.1111/j.1398-9995.2011.02635.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [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: 11/29/2022]
Abstract
BACKGROUND Cow's milk is one of the most common causes of food allergy. In two-thirds of patients, adverse symptoms following milk ingestion are caused by IgE-mediated allergic reactions, whereas for one-third, the mechanisms are unknown. Aim of this study was to investigate whether patients suffering from non-IgE-mediated cow's milk protein intolerance can be distinguished from persons without cow's milk protein intolerance based on serological measurement of IgG and IgA specific for purified cow's milk antigens. METHODS We determined IgG(1-4) subclass and IgA antibody levels to purified recombinant αS1-casein, αS2-casein, β-casein, κ-casein, α-lactalbumin, and β-lactoglobulin in four patient groups by ELISA: Patients with IgE-mediated cow's milk allergy (CMA, n=25), patients with non-IgE-mediated cow's milk protein intolerance (CMPI, n=19), patients with gastrointestinal symptoms not associated with cow's milk ingestion (GI, n=15) and control persons without gastrointestinal problems (C, n=26). Cow's milk-specific IgE levels were determined by ImmunoCAP. RESULTS Only CMA patients had IgE antibodies to cow's milk. Cow's milk allergic patients mounted the highest IgG(1) and IgG(4) antibody levels to αS1-casein, αS2-casein, β-casein, κ-casein, and α-lactalbumin. No elevated levels of IgG(4) , IgA, and complement-binding IgG subclasses (IgG(1) , IgG(2) , IgG(3) ) to purified cow's milk allergens were found within the CMPI patients compared to persons without cow's milk protein intolerance (GI and C groups). CONCLUSION Cow's milk protein intolerant patients cannot be distinguished from persons without cow's milk protein intolerance on the basis of IgG subclass or IgA reactivity to cow's milk allergens.
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Affiliation(s)
- H Hochwallner
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
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Moehler M, Al-Batran SE, Andus T, Anthuber M, Arends J, Arnold D, Aust D, Baier P, Baretton G, Bernhardt J, Boeing H, Böhle E, Bokemeyer C, Bornschein J, Budach W, Burmester E, Caca K, Diemer WA, Dietrich CF, Ebert M, Eickhoff A, Ell C, Fahlke J, Feussner H, Fietkau R, Fischbach W, Fleig W, Flentje M, Gabbert HE, Galle PR, Geissler M, Gockel I, Graeven U, Grenacher L, Gross S, Hartmann JT, Heike M, Heinemann V, Herbst B, Herrmann T, Höcht S, Hofheinz RD, Höfler H, Höhler T, Hölscher AH, Horneber M, Hübner J, Izbicki JR, Jakobs R, Jenssen C, Kanzler S, Keller M, Kiesslich R, Klautke G, Körber J, Krause BJ, Kuhn C, Kullmann F, Lang H, Link H, Lordick F, Ludwig K, Lutz M, Mahlberg R, Malfertheiner P, Merkel S, Messmann H, Meyer HJ, Mönig S, Piso P, Pistorius S, Porschen R, Rabenstein T, Reichardt P, Ridwelski K, Röcken C, Roetzer I, Rohr P, Schepp W, Schlag PM, Schmid RM, Schmidberger H, Schmiegel WH, Schmoll HJ, Schuch G, Schuhmacher C, Schütte K, Schwenk W, Selgrad M, Sendler A, Seraphin J, Seufferlein T, Stahl M, Stein H, Stoll C, Stuschke M, Tannapfel A, Tholen R, Thuss-Patience P, Treml K, Vanhoefer U, Vieth M, Vogelsang H, Wagner D, Wedding U, Weimann A, Wilke H, Wittekind C. [German S3-guideline "Diagnosis and treatment of esophagogastric cancer"]. Z Gastroenterol 2011; 49:461-531. [PMID: 21476183 DOI: 10.1055/s-0031-1273201] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- M Moehler
- Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55101 Mainz.
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Reinisch W, Dejaco C, Feichtenschlager T, Haas T, Kaser A, Miehsler W, Novacek G, Petritsch W, Platzer R, Tilg H, Vogelsang H, Knoflach P. [Infliximab therapy for Crohn's disease - a practical guideline: actualised consensus of the working group for chronic inflammatory bowel diseases of the Austrian Society for Gastroenterology and Hepatology]. Z Gastroenterol 2011; 49:534-42. [PMID: 21442574 DOI: 10.1055/s-0029-1245930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Infliximab is a monoclonal antibody against tumor necrosis factor alpha (TNF-α), which is approved for the treatment of chronic inflammatory bowel disease (IBD) such as Crohn's disease (CD), fistulating Crohn's disease (FCD), ulcerative colitis (UC), and paediatric ulcerative colitis (PUC) from 6 years onwards. Besides its therapeutic efficacy, this antibody therapy is characterised by its side effects profile, which has been addressed in a seperate consensus statement by the Working Group for chronic inflammatory bowel diseases within the Austrian Society for Gastroenterology and Hepatology. Infliximab is an effective treatment option for the above-mentioned indications; however, use of this agent requires special knowledge to assess the benefit-risk profile for each patient individually.
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Affiliation(s)
- W Reinisch
- AKH Wien, Univ.-Klinik für Innere Medizin III, Klin. Abteilung f. Gastroenterologie und Hepatologie, Wien, Österreich.
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Meiser A, Bellgardt M, Vogelsang H, Sirtl C, Weber T. [Functioning of the anaesthetic conserving device: aspects to consider for use in inhalational sedation]. Anaesthesist 2011; 59:1029-40. [PMID: 20878139 DOI: 10.1007/s00101-010-1779-6] [Citation(s) in RCA: 7] [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: 11/26/2022]
Abstract
The new anaesthetic conserving device (ACD) allows the use of isoflurane and sevoflurane without classical anaesthesia workstations. Volatile anaesthetic exhaled by the patient is absorbed by a reflector and released to the patient during the next inspiration. Liquid anaesthetic is delivered via a syringe pump. Currently the use of the ACD is spreading among European intensive care units (ICU). This article focuses on the functioning of the device and on particularities which are important to consider. The ACD constantly reflects 90% of the exhaled anaesthetic back to the patient, but if one exhaled breath contains more than 10 ml of anaesthetic vapour (e.g. >1 vol% in 1,000 ml), the capacity of the reflector will be exceeded and relatively more anaesthetic will be lost to the patient. This spill over decreases efficiency but it also contributes to safety as very high concentrations are averted. Compared to classical anaesthesia systems the ACD used in conjunction with ICU ventilators offers advantages in the ICU setting: investment costs are low, carbon dioxide absorbent is not needed, breathing comfort is higher, anaesthetic consumption is low (equal to an anaesthesia circuit with a fresh gas flow of approximately 1 l/min) and anaesthetic concentrations can be controlled very quickly (increased by small boluses and decreased by removal of the ACD). On the other hand, case costs are higher (single patient use) and a dead space of 100 ml is added. There are pitfalls: by a process called auto-pumping, expansion of bubbles inside the syringe may lead to uncontrolled anaesthetic delivery. Auto-pumping is provoked by high positioning of the syringe pump, heat and prior cooling of the liquid anaesthetic. Inherent to the device is an early inspiratory concentration peak and an end-inspiratory dip which may mislead commonly used gas monitors. Workplace concentrations can be minimized by proper handling, a sufficient turnover of room air is important and gas from the expiration port of the ventilator should be scavenged. Inhalational compared to intravenous ICU sedation offers the advantages of better control of the sedation level, online drug monitoring, no accumulation in patients with renal or hepatic insufficiency and bronchodilation. With a lowered opioid dose spontaneous breathing and intestinal motility are well preserved. A clinical algorithm for the care of patients with respiratory insufficiency including inhalational sedation is proposed. Inhalational sedation with isoflurane has been widely used for more than 20 years in many countries and even for periods of up to several weeks. In the German S3 guidelines for the management of analgesia, sedation and delirium in intensive care (Martin et al. 2010), inhalational sedation is mentioned as an alternative sedation method for patients ventilated via an endotracheal tube or a tracheal cannula. Nevertheless, isoflurane is not officially licensed for ICU sedation and its use is under the responsibility of the prescribing physician.
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Affiliation(s)
- A Meiser
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Universitätskliniken 57.2, 66424 Homburg, Deutschland.
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Vogelsang H, Pfeiffer J, Moser G. Empfehlungen zur Therapie der chronischen Obstipation der Arbeitsgruppe für Funktionsdiagnostik und Psychosomatik der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie. Z Gastroenterol 2011; 49:294-303. [DOI: 10.1055/s-0029-1245932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Riss S, Bittermann C, Zandl S, Kristo I, Stift A, Papay P, Vogelsang H, Mittlböck M, Herbst F. Short-term complications of wide-lumen stapled anastomosis after ileocolic resection for Crohn's disease: who is at risk? Colorectal Dis 2010; 12:e298-303. [PMID: 20041915 DOI: 10.1111/j.1463-1318.2009.02180.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM There is growing evidence that stapled anastomoses are similarly effective compared to hand-sewn anastomoses in Crohn's patients. This study was designed to assess safety and limitations of wide-lumen stapled ileocolic anastomoses. METHOD All patients with ileocolic resections for Crohn's disease perfomed between 1998 and 2006 were studied. A stapled anastomosis was constructed whenever possible. Potential risk factors for postoperative complications were recorded, retrospectively. Univariate and multivariate analyses were performed. RESULTS In 209 out of 220 cases (95%, 132 primary operations) stapled anastomoses were performed. Eleven patients underwent a hand-sewn anastomosis owing to massive bowel dilatation (n = 7) or increased wall thickness (n = 4). There were 10 major (4.5%; surgical: 8, medical: 2) complications including two anastomotic leaks and one anastomotic bleed (all from stapled anastomoses) and one death not related to the anastomosis. Minor complications occurred in 25 patients. In multivariate analysis, major surgical postoperative complications were significantly associated with a low level of albumin (P = 0.0113) and previous resections for Crohn's disease (P = 0.0144). CONCLUSION Stapled ileocolic anastomosis was safe in the majority of Crohn's patients. The most important limitation was technical impracticability. A low level of albumin and a history of previous resection increased the risk of postoperative complications.
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Affiliation(s)
- S Riss
- Department of General Surgery, Medical University of Vienna, Austria
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Miehsler W, Novacek G, Wenzl H, Vogelsang H, Knoflach P, Kaser A, Dejaco C, Petritsch W, Kapitan M, Maier H, Graninger W, Tilg H, Reinisch W. A decade of infliximab: The Austrian evidence based consensus on the safe use of infliximab in inflammatory bowel disease. J Crohns Colitis 2010; 4:221-56. [PMID: 21122513 DOI: 10.1016/j.crohns.2009.12.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 12/01/2009] [Indexed: 12/15/2022]
Abstract
Infliximab (IFX) has tremendously enriched the therapy of inflammatory bowel diseases (IBD) and other immune mediated diseases. Although the efficacy of IFX was undoubtedly proven during the last decade numerous publications have also caused various safety concerns. To summarize the immense information concerning adverse events and safety issues the Austrian Society of Gastroenterology and Hepatology launched this evidence based consensus on the safe use of IFX which covers the following topics: infusion reactions and immunogenicity, skin reactions, opportunistic infections (including tuberculosis), non-opportunistic infections (bacterial and viral), vaccination, neurological complications, hepatotoxicity, congestive heart failure, haematological side effects, intestinal strictures, stenosis and bowel obstruction (SSO), concomitant medication, malignancy and lymphoma, IFX in the elderly and the young, mortality, fertility, pregnancy and breast feeding. To make the vast amount of information practicable for routine application the consensus was finally condensed into a checklist for a safe use of IFX which consists of two parts: issues to be addressed prior to anti-TNF therapy and issues to be addressed during maintenance. Both parts are further divided into obligatory and facultative items.
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Affiliation(s)
- W Miehsler
- Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.
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Miehsler W, Novacek G, Wenzl H, Vogelsang H, Knoflach P, Kaser A, Dejaco C, Petritsch W, Kapitan M, Maier H, Graninger W, Tilg H, Reinisch W. A decade of infliximab: The Austrian evidence based consensus on the safe use of infliximab in inflammatory bowel disease. J Crohns Colitis 2010. [PMID: 21122513 DOI: 10.1016/j.crohns.2009.12.001]available] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Infliximab (IFX) has tremendously enriched the therapy of inflammatory bowel diseases (IBD) and other immune mediated diseases. Although the efficacy of IFX was undoubtedly proven during the last decade numerous publications have also caused various safety concerns. To summarize the immense information concerning adverse events and safety issues the Austrian Society of Gastroenterology and Hepatology launched this evidence based consensus on the safe use of IFX which covers the following topics: infusion reactions and immunogenicity, skin reactions, opportunistic infections (including tuberculosis), non-opportunistic infections (bacterial and viral), vaccination, neurological complications, hepatotoxicity, congestive heart failure, haematological side effects, intestinal strictures, stenosis and bowel obstruction (SSO), concomitant medication, malignancy and lymphoma, IFX in the elderly and the young, mortality, fertility, pregnancy and breast feeding. To make the vast amount of information practicable for routine application the consensus was finally condensed into a checklist for a safe use of IFX which consists of two parts: issues to be addressed prior to anti-TNF therapy and issues to be addressed during maintenance. Both parts are further divided into obligatory and facultative items.
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Affiliation(s)
- W Miehsler
- Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria.
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Lorenz R, Vogelsang H. Untersuchungen über den Zusammenhang zwischen intravertebralem Druck und Liquordruck. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1228495] [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: 10/20/2022]
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