The prophylactic use of the beta-blocker esmolol in combination with phosphodiesterase III inhibitor enoximone in elderly cardiac surgery patients.

We assessed the influence of the prophylactic use of a combination of the IV beta-adrenergic blocker, esmolol, and the phosphodiesterase III inhibitor, enoximone, on postbypass hemodynamic status, inflammation, and endothelial and organ function in a prospective, randomized, placebo-controlled study in 42 patients aged >65 yr undergoing aortocoronary bypass grafting. In 21 patients, esmolol (aim: heart rate <70 bpm) plus enoximone (initial bolus of 0.5 mg/kg followed by a continuous infusion of 2.

The influence of allogeneic red blood cell transfusion compared with 100% oxygen ventilation on systemic oxygen transport and skeletal muscle oxygen tension after cardiac surgery.

In this study we investigated the effects of allogeneic red blood cell (RBC) transfusion on tissue oxygenation compared with those of 100% oxygen ventilation by using systemic oxygen transport variables and skeletal muscle oxygen tension (PtiO2). Fifty-one volume-resuscitated, mechanically ventilated patients with a nadir hemoglobin concentration in the range from 7.5 to 8.

Levosimendan in patients with cardiogenic shock undergoing surgical revascularization: a case series.

Background: Levosimendan is a new calcium sensitizer, which enhances myocardial contractility while simultaneously having vasodilatory and cardioprotective effects. These properties could be advantageous in patients with myocardial ischemia requiring inotropic support.

Material/methods: 10 patients with acute myocardial ischemia, cardiogenic shock, and/or cardiopulmonary resuscitation undergoing emergency surgical revascularization were treated with levosimendan (bolus 6 microg.

[A comparison of the Arndt endobronchial blocker with a double lumen tube in robotic cardiac surgery].

Objective: In this prospective, randomised study a double lumen tube (DLT) or an Arndt bronchial blocker (BB) was used for one lung ventilation (OLV). Intraoperative oxygenation, ventilation, haemodynamics, and ease of placement were compared.

Methods: In 32 patients undergoing robotic harvesting of the left internal thoracic artery (ITA) a left-sided DLT or a BB controlled by bronchoscopy was used for OLV of the right lung.

A comparison of nefopam and clonidine for the prevention of postanaesthetic shivering: a comparative, double-blind and placebo-controlled dose-ranging study.

Postanaesthetic shivering is a frequent complication following general anaesthesia. The aim of this study was to compare the effectiveness of three doses of nefopam with clonidine and placebo in the prevention of postanaesthetic shivering. We studied 371 patients undergoing abdominal or orthopaedic surgery.

Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence.

Purpose: Volume replacement regimens are discussed very emotionally. Interpretation of the literature is difficult due to variations in study design, patient population, target for volume replacement, endpoints, and type of fluids. Meta-analyses may not be very helpful because all kinds of patients and very old studies are included.

[Hydroxyethylstarch (HES)].

Adequate volume replacement therapy is a mainstay of managing the critically ill. The ideal kind of volume replacement in this situation still remains a challenge. In spite of an immense number of contributions to this problem there is still no definite answer.

Do we necessarily need local anaesthetics for venous cannulation? A comparison of different cannula sizes.

Background And Objective: This randomized, prospective study was performed to evaluate the efficacy of a subcutaneous local anaesthetic infiltration prior to venepuncture using different cannula sizes.

Methods: Three-hundred-and-one patients were included in the study, 150 received mepivacaine 1% (0.25 mL) subcutaneously, 151 were cannulated without local analgesia.

[ProSeal-laryngeal mask versus endotracheal intubation in patients undergoing gynaecologic laparoscopy].

Background: The aim of this study was to assess the practicality of the ProSeal laryngeal mask (PS-LMA) airway during laparoscopic surgery with capnoperitoneum compared to endotracheal intubation (ET).

Methods: Prospective, randomized study. 104 patients undergoing gynaecologic, laparoscopic surgery were allocated randomly to two groups: 1.

[Volume replacement with hydroxyethyl starch: is there an influence on kidney function?].

Hydroxyethyl starch (HES) solutions are synthetic colloids with the pharmacological properties that are closest to natural colloids. In Germany, numerous types of HES preparations with different combinations of concentration, weight-averaged mean molecular weight (Mw), and hydroxyethylation pattern are available. They differ with regard to their volume-supporting capacity, intravascular half-life, and side effect profile.

Arthrofibrosis associated with total knee arthroplasty: gray-scale and power Doppler sonographic findings.

Objective: The objective of this study was to determine gray-scale and power Doppler sonographic findings in patients with arthrofibrosis associated with total knee arthroplasty. SUBJECTS AND METHODS. From a consecutive cohort of more than 3000 mobilebearing total knee arthroplasties, 44 cases (1.

Influence of different volume replacement strategies on inflammation and endothelial activation in the elderly undergoing major abdominal surgery.

Objective: Adequate restoration of intravascular volume remains an important maneuver in the management of the surgical patient. Influence of different volume replacement regimens on inflammation/endothelial activation in elderly surgical patients was assessed.

Design: Prospective, randomized study.

[Can we afford the costs of progress in intensive care medicine? A plea for a candid debate].

Intensive care medicine is one of the most fast growing segments in medicine. New substances that may improve therapy of the critically ill dramatically have entered the market. Improvements include therapy of methicilline-resistant Staphylococcus aureus (MRSA) infections (linezolid), severe heart failure (calcium sensitizer levosimendan), intractable bleeding (recombinant factor VIIa) and severe sepsis (recombinant activated protein C (aPC)).

[Effects of esmolol- and sodium nitroprusside-induced controlled hypotension on hepatocellular integrity in patients undergoing endonasal sinus surgery].

Background: Controlled hypotension (CH) is an established method to reduce intraoperative bleeding. The aim of the study was to investigate the influence of CH induced by sodium nitroprusside (SN) or esmolol on hepatocellular integrity.

Methods: Prospective, randomized, controlled study.

Volume replacement with HES 130/0.4 may reduce the inflammatory response in patients undergoing major abdominal surgery.

Purpose: To investigate the effects of intravascular volume replacement therapy on the inflammatory response during major surgery.

Methods: Thirty-six patients scheduled for elective abdominal surgery were randomized to receive either 6% hydroxyethylstarch (130,000 Dalton mean molecular weight, degree of substitution 0.4; n = 18, HES-group) or lactated Ringer's solution (RL-group; n = 18) for intravascular volume replacement.

New light on intravascular volume replacement regimens: what did we learn from the past three years?

Unlabelled: Definition of the "ideal" intravascular fluid volume replacement strategy still remains a critical problem. This article analyzes studies on volume replacement by using a MEDLINE search of the past 3 years (from January 1, 2000, to December 12, 2002). Forty original studies in humans with a total of 2454 subjects were identified.

Kidney-specific proteins in elderly patients undergoing cardiac surgery with cardiopulmonary bypass.

Unlabelled: In cardiac surgery, acute renal failure (ARF) is more likely in elderly patients than in younger patients. We assessed whether kidney function is different between elderly and younger cardiac surgery patients by measuring kidney-specific proteins. Forty consecutive patients aged <60 yr and 40 patients aged >70 yr without preoperative kidney dysfunction undergoing elective cardiac surgery with cardiopulmonary bypass (CPB) were included.

Reversible inhibitors of lambda integrase-mediated recombination efficiently trap Holliday junction intermediates and form the basis of a novel assay for junction resolution.

The bacteriophage lambda integrase catalyzes four site-specific recombination pathways with distinct protein and DNA requirements and nucleoprotein intermediates. Some of these intermediates are very transient and difficult to obtain in significant amounts, due to the high efficiency and processivity of integrase, the lack of requirements for external energy factors or metal ions, and the highly reversible nature of each of the intermediates. We have previously used mixture-based combinatorial libraries to identify hexapeptides that trap 40-60% of recombination substrates at the Holliday junction stage of the reaction.

[Injection pain secondary to propofol-MCT/LCT and propofol-LCT--comparison of prophylaxis with lidocaine].

Objective: Pain on injection is one of the most described side-effects of the intravenous application of propofol. This study was designed to assess the efficacy of lidocaine 40 mg in preventing incidence and severity of injection pain for two different propofol solvents.

Methods: In a double-blind and prospective study 202 patients were enrolled and randomized to 4 different groups: group A receiving 2 ml NaCl 0.

The role of Ca++-sensitizers for the treatment of heart failure.

For increasing myocardial contractility in patients with cardiac failure, catecholamines, phosphodiesterase-III (PDE) inhibitors, and calcium sensitizers are available. Improving myocardial performance with catecholamines and PDE inhibitors leads to increased intracellular calcium concentration as an unavoidable side effect. An increase in intracellular calcium can induce harmful arrhythmias and increases the energetic demands of the myocardium.

[Is levosimendan an inoprotective drug in patients with acute coronary syndrome undergoing surgical revascularization?].

Levosimendan, is a new calcium sensitiser with 2 major effects. First, levosimendan acts as a positive inotropic agent by binding calcium dependently to cardiac troponin C. Second, levosimendan activates adenosine triphosphate-regulated potassium (K (ATP)) channels.

[Influence of cardiopulmonary bypass (CPB) on the natriuretic peptides ANP and BNP. A comparison between long and short duration of CPB and off pump surgery].

Objective: Plasma atrial and brain natriuretic peptide (ANP and BNP) are cardiac hormones secreted mainly due to cardiac overload. The study was designed to assess plasma concentrations of ANP and BNP in patients undergoing coronary bypass grafting (CABG) with long and short duration of cardiopulmonary bypass (CPB) and without CPB (off-pump surgery).

Methods: We studied 45 patients scheduled for elective CABG.

[Rehabilitation guidelines after total knee arthroplasty].

Rehabilitation programs after total knee arthroplasty vary as much as do the surgical procedures employed. The postoperative range of motion of the knee is considered to be one of the primary indicators of the success of arthroplasty surgery. Protocols focusing on improving range of motion have been widely investigated: the end result does not seem to depend on using specific devices or exercises.

Human oocyte cryopreservation as an adjunct to IVF-embryo transfer cycles.

Background: The purpose of this work was to develop methods for successful cryopreservation of human oocytes.

Methods: Two cryopreservation procedures were used. Method 1 involved use of 1.

[Shortage of anaesthesiologists in Germany].

After the glut of doctors in the past, we find a shortage of doctors in the present time. Approximately only 60% of all doctors would decide to become a doctor again. These alarming news should urge us to improve the situation for the rising generation of doctors especially for young anaesthesiologists.