[Implementation of a web based software for documentation and control of quality of an acute pain service].

Providing an acute pain service means accumulation of a large amount of data. The alleviation of data collection, improvement of data quality and data analysis plays a pivotal role. The electronic medical record (EMR) is gaining more and more importance in this context and is continuously spreading in clinical practice.

The effects of fenoterol inhalation after acid aspiration-induced lung injury.

Background: Acid aspiration is a serious complication that can occur during general anesthesia. Studies show that beta-agonists have beneficial effects on lung injury. Therefore, we tested the effect of the nebulized beta-agonist fenoterol on lung variables in a rodent model of acid-induced lung injury.

Hydrochloric acid aspiration increases right ventricular systolic pressure in rats.

Background And Objective: Pulmonary aspiration of gastric acid is a serious complication during anaesthesia and may cause aspiration pneumonitis and adult respiratory distress syndrome. The development of pulmonary hypertension may aggravate the initial course of the aspiration pneumonitis. The authors hypothesized that acid aspiration induces an acute increase in right ventricular pressure in the rat heart.

The accuracy of jugular bulb venous monitoring in detecting cerebral ischemia in awake patients undergoing carotid endarterectomy.

To investigate the accuracy of jugular bulb venous monitoring in detecting cerebral ischemia, we performed ipsilateral jugular bulb venous monitoring in 48 patients undergoing carotid surgery under regional anesthesia. Cerebral ischemia was assumed when neurologic deterioration occurred. During carotid clamping, the maximal arterial-jugular venous oxygen content difference [AJDO2 (max)], the minimal jugular venous oxygen saturation [SjO2 (min)], the maximal arterial-jugular venous lactate content difference [AJDL (max)], the maximal lactate oxygen index [LOI (max)], and the maximal modified LOI [mLOI (max)] were determined.

Accuracy of cerebral monitoring in detecting cerebral ischemia during carotid endarterectomy: a comparison of transcranial Doppler sonography, near-infrared spectroscopy, stump pressure, and somatosensory evoked potentials.

Background: This study compares the accuracy of cerebral monitoring systems in detecting cerebral ischemia during carotid endarterectomy.

Methods: The authors compared transcranial Doppler sonography (TCD), near-infrared spectroscopy (NIRS), stump pressure (SP) measurement, and somatosensory evoked potentials (SEP) in 48 patients undergoing carotid surgery during regional anesthesia. Cerebral ischemia was assumed when neurologic deterioration occurred.

[Positioning therapy in intensive care medicine in Germany. Results of a national survey].

Background: The effects of a systematic change in a patient's position [prone position, continuous lateral rotational therapy (CLRT)] have been investigated in recent years in acute lung injury and have shown an improvement in oxygenation, but controversial results regarding duration of mechanical ventilation, intensive care treatment and mortality compared to conventionally treated patients. We were interested in the practice and acceptance of positioning therapy in German intensive care units (ICU) and performed a national postal survey with respect to evaluation of indications, preference of particular positions, observed complications and additional aspects (costs, influence on other intensive care measures etc.).

Interhospital transport: transport of critically ill patients.

Primary emergency medicine systems in developed countries are well organized. Besides this primary system a secondary interhospital transport system has been developed in the past decade. The need for this system is expected to increase in the future following dramatic changes in the organization of the medical health system.

Anaesthesia for magnetic resonance imaging/computed tomography.

The need for general anaesthesia for magnetic resonance imaging/computed tomography investigations can be reduced by the implementation of structured sedation programmes supervised by anaesthetists. Despite its side-effects, chloral hydrate is still the drug most widely used. Rectal thiopental or intravenous propofol are suggested anaesthetic agents for pre-school children and uncooperative or claustrophobic individuals.

A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia.

Objective: Pump-driven extracorporeal gas exchange systems have been advocated in patients suffering from severe acute respiratory distress syndrome who are at risk for life-threatening hypoxemia and/or hypercapnia. This requires extended technical and staff support.

Design: We report retrospectively our experience with a new pumpless extracorporeal interventional lung assist (iLA) establishing an arteriovenous shunt as the driving pressure.

Impact of the Narcotrend Index on propofol consumption and emergence times during total intravenous anaesthesia with propofol and remifentanil in children: a clinical utility study.

Background And Objective: The electroencephalographic Narcotrend Index (NI) is a measure of the hypnotic component of general anaesthesia. The purpose of this study was to evaluate the impact of Narcotrend guidance on propofol consumption and emergence times in children receiving total intravenous anaesthesia with propofol and remifentanil.

Methods: Thirty children, aged 1-11 yr, scheduled for paediatric urological surgery were enrolled.

The correlation of the Narcotrend Index with endtidal sevoflurane concentrations and hemodynamic parameters in children.

Background: The Narcotrend Index (NI) of anesthetic depth is potentially a pharmacodynamic measure of the effects of sevoflurane on the brain.

Methods: In this prospective observational study of 30 pediatric surgical patients (1-11 years), we investigated the correlation between nonsteady-state endtidal sevoflurane (eT(Sevo)), NI, mean arterial pressure (MAP), and heart rate (HR). The performance of the Narcotrend for differentiation between consciousness and unconsciousness was evaluated using prediction probability (P(K)).

Clearance of moxifloxacin during continuous haemofiltration (CVVHF) in vitro.

Background/aims: The clearance of moxifloxacin is reported to be unaltered in the presence of renal insufficiency. There is little information about the clearance of intravenous moxifloxacin in renal replacement therapies during intensive care. The aim of this study was to determine the clearance of moxifloxacin during continuous veno-venous haemofiltration (CVVHF) in vitro.

The correlation of the Narcotrend Index and classical electroencephalographic parameters with endtidal desflurane concentrations and hemodynamic parameters in different age groups.

Background: The Narcotrend Index (NI) for assessment of depth of anesthesia by analysis of the electroencephalogram (EEG), is potentially a pharmacodynamic measure of the effects of desflurane on the brain.

Methods: In this prospective study of 30 pediatric and adult patients (group 1: 3-6 years, n = 10; group 2: > 6 < 12 years; group 3: 12-40 years), undergoing ophthalmological surgery, we investigated the pharmacodynamic relationship between nonsteady state endtidal desflurane concentrations (eT(Des)), NI, classical EEG parameters (cEEG), heart rate (HR) and mean arterial pressure (MAP). The performance of the Narcotrend for differentiation between consciousness and unconsciousness was evaluated using prediction probability (P(K)).

Early treatment with pentoxifylline reduces lung injury induced by acid aspiration in rats.

Study Objectives: To evaluate the effect of pentoxifylline treatment on gas exchange and mortality immediately after bilateral instillation of hydrochloric acid.

Design: Randomized, prospective, placebo-controlled trial.

Setting: Animal laboratory of a university hospital.

[Comparison of incomplete (135 degrees ) and complete prone position (180 degrees ) in patients with acute respiratory distress syndrome. Results of a prospective, randomised trial].

Background: Ventilation in the prone position is carried out for improvement of pulmonary gas exchange in patients with acute respiratory distress syndrome (ARDS). We compared the effects of an incomplete prone position (IPP, 135( degrees )) with a complete prone position (CPP, 180( degrees )) in patients with ARDS.

Patients And Methods: For this trial 59 patients with ARDS were randomly assigned and were positioned in a "cross-over" design: patients of group A were placed in IPP for 6 h and then immediately positioned in CPP for another 6 h.

Mild hyperthermia down-regulates receptor-dependent neutrophil function.

Mild hypothermia impairs resistance to infection and, reportedly, impairs phagocytosis and oxidative killing of unopsonized bacteria. We evaluated various functions at 33 degrees-41 degrees C in neutrophils taken from volunteers. Adhesion on endothelial cells was determined using light microscopy.

Evaluation of the Alaris Auditory Evoked Potential Index as an indicator of anesthetic depth in preschool children during induction of anesthesia with sevoflurane and remifentanil.

Background: Autoregressive modeling with exogenous input of middle latency auditory evoked potentials (A-Line autoregressive index [AAI]) has been proposed for monitoring depth of anesthesia in adults. The aim of this study was to evaluate the performance of the AAI during induction of anesthesia with sevoflurane and remifentanil in pediatric patients.

Methods: Twenty preschool children were anesthetized with sevoflurane and remifentanil.

[Anaesthesia for radiation therapy of brain tumours in children. A multidisciplinary challenge].

Radiation therapy of childhood intracranial malignancies is always a challenge for radiation oncologists, anaesthetists and paediatric oncologists. Detailed knowledge of the course of the disease prior to radiation therapy and a critical evaluation of the child's actual physical status are mandatory in each case. Furthermore the anaesthetist should be informed about the child's individual preferences and aversions.

[Pumpless extracorporeal lung assist using arterio-venous shunt in severe ARDS. Experience with 30 cases].

Background: Extracorporeal lung assist has been proposed as an invasive measure in patients with acute respiratory distress syndrome (ARDS) when oxygenation is critically impaired. However, this technique generally requires high personnel and technical resources. We report on a new system, which is characterised by a short circuit arterio-venous shunt using arterio-venous pressure gradient as driving force (pumpless extracorporeal lung assist [pECLA]).

Convective air warming is more effective than resistive heating in an experimental model with a water dummy.

Trauma patients with accidental hypothermia have adverse outcomes when compared with normothermic patients. Studies with a small number of mild hypothermic volunteers suggested that convective warming is more effective than warming with 12 volt resistive heating blankets. In a laboratory study, we compared the warming effectiveness of two electric blankets and convective air warming.

[Hb 1.1 g/dl: successful treatment of a polytraumatized patient in hemorrhagic shock].

We report on the successful treatment of a seriously traumatized patient (injury severity score=59) who presented with exsanguinating hemorrhage in the emergency room. Preclinical and emergency room management included "small volume" hypertonic resuscitation as well as massive transfusion, C-clamp stabilization of a pelvic ring instability, and attachment of external fixators to multiple bone fractures. During the intensive care period,we started enteral immunonutrition immediately after an abdominal compartment syndrome was removed by laparotomy and a jejunal catheter had been inserted.

[Patient-controlled analgesia: psychological predictors of pain experience, analgesic consumption and satisfaction].

Introduction: The present study examines the relationship between different psychological variables (including anxiety, depression, locus of control, expectations of pain intensity and social support) and postoperative pain, analgesic consumption and satisfaction with the pain management in a study sample of 67 patients.

Methods: Intravenous patient-controlled analgesia was used for postoperative analgesia. Pain intensity was assessed by numerical rating scales and obtained from the PCA-report.

Cytokines down-regulate alpha1-adrenergic receptor expression during endotoxemia.

Objective: The reduced pressure response to norepinephrine in septic patients has directed our interest to the regulation of alpha1-adrenergic receptors in vitro and in vivo during conditions mimicking acute sepsis.

Design: Prospective animal trial followed by a controlled cell culture study.

Setting: Laboratory of the Department of Anesthesiology.