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Hinnerk Wulf

Publications and source records attributed to Hinnerk Wulf.

25 records · Page 2Linked to original sources
PubMed2003

Caudal bupivacaine and s(+)-ketamine for postoperative analgesia in children.

BACKGROUND: The aim of this study was to evaluate whether caudal s-ketamine would prolong analgesia together with caudal bupivacaine. METHODS: Thirty children, ASA I-II, 1 month-9 years, scheduled for minor inguinal or penile surgery, were randomly assigned in a prospective, double-blind fashion to receive single shot caudal blockade by either bupivacaine 0.125% 1 ml.kg(-1) (group B, n = 15) or a mixture of bupivacaine 0.125% 1 ml.kg(-1) and preservative-free s-ketamine 0.5 mg.kg(-1) (group K, n = 15). Postoperative pain was assessed by means of an observational 10-point scoring system and analgesia was administered if the pain score exceeded a value of 3. RESULTS: Within 24 h after caudal block 10 patients (67%) in group K and three patients in group B (20%) did not require additional analgesic medication (P < 0.01). There were no significant differences between the groups for incidence of haemodynamic changes. We did not observe any negative side-effects attributable to the caudal block or s-ketamine. CONCLUSIONS: Addition of preservative-free s-ketamine 0.5 mg.kg(-1) to caudal bupivacaine 0.125% 1 ml.kg(-1) provides significant prolongation of analgesia without producing negative side-effects.

Analgesics↗
PubMed2003

Lacticacidosis after short-term infusion of propofol for anaesthesia in a child with osteogenesis imperfecta.

We describe the case of a 7-year-old boy with osteogenesis imperfecta, who underwent anaesthesia with propofol-fentanyl-nitrous oxide-suxamethonium for orthopaedic surgery of a distal femur fracture. He developed lacticacidosis after short-term propofol infusion (150 min, mean infusion rate 13.5 mg.kg-1.h-1) associated with a prolonged recovery time without serious haemodynamic changes. The highest lactate concentration was 9.2 mmol.l-1 at 160 min after discontinuation of propofol. There was no significant increase in body temperature. The boy fully recovered.

Acidosis, Lactic↗
PubMed2003

Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery.

OBJECTIVES/HYPOTHESIS: Controlled hypotension is used to improve surgical conditions during microscopic and endoscopic sinus surgery. New short-acting anesthetics such as propofol and remifentanil allow exact control of intraoperative blood pressure and thus might be valuable tools to improve intraoperative conditions for the otorhinolaryngological surgeon. Intravenous anesthesia was compared with traditional balanced anesthesia by subjective assessment of surgical conditions made by two experienced otorhinolaryngological surgeons. STUDY DESIGN: Prospective, randomized, patient- and observer-blinded study. METHODS: Ninety consecutive patients were randomly assigned to receive intravenous anesthesia with propofol 5 to 8 mg.kg-1.h-1 and remifentanil 10 to 30 microg.kg-1.h-1 or with isoflurane (0.4-1.0 vol%) and repetitive doses of 0.5 to 1 mg alfentanil. An injectable vasodilator was used in both groups to keep mean arterial pressure between 60 and 70 mm Hg (8-9.3 hecto-pascal). The attending otorhinolaryngological surgeon was unaware of the type of anesthesia administered. Immediately after the operation the surgeons rated surgical conditions (bleeding from the surgical field) on a visual analogue scale (0-10 cm) and on a verbal rating scale. RESULTS: Blood pressure was not different between the two groups, but heart rate was lower in the intravenous anesthesia group (mean heart rate in the intravenous anesthesia group, 62 beats per min [95% confidence interval, 52-72]; mean heart rate in the balanced anesthesia group, 75 beats per min [95% confidence interval, 67-83]). Surgical conditions were rated to be significantly better (P <.0001) during anesthesia with propofol-remifentanil (median rating: 2.8; 25th/75th percentile: 2.0/3.4) compared with isoflurane-alfentanil (median rating: 4.9; 25th/75th percentile: 3.6/7.6). CONCLUSIONS: Intravenous anesthesia using propofol-remifentanil provides better surgical conditions compared with a traditional balanced anesthesia technique using isoflurane-alfentanil. It is hypothesized that lower cardiac output caused by decreased heart rate during deep general anesthesia is responsible for this result.

Adult↗
PubMed2003

Ginger does not prevent postoperative nausea and vomiting after laparoscopic surgery.

IMPLICATIONS: The potential antiemetic effect of two different oral doses of the herbal remedy ginger (Zingiber officinale) to prevent postoperative nausea and vomiting in 180 patients undergoing gynecologic laparoscopy was investigated in this randomized, double-blinded trial. Ginger failed to reduce the incidence of postoperative nausea and vomiting after these procedures.

Adult↗
PubMed2002

The efficacy and safety of transdermal scopolamine for the prevention of postoperative nausea and vomiting: a quantitative systematic review.

UNLABELLED: The role of scopolamine administered via transdermal therapeutic systems in the prevention of postoperative vomiting, nausea, and nausea and vomiting is unclear. We performed a systematic search for full reports of randomized comparisons of transdermal scopolamine with inactive control. Dichotomous data were extracted. In the meta-analysis, relative risks and numbers-needed-to-treat/harm were calculated with 95% confidence intervals (CI). In 23 trials, 979 patients received transdermal scopolamine, and 984 patients received placebo. Sensitivity analyses were performed using restricted data for truncated control event rates (40%-80%) and for large trials. With these data, the relative risks for postoperative vomiting (five reports), nausea (five reports), nausea and vomiting (eight reports), and rescue treatment (three reports) were 0.69 (95% CI, 0.58-0.82), 0.69 (95% CI, 0.54-0.87), 0.76 (95% CI, 0.66-0.88), and 0.68 (95% CI, 0.54-0.85), respectively. This means that of 100 patients who receive transdermal scopolamine, approximately 17 will not experience postoperative vomiting who would have done so had they all received a placebo. However, 18 of 100 patients will have visual disturbances, eight will report dry mouth, two will report dizziness, one will be classified as being agitated, and 1-13 patients who are prescribed transdermal scopolamine will not use it correctly. The timing of application does not alter efficacy. IMPLICATIONS: Of 100 patients who receive transdermal scopolamine, approximately 17 will not vomit in the postoperative period who would have done so had they all received a placebo. However, 18 of 100 patients will have visual disturbances, and eight will report dry mouth. Incorrect use further limits its efficacy.

Administration, Cutaneous↗
PubMedDate not supplied

Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block.

BACKGROUND AND OBJECTIVES: Continuous femoral nerve block is a well-accepted technique for regional analgesia after total-knee replacement. However, many patients still experience considerable pain at the popliteal space and at the medial aspect of the knee. The goal of this study is to evaluate whether a psoas compartment catheter provides better postoperative analgesia than a femoral nerve catheter does and whether it is as effective as the combination of a femoral and a sciatic nerve catheter and, thus, improves functional outcome. METHODS: Ninety patients who underwent total-knee replacement under standardized general anesthesia participated in this prospective randomized study. Group FEM received a continuous femoral nerve block, group FEM/SCI received a combination of a femoral and a sciatic continuous nerve block, and group PSOAS received a continuous psoas compartment block. Patient-controlled analgesia with piritramide was available for 48 hours. Maximal bending and extending of the knee and walking distance was assessed during the first 7 days. A standardized telephone survey was conducted after 9 to 12 months to evaluate residual pain and functional outcome. RESULTS: Postoperative opioid consumption during 48 hours was significantly less in the FEM/SCI group (median: 18 mg; 25th/75th percentile: 6/40) compared with the FEM group (49 mg; 25/66) and the PSOAS group (44 mg; 30/62) (P =.002). Postoperative pain scores were not different, and no differences occurred with respect to short-term or long-term functional outcome. CONCLUSION: The FEM/SCI catheter is superior to FEM and PSOAS catheter with respect to reduced analgesic requirements after total-knee replacement, but functional outcome does not differ with those 3 continuous regional analgesia techniques.

Aged↗