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Martin Jöhr

Publications and source records attributed to Martin Jöhr.

17 recordsLinked to original sources
PubMed2005

Paediatric anaesthesia and inhalation agents.

Inhalation agents are amongst the mainstays of paediatric anaesthesia, as children are often induced by mask before venous access is obtained. Children do not like needles and obtaining venous access in an awake and moving child can be very demanding. Safety aspects are of particular importance in paediatric anaesthesia. Therefore, the possibility of monitoring end-tidal concentrations facilitates correct dosing in all patients, from the preterm infant weighing less than 1000 g to the adult-sized adolescent. For induction, sevoflurane has nearly universally replaced halothane, leading to increased cardiovascular safety. The main disadvantages of inhalation agents, especially sevoflurane and desflurane, are delirious behaviour and agitated states during emergence. In addition, there remains uncertainty regarding the relevance of the cerebral stimulating pattern of some of these agents. Inhalation anaesthesia has a long tradition, whereas the experience with propofol is comparatively small. The incidence and clinical relevance of the propofol infusion syndrome during clinical anaesthesia are still unknown. Inhalation anaesthesia is still considered to be the gold standard by the overwhelming majority of paediatric anaesthetists world-wide, however, intravenous techniques can be an attractive alternative in specific clinical situations.

Anesthesia, General↗
PubMed2005

Psoas compartment block in children: Part I--description of the technique.

BACKGROUND: Until recently only small series of psoas compartment blocks (PCB) in children have been reported. A high incidence of epidural spread as an important side effect was noted. A series of 100 consecutive blocks using new standardized landmarks is reported. METHODS: In 100 consecutive children (5.9-106 kg) PCB was performed using a nerve stimulator. In the lateral position, the needle was inserted between the medial 2/3 and the lateral 1/3 on a line from the spinous process of L4 to the posterior superior iliac spine. The blocks were performed by residents in training under supervision of one specific designated pediatric anesthetist. RESULTS: All blocks were clinically successful. In 64% only one attempt was necessary, in 26 patients two attempts were necessary and in 10 patients more than two attempts were necessary. In 16% a vascular puncture occurred. In one patient with a dense unilateral block a partial epidural spread occurred. No serious complications were observed during the perioperative period. CONCLUSIONS: The described new technique has a very high success rate with no relevant side effects. Although only one case of epidural spread occurred, PCB remains an invasive technique with the potential for serious complications.

Anesthesia, Epidural↗
PubMed2005

Psoas compartment block (PCB) in children: Part II--generation of an institutional learning curve with a new technique.

BACKGROUND: Literature concerning institutional learning processes for anesthesia procedures in pediatric anesthesia is rare. Until recently only small series of psoas compartment blocks (PCB) in children have been reported. We report on a series of 100 consecutive blocks using new landmarks and the institutional learning process. METHODS: In 100 consecutive children (5.9-106 kg) PCB was performed using a nerve stimulator. In the lateral position, the needle was inserted between the medial 2/3 and the lateral 1/3 on a line from the spinous process of L4 to the posterior superior iliac spine. Residents unfamiliar with PCB were instructed by one single staff member without manual intervention. Failure was defined as a bloody tap, more than one skin perforation with the needle or relinquishing the procedure to senior staff. To evaluate the institutional learning process the cumulative sum (CUSUM) statistical technique was used. CUSUM analysis was performed using an acceptable failure rate of 10%. A learning curve using a bootstrap technique and a least square fit model was also used. RESULTS: Although all blocks were clinically successful, only in 64% was a single attempt sufficient. In 16% vascular puncture occurred. Surprisingly the CUSUM analysis showed a clear institutional learning phenomenon. Applying a strict definition for a successful block, more than 100 PCB in an institution may be necessary. Using the generated learning curve, for a success rate of 70% a case load of at least 55 attempts is required. CONCLUSIONS: Although the described new technique had a very high success rate with a low complication rate, PCB in children is not easily implemented into clinical practice when strict criteria of success were used, despite a well-controlled environment. Training programs could use CUSUM to track the progress of their institutional learning in order to guarantee adequate experience.

Anesthesia, Epidural↗
PubMed2004

Regional anaesthetic techniques for neonatal surgery: indications and selection of techniques.

The goal of neonatal care is to optimise the outcome of term and preterm infants with minimal suffering. Neonates are rare patients for the anaesthetist, therefore personal and even global experiences are limited. This chapter focuses on strategies for dealing with common clinical situations, e.g. heel lancing, obtaining vascular access, circumcision, hernia repair and pyloric stenosis, as well as major neonatal surgery. With the exception of heel lancing, regional techniques are useful in all cases. However, a careful risk-benefit analysis is mandatory, especially when considering more invasive techniques such as epidural catheters.

Anesthesia, Conduction↗
PubMed2004

Recent developments in paediatric regional anaesthesia.

PURPOSE OF REVIEW: This review will focus on recently published data concerning side effects and complications of paediatric regional anaesthesia, putting into perspective the currently used techniques. RECENT FINDINGS: Penile block is clearly a technique with a very large benefit and minimal side effects. Ilioinguinal nerve block, on the other hand, quite commonly leads to complications. Single-shot caudal anaesthesia is considered a safe and effective technique; however, even with this widely used block, complications such as sacral osteomyelitis can occur. Recent review articles have focussed on the role of additives for prolonging the duration of paediatric caudal anaesthesia. The use of ketamine or s-ketamine as an additive appears to be most promising for the future. SUMMARY: Paediatric regional anaesthesia is now widely used for postoperative pain relief in children. However, a careful risk-benefit analysis is always mandatory before such medical interventions are undertaken.

Journal Article↗
PubMed2004

Generating a learning curve for penile block in neonates, infants and children: an empirical evaluation of technical skills in novice and experienced anaesthetists.

BACKGROUND: Literature concerning learning curves for anaesthesiological procedures in paediatric anaesthesia is rare. The aim of this study was to assess the number of penile blocks needed to guarantee a high success rate in children. METHODS: At a teaching hospital, the technical skills of 29 residents in anaesthesiology who performed penile blocks under the supervision of two staff anaesthesiologists were evaluated during a 12-month period using a standardized self-evaluation questionnaire. At the start of the study period, the residents had no prior experience in paediatric anaesthesia or in performing penile block. All residents entered the paediatric rotation after a minimum of 1-year training in adult general and regional anaesthesia. The blocks were rated using a binary score. For comparison, the success rates of the two supervising staff anaesthesiologists were collected during the same period using the same self-evaluation questionnaire. Statistical analyses were performed by generating individual and institutional learning curves by using the pooled data. The learning curves were calculated with the aid of a least square fit model. A 95% CI were estimated by a Monte Carlo procedure with a bootstrap technique. RESULTS: In a total number of 392 blocks performed, the overall success rate was 92.1%. There was no statistical difference between the success rate of the two staff members (success rate: 96.3%) and the overall success rate of the 29 residents performing a total of 339 blocks. The total success rate for this group was 91.5%. The failure rate for the first 10 blocks performed by the residents was 8.82% (95% CI: 5.0-14.14%), it was 4.12% (95% CI: 1.13-10.22%) for the next 10 blocks and from blocks 21 to 40 it was 6.5% (95% CI: 2.65-12.9%). For blocks 41-60, the failure rate was 4.4% (95% CI 0.54-15.15%). CONCLUSIONS: Penile block in children is easily learned by residents. A steep learning curve was found. The success rate was over 93.5% after more than 40 blocks.

Adult↗
PubMed2003

Congenital laryngotracheo-oesophageal cleft: successful ventilation with the Laryngeal Mask Airway.

A congenital laryngotracheo-oesophageal cleft is a rare airway malformation which results from incomplete separation of the larynx and trachea from the hypopharynx and oesophagus. Patients usually present with stridor, aspiration and cyanosis associated with feeding. For early diagnosis, a high index of suspicion is needed. Unless an appropriate diagnostic approach is taken, the diagnosis can be missed. The successful ventilation of a neonate with the Laryngeal Mask Airway is described.

Esophagus↗