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R Hofmockel

Publications and source records attributed to R Hofmockel.

14 recordsLinked to original sources
PubMed1998

[Sore throat after use of the laryngeal mask and intubation].

The laryngeal mask was developed by Brain in 1981 and described for the first time in 1983. It has been applied a few million times worldwide since 1988. One of the main complication is soreness of the throat. Two hundred unselected patients who had gynaecological procedures under general anaesthesia--100 under laryngeal mask airway and 100 under intubation--were surveyed to ascertain the incidence of sore throats under laryngeal mask airway. Each patient was asked about soreness of the throat during the next two days. The incidence and duration of sore throats were recorded using a pain scale (0-100). After narcoses with the laryngeal mask, 63 patients had no complaints. Thirty-seven had sore throats with an average pain score of 8.1 +/- 13.8 on the day of operation. The average pain scores showed a decreasing tendency (4.2 +/- 9.5 and 0.4 +/- 2.6) for the first and second postoperative day. After intubation narcoses, we recorded sore throats significantly more frequently (p < 0.05) and the average pain score on the day of operation was significantly higher (13.2 +/- 17.5; p < 0.05) than after narcoses with the laryngeal mask. Also after narcoses with the laryngeal mask, the average pain scores decreased quickly on the first and second postoperative days (5.1 +/- 9.0 and 0.2 +/- 1.4). There were no differences regarding sore throats between narcoses with the laryngeal mask or intubation on these two postoperative days. Using both anaesthesiological methods, sore throat was not related to duration of anaesthesia or the experience of the anaesthetist.

Adolescent↗
PubMed1997

[Comparison of dosage relations of prilocaine and bupivacaine for axillary plexus anesthesia].

The effects of 40 ml of prilocaine 1% compared to 30 ml prilocaine 1% added to 10 ml bupivacaine 0.5% and 20 ml prilocaine 1% added to 20 ml bupivacaine 0.5% after injection into the brachial plexus sheath were evaluated. In a prospective study, 90 patients who underwent surgery on the upper limb were randomly allocated to one of these three groups. In each group 15 patients were treated using nerve stimulation with an immobile needle and 15 using a plexus catheter. We assessed the sensory and motor blockade of the appropriate nerves every 5 minutes after injection for a period of 45 minutes (pin-prick testing or strength of the appropriate muscles). Postoperatively the patients documented the strength of their pain on a score of 0 to 10 four hours, six hours and 24 hours after injection. There were no differences in onset time between the groups, the operation normally starting after about 30 minutes. Compared to other nerves, blockade of the musculocutaneous nerve was delayed and not as complete. The quality of the blockade of the radial nerve was not worse than that of the ulnar and median nerve. Eighty-four patients were operated on in regional anaesthesia, 74 patients without supplementary measures. There were no differences in postoperative pain between the two different techniques. Significant differences, however, were found between the three drug groups: Patients given 40 ml of prilocaine 1% documented pain (0.75) 4 hours after injection; the other two groups reported nearly none. Six hours after injection the patients who had received 40 ml of prilocaine 1% had significantly more pain (2.25) than patients who had received 30 ml of prilocaine 1% plus 10 ml of bupivacaine 0.5% (0.96); patients who had received 20 ml of prilocaine 1% plus 20 ml of bupivacaine 0.5% had nearly no pain (0.19). We can conclude that mixing of prilocaine 1% with bupivacaine 0.5% is a useful way to achieve adequate duration of anaesthesia and to reduce postoperative pain without extending onset times for axillary plexus block. Postoperative application of analgetics can often be avoided completely.

Adult↗
PubMed1995

[Comparison of neuromuscular blockade by mivacurium and atracurium].

The aim of our randomized controlled study was to compare the neuromuscular characteristics of mivacurium and atracurium by evaluating the intubation conditions, intubation times, onset times and the duration of action of these two muscle relaxants using two different dosing principles. Forty-eight patients were included in this study. All patients were premedicated orally with 0.2 mg/kg diazepam. Anaesthesia was induced with 2.0 mg/kg propofol and 0.02 mg/kg alfentanil and maintained with 6 mg/kg/h propofol and 60% nitrous oxide in oxygen. Neuromuscular monitoring was carried out with supramaximal TOF-stimulation (2 HZ) of the ulnar nerve every 10 seconds and recording of the mechanomyogram (MMG) (Myograph 2000, Biometer) at the adductor pollicis muscle. The patients of group 1 (n = 12) received an intubation dose of 0.15 mg/kg mivacurium (2 x ED95) and the patients of group 2 (n = 12) received a priming dose of 0.015 mg/kg mivacurium (20% of ED95) followed by an intubation dose of only 0.07 mg/kg mivacurium (ED95) two minutes later. The patients of group 3 (n = 12) were intubated with 0.46 mg/kg atracurium (2 x ED95) and the patients of group 4 (n = 12) received a priming dose of 0.046 mg/kg atracurium (20% of ED95) and an intubation dose of 0.23 mg/kg atracurium (ED95) four minutes later. The patients were intubated under normocapnic conditions and following stabilisation of the palmar skin temperature after a 90% neuromuscular block (T1) had occurred. The intubation conditions were measured semiquantitatively using an intubation score.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Documentation and information processing in clinical anesthesia].

Whereas anaesthesia recording was already introduced by Codman and Cushing in 1894 and is now stipulated by law, work registration in anaesthesia and work comparison between departments of anaesthesia have only been built up in the last ten years. Based on the rapid development of computer technology specific solutions were found, ranging from simple software developments to complex on-line monitor systems. The basic data bank published by the German Society of Anaesthesiology and Intensive Medicine represents a minimum of data, which can be added to at will. We report on our new anaesthesia record and corresponding software with computer supported manual data registration, which was developed at our clinic, taking into account state-of-the-art data processing and quality assurance. A new development, which includes on-line data processing with automatic data registration followed by graphic or numeric data print-out, is now presented by Datex. In combination with manual data input of all parameters of work registration, complete automatic anaesthesia recording can be achieved. The authors report on their first own experience with this system.

Anesthesia Department, Hospital↗
PubMed1995

[EEG changes during propofol-alfentanil-nitrous oxide anesthesia].

Blood pressure, heart rate and perspiration were and still are the only clinical signs for recognizing the depth of balanced anaesthesia in combination with muscle relaxants. Even experienced anaesthetists sometimes have difficulties in recognizing the necessary depth of anaesthesia using these parameters and in relatively rare cases the very unpleasant symptom of awareness occurs. Nowadays, processed EEG monitoring (pEEG) is used scientifically and also clinically for exact controlling of general anaesthesia. We report on our first experience with this method in 21 patients who were anaesthetized with propofol, alfentanil and nitrous oxide and relaxed with atracurium and whose depth of anaesthesia was carefully controlled by pEEG using the pEEG Monitor of Drägerwerke. The following parameters were recorded continuously: Spectral Edge Frequency (SEF) 50, SEF 90, SEF 95 and power between 8 and 20 Hz in relation to the power between 0 and 4 Hz (delta ratio). In agreement with other investigators we found that a sufficient depth of anaesthesia could be expected when the SEF 50 ranged between 2 and 6 Hz (4.9 +/- 0.9), the SEF 90 ranged between 10 and 13.5 Hz (11.9 +/- 0.6), the SEF 95 ranged between 14 and 16 Hz (14.8 +/- 0.8) and the delta-ratio ranged between 0.7 and 1.4 (1.1 +/- 0.2). Using this anaesthetic technique and a premedication with benzodiazepine, SEF 90 SEF 95 are the best parameters for monitoring the depth of anaesthesia. In one patient blood pressure and heart rate remained constant intraoperatively, but she described intensive dreams postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Time-course of action and intubating conditions with rocuronium bromide under propofol-alfentanil anaesthesia.

Thirty ASA I and II patients received either an intubating dose of 0.6 mg kg-1 rocuronium (2 x ED95, group 1) or 0.06 mg kg-1 as a priming dose followed by an intubating dose of 0.24 mg kg-1 rocuronium (group 2) 4 min later. Anaesthesia was induced with propofol (2.0 mg kg-1) and alfentanil (0.02 mg kg-1) and maintained with nitrous oxide/oxygen and propofol (6.0 mg kg-1 h-1). Neuromuscular function was monitored mechanomyographically and electromyographically with train-of-four (TOF) stimulation at the wrist every 10 s. The following parameters were measured and compared between the two groups: time to 90% block (intubation time), time to maximum block (onset time), and the times for T1 (25%, 75% and 90%) and TOF > 70%. In group 1 the intubation time was significantly shorter (40 +/- 10 s) than in group 2 (51 +/- 11 s). Intubating conditions were good or excellent in both groups. The clinical duration of action was 28 +/- 8 min in group 1 and 15 +/- 3 min in group 2, respectively. Mechanomyography showed a significantly faster development of neuromuscular block than electromyography. The comparison of mechanomyographically and electromyographically measured recovery times did not show any differences. In 60% of the patients a priming dose of 0.06 mg kg-1 was followed by a considerable decrease in neuromuscular function.

Adult↗
PubMed1994

[Mechanomyographic and electromyographic studies of endotracheal intubation with 2 different rocuronium dosages].

Rocuronium is a new, intermediate-acting, nondepolarizing relaxant with rapid onset of action leading to both good and very good intubation conditions. It was the aim of our study to investigate the onset of action, the intubation conditions and the course of relaxation using two different dosage regimes. Thirty consenting ASA 1 and 2 patients received either 0.6 mg/kg (2 x ED 95; group 1) or 0.06 mg/kg as priming dose followed by an intubating dose of 0.24 mg/kg rocuronium (group 2) four min later. Anaesthesia was induced with propofol (2 mg/kg) and alfentanil (0.02 mg/kg) and maintained with nitrous oxide/oxygen and propofol (6 to 8 mg/kg/h). Neuromuscular function was monitored mechanomyographically and electromyographically with TOF stimulation at the wrist every 10 seconds. Intubation conditions were determined using a semiquantitative score system, and times to 90% block (intubation time), maximum block (onset time) and recovery from neuromuscular blockade to 25%, 50%, 75% and 90% were calculated and comparisons were made between the corresponding results of the two groups. The intubation dose of 2 x ED 95 (group 1) was followed by a significantly shorter intubation time (39.1 +/- 9.6 sec.) than in group 2 with priming and an intubation dose of 0.24 mg/kg (50.7 +/- 11.0 sec). The intubation conditions showed no differences. In both groups they were good or very good. The clinical duration of action was significantly longer in group 1 (28.4 +/- 8.0 min) than in group 2 (14.8 +/- 2.5 min). It can be concluded that rocuronium which has shorter intubation times than atracurium and vecuronium is very useful for endotracheal intubation in both dosage regimes in long and very long lasting operations. Using the "priming principle" the patient has to be carefully controlled during priming time.

Adult↗
PubMed1994

[LEVEL 1--a new blood warming device].

Hypothermia of less than 35 degrees C, which frequently occurs in connection with massive blood transfusion, is a serious problem in many patients, in particular in those with polytrauma. The restoration of normal body temperature is very important and requires the use of a rapidly-acting, efficient and safe blood warmer, which is able to work effectively at high flow-rates. The LEVEL 1 (Technologies, Rockland, MA) is such a new blood warmer and works as a heat-exchanger via an aluminium column. This system is highly effective. Six hundred ml of sodium chloride 0.9% are warmed from 4 to 35 degrees C within one minute. This device is quickly operational and has a low priming volume. The LEVEL 1 is the only device currently available which is able to warm blood sufficiently during a very rapid blood transfusion.

Blood Component Transfusion↗
PubMed1994

[Mixtures of different local anesthetics for subaxillary plexus anesthesia].

In a prospective clinical study, 76 patients were scheduled for subaxillary plexus block in order to investigate onset time, duration of action and quality of motor and sensitive blockade of various mixtures of local anaesthetics. Sixty-one patients were allocated to four groups. Each of them received 15 ml of bupivacaine 0.5% with either 15 ml of lidocaine 1% (n = 14), of mepivacaine 1% (n = 16), of prilocaine 1% (n = 15) or of etidocaine 1% (n = 15). Fifteen patients (control group) received only 30 ml bupivacaine 0.5%. The investigation showed that in comparison with the control group the mixtures of the intermediate-acting local anaesthetics led to significantly shorter times of onset and duration. Within these three groups we did not find any significant differences regarding onset time and duration of action. But regarding the quality of motor block, the mixture of bupivacaine and lidocaine was less effective than the other combinations, of which the mixture of bupivacaine and prilocaine showed the best motor block. The combination of the two long-acting local anaesthetics bupivacaine and etidocaine had the longest effect and, therefore, this mixture is a real alternative to subaxillary block via catheter technique. Specific electric stimulation of the radial nerve leads to higher success rate of subaxillary plexus block.

Anesthetics, Local↗
PubMed1987

[Catheter problems in the use of ventricular cardiovascular assist systems].

The prerequisite for efficient assist-ventricles and impulses in the pulsatile pumping function are sufficiently dimensioned afflux and flowing off connections. In systematic investigations on the hydraulic circulation model the cannulas from an internal parameter of 12 mm with a total length of the connection distance to the inflow and outflow valve, respectively, at the bypass ventricle of 30 cm proved sufficient for performing a volume of output of 5-6 l/min in clinic-relevant filling pressures in a hypodynamic circulatory situation. Connection cannulas for the heart-lung machine used in routine work are not sufficient in periodic filling and ejection processes in the pulsatile pumping function for an effective decompression and effective increase of the cardiac output. In case of an ECG-triggered mode of action of the ventricular assist-system an increase of frequency up to 130/min in after that incomplete filling of the assist-ventricle does not remarkably restrict the effectiveness of the assist-system.

Assisted Circulation↗
PubMed1987

Comparison of atracurium, pipecuronium, and vecuronium for tracheal intubation.

In order to compare tracheal intubation conditions, 34 adult patients about to undergo elective surgery received at random atracurium 0.5 mg X kg-1, pipecuronium 0.1 mg X kg-1 or vecuronium 0.1 mg X kg-1, intravenously. Intubation was attempted when only the first of the train-of-four finger contractions, arising from ulnar nerve stimulation, remained. The three relaxants provided effective conditions for intubation. The time required to suppress all but the first train-of-four response was shortest in the group given atracurium (P less than 0.05). Compound muscle action potentials (emg) were continuously filmed from just before induction of anesthesia until the trachea was intubated. The degree of neuromuscular blockade was similar in the three study groups.

Action Potentials↗