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Biomedical subjects

S Suttner

Publications and source records attributed to S Suttner.

At least 19 recordsLinked to original sources
PubMed2007

Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery.

BACKGROUND: Thermodilution technique using a pulmonary artery catheter (PAC) is a widely used method to determine cardiac output (CO). It is increasingly criticized because of its invasiveness and its unclear risk-benefit ratio. Thus, less invasive techniques for measuring CO are highly desirable. We compared a new, semi-invasive device (FloTrac/Vigileo) using arterial pressure waveform analysis for CO measurement in patients undergoing cardiac surgery with bolus thermodilution measurements. METHODS: Forty patients undergoing coronary artery bypass grafting or valve repair were enrolled. A PAC was inserted and routine radial arterial access was used for semi-invasive determination of CO with the Vigileo. CO was measured simultaneously by bolus thermodilution and the Vigileo technique after induction of anaesthesia (T1), before cardiopulmonary bypass (CPB) (T2), after CPB (T3), after sternal closure (T4), on arrival in the intensive care unit (ICU) (T5), and 4 h (T6), 8 h (T7), and 24 h after surgery (T8). CO was indexed to the body surface area (cardiac index, CI). RESULTS: A total of 244 pairs of CI measurements were analysed. Bias and precision (1.96 sd of the bias) were 0.46 litre min(-1) m(-2) and +/- 1.15 litre min(-1) m(-2) (r = 0.53) resulting in an overall percentage error of 46%. Subgroup analysis revealed a percentage error of 51% for data pairs obtained intraoperatively (T1-T4), 42% in ICU (T5-T8), and 56% for values obtained during low CI (T1-T8). CONCLUSIONS: In cardiac surgery patients, CO measured by a new semi-invasive arterial pressure waveform analysis device showed only moderate agreement with intermittent pulmonary artery thermodilution measurement.

Adult↗
PubMed2006

Early recovery, cognitive function and costs of a desflurane inhalational vs. a total intravenous anaesthesia regimen in long-term surgery.

BACKGROUND: The purpose of the study was to compare time of recovery, return of cognitive function, post-anaesthetic care unit (PACU) stay and costs of a propofol/remifentanil (TIVA) with a desflurane/fentanyl-based anaesthesia (desflurane group) in surgical procedures lasting more than 150 min. METHODS: Forty-nine patients undergoing elective abdominal prostatectomy were allocated randomly to receive bispectal index (BIS)-controlled desflurane/fentanyl (n=24) or propofol/remifentanil (n=25). Awakening, clinical recovery, direct drug acquisition and post-operative pain treatment were documented. Cognitive skills were tested using the Mini-Mental Status (MMST) test. RESULTS: Extubation was significantly faster with desflurane (6.9+/-3.5 min) than with TIVA (11.2+/-4.0 min) as well as times for stating name and date of birth (desflurane: 6.1+/-3.9 and 6.6+/-4.0 min; TIVA: 12.4+/-11.5 min and 13.4+/-11.3 min). There were no significant differences in PACU discharge times or MMS scores between the groups. Significantly more patients suffered post-operative nausea and vomiting (PONV) in the desflurane (33% vs. 0%) than the TIVA group. Overall costs were significantly higher in the TIVA (58.8+/-11.6 euro) than in the desflurane group (35.0+/-5.7 euro). CONCLUSION: Patients undergoing prolonged surgical procedures showed a faster early recovery after desflurane/fentanyl than using TIVA, whereas stay in the PACU and recovery of cognitive function were similar in both groups. Costs of a TIVA regimen were significantly higher than using a desflurane-based anaesthesia technique.

Anesthesia Recovery Period↗
PubMed2005

Plasma substitutes.

Adequate restoration of intravascular volume remains an important therapeutic manoeuvre in managing the surgical, medical and the critically ill intensive care patient. Definition of the ideal volume replacement strategy still remains one of the burning problems. The choice between colloid and crystalloid solutions continues to generate controversy. The highly controversial crystalloid/colloid dispute has been enlarged to a colloid/colloid debate because aside of the natural colloid albumin several non-protein (synthetic) colloids are available as plasma substitutes (e.g. dextrans, gelatins, hydroxyethyl starch [HES] solutions). Due to their varying physico-chemical properties, these solutions widely differ with regard to their pharmacokinetic and pharmacodynamic properties as well as to their hemodynamic efficacy and side-effects. HES is the most intensively studied plasma substitute. The different HES preparations are defined by concentration, molar substitution (MS), mean molecular weight (MW), and the C2/C6 ratio of substitution. Two new HES specification, a third-generation HES with a lower Mw and a lower MS (6% HES 130/0.4) than all other HES preparation and a first-generation HES prepared in a balanced solution, may be promising by improving the therapy of the hypovolemic patient. Albumin cannot be recommended for correction of hypovolemia because of ist extreme costs and because it can easily be replaced by other no-protein colloids. Dextrans should also not be used any more due to the negative effects on coagulation and its high anaphylactic potency. The historical crystalloid/colloid controversy has been focused primarily on outcome. There is increasing evidence that outcome (mortality) is not the correct measure when assessing the ideal volume replacement strategy. New concepts about critical care such as organ perfusion and organ function, the role of inflammation, immunological aspects, and wound healing may change this point of view. Volume replacement has been hitherto often based on art, dogma and personal beliefs. Further well-performed studies in this area will help more to shed new light on the ideal volume replacement strategy of the hypovolemic patient than more meta-analyses that are pooling old-to-very old studies to solve this problem.

Blood Volume↗
PubMed2004

[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. The elimination of HES molecules varies with the Mw and degree of substitution (DS). Large HES molecules undergo hydrolytic cleavage by alpha-amylase and are excreted in the urine, or they are phagocytosed by the reticuloendothelial system. The smaller HES molecules are eliminated by glomerular filtration. The higher the DS, the slower the metabolism and elimination of the molecule. Although HES can be used safely even in large doses in patients without altered kidney function, renal dysfunction and acute renal failure after HES infusion have been reported in patients who share several risk factors, such as preexisting renal disease, advanced age in combination with dehydration, or treatment with high doses of slow degradable HES solutions. Since there is no direct chemical toxicity of HES, the most likely mechanism for HES-induced renal dysfunction may be swelling and vacuolization of tubular cells ("osmotic nephrosis-like lesions") and tubular obstruction due to the production of hyperviscous urine. Considering this pathogenesis, it can be hypothesized that all hyperoncotic colloid solutions can induce renal impairment. In the case of HES, the risk of high plasma colloid osmotic pressure and thus the risk of acute renal failure are probably increased by high concentrations of the colloid or repeated administration of slowly degradable HES with a high Mw and DS. With adequate hydration, using sufficient amounts of crystalloids, HES has little if any adverse effects on renal function. Furthermore, modern -rapidly degradable HES solutions with a low Mw and DS, such as HES 130/0.4, do not increase the risk for renal dysfunction even when used in large amounts perioperatively.

Animals↗
PubMed2002

Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend) on measures of coagulation.

BACKGROUND: Hydroxyethyl starch (HES) may affect blood coagulation. We studied the effects of a modified, balanced, high-molecular weight [mean molecular weight (MW) 550 kDa], high-substituted [degree of substitution (DS) 0.7] HES preparation (Hextend) on coagulation in patients undergoing major abdominal surgery. METHODS: Patients were allocated randomly to receive Hextend) (n=21), lactated Ringer's solution (RL, n=21) or 6% HES with a low MW (130 kDa) and a low DS (0.4) (n=21). The infusion was started after induction of anaesthesia and continued until the second postoperative day to maintain central venous pressure between 8 and 12 mm Hg. Activated thrombelastography (TEG) was used to assess coagulation. Different activators were used (extrinsic and intrinsic activation of TEG) and aprotinin was added to assess hyperfibrinolytic activity (ApTEG). We measured onset of coagulation [coagulation time (CT=reaction time, r)], the kinetics of clot formation [clot formation time (CFT=coagulation time, k)] and maximum clot firmness (MCF=maximal amplitude, MA). Measurements were performed after induction of anaesthesia, at the end of surgery, 5 h after surgery and on the mornings of the first and second days after surgery. RESULTS: Significantly more HES 130/0.4 [2590 (SD 260) ml] than Hextend) [1970 (310) ml] was given. Blood loss was greatest in the Hextend) group and did not differ between RL- and HES 130/0.4-treated patients. Baseline TEG data were similar and within the normal range. CT and CFT were greater in the Hextend) group immediately after surgery, 5 h after surgery and on the first day than in the two other groups. ApTEG MCF also changed significantly in the Hextend) patients, indicating more pronounced fibrinolysis. Volume replacement using RL caused moderate hypercoagulability, shown by a decrease in CT. CONCLUSION: A modified, balanced high-molecular weight HES with a high degree of substitution (Hextend) adversely affected measures of coagulation in patients undergoing major abdominal surgery, whereas a preparation with a low MW and low DS affected these measures of haemostasis less. Large amounts of RL decreased the coagulation time.

Abdominal Neoplasms↗
PubMed2002

Are lactated Ringer's solution and normal saline solution equal with regard to coagulation?

UNLABELLED: Crystalloids represent an attractive strategy to alleviate intravascular volume deficits. Crystalloid hemodilution was associated with hypercoagulability in in vitro and in vivo studies. The influence of different crystalloids on coagulation in the surgical patient is not well studied. In a prospective, randomized study in patients undergoing major abdominal surgery, we used either lactated Ringer's solution (RL) (n = 21) or 0.9% saline solution (SS) (n = 21) exclusively for intravascular volume replacement over 48 h to maintain central venous pressure between 8 and 12 mm Hg. Activated thrombelastography (TEG) using different activators (intrinsic TEG, extrinsic TEG, heparinase TEG, aprotinin TEG) was used to measure coagulation time, clot formation time, and maximum clot firmness. Measurements were performed after induction of anesthesia (T0), immediately after surgery (T1), 5 h after surgery (T2), and on the morning of the first (T3) and second (T4) postoperative days. RL 18,750 +/- 1890 mL and 17,990 +/- 1790 mL of SS were infused during the study period. Acidosis was seen only in the SS-treated group. Blood loss was not different between the groups. Fibrinogen and antithrombin III decreased similarly at T1 and T2 in both groups, most likely because of hemodilution. Differences in TEG data from normal baseline were seen only immediately after surgery and 5 h thereafter, indicating mild hypercoagulability in the intrinsic TEG (RL, from 147 +/- 130 s to 130 +/- 11 s; SS, from 146 +/- 12 s to 131 +/- 12 s). There were no differences in coagulation between RL- and SS-treated patients. We conclude that in major abdominal surgery intravascular volume replacement with crystalloids resulted in only moderate and abbreviated changes in coagulation. No differences in activated TEG and blood loss were seen between an RL- and an SS-based intravascular volume replacement regimen. IMPLICATIONS: In 42 patients undergoing major abdominal surgery, either lactated Ringer's solution or 0.9% saline solution were exclusively used for volume therapy for 48 h. Activated thrombelastography revealed some mild hypercoagulability after surgery. No differences in coagulation were seen between the two intravascular volume replacement strategies.

Abdomen↗
PubMed2001

[Change in kidney function in elderly patients in the perioperative phase].

BACKGROUND: Reduction in organ function is a common problem in the perioperative period of the elderly patient. Especially renal function is often decreased in this situation. PATIENTS AND METHODS: In a prospective study, we assessed the perioperative changes of renal function in elderly (> 65 years, n = 30) and younger (< 65 years, n = 30) patients without preoperative renal dysfunction who were scheduled for major abdominal surgery. After induction of anesthesia (t0), at the end of surgery (t1), 4 h after surgery (t2), and on the first (t3), second (t4) and third postoperative day (t5), alpha-1-microglobulin, beta-N-acetyl-glucosaminidase, fractional sodium clearance, and creatinine clearance were measured. RESULTS: The creatinine clearance was significantly higher at all time points in the elderly than in the younger patients (p < 0.05). Fractional sodium clearance showed no significant differences between the two groups. At t4 and t5, alpha-1-microglobulin had increased significantly from the baseline value only in the elderly patients. Beta-N-acetyl-glucosaminidase was significantly elevated compared with the baseline value in the elderly patients and also differed significantly from younger patients during the study period. CONCLUSION: In elderly patients undergoing major abdominal surgery, short-term alternations in the renal system were observed in the perioperative period. With adequate volume replacement, no relevant disturbances in renal function are to be expected in the elderly surgical patient.

Adult↗
PubMed2001

Point-of-care (POC) testing of lactate in the intensive care patient. Accuracy, reliability, and costs of different measurement systems.

BACKGROUND: Point-of-care (POC) monitoring may facilitate diagnostic and therapeutic interventions in the critically ill. In a prospective study reliability and costs of two POC lactate testing devices were compared to the central laboratory lactate monitoring method. METHODS: From arterial whole blood and capillary blood samples of 40 intensive care unit (ICU) patients lactate concentrations were measured using either a battery-powered hand-held lactate analyser (Accusport) or a bench-top blood gas analyser (Chiron 865 series) and compared with lactate measured by the hospital's central laboratory ('reference' method). Measurements were carried out on the day of inclusion in the study ('baseline'), 8 h later, and in the morning of the 1st, 2nd, and 3rd days thereafter. Costs for blood lactate measurements were analysed for each method. RESULTS: A total of 197 lactate measurements were done with each system. Lactate measured from arterial blood using the Accusport and the central laboratory showed excellent agreement (bias: -0.15 mmol/l; relative error: -2.74%). Lactate measured by the blood gas analyser had also excellent agreement with the reference method (bias: 0.09 mmol/l; relative error: 2.24%) and the hand-held device (bias: -0.24 mmol/l; relative error: -5.06%). Time from blood sampling to availability of data was significantly longer for the central laboratory (85+/-35 min [range: 45-168 min]) than for both POC systems (range: 1-10 min). Total cost for measuring blood lactate was lowest using the Accusport device. CONCLUSION: The trend towards miniaturizing laboratory monitoring devices will continue, resulting in greater flexibility of management of the critically ill. Blood lactate can rapidly, easily, accurately, and economically be measured at the bedside with the hand-held monitor apparatus Accusport and the bench-top blood gas analyser.

Aged↗
PubMed2001

Influence of a new hydroxyethylstarch preparation (HES 130/0.4) on coagulation in cardiac surgical patients.

OBJECTIVE: To compare volume therapy with HES 130/0.4, a new hydroxyethylstarch (HES) solution with a gelatin-based fluid replacement strategy. DESIGN: Prospective, randomized, safety study. SETTING: Urban, university-affiliated hospital (single institution). PARTICIPANTS: Forty-two patients undergoing elective cardiac surgery. INTERVENTIONS: Patients were prospectively randomized into 2 groups: In group 1 (n = 21), gelatin was given perioperatively for volume support until the 1st postoperative day to keep the central venous pressure (CVP) between 10 and 14 mmHg; in group 2 (n = 21) HES 130/0.4 was administered using the same protocol as in group 1. MEASUREMENTS AND MAIN RESULTS: Standard coagulation variables and modified thromboelastography (TEG) were used. Using different activators for extrinsic and intrinsic activation and heparin inactivation by heparinase, the onset of coagulation (coagulation time), kinetics of clot formation (clot formation time), and maximum clot firmness were measured. Measurements were performed after induction of anesthesia (T0), at the end of surgery (T1), 4 hours after surgery (T2), and on the morning of the 1st postoperative day (T3). A total of 3310 +/- 810 mL of gelatin and 3070 +/- 570 mL of HES 130/0.4 were used in the 2 groups during the study period. The 2 groups did not differ with regard to postoperative bleeding or in use of packed red blood cells or fresh frozen plasma. Standard coagulation variables were similar between the 2 groups. All TEG variables were within the normal range at baseline. Coagulation time and clot formation time data were significantly elevated after surgery and in the intensive care unit, without showing specific differences between the 2 volume replacement groups. Intrinsic TEG and heparinase TEG clot formation times remained significantly higher until the end of the study period. No differences were seen between HES-treated and gelatin-treated patients. CONCLUSIONS: Volume replacement with the new HES preparation was as safe as gelatin-based volume replacement with regard to coagulation in cardiac surgical patients. HES 130/0.4 is an alternative plasma substitute to treat volume deficits.

Aged↗
PubMed2001

Changes of haemostasis in patients undergoing major abdominal surgery--is there a difference between elderly and younger patients?

Many physiological functions are altered in the elderly. It is not clear whether this applies to haemostatic mechanisms in patients undergoing major surgery. Twenty-five consecutive patients <60 yr and 25 consecutive patients >70 yr scheduled for abdominal surgery for malignancies were included in our study. Various standard coagulation variables and specific markers of coagulation were serially measured before surgery (baseline), at arrival on the intensive care unit (ICU), 4 h after arrival on ICU, and on the morning of the first postoperative day. Platelet function was assessed using the Platelet Function Analyser PFA-100 with adenosine diphosphate (ADP) as an inductor. Anaesthesia and surgery were similar between the elderly (76(3) years) and younger (53(5) years) groups. Baseline plasma levels of prothrombin fragments F1+2, thrombin-antithrombin III (TAT) complex, and D-dimers were significantly different between the two groups, indicating thrombin activation and fibrin formation in the elderly. Postoperatively, only F1+2 plasma levels were significantly higher in the elderly (4.0(0.8) nmol/l) than in the younger patients (2.2(0.9) nmol/l), whereas the course of D-dimer and TAT did not differ significantly between the two groups. Endothelial-derived markers of coagulation (von Willebrand factor, collagen-binding activity of von Willebrand factor) were not different between the groups throughout the study period. Platelet function was impaired in the elderly compared with the younger patients. It is concluded that elderly patients showed more prothrombin activation/thrombin generation and increased fibrinolytic activity prior to surgery than younger patients. However, perioperative changes of coagulation in the elderly were similar to those seen in younger patients.

Abdominal Neoplasms↗
PubMed2001

The influence of intravascular volume therapy with a new hydroxyethyl starch preparation (6% HES 130/0.4) on coagulation in patients undergoing major abdominal surgery.

UNLABELLED: A new hydroxyethyl starch (HES) preparation with a mean molecular weight of 130,000 daltons and a degree of substitution of 0.4 shows favorable pharmacokinetic properties. We conducted a study of the influence of the new HES specification on coagulation and compared it with another colloidal intravascular volume replacement regimen using gelatin. According to a prospective, random sequence, 42 patients undergoing major abdominal surgery received either HES 130/0.4 (n = 21) or gelatin (n = 21) until the first postoperative day (POD) to keep central venous pressure between 10 and 14 mm Hg. From arterial blood samples, standard coagulation variables were measured, and modified thrombelastogram (TEG) measurements using different activators were performed. A total of 2830 +/- 350 mL of gelatin and 2430 +/- 310 mL of HES 130/0.4 were administered until the morning of the first POD. The use of allogeneic blood/blood products and standard coagulation variables did not differ significantly between the two groups. After induction of anesthesia, all TEG data for both groups were within normal range. Coagulation time and maximum clot firmness did not change significantly in any TEG measurements during the study period. The kinetics of clot formation (clot formation time) significantly increased immediately after surgery, but without showing significant group differences. On the morning of the first POD, the clot formation time returned to almost normal levels, except for aprotinin-activated TEG(R). We conclude that administration of moderate doses of the new HES 130/0.4 preparation in patients undergoing major abdominal surgery results in similar coagulation alterations as those after using an established gelatin-based volume-replacement regimen. IMPLICATIONS: We compared the effects of infusion of a new hydroxyethyl starch preparation (6% hydroxyethyl starch; mean molecular weight 130,000 daltons; degree of substitution 0.4) on coagulation with a gelatin-based intravascular volume replacement regimen in patients undergoing major abdominal surgery. After moderate doses of hydroxyethyl starch (2430 +/- 310 mL until the morning of the first postoperative day), coagulation monitoring, including modified thrombelastography, did not show impaired hemostasis.

Abdomen↗
PubMed2001

Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery.

UNLABELLED: The effects of intravascular volume replacement regimens on tissue oxygen tension (ptiO(2)) are not definitely known. Forty-two consecutive patients scheduled for elective major abdominal surgery were prospectively randomized to receive either 6% hydroxyethyl starch (HES) (mean molecular weight 130 kd, degree of substitution 0.4, n = 21) or lactated Ringer's solution (RL, n = 21) for intravascular volume replacement. Fluids were administered perioperatively and continued for 24 h on the intensive care unit to keep central venous pressure between 8 and 12 mm Hg. The ptiO(2) was measured continuously in the left deltoid muscle by using microsensoric implantable partial pressure of oxygen catheters after the induction of anesthesia (baseline, T0), 60 min (T1) and 120 min thereafter (T2), at the end of surgery (T3), and on the morning of the first postoperative day on the intensive care unit (T4). HES 130/0.4 2920 +/- 360 mL and 11,740 +/- 2,630 mL of RL were given to the patients within the study period. Systemic hemodynamics and oxygenation (PaO(2), PaCO(2)) did not differ significantly between the two volume groups throughout the study. From similar baseline values, ptiO(2) increased significantly in the HES-treated patients (a maximum of 59% at T4), whereas it decreased in the RL group (a maximum of -23% at T4, P < 0.05). The largest differences of ptiO(2) were measured on the morning of the first postoperative day. We conclude that intravascular volume replacement with 6% HES 130/0.4 improved tissue oxygenation during and after major surgical procedures compared with a crystalloid-based volume replacement strategy. Improved microperfusion and less endothelial swelling may be responsible for the increase in ptiO(2) in the HES 130/0.4-treated patients. IMPLICATIONS: In patients undergoing major abdominal surgery, a colloid-based (with hydroxyethyl starch [HES] 130/0.4) and a crystalloid-based (with lactated Ringer's solution [RL]) volume replacement regimen was compared regarding tissue oxygen tension (ptiO(2)) measured continuously by microsensoric implantable catheters. The ptiO(2) increased in the HES-treated (+59%) but decreased in the RL-treated (-23%) patients. Improved microcirculation may be the mechanism for the better ptiO(2) in the HES group.

Abdomen↗
PubMed2001

Influence of prophylactic use of pentoxifylline on postoperative organ function in elderly cardiac surgery patients.

OBJECTIVE: To study the effects of pretreatment with pentoxifylline before cardiac surgery on postoperative organ function in elderly patients (>80 yrs) undergoing cardiac surgery. DESIGN: Prospective, randomized, placebo-controlled study. SETTING: Two-day clinical investigation in an intensive care unit of a university-affiliated hospital. PATIENTS: Forty elderly patients (age >80 yrs) undergoing first-time elective aortocoronary bypass grafting. INTERVENTIONS: In 20 patients, pentoxifylline (loading bolus of 300 mg followed by a continuous infusion of 1.5 mg.kg-1.hr-1 until the second postoperative day) was given after induction of anesthesia; another 20 patients received saline solution as placebo. MEASUREMENTS AND MAIN RESULTS: Concentrations of soluble adhesion molecules (soluble E-selectin, soluble vascular cell adhesion molecule-1, and soluble intercellular adhesion molecules) were measured to assess endothelial function. Liver function was evaluated by monoethylglycinexylidide test and by measuring alpha-glutathione S-transferase plasma concentrations. Renal function was assessed by measuring serum creatinine and urine concentrations of alpha-1-microglobulin. Splanchnic perfusion was assessed by monitoring intramucosal pH by using continuous tonometry. All measurements were performed before pentoxifylline infusion (T0), at the end of surgery (T1), 5 hrs after surgery (T2), and at the morning of the first (T3) and second (T4) postoperative day. Postoperative concentrations of all measured soluble adhesion molecules were significantly higher in the nontreated controls than in the pentoxifylline-treated patients. Monoethylglycinexylidide serum concentrations were significantly lower and abnormal (<50 ng/mL) postoperatively only in the untreated control patients. alpha-Glutathione S-transferase increased in both groups with a significantly higher increase in the control group (from 3.2 +/- 1.2 to 24.1 +/- 4.2 ng/mL) than in the pentoxifylline-treated patients (from 3.8 +/- 1.9 to 11.5 +/- 2.1 ng/mL). Serum creatinine was unchanged in both groups, whereas alpha-1-microglobulin increased significantly more in the control group than in the pentoxifylline-treated group. Intramucosal pH remained almost unchanged in the pentoxifylline patients (>7.35) but decreased significantly in the control group (5 hrs after surgery, intramucosal pH 7.29 +/- 0.13). CONCLUSIONS: Pretreatment of patients aged >80 yrs undergoing cardiac surgery with pentoxifylline attenuated deterioration of endothelial, renal, and liver function as seen in an untreated control group. Splanchnic perfusion also appears to be improved in the pentoxifylline-treated group. Whether pretreatment with pentoxifylline will improve outcome in this patient population remains to be elucidated.

Aged↗
PubMed2000

Economic aspects of different muscle relaxant regimens.

OBJECTIVE: At a time of cost reduction in medical care efforts to manage the ever-increasing costs of new pharmaceutical drugs become increasingly important. Costs of four different muscle relaxant regimens including the new intermediate-acting neuromuscular blocking drugs (NMBD) cisatracurium and rocuronium will be analyzed. METHODS: Eighty patients undergoing laparoscopic cholecystectomy were prospectively studied. All patients received standardized general anaesthesia with desflurane/fentanyl. Muscle relaxation was achieved with atracurium, cisatracurium, vecuronium, or rocuronium with 20 patients in each group. Intraoperatively muscle relaxants were added to maintain two twitches of the train-of-four (TOF) assessment. RESULTS: There were no differences among the four groups regarding biometric data, duration of surgery and anesthesia, number of patients with reversal of neuromuscular blockade, and time of extubation. Length of stay in the postanesthesia care unit (PACU) and the incidence of side effects were similar in all groups. Total costs of used drugs were significantly lowest in the atracurium-treated patients (per patient: 18.27 Euro) and significantly highest in the cisatracurium group (26.71 Euro) compared with the other groups (vecuronium: 22.61 Euro; rocuronium: 22.63 Euro). CONCLUSION: It is summarized that the use of cisatracurium was associated with higher costs compared to a standard muscle relaxant regimen using atracurium, whereas patient outcome was the same in all study groups. The routine use of the newer NMBDs can only be justified economically, if considerable improvements to clinical practice can be demonstrated.

Adult↗
PubMed2000

Influence of different colloids on molecular markers of haemostasis and platelet function in patients undergoing major abdominal surgery.

Synthetic colloids have been reported to cause haemorrhagic complications. The effects of perioperative volume replacement with 4% gelatin (n = 20), 6% low-molecular weight (LMW) hydroxyethyl starch (HES) (Mw: 70,000 dalton; HES 70/0.5; n = 20) and 6% medium-molecular weight (MMW) HES (Mw: 200,000 dalton; HES 200/0.5; n = 20) on haemostasis were assessed in patients undergoing major abdominal surgery. Volume was administered to keep central venous pressure (CVP) between 10 and 14 mm Hg. Conventional global coagulation tests, molecular markers of coagulation, and platelet function (using a platelet function analyser (PFA-100) with ADP as inductor) were monitored prior to surgery (T0), at the end of surgery (T1), 4 h after the end of surgery (T2), and on the morning of the first postoperative day (T3). Significantly more gelatin (2900 (SD 320) ml) than HES 200 (2150 (312) ml) was given during the study period. Bleeding and the use of allogeneic blood-blood products were similar in all groups. Markers of thrombin generation (F1 + 2), of thrombin neutralization (TAT III complex), and of fibrin formation and its degradation (D-dimer) increased significantly during and after surgery without showing significant group differences. Factor VIII and von Willebrand factor (vWF) also increased in all groups beyond the normal range, showing the significantly highest increase in the gelatin-treated group (VIII: from 173 (36) to 266 (33) U dl-1; vWF: from 164(33) to 238 (31) U dl-1). Platelet function remained within the normal range and without group differences throughout the study period. We can conclude that all three solutions can be used safely in patients undergoing major abdominal surgery with regard to the haemostatic process.

Abdomen↗
PubMed2000

Low-flow anaesthesia. Does it have potential pharmacoeconomic consequences?

Healthcare reform has placed increasing pressure on anaesthetists to consider the costs of current anaesthesia strategies. Although the cost of anaesthesia constitutes only a small proportion of total healthcare costs, anaesthetic drug expenditures have been a focus of cost-containment efforts. Low-flow anaesthesia is a simple method of reducing the fresh gas flow rate for anaesthetic gases during inhalational anaesthesia. A knowledge of the pharmacokinetic behaviour of inhaled anaesthetics and the use of modern equipment and monitoring technology meet the requirements for safe application of this anaesthetic technique. Millions of patients receive general anaesthesia each year, and thus the use of this technique could generate substantial savings in anaesthetic drug expenditure without reducing the patient's comfort or increasing adverse events. The new inhaled anaesthetics desflurane and sevoflurane, which have low tissue solubility, provide promising options when used in low-flow anaesthesia. Apart from the economic advantages, low-flow anaesthesia helps to reduce environmental pollution and is associated with several physiological benefits for the patient. Low-flow anaesthesia is a simple but highly effective method of cost minimisation that can be applied to a large number of patients without any compromise in patient care or safety.

Anesthesia↗