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Sascha Meyer

Publications and source records attributed to Sascha Meyer.

At least 19 recordsLinked to original sources
PubMed2007

Sedation and analgesia for brief diagnostic and therapeutic procedures in children.

The number of diagnostic and therapeutic procedures done outside of the operating room and the intensive care unit has increased substantially in recent years. In parallel, the management of acute pain and anxiety in children undergoing therapeutic and diagnostic procedures has developed considerably in the past two decades. The primary goal of procedural sedation and analgesia is the safe and efficacious control of emotional distress and pain. The availability of non-invasive monitoring, short-acting opioids and sedatives has broadened the possibilities of sedation and analgesia in children in diverse settings. While most of these procedures themselves pose little risk to the child, the administration of sedation or analgesia may add substantial risk to the patient. This article reviews the current status of sedation and analgesia for invasive and non-invasive procedures in children providing an evidence-based approach to several topics of importance, including patient assessment, personnel requirements, equipment, monitoring, and drugs.

Analgesia↗
PubMed2006

Arginine-vasopressin in catecholamine-refractory septic versus non-septic shock in extremely low birth weight infants with acute renal injury.

INTRODUCTION: The aim of this study was to assess the efficacy of arginine-vasopressin (AVP) as a rescue therapy in catecholamine-refractory septic and non-septic shock in extremely low birth weight (ELBW) infants with acute renal injury. METHODS: Prospective assessment of AVP therapy in three ELBW infants with catecholamine-refractory septic shock and acute renal injury (mean birth weight 600 +/- 30 g) and three ELBW infants with non-septic shock and acute renal injury (mean birth weight 770 +/- 110 g) at a University hospital. The main outcome measures were restoration of blood pressure with adequate organ perfusion and survival at discharge. RESULTS: In all three ELBW infants with catecholamine-resistant septic shock, systemic arterial blood pressure increased substantively with restoration of urine output after AVP administration (dosage, 0.035 to 0.36 U/kg/h; length, 70 +/- 21 hours). In the three ELBW infants with non-septic shock, only a transient stabilization in mean arterial pressure with restoration of urine output was observed after AVP therapy (dosage, 0.01 to 0.36 U/kg/h; length, 30 +/- 16 hours). The mortality rate was 1/3 in the sepsis group versus 3/3 in the non-septic group. CONCLUSION: AVP may be a promising rescue therapy in catecholamine-resistant shock in ELBW infants with acute renal injury. Larger prospective clinical trials are warranted to assess the efficacy and safety of AVP as a pressor adjunct in septic versus non-septic shock in ELBW infants.

Acute Kidney Injury↗
PubMed2006

Intracranial germinoma: a rare but important differential diagnosis in children with growth retardation.

AIM: Intracranial germinoma is a rare malignant tumour in childhood with an excellent prognosis under adequate therapy. Finding the right diagnosis at an early stage is difficult because of the slow-growing tumour and the resulting lack of clinical symptoms. METHODS: Our patients with histologically secured germinoma were retrospectively assessed concerning growth retardation, pituitary hormone status, magnetic resonance imaging scan results and clinical symptoms to find out whether there is a leading parameter. RESULTS: In all our patients, the leading symptom was growth retardation of at least 2 y before being diagnosed. CONCLUSION: Growth retardation seems to be a very early sign of germinoma in the suprasellar region. Therefore, early neuroradiological imaging combined with pituitary hormone status should be considered in every paediatric patient with a history of secondary growth retardation.

Adolescent↗
PubMed2006

Vasopressin in catecholamine-resistant septic and cardiogenic shock in very-low-birthweight infants.

AIM: To evaluate vasopressin as a rescue therapy in catecholamine-refractory septic and cardiogenic shock in very-low-birthweight (VLBW) infants. METHODS: Prospective assessment of vasopressin therapy in three VLBW infants with catecholamine-refractory septic shock (24 + 6 wk, 600 g) and cardiogenic shock (26 + 1 wk, 890 g; 26 + 1 wk, 880 g) at a university hospital. RESULTS: Adequate systemic arterial blood pressure could only be restored after vasopressin administration as a continuous infusion over a 36-h period in the preterm suffering from septic shock; in the two neonates with cardiogenic shock, only a transient stabilization in mean arterial pressure was observed, which did not impact on the poor prognosis. CONCLUSION: Although vasopressin appears to be a suitable rescue therapy in catecholamine-resistant septic shock in VLBW infants, further evaluation in controlled clinical trials is warranted.

Diseases in Twins↗
PubMed2005

Assessing the risk of mortality in paediatric cancer patients admitted to the paediatric intensive care unit: a novel risk score?

UNLABELLED: Intensive front-line protocols have improved survival in children with malignancies; however, intensive multimodal therapy of paediatric malignancies can be associated with a significant risk of serious adverse events. Common risk scores (PRISM, PRISM III, APACHE-II) fail to predict mortality in these patients. A retrospective chart analysis of 32 paediatric cancer patients admitted to the Paediatric Intensive Care Unit (PICU) at the University Hospital of Saarland between January 2001 and December 2003 for life-threatening complications was performed. The aim of this study was to assess risk factors for short-term outcome (survival vs. non-survival when leaving the PICU) and to develop a risk score to estimate outcome in these patients. Overall survival was good (25 of 32 patients). Mortality rate was significantly related to leukaemia/lymphoma ( P = 0.029), to the number of organ failures ( P < 0.0001), neutropenia ( P = 0.001), septic shock ( P = 0.025), mechanical ventilation ( P = 0.01) and inotropic support ( P = 0.01). Employing multiple logistic regression, the strongest predictor for poor outcome was the number of organ failures ( P < 0.05). A risk score (cut-off value: >3 points for non-survival) which included the following risk factors (non-solid tumour, number of organ failures ( n > 2), neutropenia, septic shock, mechanical ventilation, and inotropic medication) yielded a sensitivity of 7/7 (95% CI: 4.56-7.00), a specificity of 23/25 (95% CI: 18.49-24.75), a positive predictive value of 23/23 (95% CI: 19.80-23.00), and a negative predictive value of 7/9 (95% CI: 3.60-8.74) for the time of admission to the PICU. CONCLUSION: Although our risk of mortality score is of prognostic value in assessing short-term outcome in these patients, prospective validation in a larger study cohort is mandatory. Furthermore, it must be emphasised that this risk score must not be used for decision-making in an individual patient.

Adolescent↗
PubMed2005

[Gamma-hydroxy butyric acid: neurotransmitter, sedative and party drug].

Gamma-hydroxybutyric acid (GHB) as a natural component of the mammalian brain was first introduced in clinical anaesthesic practice more than 40 years ago. The drug was nearly forced from clinical practice because of its prolonged and variable duration of action. The results of recent clinical studies indicate a re-evaluation of GHB in various clinical fields. In the intensive care unit, GHB may be a favourable alternative to established drugs. The results of various clinical studies also suggest that GHB is efficacious in the treatment of alcohol withdrawal syndrome, and narcolepsy. GHB has been used successfully for short-term sedation in children. In addition, GHB has emerged as a street drug ("liquid ecstasy"). Overdose may lead to respiratory depression, coma, and even death. Chronic abuse itself may lead to severe withdrawal syndrome. The purpose of this article is to outline the neurophysiological, pharmacodynamic and pharmacokinetic characteristics of GHB, and to summarize the potential fields of use and misuse of GHB in clinical medicine and toxicology.

Adult↗
PubMed2005

Propofol versus midazolam/ketamine for procedural sedation in pediatric oncology.

Different pharmacologic agents have been used for sedation in children undergoing invasive procedures. The authors prospectively compared the efficacy, the occurrence of adverse effects, cardiovascular parameters, oxygen saturation and induction, and recovery time in propofol with or without morphine versus midazolam/ketamine sedation for procedural sedation in children with malignancies and hematologic disorders. Fifty children received either propofol with or without morphine or ketamine/midazolam sedation for invasive procedures. Intravenous sedation consisted of 0.1 mg midazolam/kg and 1.0 mg ketamine/kg or 2 mg propofol/kg with or without 0.1 mg morphine/kg. Incremental dosages of ketamine or propofol were given, if necessary, to achieve or to maintain adequate sedation levels. Systolic and diastolic blood pressure, heart rate, oxygen saturation, time to induce sedation, recovery time, and adverse effects were recorded. All invasive procedures were successfully completed, with satisfactory sedation levels in all 25 patients in the propofol group and 23 of the 25 patients in the ketamine group. In 14 of the 25 procedures in the propofol group and 4 of the 25 procedures in the ketamine group, sedation was associated with side effects, the most common being oxygen desaturation. There was a significant increase in diastolic blood pressure after ketamine medication and a significant decrease in systolic and diastolic blood pressure and heart rate in the propofol group. Induction and recovery times in the propofol group were significantly shorter. Both regimens for procedural sedation are efficacious in achieving satisfactory sedation levels for invasive procedures. Propofol offers a quicker onset of sedation and a faster, smoother recovery but is associated with a higher rate of side effects. Considering the substantial rate of adverse effects, these procedural sedations should be performed only by physicians trained in advanced airway management and life support.

Adolescent↗
PubMed2005

Acute pancreatitis induced by short-term propofol administration.

The incidence of a drug-induced pancreatitis is rare and so far more than 85 different drugs have been reported to have induced pancreatitis. Some case reports consider a relationship between propofol and acute pancreatitis. However, in these cases a number of different drugs were coadministered, thus preventing a clear causal link being established. We report a case of a drug-induced acute pancreatitis that was most likely triggered by a single dosage of propofol. It occurred in a young girl who underwent elective magnetic resonance imaging. She developed pancreatitis within hours after exposure to propofol. Other possible triggers, e.g. gallstones or infection were ruled out. Physicians should consider pancreatitis as a potentially life-threatening adverse event associated with propofol sedation, which is nowadays extensively used.

Acute Disease↗
PubMed2004

Pulmonary dysfunction in pediatric oncology patients.

Children suffering from cancer may experience short episodes of respiratory distress and/or chronic impairment in pulmonary function. Pulmonary dysfunction may be primarily disease-related, but it may also result secondarily from treatment. Emergencies with critical respiratory dysfunction in childhood cancer include mechanical obstruction of vital anatomical structures and hyperleukocytosis syndrome. This paper focuses on the most relevant causes of respiratory distress and lung injury in pediatric oncology patients and bone marrow transplant patients. Infectious causes, lung disease resulting from anti-neoplastic agents, and bone marrow transplant-related pulmonary dysfunction are emphasized. A review of the literature pertinent to this subject is given.

Antineoplastic Agents↗
PubMed2004

Inter- and intraindividual variability in ketamine dosage in repetitive invasive procedures in children with malignancies.

Midazolam/ketamine sedation has been used successfully in children undergoing painful invasive procedures. The authors prospectively assessed inter- and intra-individual variability in ketamine dosage for sedation in repetitive invasive procedures in children with malignancies. A total of 92 invasive procedures (58 lumbar punctures, 34 bone marrow biopsies; range: 2-9 procedures/patient) were performed on 25 children (median age: 12 years). Intravenous sedation consisted of 0.1 mg midazolam/kg and 0.5-1.0 mg ketamine/kg. Incremental dosages of ketamine (0.33 mg/kg) were given if necessary to achieve or maintain deep sedation. Primary outcome measure was the inter- and intraindividual ketamine dosage required to achieve adequate sedation; secondary outcome measures were the number of procedures with adequate sedation (Ramsay score of > 4), the number of adverse side effects, and the need for therapeutic interventions. All 92 invasive procedures were completed with satisfactory sedation levels in 88 procedures (95.7%). There was a great inter- and intraindividual variability in ketamine dosage required to achieve or maintain adequate sedation. In 12% of procedures side effects were seen, which required no or only minor interventions. Due to great inter- and intraindividual differences, ketamine dosage should be titrated toward the desired level of sedation. Thus, ketamine can be adjusted to the individual's need while achieving adequate sedation.

Adolescent↗
PubMed2004

First report of a vincristine dose-related Raynaud's phenomenon in an adolescent with malignant brain tumor.

The authors report a case of a vincristine-induced, reproducible dose-related Raynaud's phenomenon. It occurred in a 14-year-old boy with a malignant brain tumor who received repeated vincristine injections. The authors describe how they handled this severe secondary Raynaud's phenomenon with acral cutaneous tissue necrosis. Reducing the dose of the vinca-alkaloid injections, together with an additional medication with a calcium-channel blocking agent, was a successful strategy in this patient. There are few case reports of secondary Raynaud's phenomenon in adult oncologic patients receiving certain anticancer drugs (including vincristine, bleomycin, and cisplatin), and to the authors' knowledge this kind of vincristine toxicity has not previously been described in either adults or children.

Adolescent↗
PubMed2003

Sedation with midazolam and ketamine for invasive procedures in children with malignancies and hematological disorders: a prospective study with reference to the sympathomimetic properties of ketamine.

Different pharmacological agents have been used for sedation in children undergoing invasive procedures. The authors prospectively evaluated the efficacy, the occurrence of adverse side effects, and cardiovascular parameters in midazolam and ketamine sedation for invasive procedures in children with malignancies and hematological disorders. A total of 183 invasive procedures were performed on 63 children (mean age 9.2 +/- 5.2 years). Intravenous sedation consisted of 0.1 mg midazolam/kg and 1.0 mg ketamine/kg. Incremental dosages of ketamine (0.33 mg/kg) were given if necessary to maintain deep sedation. Systolic and diastolic blood pressure, heart rate, and oxygen saturation were recorded. All 183 invasive procedures were successfully completed with satisfactory sedation levels in 170 procedures (92.9%; 95% CI:88.2-96.2%). In 33 procedures (18%; 95% CI: 12.8-24.4%) sedation was associated with side effects, the most common being oxygen desaturation. One patient experienced a transient episode of laryngospasm. There was a significant increase in both systolic and diastolic blood pressure and heart rate after ketamine medication (p <.01). Procedure and recovery time were correlated to ketamine dosage (p <.01). The combination of midazolam and ketamine is efficacious in achieving deep sedation for painful invasive procedures. Considering the possibility of potentially serious respiratory complications it should be performed only by physicians who are trained in advanced airway management and life support. As opposed to many other sedative drugs with cardio-depressant properties, ketamine causes a rise in both systolic and diastolic blood pressure, and heart rate.

Anesthetics, Combined↗
PubMed2002

Arterial embolization of a secondary aneurysmatic bone cyst of the thoracic spine prior to surgical excision in a 15-year-old girl.

We report on a 15-year-old girl with a secondary aneurysmatic bone cyst of the thoracic spine with extension into the spinal canal on the basis of an osteoblastoma. Surgical treatment was facilitated by preoperative embolization of the highly-vascular tumor. Excision of the tumor was performed without extensive intraoperative blood loss. Following excision, transpedicular-stabilization of the spinal column was achieved using a fixateur intern. We conclude that superselective embolization of benign lesions of the spinal column constitutes a feasible means of reducing intraoperative bleeding complications, thus enhancing resectability.

Adolescent↗