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Biomedical subjects

G Hempelmann

Publications and source records attributed to G Hempelmann.

At least 55 records · Page 3Linked to original sources
PubMed2002

Shorter discharge time after regional or intravenous anaesthesia in combination with laryngeal mask airway compared with balanced anaesthesia with endotracheal intubation.

BACKGROUND AND OBJECTIVE: The efficiency of operating room times can be significantly improved using rapid changes between operative procedures. We performed a retrospective analysis using electronic anaesthesia charts that compared anaesthesia-related times between the three most frequently performed types of anaesthesia (for orthopaedic surgery) to evaluate the potential for a quicker turn-around between cases. METHODS: A total of 5614 anaesthetic procedures in trauma-related orthopaedic surgery were performed from 1997 to 1999. All were documented with an automatic record-keeping system. Data were compared for intravenous anaesthesia with the laryngeal mask airway, balanced anaesthesia with tracheal intubation and regional anaesthesia. The primary outcome measure was the time needed for emergence from anaesthesia after the end of surgery. Statistical evaluation was performed with matched triples for all three types of anaesthesia (155 triples for ambulatory surgery, 249 triples for in-patient care). RESULTS: For ambulatory surgery, the induction time was significantly shorter for general anaesthesia (23.7 min for intravenous anaesthesia, 22.7 min for balanced anaesthesia techniques) compared with regional anaesthesia (27.2 min). The time from the end of the surgical procedure to transfer of the patient out of the operating room was shortest for regional anaesthesia (6.3 min) compared with intravenous anaesthesia (9.0 min) and balanced anaesthesia (12.5 min) techniques. Results were comparable for in-patients: regional anaesthesia required significantly longer for its induction, but less time for patient discharge from the operating room. CONCLUSIONS: The use of a regional anaesthesia technique or one involving intravenous anaesthesia in combination with the laryngeal mask airway may lead to a reduction in discharge time compared with a balanced anaesthesia technique with endotracheal intubation. Thus, improved use of resources may be achieved.

Adult↗
PubMed2002

Effects of desflurane and isoflurane on intestinal tissue oxygen pressure during colorectal surgery.

Volatile anaesthetics differ in the effects they have on splanchnic haemodynamics and oxygenation. The aim of this study was to evaluate the effects of desflurane and isoflurane as part of a balanced anaesthetic technique on intestinal tissue oxygenation during colorectal surgery. Data were analysed from 44 patients randomly assigned to receive either desflurane (desflurane group, n = 20), or isoflurane (isoflurane group, n = 24) for inhalational anaesthesia. Tissue oxygen pressure (P(tiss)O2) was measured on the serosal side of the large intestine prior to colonic resection (T1) and following the completion of the bowel anastomosis (T2). In addition, haemodynamic and oxygenation parameters were assessed. No difference in mean P(tiss)O2 was observed between the groups at T1 [desflurane group: 8.1 (2.9) kPa vs. isoflurane group: 7.7 (2.7) kPa]. Following completion of the anastomosis (T2) mean P(tiss)O2 was higher in the isoflurane group [9.6 (2.9) kPa] than the desflurane group [7.7 (2.4) kPa, p = 0.025]. During surgery no difference between the groups could be observed with regard to haemodynamics and global oxygenation parameters. The lack of a difference between the groups in P(tiss)O2 before resection of the colon suggests that, under normal conditions, desflurane and isoflurane have comparable effects on intestinal blood flow and oxygenation. However, following local ischaemia, the reactive hyperaemia seems to be better preserved during isoflurane anaesthesia indicated by a local increase in P(tiss)O2blank(p = 0.013) following completion of the bowel anastomosis.

Adult↗
PubMed2002

The effect of a pre-operative infusion of Ringer's solution on splanchnic perfusion in patients undergoing coronary artery bypass grafting.

Surgical patients develop a fluid deficit during pre-operative starvation. This study examines the effects of pre-operative fluid administration on haemodynamic variables, oxygenation and splanchnic perfusion in patients undergoing elective coronary artery bypass grafting. Forty-eight patients were randomised to receive either a pre-operative crystalloid infusion (crystalloid group, n = 24) or no infusion (control group, n = 24). Patients in the crystalloid group received a continuous infusion of Ringer's solution at 1.5 ml.kg(-1).h(-1) from 22:00 h until induction of anaesthesia the next morning. Immediately before induction of anaesthesia, all patients were given a colloid infusion to increase pulmonary capillary wedge pressure and central venous pressure to similar levels in both groups. Haemodynamic and oxygenation parameters were measured using invasive cardiovascular monitoring, and splanchnic perfusion was assessed by indocyanine green clearance. Patients in the crystalloid group received a mean (SD) of 1008 (140) ml of Ringer's solution overnight. Patients in the crystalloid group had a higher splanchnic blood flow than the control group before induction of anaesthesia [mean (SD) = 1782 (573) ml.min(-1) vs. 1391 (333) ml.min(-1), p < 0.05]. There were no significant differences in systemic haemodynamic data and global oxygenation parameters between the two groups. Pre-operative infusion of crystalloid appears to result in an improvement in pre-operative splanchnic perfusion.

Aged↗
PubMed2002

[Registration of material consumption in anesthesia using a data management system].

BACKGROUND: The aim of this study was to investigate whether an Anesthesia Information Management System (AIMS) can provide reliable data on the consumption of single-use anesthetic material without necessitating an expensive and time-consuming inventory. To this end, the number of selected anesthesia-related materials and the total costs in orthopedic theatres for which the department of anesthesia had been charged in the year 2000 were compared to the data calculated by the AIMS. METHODS: Anesthesia-related material is provided by a computer-based system of storage facilities (KLIMA II) in the Department of Anesthesiology and Intensive Care Medicine at the University Hospital Giessen. All costs arising in orthopedic theatres are exclusively charged to one single account. At the same time, the online-documentation software, NarkoData (IMESO GmbH, Hüttenberg, Germany), collects all data on consumption of anesthetic single-use material. The total amount of peripheral (PVC) and central-venous catheters (CVC), urinary catheters (UC) and endotracheal tubes (ET) used in the year 2000 was ascertained by the AIMS and compared to the respective data accounted by the administration. RESULTS: In the year 2000, the number of patients treated in orthopedic theatres totaled 1,865. By means of the AIMS, a consumption of 783 CVCs, 644 UCs and 949 ETs could be documented. In contrast, hospital administration had billed 880 CVCs, 700 UCs, and 1,050 ETs: discrepancies of 11.0 % for CVCs, 8.0 % for UCs and 9.6 % for ETs. Concerning the two most frequently used CVCs, the AIMS failed to document costs of 3,238 DM. For PVCs (16 gauge and 14 gauge), the official cost was 10.8 % and 46.7 % higher compared to the number documented by the AIMS. Since the number of PVCs totaled 3,400, the AIMS failed to document costs of 1,900 DM. CONCLUSION: Comparison of both methods revealed substantial deficits in documenting cost-relevant materials. There were no detailed data available on the whereabouts of the materials used, i.e. whether tubes and catheters were undocumented, used or discarded. However, the AIMS may provide additional valuable information about possible sources of material wastefulness. This is especially true for infrequently used anesthesia-related materials.

Anesthesiology↗
PubMed2002

[Variations of pain in the treatment of one classical acupuncture-point versus one point of Yamamoto's new scalp acupuncture].

INTRODUCTION: In an experimental design the pain reduction effect of acupuncture is studied and compared to the treatment of a classical acupuncture point and a point of the Yamamoto New Scalp Acupuncture (YNSA). METHODS: Experimental pain stimuli (32 per test person) were set in 42 test persons at the upper calcaneus edge and pain reduction was checked intra-individually by using the following variations of treatment: Acupuncture YNSA basis-point D, Acupuncture at the classical point Xiao Chang Shu = Bl 27, Acupuncture at a placebo point of the head, Acupuncture at a placebo point of the gluteal region. RESULTS: Evaluation of the data as well as a statistical investigation using a bi-factoral variance analysis with repeated measurements of 2 respectively 1 factor yielded following results: There are highly significant differences concerning pain reduction through the stimulation of the YNSA basis-point D and the acupuncture at the classical point Bl 27 (p < 0,0007). There are also highly significant differences concerning the verum and the placebo treatment (p < 0,00006). Further hypothesis of controlling the experimental design were tested. CONCLUSIONS: On the whole, the investigation shows that there is a marked difference between the verum and placebo treatment as well as a difference between the acupuncture of the YNSA basis-point D and the classical acupuncture point Xiao Chang Shu (Bl 27) with regard to pain reduction induced by experimental stimuli at the calcaneus. These differences are significant.

Acupuncture Analgesia↗
PubMed2002

[Requirements for the successful installation of an data management system].

Due to increasing requirements on medical documentation, especially with reference to the German Social Law binding towards quality management and introducing a new billing system (DRGs), an increasing number of departments consider to implement a patient data management system (PDMS). The installation should be professionally planned as a project in order to insure and complete a successful installation. The following aspects are essential: composition of the project group, definition of goals, finance, networking, space considerations, hardware, software, configuration, education and support. Project and finance planning must be prepared before beginning the project and the project process must be constantly evaluated. In selecting the software, certain characteristics should be considered: use of standards, configurability, intercommunicability and modularity. Our experience has taught us that vaguely defined goals, insufficient project planning and the existing management culture are responsible for the failure of PDMS installations. The software used tends to play a less important role.

Anesthesia Department, Hospital↗
PubMed2002

Editorial.

Explore the source record for details and available documents.

Journal Article↗
PubMed2002

[Risk predictors, scoring systems and prognostic models in anesthesia and intensive care. Part I: anesthesia].

Risk predictors and scoring systems are commonly used in medicine to provide a reliable and objective estimation of disease prognoses, probability of adverse events and outcome. Furthermore, they were designed to classify severity of illness or the course of diagnostic and therapeutic interventions and to perform a risk stratification for scientific studies in a standardized way. In quality management and cost control, scoring systems and predictors are used for risk adjustment and evaluation of care performance. The aim of this review article was to describe common risk indices and scoring systems in anesthesia (part I) and intensive care (part II), and to point out their possible benefits and limitations. Different scoring systems and classifications are available to stratify perioperative risk and adverse events in anesthesia. Especially in cardiac surgery, an increasing interest in risk-adjusted outcome studies led to the modeling and validation of different prognostic systems for postoperative morbidity, mortality and length of stay. Furthermore, there are scoring-systems for special events, such as difficult laryngoscopy or postoperative nausea and vomiting (PONV). Risk check lists and risk indices are superior to the ASA classification of physical status in providing more exact results and the possibility of statistic risk calculation. Nevertheless, they are not frequently used in clinical routine. Because of its simplicity and easy handling the ASA classification has worldwide popularity and recent studies demonstrated at least equal prognostic performance.

Anesthesia↗
PubMed2002

[Risk predictors, scoring systems and prognostic models in anesthesia and intensive care. Part II. Intensive Care].

The aim of the second part of this review article was to describe common scoring systems in intensive care, and to point out their possible benefits and limitations. Intensive care medicine multipurpose scoring-systems are currently used to estimate severity of illness, mortality and the amount of treatment required. Costs (only commercial available scores e.g. Acute Physiology and Chronic Health Evaluation [APACHE] III) and time needed for calculation have to be taken into consideration. Prognostic models of the third generation (APACHE III, Simplified Acute Physiology Score [SAPS] II, Mortality Prediction Model [MPM] II) should be preferred having better prognostic performance compared to scoring systems of prior generations. Although no prospective study exists comparing these three common scoring systems, it appears that all three systems are able to provide useful information to the clinician and researcher. These scoring systems were designed to classify severity of illness or the course of diagnostic and therapeutic interventions and to perform a risk stratification for scientific studies in a standardized way. In quality management and cost control, scoring systems and predictors are used for risk adjustment and evaluation of care performance.

APACHE↗
PubMed2002

Incidence and risk calculation of inotropic support in patients undergoing cardiac surgery with cardiopulmonary bypass using an automated anaesthesia record-keeping system.

BACKGROUND: This retrospective study analysed the effects of preoperative and intraoperative factors on the occurrence of inotropic support after cardiopulmonary bypass (CPB). METHODS: The data sets of 1471 adult patients having received elective cardiac surgery with CPB were recorded using an online anaesthesia record-keeping system. Patients were judged to have required inotropic drug support if they had received one or a combination of the positive inotropic drugs, epinephrine, dobutamine and enoximone. The effects of age, height, weight, body mass index, gender, chronic heart failure, documented preoperative myocardial infarction, left main coronary artery disease, preoperative history of hypertension, chronic renal failure, diabetes mellitus, chronic obstructive pulmonary disease (COPD), preoperative medical treatment, type of surgical procedure, duration of CPB, duration of aortic clamping and reperfusion time were analysed by logistic regression for predictive power of the need for positive inotropic drugs. RESULTS: Of the patients, 32.4% received positive inotropic drugs in the operating theatre after weaning from CPB. The overall 30-day mortality was 2.2%. Of non-survivors, 81.8% received inotropes compared with 18.2% of survivors (P < 0.01). The numbers of previous myocardial infarctions (odds ratio (OR), 2.01), congestive heart failures New York Heart Association class > 2 (OR, 1.85), COPD (OR, 1.85) and age > 65 yr (OR, 1.62), aortic cross clamping time of > 90 min (OR, 2.32) and coronary artery bypass surgery (OR, 0.43) all represented influential factors within the logistic regression model. CONCLUSION: The knowledge of these risk factors should be useful in increasing the anaesthetist's vigilance in those patients most at risk for inotropic support and in providing for more timely therapeutic intervention and optimizing anaesthesia management.

Aged↗
PubMed2002

An Anesthesia Information Management System (AIMS) as a tool for controlling resource management of operating rooms.

OBJECTIVES: In our department, we have been using an Anesthesia Information Management System (AIMS) for five years. In this study, we tested to what extent data extracted from the AIMS could be suitable for the supervision and time-management of operating rooms. METHODS: From 1995 to 1999, all relevant data from 103,264 anesthetic procedures were routinely recorded online with the automatic anesthesia record keeping system NarkoData. The program is designed to record patient related time data, such as the beginning of anesthesia or surgical procedure, on a graphical anesthesia record sheet. The total number of minutes of surgery and anesthesia for each surgical subspecialty per hour/day and day of the year was calculated for each of the more than 40 ORs, amounting to a total of 112 workstations. RESULTS: It was possible to analyze the usage and the utilization of ORs at the hospital for each day of the year since 1997. In addition, annual and monthly evaluations are made available. It is possible to scrutinize data of OR usage from different points of view: queries on the usage of an individual OR, the usage of ORs on certain days or the usage of ORs by a certain surgical subspecialty may be formulated. These data has been used repeatedly in our hospital for decision making in OR management and planning. CONCLUSIONS: In assessing the results of our study, it should be considered that the system used is not a specialized OR management tool. Despite these restrictions, the system contains data which can be used for an exact and relevant presentation of OR utilization.

Anesthesiology↗
PubMed2001

Plasminogen-activator-inhibitor-1 4G/5G promoter polymorphism and prognosis of severely injured patients.

A single base pair insertion/deletion (4G/SG) promoter polymorphism in the plasminogen-activator-inhibitor-1 (PAI-1) gene is thought to play a part in prognosis after severe trauma. We investigated the relation between outcome of severe trauma, PAI-1 concentrations, and PAP-1 genotype in 61 patients who had been severely injured. 11 (58%) of 19 patients with genotype 4G/4G did not survive, whereas only eight (28%) of 29 patients with heterozygous genotype 4G/SG, and two (15%) of 13 patients with genotype 5G/5G died. The PAI-1 4G allele is associated with high concentrations of PAI-1 in plasma and a poor survival rate after severe trauma.

Alleles↗
PubMed2001

Conscientious metabolic monitoring on a patient with hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome undergoing anaesthesia.

Currently we know not more than 50 patients who show an interesting combination of increased plasma ornithine concentrations, postprandial hyperammonemia, and homocitrullinuria (HHH-syndrome). Since exact knowledge of this severe, although rare syndrome is important for any perioperative or intensive medical treatment concerning therapy and progression of the disease, we report a comprehensive study on a 32-year old woman with this rare multifaceted disorder who had to undergo general anaesthesia. For the first time amino acid status in plasma, urine, cerebrospinal fluid and especially polymorphonuclear leucocytes, which in the investigation showed to be valuable tool for evaluating amino acid metabolism in nucleated cells in HHH-syndrome, and further important pathophysiologic indicators of cellular and metabolic function have been conscientiously investigated and compared. The pathophysiological repercussions of our results as well as the recommendations for conscientious therapeutical management are discussed.

Adult↗