Search PubMed⌕ Search

Biomedical subjects

H K Eltzschig

Publications and source records attributed to H K Eltzschig.

10 recordsLinked to original sources
PubMed2006

Remifentanil or sufentanil for coronary surgery: comparison of postoperative respiratory impairment.

BACKGROUND AND OBJECTIVE: High-dose opioid anaesthesia contributes to decreasing metabolic and hormonal stress responses in patients undergoing cardiac surgery. However, the increase in context-sensitive half-life of opioids given as a high-dose regimen can affect postoperative respiratory recovery. In contrast, remifentanil can be given in high doses without prolonging context-sensitive half-life due to its rapid metabolism. Therefore, we performed a prospective, randomized trial to compare anaesthesia consisting of propofol/remifentanil or propofol/sufentanil with regard to postoperative respiratory function and outcome. METHODS: Patients undergoing coronary artery bypass grafting were randomized to a propofol/remifentanil (0.5-1.0 microg kg(-1) min(-1)) or propofol/sufentanil (30-40 ng kg(-1) min(-1)) based anaesthetic. Carbon dioxide response, forced expiratory volume in one second, vital capacity, and functional residual capacity were measured 1 day prior to the operation, 1 h before extubation, 1, 24 and 72 h after extubation. In addition, the incidence of atelectasis, pulmonary infiltrates, intensive care unit and postoperative length of stay were compared. Patients and physicians were blinded to the treatment group. RESULTS: Twenty-five patients in each treatment group completed the study. There was no difference between patients of the treatment groups regarding demographics, risk- or pain scores. In all patients, carbon dioxide response, forced expiratory volume in one second, vital capacity and functional residual capacity were decreased postoperatively compared to baseline. Patients randomized to remifentanil had less depression of carbon dioxide response, less atelectasis and shorter postoperative length of stay (12 d vs. 10 d) than after sufentanil (P < 0.05). CONCLUSIONS: Intraoperative use of high-dose remifentanil for coronary artery bypass grafting may be associated with improved recovery of pulmonary function and shorter postoperative hospital length of stay than sufentanil.

Aged↗
PubMed2006

[Perioperative echocardiography: basic principles].

Over the past decades, echocardiography has undergone a continuous evolution in technology that has promoted its clinical application and acceptance throughout perioperative medicine. These technological advances include improvements in transducer development that permit superior imaging quality and a wider selection of probes for epicardial, epiaortic, and surface echocardiography which can also be used in conjunction with multiplane transesophageal echocardiography. Moreover, the addition of Doppler technology and digital acquisition has secured the role of echocardiography as a valuable and relatively noninvasive diagnostic tool for the assessment of cardiovascular disease and hemodynamic monitoring throughout the perioperative period. Therefore, it has become increasingly important for perioperative physicians to understand the basic principles and underlying fundamental concepts pertaining to the technology and physics of echocardiography, as well as its inherent limitations. The current review outlines the modes and applications of different echocardiographic techniques used in perioperative echocardiography including M-mode, two-dimensional echocardiography, and Doppler assessment of blood flow. In addition, the limitations of these techniques and typical artifacts associated with the perioperative use of echocardiography are described.

Artifacts↗
PubMed2005

[Preoperative evaluation and perioperative management of patients with increased cardiovascular risk].

Due to the increasing age in western countries, combined with high rates of major surgical interventions in high-risk patients, perioperative reduction of cardiovascular complications becomes increasingly more important for perioperative physicians. After identifying patients with increased perioperative risk, specific interventions need to be considered to reduce their risk for cardiovascular complications, either by perioperative medical therapy or specific treatment options (e.g. coronary intervention). Several trials have demonstrated an effect of perioperative beta-blocker-therapy in reducing cardiovascular complications among high-risk patients. Additionally, several monitoring techniques are effective in detecting cardiovascular complications. Nevertheless, it remains unclear whether they are associated with a measurable improvement of outcome. Based on the ACC/AHA-guidelines, the present review describes a stepwise approach to surgical patients to identify perioperative risks, based on specific patient related risk factors, the kind of surgery and on the specific setting (emergency versus elective surgery). In addition, strategies to reduce perioperative cardiovascular complications are discussed.

Cardiovascular Diseases↗
PubMed2003

[Perioperative implications of heart transplant].

Over the past 30 years, heart transplantation has evolved into a definitive therapy for patients with end-stage cardiomyopathy. However, perioperative management of patients undergoing heart transplantation remains a challenge for anesthesiologists. The presence of biventricular failure, arrhythmias and associated multisystem organ dysfunction may contribute to significant intraoperative hemodynamic instability prior to the initiation of cardiopulmonary bypass (CPB). Even after an uneventful transplantation, weaning from CPB may be difficult. Acute right ventricular failure can develop in the recipient secondary to pre-existing pulmonary hypertension. Treatment options frequently focus on therapeutic interventions directed towards decreasing pulmonary vascular resistance and improving right ventricular contractility. Intraoperative use of transesophageal echocardiography (TEE) enables the anesthesiologist to diagnose acute right ventricular failure early on and guide therapy. Concurrent pathology including kinking of the pulmonary artery anastomosis or valvular insufficiency in the transplanted heart can also be recognized and addressed. The number of patients undergoing cardiac transplantation is continually increasing. In addition, the use of more effective immunosuppressive agents has curtailed transplant rejection and permitted longer survival. Consequently, heart transplant recipients are more frequently presenting for non-cardiac surgical procedures. Thus, an understanding of physiological and pharmacological implications associated with heart transplantation is crucial for managing these patients in the perioperative period.

Adult↗
PubMed2003

[Epicardial echocardiography intraoperative diagnostic utility to assess valve function].

Epicardial echocardiography has been available since the early 1970s as an intraoperative diagnostic modality to assess ventricular and valvular function. With this technique, an ultrasonic transducer is placed directly on the epicardial surface of the heart, following sternotomy and pericardiotomy. Under the guidance of the cardiac anesthesiologist, the surgeon places the transducer so that the desired views of cardiac structures and great vessels can be obtained. The anesthesiologist performs the acquisition, analysis and interpretation of the echocardiographic images. Despite the feasibility of epicardial echocardiography, transesophageal echocardiography (TEE) has emerged over the last two decades as the main form of intraoperative echocardiography. Although TEE allows continuous monitoring of cardiac and valvular function without interruption of the surgical procedure, placement of a TEE probe may be difficult or contraindicated in some patients. In such cases, epicardial echocardiography may be the optimal ultrasonographic imaging modality to assess ventricular and valvular function during cardiac surgery. We describe the use of epicardial echocardiography for intraoperative assessment of valvular function in two patients where TEE was either contraindicated or probe placement could not be performed safely. The first patient underwent surgical repair of the mitral valve for severe mitral regurgitation. After weaning the patient from cardiopulmonary bypass (CPB), epicardial echocardiography was used to confirm successful reconstruction of the valve and to exclude residual mitral regurgitation. The second patient was scheduled for coronary artery bypass grafting (CABG). Prior to the initiation of CPB, the presence of moderate aortic stenosis was confirmed using Doppler echocardiography via an epicardial approach.

Aged↗
PubMed2002

[Transesophageal echocardiography: perioperative evaluation of valvular function].

Since its introduction into the operating room, transesophageal echocardiography (TEE) has proven to be an invaluable diagnostic tool for perioperative patient management. TEE allows direct visualization of structural and functional cardiac abnormalities. Therefore, it has become the most important imaging technique to evaluate valular function. Pressure gradients across a stenotic valve can be calculated by measuring the blood flow velocity within the valve. Additionally, the area of the valve can be estimated by using the continuity equation. The severity of regurgitant blood flow across an incompetent valve can be assessed using color flow, continuous or pulsed-wave Doppler. Surgical patients experience significant changes in blood pressure, intrathoracic pressures and volume status in the perioperative period. Therefore, the interaction between these parameters and valvular function is the focus of recent clinical studies and might in future contribute to the perioperative as well as anesthesiological management of patients with valvular dysfunction.

Algorithms↗
PubMed2001

Effect of tracheal intubation or laryngeal mask airway insertion on intraocular pressure using balanced anesthesia with sevoflurane and remifentanil.

STUDY OBJECTIVES: To study the effect of tracheal intubation or laryngeal mask airway (LMA) insertion on intraocular pressure (IOP) in strabismus patients undergoing balanced anesthesia with sevoflurane and remifentanil. DESIGN: Open, prospective, randomized study. SETTING: Tertiary care academic medical institution. PATIENTS: 40 adult ASA physical status I and II patients scheduled for elective strabismus surgery. INTERVENTION: Patients were randomized to receive either tracheal intubation or LMA insertion following mask induction with sevoflurane in combination with IV remifentanil. MEASUREMENTS: Intraocular pressure, mean arterial pressure (MAP), and heart rate (HR) were measured before induction, immediately following induction, and after airway insertion. MAIN RESULTS: Intraocular pressure after tracheal intubation or LMA insertion did not differ significantly from preoperative baseline values. Mean arterial pressure and HR did not significantly differ between groups at any time point. CONCLUSIONS: Remifentanil and sevoflurane are not associated with an increase in IOP response during tracheal intubation or LMA insertion above baseline in healthy patients undergoing ophthalmic surgery.

Adjuvants, Anesthesia↗