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Biomedical subjects

H Laubenthal

Publications and source records attributed to H Laubenthal.

At least 19 recordsLinked to original sources
PubMed2006

[In-hospital resuscitation. Concept of first-responder resuscitation using semi-automated external defibrillators (AED)].

BACKGROUND AND OBJECTIVE: The prognosis after in-hospital resuscitation has not significantly improved in the last 40 years. This account presents the results over a three-year period of a hospital-wide emergency plan which implements the use of an automated external defibrillator (AED) by the first responder to the emergency call. BACKGROUND AND OBJECTIVE: 15 "defibrillator points" were installed, which could be reached within 30 s from all wards, out-patient departments and other areas, thus making them accessible for immediate defibrillator application. The hospital personnel is trained periodically in the alarm sequence, cardiopulmonary resuscitation and use of the defibrillator. Data on 57 patients who had sustained a cardiac arrest were prospectively recorded and analysed. RESULTS: In 46 patients (81%) the "on-the-spot" personnel (first-responder) was able to apply AED before arrival of the hospital's resuscitation team. Mean period between arrest alarm and activation of the AED was 2.2 (0.7-4.7) min. Ventricular fibrillation or ventricular tachyarrhythmia was recorded in 40 patients, making immediate shock delivery by AED possible. Restoration of the circulation was achieved in 23 (80%) of the patients and 20 (50%) were discharged home, 17 (43%) without neurological deficit. The high proportion of first-responder AED applications and evaluation of the personnel training indicate a wide acceptance of the emergency plan among the personnel. CONCLUSION: An immediate resuscitation plan consisting of an integrated programme of early defibrillation is feasible and seems to achieve an improved prognosis for patients who have sustained an in-hospital cardiac arrest.

Adult↗
PubMed2006

[Current level of patients' knowledge of anaesthesiology].

The anaesthesiologist's competence in anaesthesia, intensive care medicine, pain therapy and emergency medicine is accepted throughout the medical society. Nevertheless, during the last decades patient surveys demonstrated a considerable lack of information of the responsibility of our work. By continuous education and information anaesthesiologists have aimed to improve the information and decision-making process for the patient. This multicentre trial was designed to investigate the current public view on our profession in seven German hospitals. In-hospital patients were asked to fill out a standardised questionnaire prior to the anaesthesia premedication visit and a total of 692 questionnaires (77%) were analysed. Results demonstrated an increased level of knowledge for anaesthesia (>95%), intensive care medicine (74%), and pain therapy (50% acute pain; 32% severe pain). In the case of emergency medicine (10%) the in-hospital and out-of-hospital responsibilities were not clear among patients. We conclude that the continuous distribution of information in recent years has contributed to improving patients' knowledge on interdisciplinary responsibilities. Future efforts should focus on the gaps in patient's knowledge to allow the patient to ask the right questions necessary for decision-making.

Adult↗
PubMed2006

[(section sign) 115 b SGB V threatens outpatient treatment for inguinal hernia. Analysis of outcome and economics].

BACKGROUND: Current German legislation ( (section sign) 115 b SGB V) allows groin hernia inpatient treatment only under particular circumstances. That allows the operative technique of first choice for outpatient groin hernia repair to be determined by basic market principles. The aim of this paper was to study the feasibility of outpatient minimally invasive hernia surgery with regard to complication rates, patient satisfaction, and economic considerations. METHODS: For 1 year, a total of 571 patients with inguinal hernias (131 male, eight female, mean age 46 years, all ASA I) were treated at two surgical centers. Twenty-four percent (139/571) underwent outpatient total extraperitoneal repair (TEP). Complication rates were recorded. Patient satisfaction with the procedure was evaluated by a standard questionnaire. Cost calculations were compared with revenues according to the EBM2000plus. RESULTS: Of the patients, 96.4% were discharged on the day of operation without subsequent rehospitalization, 84% had no fears of complications at home, 54% went back to work in less than 14 days, and 88.7% were willing to undergo TEP a second time if necessary. Calculated average total cost of euro 709 exceeded the revenue of euro 565 by 20%. CONCLUSION: For a carefully selected group, outpatient TEP is patient-friendly and safe. Despite these advantages, it still remains economically unattractive to hospital management because of the 20% cover shortage. Improvements in the current legislation are urgently desired.

Adult↗
PubMed2005

[Organized pain management in the DRG reimbursement system].

Multidisciplinary pain management in pain centers can only be guaranteed if the DRG reimbursement system takes into account the multiple risk factors. The German pain associations prospectively analyzed clinical and administrative (DRG-related) data sets (n=3943) of inpatient and day care pain treatment facilities. The index diagnoses of 84% of the patient sample were grouped into nine basic DRGs. The most frequent pain procedure code was 8-918 ("multimodal pain management"). The minimal length of stay for this code set to 7 days was 17.2 days for the study sample. The DRG grouper software 2003 categorized 68.6% of the patients into PCCL 0 despite the proven complexity of risks and secondary diseases. The mean case weight in the sample was set at about 1. The pain-related data set analyzing pain severity, chronicity, and its influence on various functions emphasizes the total severity and burden of disease and thus the necessity for multimodal pain management. The German pain societies carried the motion that a new complex ICD code for chronic pain (with biopsychosocial consequences) should be established in the German Modification of the ICD. The new ICD code F62.80 and the procedure code 8-918 had not yet been implemented into the German DRG algorithm. Due to modifications in DRG systematics and the DRG algorithm, to be activated in 2005, the procedure code 8-918 will now automatically trigger into four special basic pain DRGs corresponding to the index pain diagnosis.

Combined Modality Therapy↗
PubMed2005

Inhalational anaesthetics in the ICU: theory and practice of inhalational sedation in the ICU, economics, risk-benefit.

ICU sedation poses many problems. The action and side-effects of intravenous drugs in the severely ill patient population of an ICU are difficult to control. The incidence of post-traumatic stress disorder after long-term sedation is high. The recent focus on propofol infusion syndrome entails restrictions in the use of this drug. On the other hand, volatile anaesthetics very selectively suppress consciousness but leave many autonomic functions intact. In the absence of perception and disturbed information processing the number of adverse experiences should be lower, leading to a better psychological outcome. Respiration and intestinal motility are not depressed, facilitating modern therapeutic concepts such as early enteral feeding and augmentation of spontaneous breathing. Awakening after inhalational ICU sedation is quick and predictable, extubation can be planned and organized, and the time during which the patient needs very close observation will be short. Technological advances have greatly simplified the application of inhalational anaesthetics. New anaesthesia ventilators offer ventilatory modes and high flow generation comparable to ICU ventilators. However, they are not yet licensed for stand-alone use. The introduction of a volatile anaesthetic reflection filter for the first time enables the concept of inhalational sedation to be performed with very little effort by many ICUs. This 'anaesthetic conserving device' (AnaConDa) is connected between the patient and a normal ICU ventilator, and it retains 90% of the volatile anaesthetic inside the patient just like a heat and moisture exchanger. In this chapter possible advantages of the new concept and the choice of the inhalational agent are discussed. The technical prerequisites are explained, and the practice and pitfalls of inhalational ICU sedation in general and when using the AnaConDa are described in detail.

Anesthesia, Inhalation↗
PubMed2002

[Postoperative pain therapy in Germany].

OBJECTIVE: A survey was performed to obtain information on the organization and practice of postoperative pain management. METHODS: A questionnaire was mailed to 773 directors of German departments of anesthesiology. RESULTS: A total of 446 replies (57.7%) could be analyzed. Of the departments, 161 (36.1%) had established an acute pain service (APS), more often in hospitals > or = 1000 beds (63%) than in hospitals with 400-999 beds (40%) and hospitals with < 400 beds (27%). Epidural analgesia was practiced in 97% of the departments, however, it was the analgesic technique of choice for larger abdominal surgery or amputation of the lower limb only in 60.8% and 45.5% of the departments, respectively. Departments with APS provided epidural analgesia more often on general wards than departments without APS (88.2% vs. 68.4%, p < 0.01). Technically more challenging methods (e.g. catheters for regional anesthesia, PCA, PCEA) were more often provided in hospitals running an APS (p < 0.001). CONCLUSIONS: The number of departments with APS has increased over the last 10 years. Future decisions on reimbursement should consider this extensive service.

Analgesia, Epidural↗
PubMed2001

[Quantification of blood loss. How precise is visual estimation and what does its accuracy depend on?].

Estimation of blood loss is a difficult task. Apart from measuring the volume of the suctioned blood the anaesthetist has to make a visual estimate of blood shed on the floor, spread in the surgeons' gowns and gloves and hidden in drapes and sponges at nearly every operation. We were interested in how exact visual estimation of blood loss can be and what factors influence accuracy and precision of the visual estimate. In one OR we simulated typical blood loss scenes occurring during a mock hip joint replacement, using our normal customary equipment of drapes, sponges and containers. More than 8 litres of blood from autologous whole blood donations were partitioned with a graduated measure and syringes and were distributed around the OR in 22 locations in typical ways. 36 members of staff entered the OR one by one and all gave their 22 estimates. Results were analysed by repeated measures analysis of variance. Bias (accuracy) and variation error (precision) were calculated for individuals and groups of individuals. We found a broad deviation of the visual estimates and little coincidence with the actual values. Over- and underestimations by 2 or even 3 were rather common; underestimations were more frequent. We found a significant trend to overestimate diluted blood, even though these certain sites were known to exhibit diluted blood. On the other hand laparotomy pads and sponges fully saturated with blood as well as the simulation of the operative site were grossly underestimated. Age, sex and professional experience (!) did not influence the magnitude of estimation errors, but the professional groups'estimates differed: anaesthetists estimated slightly but significantly more than orthopedic or general surgeons. Obviously our capability to estimate lost blood volumes is more influenced by our belonging to a professional group than by our professional experience. Do we not learn by experience? Diluted blood is overestimated, whereas in some other typical scenes blood loss is grossly underestimated. Simulations such as this one may improve our estimation capabilities and thus result in better patient care in the OR.

Adult↗
PubMed2000

The 2'-5' oligoadenylate/RNase L/RNase L inhibitor pathway regulates both MyoD mRNA stability and muscle cell differentiation.

The 2'-5' oligoadenylate (2-5A)/RNase L pathway is one of the enzymatic pathways induced by interferon. RNase L is a latent endoribonuclease which is activated by 2-5A and inhibited by a specific protein known as RLI (RNase L inhibitor). This system has an important role in regulating viral infection. Additionally, variations in RNase L activity have been observed during cell growth and differentiation but the significance of the 2-5A/RNase L/RLI pathway in these latter processes is not known. To determine the roles of RNase L and RLI in muscle differentiation, C2 mouse myoblasts were transfected with sense and antisense RLI cDNA constructs. Importantly, the overexpression of RLI in C2 cells was associated with diminished RNase L activity, an increased level of MyoD mRNA, and accelerated kinetics of muscle differentiation. Inversely, transfection of the RLI antisense construct was associated with increased RNase L activity, a diminished level of MyoD mRNA, and delayed differentiation. In agreement with these data, MyoD mRNA levels were also decreased in C2 cells transfected with an inducible RNase L construct. The effect of RNase L activity on MyoD mRNA levels was relatively specific because expression of several other mRNAs was not altered in C2 transfectants. Therefore, RNase L is directly involved in myoblast differentiation, probably through its role in regulating MyoD stability. This is the first identification of a potential mRNA target for RNase L.

ATP-Binding Cassette Transporters↗
PubMed1999

Tissue deposits of hydroxyethyl starch (HES): dose-dependent and time-related.

Tissue deposits occur after administration of plasma substitutes. After hydroxyethyl starch (HES), deposits may last for months, causing pruritus and impairment of function. Because elimination of HES deposits has not been demonstrated in humans, we studied 26 patients, for up to 7 yr after HES administration, to assess HES storage. HES dose ranged from 0.34 to 15.00 g kg-1 body weight, and administration intervals from 1 day to 7 yr. Biopsies of the liver, muscle, spleen, intestine or skin were studied using light and electron microscopy and immunohistochemistry. HES storage was dose-dependent, decreased in all organs with time and was greater in patients suffering from pruritus. We conclude that tissue deposition of HES is transitory and dose-dependent, with differences between subjects in severity and duration.

Adult↗
PubMed1998

Hydroxyethyl starch antibodies in humans: incidence and clinical relevance.

UNLABELLED: Hydroxyethyl starch (HES) is a plasma expander used for perioperative i.v. fluid management, as well as for resuscitation from trauma and shock. HES is very well tolerated, and the incidence of anaphylactic reactions is lower than with dextran or gelatin. Dextran anaphylaxis is caused by circulating dextran-reactive antibodies (ABs) of the immunoglobin G (IgG) class found in most adults. Histamine release from mast cells induces adverse reactions after gelatin infusion. The cause of adverse reactions due to HES is not yet clear. To investigate AB formation due to HES, we collected sera of 1004 patients at least 14 days after starch administration. Using a highly sensitive enzyme-linked immunoabsorbent assay technique, we found one patient with a low 1:10 titer of HES-reactive ABs (immunoglobin M [IgM] class). Despite repeated HES infusions, no clinical reaction could be detected in this patient. On the basis of a binomial distribution, a one-tailed confidence interval (99%) was used to calculate the percentage of the occurrence of ABs in general with maximum of 33 in 10,000 persons (IgM) and 23 in 10,000 persons (IgG). We suggest that HES-reactive ABs are extremely rare and that they do not necessarily induce anaphylaxis. Other mechanisms may be responsible for adverse reactions due to HES. IMPLICATIONS: The frequency of antibody formation due to hydroxyethyl starch, a commonly used plasma expander, was prospectively investigated in 1004 patients. Only one patient showed transient antibody formation, which was not harmful to the patient. This low antigenicity could explain the excellent tolerance of hydroxyethyl starch compared with other plasma expanders.

Adolescent↗
PubMed1997

[Clinical studies on the peripheral effect of opioids following knee surgery. A literature review].

In this article 34 randomized controlled trials examining peripherally mediated opioid effects after knee surgery are discussed. All studies examined small doses of morphine injected intraarticularly at the end of knee surgery, but not all studies did show an analgesic effect of the peripheral opioid. Because of differing study designs a meta-analysis of the data is not possible. Some important factors like those that the respective authors try to explain the contradictory results with are discussed here: The used concentrations, volumes and doses of morphine are not of major importance. An addition of adrenaline to the study drug, as well as the use of a tourniquet and the time interval between the intra-articular injection and tourniquet release do not seem crucial either. The use of intra-articular drainage (which is opened 10 min after injection of the study drug) and of patient-controlled analgesia as an evaluative method also do not seem to play a major role. But it is remarcable that peripheral opioid effects have often been described after general and local anesthesia but only once after regional anaesthesia. It may be that the activation or expression of peripheral opioid receptors is inhibited by the blockade of input to the central nervous system. Animal experiments are needed to clarify this issue. But it may also be that postoperative pain after regional anaesthesia does not reach a level high enough to make an analgesic effect measurable. If patients after regional anesthesia are not considered, 20 studies out of 29 were able to demonstrate opioid effects whereas 9 were not: The work of Heard and coll. as well as Ruwe and coll. must be criticized because of methodological shortcomings. In the remaining 7 studies the patients of the comparative groups only show low pain scores which may make it impossible to measure an analgesic effect by intraarticular morphine. In summary it can be concluded that very small doses of morphine injected intra-articularly after knee surgery do exert an analgesic effect. In some studies this effect lasted even up to 48 h. But at least during the first two hours the effect is small or else doubtfull. Therefore a combination with bupivacain, a local anesthetic which acts rapidly but only for some hours can be recommended. Most authors testing this combination found it most useful.

Analgesics, Opioid↗
PubMed1997

Intracutaneous histamine injection can detect damage of cutaneous afferent fibres in postherpetic neuralgia.

BACKGROUND: The axon reflex response in diseased skin of patients with postherpetic neuralgia may be significantly impaired. OBJECTIVE: In the present study we introduced a simple test for quantifying the decreased axon reflex flare response in the clinical routine. METHODS: Histamine was intradermally applied to the diseased dermatome as well as to the corresponding dermatome of the contralateral side of the body. Ten minutes after application, skin blood flow and the extension of the hyperaemic response were assessed by means of laser Doppler scanning. RESULTS: In the skin region affected by the postherpetic neuralgia, the hyperaemic area was significantly smaller than in the healthy skin. The mean flux values did not differ significantly between the two sites. There was no correlation between the hyperaemic response and the intensity of pain sensation assessed by a clinical visual analogue score. CONCLUSION: The smaller hyperaemic area in the dermatome with postherpetic neuralgia strongly indicates a C fibre or C nociceptor damage. We consider histamine injections as a useful tool in the differential diagnosis of postherpetic neuralgia.

Aged↗