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W Wilhelm

Publications and source records attributed to W Wilhelm.

At least 19 recordsLinked to original sources
PubMed2006

[Influence of gender on stimulated cytokine response in patients with severe sepsis].

AIM: Studies suggest that female mice have lower mortality rates than males after sepsis or trauma-hemorrhage. This study investigated the impact of gender and disease severity on monocyte hyporesponsiveness in severe human sepsis. METHODS: We prospectively investigated 49 (male n=28, female n=21) consecutive patients with severe sepsis. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) were assayed by ELISA in unstimulated whole blood cultures or after stimulation with lipopolysaccharide (LPS; E. coli 0111:B4) or Staph. aureus Cowan strain I (SAC-I) lysate at days 1, 2, 3, 4, and 8 after enrollment. Testosterone and estradiol levels were quantified by electrochemoluminescence immunoassays. RESULTS: Mortality was similar for males (35.7%) and females (42.9%). While disease severity was also comparable, septic patients showed a substantial suppression in stimulated TNF-alpha response compared to healthy controls who recovered within 8 days in surviving patients. Stimulated cytokine response recovered in female non-surviving patients, while it remained suppressed in non-surviving male patients and was significantly different compared to female non-surviving patients. Testosterone levels were substantially suppressed in male but not female septic patients compared to normal values but did not differ between surviving and non-surviving patients. Estradiol levels were elevated in female and male septic patients. Addition of different concentrations of testosterone and estradiol to whole blood obtained from younger (<35 years old) and older (>60 years old) male as well as from younger (proestrous premenopausal) and older (postmenopausal) female non-septic volunteers revealed no effect on LPS-stimulated TNF-alpha and IL-10 release. CONCLUSION: Severe sepsis leads to a substantial suppression of stimulated cytokine response. Prolonged suppression may serve as a marker of unfavourable outcome in male but not in female individuals suffering from severe sepsis. Furthermore, our data suggest that gender differences in cellular immunity described for young, sexually mature animals obviously persist in typical postmenopausal intensive care unit patients, although a direct interaction between testosterone or estradiol and LPS-stimulated cytokine response could not be demonstrated.

APACHE↗
PubMed2006

[Videolaryngoscopy versus direct laryngoscopy for elective endotracheal intubation].

BACKGROUND: We compared the ease of viewing the glottis under direct vision during conventional laryngoscopy with the quality of indirectly viewing on a monitor during laryngoscopy with a Macintosh videolaryngoscope in a multicenter study. PATIENTS AND METHODS: After ethical approval and written informed consent of 300 patients with no anticipated difficult airway, conventional laryngoscopy with a Macintosh videolaryngoscopy blade was performed and the quality of the view of the glottis was assessed and documented according to the Cormack and Lehane scoring system as modified by Yentis and Lee. Subsequently, the indirect viewing conditions on the monitor were documented without changing the position of the blade. Differences between both distributions were analyzed using the Bland-Altman Test. RESULTS: Videolaryngoscopy improved the laryngoscopy score by 1 grade in 72 cases, by 2 grades in 17 cases and by 3 grades in 2 cases. A relevant improvement (from grades III/IV to II) was found in 28 patients. Viewing conditions worsened in 3 cases by 1 grade, in 4 cases by 2 grades and in 3 cases by 3 grades. A statistical analysis of the data gave a bias of 0.31 and an SD bias of 0.77.The 95% confidence interval of the distribution ranged from -1.12 to 1.81. CONCLUSION: Videolaryngoscopy can lead to better viewing conditions but in rare cases it may result in worse viewing conditions.

Adult↗
PubMed2006

[Desflurane and isoflurane in minimal-flow anesthesia. Consumption and costs with forced fresh gas reduction].

BACKGROUND: In the present investigation we compared the consumption of desflurane (DES) and isoflurane (ISO) using a standardized minimal-flow protocol with a forced reduction of the fresh gas flow (FGF). METHODS: 54 adult women were examined. After induction of anaesthesia a forced reduction of the FGF was started: 5 min 0.5 l/min O(2) + 1 l/min N(2)O, 10 min 0.5 l/min O(2) + 0.5 l/min N(2)O; finally 0.3 l/min O(2) + 0.2 l/min N(2)O up to the end of surgery. The consumption of DES/ISO was determined with a precision balance. RESULTS: In the DES group the uptake was around 0.3 vol-%, i.e. less than 8% of the target 2/3 MAC value was taken up. For ISO the uptake was around 0.25 vol-%, i.e. the uptake was approximately 30% of the target 2/3-MAC value. The DES consumption was after 60 min 17.0+/-1.1 g, 120 min--27.3+/-1.8 g and 180 min--36.5+/-1.7 g. ISO consumption was significantly lower: 7.6+/-0.8 g, 12.4+/-1.7 g and 15.5+/-1.6 g. The use of DES yielded higher costs, i.e. 2.28 EUR for 60 min, 3.63 EUR for 120 min and 4.97 EUR for 180 min. The consumption of the inhaled anaesthetics can be calculated as: DES (g)=4.84+0.184 x duration (min) (R(2)=0.981), ISO (g)=2.049+0.0826 x duration (R(2)=0.979). The costs are: DES (EUR)=0.85+0.0323 x duration (min); ISO (EUR)=0.19+0.0077 x duration (min). CONCLUSION: With a forced reduction of the FGF the DES consumption is still higher.

Adult↗
PubMed2006

The Narcotrend monitor.

The Narcotrend (MonitorTechnik, Bad Bramstedt, Germany) is an EEG monitor designed to measure the depth of anaesthesia. It has been developed at the University Medical School of Hannover, Germany, has been commercially available for 5 years and has meanwhile received US Food and Drug Administration approval. The Narcotrend algorithm is based on pattern recognition of the raw electroencephalogram (EEG) and classifies the EEG traces into different stages from A (awake) to F (increasing burst suppression down to electrical silence). The newest Narcotrend software version includes a dimensionless Narcotrend index from 100 (awake) to 0 (electrical silence). The raw EEG signal can be recorded by standard electrocardiogram electrodes for single- and double-channel registration. The Narcotrend monitor provides a vast amount of information: the actual Narcotrend stage and index, the trend ('cerebrogram'), the raw EEG signal and a power spectrum and several derived EEG parameters. Multiple clinical and validation studies are available for the Narcotrend monitor, including comparisons with the BIS monitor (Aspect Medical Systems, Natick, USA).

Algorithms↗
PubMed2006

Reduction in anaesthetic drug consumption is correlated with mean titrated intra-operative Bispectral Index values.

BACKGROUND: Several studies have shown a reduction in anaesthetic drug consumption with Bispectral Index (BIS) titration compared with standard clinical practice. However, the amount of reduction varied widely between 1% and 40%. We investigated the correlation between reduction in anaesthetic drug consumption and mean titrated BIS values. METHODS: An analysis upon randomized controlled trials cited until January 2006 in MEDLINE and other databases investigating the potential reduction in anaesthetic (hypnotic) drug consumption with BIS titration was performed. Investigations with a marked difference (> 15%) in opioid drug consumption between the BIS group and the standard practice group were excluded. Correlations between amount of reduction in hypnotic drug use and the mean titrated BIS value were analysed with linear regression. RESULTS: Fourteen manuscripts covering 2582 patients were included into the analysis. The mean BIS value in the standard clinical practice group averaged over all studies was 43.6 +/- 3.2 and the mean BIS value in the BIS-titrated group was 49.9 +/- 5.4. The amount of reduction in hypnotic drug use correlated significantly with the mean BIS values in the BIS-titrated groups (r =0.68) and with the differences between the mean BIS value in the BIS-titrated group and the mean BIS value in the standard clinical practice group (r = 0.70). Every point of BIS difference between the two groups resulted in a reduced hypnotic drug use of approximately 2%. CONCLUSION: Despite differences in the study designs and in the drugs used, a linear correlation between the mean titrated BIS value and the hypnotic drug saving potential was found.

Anesthetics↗
PubMed2005

[Influence of gender on propofol consumption and recovery times].

INTRODUCTION: We investigated gender differences of drug consumption and recovery times for propofol-remifentanil anaesthesia. METHODS: Adult patients scheduled for minor orthopaedic surgery were randomised to receive a propofol-remifentanil anaesthesia controlled either by EEG monitoring (Narcotrend or BIS) or solely by clinical parameters. Anaesthesia was induced with remifentanil 0.4 microg/kg/min and a propofol target-controlled infusion (TCI) at 3.5 microg/ml. After intubation remifentanil was reduced to 0.2 microg/kg/min whereas propofol TCI was adjusted according to clinical parameters or to the following EEG target values: during maintenance to "D(0)" (Narcotrend) or "50" (BIS), 15 min before the end of surgery to "C(1)" (Narcotrend) or "60" (BIS). Recovery times were recorded and average normalised propofol consumption was calculated from induction and maintenance doses. RESULTS: A total of 60 male and 60 female patients completed the study. Gender differences were observed for recovery times (with standard practice) and for propofol consumption (with BIS monitoring). In the standard protocol group, propofol consumption was nearly identical for male and female patients whereas recovery times were significantly longer in the male group. In both EEG-guided groups propofol consumption was less for male patients while recovery times were slightly longer. In the group of female patients higher propofol TCI concentrations had to be used to reach the same BIS or Narcotrend values. CONCLUSION: With propofol-remifentanil anaesthesia, gender has impact on recovery times and propofol consumption. If the same amounts of propofol are applied, males awake later, with BIS or Narcotrend monitoring males receive less propofol for comparable EEG effects.

Aged↗
PubMed2005

Impact of patient age on propofol consumption during propofol-remifentanil anaesthesia.

BACKGROUND: This study was designed to investigate the impact of patient age on propofol consumption and recovery time using a propofol-remifentanil anaesthetic standardized with Narcotrend EEG monitoring. The Narcotrend is a monitor for measuring the depth of anaesthesia based upon a six-letter classification from A (awake) to F (increasing burst suppression) including 14 substages. METHODS: In 200 patients scheduled for minor orthopaedic surgery Narcotrend EEG electrodes were positioned on the patient's forehead as recommended by the manufacturer. Anaesthesia was induced with remifentanil 0.4 microg kg(-1) min(-1) and 2 mg kg(-1) propofol. Immediately after intubation remifentanil was reduced to a constant rate of 0.2 microg kg(-1) min(-1) whereas a propofol infusion was now started at 3 mg kg(-1) h(-1) and then adjusted accordingly to achieve a target Narcotrend stages of D(0-2) indicating general anaesthesia. At the end of surgery the propofol and remifentanil infusions were stopped without tapering, the time to unstimulated opening of eyes was determined, and the propofol consumption (given as mg kg(-1) h(-1)) was calculated from the total amount of infused propofol but without the induction bolus, from the actual body weight and the duration of propofol infusion. Furthermore, a linear regression analysis was applied for propofol consumption vs. age. RESULTS: The ages of the patients studied ranged from 16 to 83 yr old and patients were classified as ASA I-III. Propofol consumption significantly decreased with the patients' age: 30 yr of age or below the propofol consumption was calculated as 5.9 +/- 1.7 mg kg(-1) h(-1), for 31-50 yr as 5.4 +/- 1.8 mg kg(-1) h(-1), for 51-70 yr as 4.5 +/- 1.7 mg kg(-1) h(-1) and above 70 yr as 3.5 +/- 1.4 mg kg(-1) h(-1). Linear regression analysis revealed propofol (mg kg(-1) h(-1)) = 9.136 - (0.0597 x age (yr)); R = 0.53. Concomitantly, the recovery time to opening of eyes increased with the patients' age: < or = 30 yr, 7.4 +/- 3.7 min; 31-50 yr, 9.5 +/- 4.0 min; 51-70 yr, 9.8 +/- 4.1 min; and > or = 71 yr, 14.9 +/- 12.1 min. CONCLUSIONS: We conclude that with Narcotrend guidance, mean propofol consumption and recovery times are age dependent. However, as a result of large inter-individual variability, age per se does not allow a prediction of individual propofol need or recovery time.

Adolescent↗
PubMed2004

Bispectral index and A-line AAI index as guidance for desflurane-remifentanil anaesthesia compared with a standard practice group: a multicentre study.

BACKGROUND: This study was designed to investigate the impact of bispectral index (BIS) or A-line AAI index (based on middle-latency auditory evoked potential) monitoring on recovery times and drug consumption when compared with standard anaesthetic practice during desflurane-remifentanil anaesthesia. METHODS: After having obtained approval from the institutional review board and written informed consent, 200 adult patients undergoing minor surgical procedures were randomized to receive a desflurane-remifentanil anaesthetic controlled either solely by clinical parameters or by BIS or AAI to the following target values: during maintenance of anaesthesia to a value of '50' (BIS) or '30' (AAI), 15 min before the end of surgery to '60' (BIS) or '45' (AAI). Recovery times and drug consumption were recorded by a blinded investigator. RESULTS: Compared with standard practice, patients with BIS or AAI monitoring needed similar desflurane concentrations (standard practice 2.9 [0.5] vol%, BIS 3.3 [0.9] vol%, AAI 2.6 [0.5] vol%), and had similar recovery times (open eyes 5.6 [2.5] min, 5.9 [3.4] min, 5.0 [3.1] min; extubation 6.3 [2.4] min, 6.6 [3.5] min, 5.6 [3.0] min; stating name 7.3 [2.4] min, 7.6 [3.5] min, 7.3 [6.6] min). CONCLUSIONS: Compared with standard anaesthetic practice BIS and AAI guided titration to the used target ranges did not result in a reduction of desflurane consumption or recovery times during minor surgery with use of remifentanil.

Adolescent↗
PubMed2004

Comparability of Narcotrend index and bispectral index during propofol anaesthesia.

BACKGROUND: The dimensionless Narcotrend (NCT) index (MonitorTechnik, Germany, version 4.0), from 100 (awake) to 0, is a new index based on electroencephalogram pattern recognition. Transferring guidelines for titrating the Bispectral Index (BIS, Aspect Medical Systems, USA, version XP) to the NCT index depends on their comparability. We compared the relationship between BIS and NCT values during propofol anaesthesia. METHODS: Eighteen adult patients about to have radical prostatectomy were investigated. An epidural catheter was placed in the lumbar space and electrodes for BIS and NCT were applied as recommended by the manufacturers. After i.v. fentanyl 0.1 mg, anaesthesia was induced with a propofol infusion. After intubation, patients received bupivacaine 0.5% 15 ml via the epidural catheter. Forty-five minutes after induction, the propofol concentration was increased to substantial burst suppression pattern and then decreased. This was done twice in each patient, and BIS and Narcotrend values were recorded at intervals of 5 s. The efficacy of NCT and BIS in predicting consciousness vs unconsciousness was evaluated using the prediction probability (P(K)). RESULTS: We collected 38 629 artefact-free data pairs of BIS and NCT values from the respective 5-s epochs. Because of artefacts, another 5008 epochs had been excluded from data analysis (3855 epochs for the NCT index alone, 245 epochs for the BIS alone and 908 epochs for both indices). Mean (sd) values in awake patients were 94 (6) for Narcotrend and 91 (8) for BIS. With loss of the eyelash reflex, both values were significantly reduced, to 72 (9) for NCT (P<0.001) and to 77 (11) for the BIS index (P<0.001). The PK value for loss of eyelash reflex was similar for BIS (0.95) and NCT (0.93). Decreasing BIS values coincided with decreasing NCT values. A sigmoid model [NCT index=52.8+26.8/(1+exp(-(BIS-78.3)/4.8))(0.4); r=0.52] described the correlation between BIS and NCT index in a BIS range between 100 and 50. For BIS values lower than 50, a second sigmoid model with a correlation of r=0.83 was applied [NCT index=6.6+45.3/(1+exp(-(BIS-29.8)/2.4)) (0.6) r=0.83]. The relationship between burst suppression ratio (BSR) and NCT index was best described by the following sigmoid model: NCT index=265/(1+exp((-BSR+108)/-49); r=0.73. CONCLUSIONS: We found a sufficient correlation between BIS and NCT index, but deviations from the line of identity in some ranges require attention. Therefore, a simple 1:1 transfer from BIS to NCT values is not adequate. Our results might serve as a blueprint for the rational translation of BIS into NCT values.

Aged↗
PubMed2004

[Bispectral index and desflurane concentration below 1 MAC].

INTRODUCTION: We investigated the relationship between bispectral index (BIS, A-2000, Aspect Medical Systems, USA) and end-tidal desflurane concentrations below 1 MAC which is especially the range of interest if desflurane is combined with remifentanil for fast-track anaesthesia. METHODS: With institutional review board approval and written informed consent we investigated 50 adult ASA I-III patients scheduled for minor orthopaedic surgical procedures. The BIS electrode (BIS-Sensor, Aspect Medical Systems, USA) was positioned on the patient's forehead as recommended by the manufacturer. All patients were premedicated with 0.15 mg x kg(-1) diazepam orally in the evening and on the morning before surgery. Induction of anaesthesia was started with a remifentanil infusion at 0.4 micro g x kg(-1) x min(-1) and 5 min later 2 mg x kg(-1) propofol was given for hypnosis. Immediately after intubation, remifentanil was reduced to 0.2 micro g x kg(-1) x min(-1), and the depth of anaesthesia was adjusted according to clinical needs by regulating the desflurane concentration. Starting 20 min after induction, a total of 1,483 data pairs, i.e. end-tidal desflurane concentrations with corresponding BIS values, was recorded. During surgery data pairs were analysed by linear regression analysis for each patient separately. During emergence from anaesthesia, desflurane effect compartment concentrations were simulated and non-linear regression analysis was applied. RESULTS: We found a relationship between BIS ranges and mean end-tidal desflurane concentrations: A BIS range of 100-85 was related to 1.1+/-0.7 vol%, BIS 84-65 to 1.5+/-1.2 vol%, BIS 64-50 to 2.9+/-1.3 vol% and BIS 49-40 to 3.1+/-0.9 vol%. In particular, end-tidal desflurane concentrations related to these BIS ranges were significantly different from each other (ANOVA; P<0.05). Intraoperatively, we obtained a correlation coefficient of R=0.42+/-0.24 (mean+/-SD, range 0.05-0.96), during emergence from anaesthesia the correlation coefficient was R=0.84+/-0.12 (range 0.61-0.99). CONCLUSION: We could demonstrate a relationship between bispectral index and end-tidal desflurane concentrations below 1 MAC with a BIS range of 49-40 being associated with approximately 0.5 MAC of desflurane during desflurane-remifentanil-anaesthesia.

Adult↗
PubMed2004

[Laryngeal tube versus laryngeal mask airway in anaesthetised non-paralysed patientsA comparison of handling and postoperative morbidity].

BACKGROUND: The purpose of this study was to compare the classical laryngeal mask airway (LMA) with the laryngeal tube (LT) in anaesthetised non-paralysed patients. PATIENTS AND METHODS: A total of 100 patients scheduled for minor elective surgery were included. After standardised induction and maintenance of anaesthesia with propofol and remifentanil, patients were randomly allocated to receive either a LMA or LT; muscle relaxants were not applied. Selection of the appropriate size and the initial inflation volume were chosen according to the manufacturers instructions. Ease of insertion, initial intra-cuff pressure, oropharyngeal leak pressure at an intra-cuff pressure of 60 cm H(2)O and incidence and severity of complications during and after anaesthesia were compared. RESULTS: The LT was inserted significantly quicker than the LMA (35.1+/-15.9 s vs. 56.6+/-42.5 s; mean+/-SD). Insertion of the LT was successful within 1 attempt in 90% and within 2 or 3 attempts in another 4% of patients for the LT compared with 68% and 20% of patients for the LMA, respectively. For the LT the initial cuff pressure was significantly lower (75.1+/-16.2 cm H(2)O) and the oropharyngeal leak pressure after adjustment of the intra-cuff pressure to 60 cm H(2)O was significantly higher (27.2+/-6.9 mbar) compared with the LMA (109.5+/-25.7 cm H(2)O and 19.9+/-4.0 mbar, respectively). Incidence of postoperative laryngeal complications in the LT group (31%) was lower compared with the LMA group (54%). CONCLUSION: In anaesthetised non-paralysed patients the LT compares favourably to the LMA in terms of ease of insertion and postoperative morbidity.

Adult↗
PubMed2004

[Iloprost and selective pulmonary vasodilation. Clinical results of intraoperative and postoperative inhalation of iloprost].

Pulmonary hypertension is a major risk factor in cardiac surgery and has significant impact on morbidity and mortality in the perioperative period. Nitric oxide (NO) is considered to be the gold standard for treatment of pulmonary hypertension in the perioperative setting. The aerosolized administration of the prostacyclin analogue iloprost is a new alternative with similar pulmonary-selective vasodilation and virtually no systemic side-effects. Relevant complications including increased postoperative bleeding have not been observed.

Administration, Inhalation↗
PubMed2004

[Iloprost. Pharmacology and clinical application during surgery].

Iloprost is a long-acting prostacyclin analogue with potent vasodilating properties. When applied per inhalation, iloprost rapidly and remarkably reduces pulmonary vascular resistance and thereby pulmonary artery pressure for approximately 60-120 min. In addition, if iloprost is inhaled and not infused, major systemic side-effects such as a significant reduction of the systemic arterial pressure can mostly be circumvented. Inhaled iloprost can be applied by means of ultrasound or by oxygen flow with both techniques being available for intensive care ventilators. For use in the anaesthesia circuit a special construction was built.

Administration, Inhalation↗
PubMed2004

[Intoxication with methadone and benzodiazepines in a morbidly obese patient in the social environment of a heroin addict receiving methadone maintenance therapy].

Methadone is a well-established maintenance drug for the therapy of opioid addicts. Reduction of mortality, social stabilization and reintegration are basic goals of this therapeutic concept. In the ideal case, total opioid abstinence can be achieved. In Germany, detailed guidelines exist for methadone maintenance treatment (e. g. choice of the maintenance drug, "take home" doses) and are regularly published and updated by the National Medical Council. In the social environment of opioid addicts, misuse or accidental intoxication in non-addict family members or co-addicts may occur. We report an intoxication with methadone of the husband of a heroin-addict patient. In this morbidly obese patient, a simultaneous ingestion of benzodiazepines was suspected. This case report describes the diagnostic and therapeutical options of an opioid intoxication in a patient with severe obesity with special emphasis on the airway management strategy in an out-of-hospital situation.

Analgesics, Opioid↗
PubMed2004

Comparison of BIS and AAI as measures of anaesthetic drug effect during desflurane-remifentanil anaesthesia.

BACKGROUND: Autoregressive modelling with exogenous input of the middle-latency auditory evoked potential has been developed for monitoring of anaesthetic depth. This study was designed to investigate the dose-response relationship between endtidal desflurane concentrations and the Alaris Autoregressive Index (AAI, Alaris Medical, Hampshire, UK, version 1.4) or the bispectral index (Aspect Medical Systems, Newton, MA, USA, version XP). METHODS: Twenty-one patients scheduled for radical prostatectomy were investigated. After premedication and induction of anaesthesia with propofol und remifentanil all patients received atracurium and a remifentanil background infusion at a constant rate of 0.1 micro g kg(-1) min(-1). During dissection of the prostate, desflurane endtidal concentrations were varied between 3 and 9 vol%. Both AAI and BIS were determined and compared with the respective endtidal desflurane concentration. RESULTS: None of the patients showed a significant change of AAI values while changing the desflurane concentrations between 3 and 9 vol%. The dose-response of BIS values and desflurane concentrations was not uniform: two patients showed increasing BIS values with increasing desflurane concentrations, while in three patients BIS values remained unchanged. In 16 patients decreasing BIS values adequately reflected an increase in desflurane concentrations. CONCLUSION: Changes of desflurane concentrations during deep anaesthesia were adequately displayed only in 16 of 21 cases by BIS but in none of the cases by AAI monitoring.

Adult↗
PubMed2003

[Procalcitonin plasma concentrations and systemic inflammatory response following different types of surgery].

OBJECTIVE: Procalcitonin (PCT) is currently recommended as a suitable parameter to detect and to evaluate the course of bacterial, fungal or parasitic infections. However, recent studies provide evidence that surgical trauma and humoral mediators of inflammation, respectively,may induce PCT synthesis, thereby reducing the validity and reliability of PCT as an "infection-monitoring" parameter. The aim of the present study was to assess and to compare PCT and CRP (C-reactive protein) plasma concentrations in patients presenting without infection following different types of surgery in the absence or presence of a systemic inflammatory response syndrome (SIRS). METHODS: PCT and CRP plasma concentrations were assessed daily on postoperative days 1-5 and maximal values were determined in 94 patients. The patients were allocated to four groups of different types of surgery as follows: A: minor, primarily aseptic surgery, B: major abdominal surgery, C: major vascular surgery and D: thoracic surgery including esophagectomy. All categories were divided into two subgroups representing patients with and without SIRS, respectively. RESULTS. PCT plasma concentrations increased moderately compared to normal values in 21% of patients after minor and aseptic surgery (A), in 27% and 41% after major vascular (C) and thoracic (D) surgery, respectively, and in 65% of patients after major abdominal (B) surgery. The difference between PCT concentrations in patients undergoing major abdominal surgery and the patients after minor, aseptic surgery was significant ( p<0,05: A vs. B). Comparing the patients presenting with or without systemic inflammatory response (SIRS), no significant differences in PCT concentrations between groups could be observed. In the majority of patients PCT values rose to peak levels on the first and second postoperative days, followed by a rapid decline based on the plasma half-life of PCT. In contrast, postoperative CRP plasma concentrations were markedly elevated above normal values in all investigated patients during the whole observation period. Between-categories statistical analysis revealed significant differences comparing patients undergoing minor and aseptic surgery with patients after major vascular, and thoracic surgery, respectively ( p<0,05,A vs.C, D). CRP concentrations were significantly increased in patients with systemic inflammatory response compared to patients with normal postoperative course in surgical categories B, C, and D, respectively ( p<0,05). CONCLUSIONS: Postoperative PCT plasma concentrations in patients presenting without signs of infection are largely influenced by the type of surgical procedure. During the first and second postoperative day PCT concentrations are more frequently elevated in patients after major abdominal, major vascular and thoracic surgery compared to patients undergoing minor, aseptic operations. Thus an "infection monitoring" considering PCT value analysis during the postoperative course may transiently be impeded after major and particularly after intestinal surgery during the first 2 days postoperatively, whereas it appears not to be substantially affected by the presence or absence of systemic inflammatory response.

Abdomen↗
PubMed2003

[Remifentanil. An update].

Remifentanil is a 4-anilidopiperidine mu-opioid analgesic which is rapidly metabolized by unspecific blood and tissue esterases. According to its unique pharmacokinetic profile, remifentanil-based anaesthesia combines high-dosage opioid analgesia intraoperatively with a rapid and predictable postoperative awakening. When compared with a standard fentanyl-based technique, the use of remifentanil has changed our present anaesthetic regimens. This includes the anaesthesia induction sequence, the choice and dosage of anaesthetics when used as adjuncts to remifentanil, and even more, the proper planning of postoperative pain management. The present paper was designed to review the current knowledge on remifentanil and all aspects of its use in anaesthesiology. In addition, present data on the use of remifentanil for analgesia and sedation of the critically ill patient are summarized.

Aging↗