91 results on '"D. M. Albrecht"'
Search Results
2. One-lung ventilation with high tidal volumes and zero positive end-expiratory pressure is injurious in the isolated rabbit lung model
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Thea Koch, Axel R. Heller, D. M. Albrecht, Manuel Heintz, Marcelo Gama de Abreu, and Roswitha Széchényi
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Artificial ventilation ,medicine.medical_treatment ,Blood Pressure ,Respiratory physiology ,Lung injury ,Pulmonary Artery ,Positive-Pressure Respiration ,Catheterization, Peripheral ,medicine ,Tidal Volume ,Animals ,ddc:610 ,Tidal volume ,Positive end-expiratory pressure ,Mechanical ventilation ,Lung ,business.industry ,Airway Resistance ,Lung Injury ,Organ Size ,respiratory system ,Respiration, Artificial ,respiratory tract diseases ,Thromboxane B2 ,medicine.anatomical_structure ,Anesthesiology and Pain Medicine ,Anesthesia ,Breathing ,Respiratory Mechanics ,Female ,Rabbits ,business ,Algorithms - Abstract
We tested the hypothesis that one-lung ventilation (OLV) with high tidal volumes (VT) and zero positive end-expiratory pressure (PEEP) may lead to ventilator-induced lung injury. In an isolated, perfused rabbit lung model, VT and PEEP were set to avoid lung collapse and overdistension in both lungs, resulting in a straight pressure-time (P-vs-t) curve during constant flow. Animals were randomized to (a) nonprotective OLV (left lung) (n = 6), with VT values as high as before randomization and zero PEEP; (b) protective OLV (left lung) (n = 6), with 50% reduction of VT and maintenance of PEEP as before randomization; and (c) control group (n = 6), with ventilation of two lungs as before randomization. The nonprotective OLV was associated with significantly smaller degrees of collapse and overdistension in the ventilated lung (P0.001). Peak inspiratory pressure values were higher in the nonprotective OLV group (P0.001) and increased progressively throughout the observation period (P0.01). The mean pulmonary artery pressure and lung weight gain values, as well as the concentration of thromboxane B(2), were comparatively higher in the nonprotective OLV group (P0.05). A ventilatory strategy with VT values as high as those used in the clinical setting and zero PEEP leads to ventilator-induced lung injury in this model of OLV, but this can be minimized with VT and PEEP values set to avoid lung overdistension and collapse.One-lung ventilation with high tidal volumes and zero positive end-expiratory pressure (PEEP) is injurious in the isolated rabbit lung model. A ventilatory strategy with tidal volumes and PEEP set to avoid lung overdistension and collapse minimizes lung injury during one-lung ventilation in this model.
- Published
- 2019
3. Regionalanästhesie als Wettbewerbsvorteil im Krankenhaus
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Axel R. Heller, K.R. Bauer, T. Koch, D. M. Albrecht, and M. Eberlein-Gonska
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Earnings ,business.industry ,Staffing ,General Medicine ,Benchmarking ,Anesthesiology and Pain Medicine ,Case mix index ,Medicine ,Operations management ,General anaesthesia ,ddc:610 ,Cost curve ,business ,Activity-based costing ,health care economics and organizations ,Reimbursement - Abstract
BACKGROUND The German Social Act V section sign 12 is aimed towards competition, efficiency and quality in healthcare. Because surgical departments are billing standard diagnosis-related group (DRG) case costs to health insurance companies, they claim best value for money for internal services. Thus, anaesthesia concepts are being closely scrutinized. The present analysis was performed to gain economic arguments for the strategic positioning of regional anaesthesia procedures into clinical pathways. METHODS Surgical procedures, which in 2005 had a relevant caseload in Germany, were chosen in which regional anaesthesia procedures (alone or in combination with general anaesthesia) could routinely be used. The structure of costs and earnings for hospital services, split by types and centres of cost, as well as by underlying procedures are contained in the annually updated public accessible dataset (DRG browser) of the German Hospital Reimbursement Institute (InEK). For the year 2005 besides own data, national anaesthesia staffing costs are available from the German Society of Anaesthesiology (DGAI). The curve of earnings per DRG can be calculated from the 2005 InEK browser. This curve intersects by the cost curve at the point of national mean length of stay. The cost curve was calculated by process-oriented distribution of cost centres over the length of stay and allows benchmarking within the national competitive environment. For comparison of process times data from our local database were used. While the InEK browser lacks process times, the cost positions 5.1-5.3 (staffing costs anaesthesia) and the national structure adjusted anaesthesia staffing costs 2005 as published by the DGAI, were used to calculate nationwide mean available anaesthesia times which were compared with own process times. RESULTS Within the portfolio diagram of lengths of stay for each DRG and process times most procedures are located in the economic lower left, in particular those with high case mix (length of stay and anaesthesia times below reimbursement relevant national mean). The driver of increased earnings is shortening length of stay. Our use of regional anaesthesia is 5 to 10-fold higher than national benchmarks and may contribute to our advantageous position in national competition. The annual increases in profit per DRG range between EUR 1,706 and EUR 467,359 and compensate by far the investment of regional anaesthesia derived pain management, besides the advantage of increased patient satisfaction and avoidance of complications. CONCLUSION Regional anaesthesia is a considerable value driver in clinical pathways by shortening length of stay. The present analysis further demonstrates that time for regional block performance is covered by anaesthesia reimbursement within the DRG costing schedule.
- Published
- 2009
4. Reduktion der Aggressivität der Beatmung nach Therapie eines Ölsäure-induzierten Lungenversagens durch Inhalation von Perfluorhexan
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D. M. Albrecht, M. G. de Abreu, M. Regner, O. Vicent, U. Tschö, J. U. Bleyl, Maximilian Ragaller, Matthias Hübler, and Thea Koch
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Gynecology ,medicine.medical_specialty ,ARDS ,Anesthesiology and Pain Medicine ,Inhalation ,business.industry ,Medicine ,General Medicine ,business ,medicine.disease - Abstract
Fragestellung Die Inhalation von Perfluorhexan (PFH) fuhrt im Olsaure-induzierten Lungenversagen am Schaf zu einer Verbesserung der Oxygenierung und der mechanischen Lungenfunktion. Ziel der Untersuchung war es, Effekte von PFH bei der Therapie eines experimentellen „acute respiratory distress syndrome“ (ARDS) uber einen langeren Beobachtungszeitraum (4 h) zu untersuchen sowie die Moglichkeit einer schrittweisen Reduktion der inspiratorischen Sauerstofffraktion (FIO2) in der Behandlungsgruppe zu evaluieren.
- Published
- 2004
5. Evaluation of a new device for noninvasive measurement of nonshunted pulmonary capillary blood flow in patients with acute lung injury
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Tilo Winkler, Dirk Leutheuser, Marcelo Gama de Abreu, Stefan Geiger, D. M. Albrecht, Thomas Pfeiffer, and Max Ragaller
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Adult ,Male ,Pulmonary Circulation ,medicine.medical_specialty ,Cardiac output ,Adolescent ,medicine.medical_treatment ,Positive pressure ,Hemodynamics ,Lung injury ,Critical Care and Intensive Care Medicine ,Positive-Pressure Respiration ,Intensive care ,Internal medicine ,medicine ,Humans ,Vasoconstrictor Agents ,Respiratory system ,Aged ,Mechanical ventilation ,Respiratory Distress Syndrome ,business.industry ,Equipment Design ,Blood flow ,Middle Aged ,respiratory system ,Respiration, Artificial ,Capillaries ,respiratory tract diseases ,Evaluation Studies as Topic ,Anesthesia ,Cardiology ,Female ,business - Abstract
Objectives: To evaluate the performance of a new device for noninvasive measurement of nonshunted pulmonary capillary blood flow (PCBF) by partial CO2 rebreathing. Design and setting: Prospective clinical trial in an intensive care unit of a university hospital. Patients and participants: Twenty mechanically ventilated patients with acute lung injury. Interventions: Variations in PEEP of ±3 cmH2O. Measurements and results: Initially PCBF was measured invasively as cardiac output minus venous admixture $${\rm (\dot Q}_{{\rm VA}} /{\rm \dot Q}_{\rm t} )$$ flow, and by partial CO2 rebreathing at baseline PEEP (PEEPb). The PEEP was then reduced by 3 cmH2O (to PEEPb-3) and measurements were repeated after 30 min. PEEP was then increased by 6 cmH2O (to PEEPb+3), and measurements were repeated after 10, 20, and 30 min. The overall correlation coefficient between noninvasive and invasive PCBF measurements at PEEPb was high (r=0.97), with close agreement between methods being observed (0.1±0.6 l/min, bias and precision, respectively). Accordingly, both the correlation coefficient and agreement between methods for changes in PCBF from PEEPb-3 to PEEPb+3 levels were satisfactory (r=0.71; 0.2±0.5 l/min, bias and precision). The new device was able to detect the correct PCBF trend in 17 of 20 patients investigated and in all patients who showed invasive PCBF changes equal to or greater than 0.3 l/min (n=12). Noninvasive PCBF changes were stable as early as 10 min after variation in PEEP, as compared to 30 min values. Conclusions: The new device appears to be clinically useful for the monitoring of PCBF in patients suffering from acute lung injury. Our results suggest that titration of PEEP aimed at improving PCBF can be performed with the new device.
- Published
- 2002
6. Hypertonic Solutions: Volume Steal?
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M. Ragaller and D. M. Albrecht
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medicine.medical_specialty ,Blood Volume ,business.industry ,Hypertonic Solutions ,Shock ,General Medicine ,Redistribution (cultural anthropology) ,Plasma expander ,Critical Care and Intensive Care Medicine ,Anesthesiology and Pain Medicine ,Intensive care ,Emergency Medicine ,Humans ,Tonicity ,Medicine ,Small volume resuscitation ,business ,Intensive care medicine ,Volume (compression) - Published
- 2001
7. Grand mal convulsion and plasma concentrations after intravascular injection of ropivacaine for axillary brachial plexus blockade
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Matthias Hübler, Rainer J. Litz, M. Müller, and D. M. Albrecht
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Male ,business.industry ,Ropivacaine ,Nerve Block ,Venous blood ,Amides ,Blockade ,Anesthesiology and Pain Medicine ,Pharmacokinetics ,Anesthesia ,Injections, Intravenous ,Toxicity ,Convulsion ,Humans ,Medicine ,Brachial Plexus ,Epilepsy, Tonic-Clonic ,Anesthetics, Local ,medicine.symptom ,Complication ,business ,Brachial plexus ,Aged ,medicine.drug - Abstract
We report a patient to whom ropivacaine 1.1 mg kg(-1) was administered for brachial plexus blockade and who developed grand mal convulsions because of inadvertent i.v. injection. No symptoms of cardiovascular toxicity occurred. Venous blood samples were taken 15, 45, 75 and 155 min after the injection. The measured total plasma concentrations of ropivacaine were 3.3, 1.6, 1.2 and 1.0 mg litre(-1) respectively. Initial plasma concentration after the end of the injection period was estimated at 5.75 mg litre(-1) using a two-compartment pharmacokinetic model.
- Published
- 2001
8. Kombinierte Anästhesie mit Epiduralkatheter
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Andreas Manseck, Axel R. Heller, I. Djonlagic, Thea Koch, D. M. Albrecht, Manfred P. Wirth, and Rainer J. Litz
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Gynecology ,medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,Regional anesthesia ,medicine ,Prostate disease ,Lumbar spine ,General Medicine ,business - Abstract
Patienten, die sich einer radikalen Prostatektomie (rPE) einschlieslich retroperitonealer Lymphadenektomie (rLA) unterziehen, haben aufgrund ihres Alters und ihrer Begleiterkrankungen ein erhohtes perioperativen Risiko. Ziel dieser Untersuchung war es, den intra- und postoperativen Verlauf der standardisierten Operation rPE+rLA unter verschiedenen Anasthesieregimen zu analysieren. Krankenakten von 433 Patienten, die sich zwischen 1994 und 1999 in unserer Einrichtung einer rPE+rLA unterzogen, wurden retrospektiv ausgewertet. Die Patienten wurden nach dem durchgefuhrten Anasthesieverfahren eingeteilt: 1. Allgemeinanasthesie (AA), 2. Kombination lumbale Epiduralanasthesie (LEA)+AA, 3. thorakale Epiduralanasthesie (TEA)+AA. Fur die intra- und postoperative Katheteranalgesie wurden Bupivacain 0,25% oder Ropivacain 0,2%, 8–12 ml/h verwendet. Die Allgemeinanasthesie wurde als balancierte Anasthesie durchgefuhrt. Diese retrospektive Erhebung zeigt unter epiduraler Analgesie, gemessen an Tachykardien und hypertensiven Episoden, eine reduzierte intra- und postoperative Stressantwort, kurzere Extubationszeiten, fruheres Wiedereinsetzen der gastrointestinalen Motilitat ([h] AA: 50,6±11,1/ LEA: 39,3±13,6/ TEA:33,8±13,0), tendenziell selteneres Erbrechen und eine um einen Tag verkurzte Krankenhausverweildauer ([d] AA: 12,4±5,8/ LEA: 11,1±3,1/ TEA: 11,5±3,8). Dabei war unter TEA die Dauer der Anasthesieprasenz im OP-Bereich vergleichbar mit AA ([min] AA: 222,9±43,5/ LEA: 238,2±41,8/ TEA: 227,0±46,2), und der Wachstationsaufenthalt verkurzt. Daneben war unter TEA die Anzahl der auffalligen postoperativen Thoraxrontgenbefunde reduziert. Zum Erreichen einer der TEA vergleichbaren Analgesie mussten unter LEA haufiger sensomotorische Blockaden, saO2-Abfalle und tendenziell eine hohere Anzahl kardialer Komplikationen in Kauf genommen werden. Gemessen an den von uns erhobenen Parametern stellt damit die Kombination einer Allgemeinanasthesie, insbesondere mit thorakaler Epiduralanalgesie ein sicheres und auch betriebswirtschaftlich effizientes anasthesiologisches Vorgehen bei radikalen Prostatektomien dar.
- Published
- 2000
9. Anästhesie in der Gefäßchirurgie - Teil I
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M. Ragaller and D. M. Albrecht
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Anesthesiology and Pain Medicine ,business.industry ,Emergency Medicine ,Medicine ,General Medicine ,Critical Care and Intensive Care Medicine ,business - Published
- 2000
10. Combination of balanced and regional anaesthesia for minimally invasive surgery in a patient with myasthenia gravis
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D. M. Albrecht, Rainer J. Litz, and Matthias Hübler
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Anesthesia, Epidural ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Anesthesia, General ,Desflurane ,Abdomen ,Cryptorchidism ,Myasthenia Gravis ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Ropivacaine ,General anaesthesia ,Anesthetics, Local ,Laparoscopy ,Mechanical ventilation ,Isoflurane ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Amides ,Myasthenia gravis ,Surgery ,Muscle relaxation ,Anesthesiology and Pain Medicine ,Anesthesia ,Anesthetics, Inhalation ,Neuromuscular junction disease ,business ,medicine.drug - Abstract
A 45-year-old man with cryptorchism, who was known to suffer from generalized myasthenia gravis, was admitted to hospital for surgical treatment using laparoscopy. Such minimally invasive surgery requires good muscle relaxation. However, the use of neuromuscular blocking agents in patients with myasthenia gravis may lead to prolonged apnoea after operation, thus necessitating mechanical ventilation of the lungs. We used a combination of general anaesthesia (with desflurane), and epidural anaesthesia (with the amide local anaesthetic ropivacaine) to obtain excellent abdominal relaxation during surgery. Tracheal extubation was possible immediately after the operation and no adverse effects were observed. The patient was discharged from hospital on the second day after operation. The combination of regional and general anaesthesia for minimally invasive surgery in this patient permitted safe anaesthetic management.
- Published
- 2000
11. Vom Isofluran zum Perfluorhexan? Perfluorkarbone – Therapiemöglichkeiten beim akuten Lungenversagen
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J. U. Bleyl, T. Koch, Maximilian Ragaller, and D. M. Albrecht
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ARDS ,Lung ,Inhalation ,business.industry ,Oxygen transport ,General Medicine ,Lung injury ,Pulmonary compliance ,medicine.disease ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Respiratory failure ,Anesthesia ,medicine ,Respiratory system ,business - Abstract
The introduction of Perfluorochemicals into medicine and especially into the treatment of severe lung injury is a fascinating scientific task. Many recall the famous experiments from Clark et al. in 1966 when he demonstrated "liquidventilation with perfluorocarbons" in the mammal species for the first time. After this hallmark, perfluorocarbons were subsequently introduced in research of acute lung injury by the techniques of Total- and Partial-Liquid-Ventilation (TLV; PLV). Perfluorocarbons (saturated organofluorids) have unique chemical and physical properties which made them attractive substances for intraalveolar application. The strong C-F bindings in the perfluorocarbon molecules are responsible for their chemical stability, biochemical inertness, high capacity to dissolve respiratory gases, low surface tension and high vapor pressures. Furthermore, the high density of the PFC lead to radio-opacity and their distribution to dependent lung areas. The efficacy of PFC liquid, applied by TLV/PLV has been demonstrated in numerous animal studies using different models of acute lung injury. Currently, several mechanisms of action of perfluorocarbon fluids in acute lung injury are discussed: recruitment of atelectatic alveoli, prevention of endexpiratory collapse of alveoli ("liquid PEEP"), redistribution of perfusion, oxygen transport, surfactant like effects and decrease of inflammation. Since total liquid ventilation has been used only in experimental models of lung injury, partial liquid ventilation has been introduced successfully into clinical trials (phase I-II). However, the results of the first randomised, controlled study of PLV in 90 adult patients suffering from severe respiratory failure (ALI/ARDS) showed no differences between PLV and conventional treatment. Furthermore, the instillation of relatively large amounts of liquid into the lungs poses several technical challenges and may be associated with complications such as liquithoraces, pneumothoraces and hypoxia. Since mammal lungs are evolutionary specialised to gas exchange using atmospheric oxygen, the application of liquids, even if they transport respiratory gases very well is not physiologic. To overcome these unwanted side effects, we developed a technique of perfluorocarbon vaporisation in analogy to the application of inhalation anaesthetic agents. After resolving some technical issues, this application technique was used successfully in an animal model of acute lung injury. Vaporisation of perfluorohexane in a concentration of 18 Vol.% of inspired gas improved significantly oxygenation and lung compliance. Though these results are promising, mechanisms of action, dose-efficacy relation, surfactant-perfluorocarbon interaction or anti-inflammatory effects of vaporised perfluorohexane are still unclear. These questions need to be clarified before this technique can be applied clinically. However, the inhalation of vapor, a technique already familiar to anaesthesiologists should avoid risks of large amounts of fluids in the bronchoalveolar space. Furthermore, this technique can be administered by established anaesthetic equipment with the advantage of exact dosing, continuous monitoring, and demand application in a way near to clinical routine.
- Published
- 2000
12. Kombinierte Anästhesieverfahren
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R J Litz, D. M. Albrecht, M. D. Frank, and J U Bleyl
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business.industry ,Convalescence ,media_common.quotation_subject ,General Medicine ,Perioperative ,Anesthesia Procedure ,Fight-or-flight response ,Anesthesiology and Pain Medicine ,Anesthesia ,Anesthetic ,Medicine ,Respiratory function ,Risks and benefits ,business ,Complication ,media_common ,medicine.drug - Abstract
The additive properties of general and regional anesthetic techniques are brought together in combined anesthesia to minimise side effects of the individual techniques. Despite a wide experience with both used as single anesthetic techniques, no definite recommendations regarding indications, general contraindications and procedure exist for their combination. Beneficial effects on haemodynamics, respiratory function, intestinal motility and postoperative stress response have been demonstrated for a combination of general anesthesia and thoracic epidural anesthesia (TEA). In addition TEA is favourable in the management of postoperative pain, which has advantageous effects on convalescence especially in a high risk patient group. Nevertheless, until now no reduction of perioperative morbidity and mortality has been demonstrated. Since the combination of two anesthesia techniques theoretically increases the rate of complication, the expected benefit for the patient must predominate. To estimate the risks and benefits of combined anesthesia, the anesthesiologist must be familiar with each single method, as well as with the synergistic effects of both techniques in order to evaluate the individual indication.
- Published
- 1999
13. Regional heterogeneity of cerebral blood flow response to graded volume-controlled hemorrhage
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M. Riedel, K. van Ackern, Klaus F. Waschke, Wolfgang Kuschinsky, and D. M. Albrecht
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Male ,Hemodynamics ,Blood Pressure ,Shock, Hemorrhagic ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,Rats, Sprague-Dawley ,Hypovolemia ,medicine ,Animals ,Homeostasis ,Humans ,Carbon Radioisotopes ,Radionuclide Imaging ,Blood Volume ,Vascular disease ,business.industry ,medicine.disease ,Rats ,Disease Models, Animal ,Blood pressure ,Cerebral blood flow ,Cerebrovascular Circulation ,Shock (circulatory) ,Anesthesia ,Breathing ,Autoradiography ,Arterial blood ,medicine.symptom ,business ,Antipyrine ,Blood Flow Velocity - Abstract
Of the animal models of human hemorrhagic shock, the volume-controlled hemorrhage model appears to come closer to the clinical situation than the commonly used pressure-controlled model, since the volumecontrolled model allows regulatory adjustment of blood pressure. The effects of volume-controlled hemorrhage on local cerebral blood flow (LCBF) of conscious animasl are not known. The present study investigates specific reaction patterns of LCBF in comparison to mean cerebral blood flow (CBF) during graded volume-controlled hemorrhagic shock in conscious rats. Conscious, spontaneously breathing, and minimally restrained rats were subjected to different degrees of volume-controlled hemorrhage (taking either 25, 30, 35, or 40 ml arterial blood/kg body weight (b.w.). Thirty minutes after the completion of blood taking, LCBF was determined during hemorrhagic hypovolemia using the autoradiographic iodo (14C) antipyrine method. A group of untreated rats (no hemorrhage) served as controls. LCBF was determined in 34 defined brain structures and mean CBF was calculated. During less severe hemorrhage (25 and 30 ml/kg b.w.) mean CBF was significantly higher than in the control group (+19% and +25%). During severe hemorrhage (35 and 40 ml/kg b.w.) mean CBF remained unchanged compared to the control values, although significant increases in LCBF could be detected in many of the brain structures analyzed (maximum +44%). The mean coefficient of variation of CBF was increased, indicating a larger heterogeneity of LCBF values at shed blood volumes of 35 and 40 ml/kg b.w. A comprehensive and novel description of the local distribution of CBF during graded volume-controlled hemorrhage in conscious rats shows unexpected increases in LCBF and mean CBF. This “hypovolemic cerebral hyperemia” might be caused by endogenous hemodilution, thus maintaining the blood supply to the brain during hypovolemic shock.
- Published
- 1996
14. Posters
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Y. M. Yao, H. M. Tian, H. P. Liang, Y. Yu, L. R. Lu, Y. P. Wang, Z. Y. Sheng, H. B. Reith, R. G. Holzheimer, A. Thiede, G. M. Galstian, A. V. Danilina, V. M. Gorodetsky, A. V. Tutelian, H. F. Galley, N. R. Webster, A. N. Djugehev, M. D. Fomin, A. A. Satalkin, V. A. Sokolov, B. Maskin, P. Fontán, E. Spinedi, A. Badolati, S. Endo, T. Kasai, K. Inada, T. Takakuwa, Y. Yamada, T. Suzuki, S. Taniguchi, H. Kern, R. Wittich, W. Schaffartzik, W. Kox, C. Spies, L. Ilkka, J. Takala, J. A. Paiva, C. Sousa-Dias, A. Bodas, J. P. Ramos, J. Candeias, A. C. Pereira, F. Torrinha, T. Ribeiro, K. Milting, C. Sanft, K. Brede, S. Beller, M. Andresen, A. Dougnac, L. M. Letelier, O. Díaz, F. F. Laterre, M. Reynaert, A. Valdivieso, A. Geppert, G. Zorn, K. Huber, P. Siostrzonek, M. Oberhoffer, D. Bögel, A. Meier-Hellmann, H. Vogelsang, K. Reinhart, F. Tsidemiadou, M. Farmakis, A. Bobota, D. Pragastis, R. Bilancia, A. Posca, D. Margiotta, E. Spampani, P. Roselli, G. Caputo, J. M. Thio, M. Sinaasappel, C. Ince, D. Berger, E. Boelke, N. Hiki, B. Poch, A. Beier, M. Graf, M. Seidelmann, H. G. Beger, X. Nuvials, J. C. Ruiz Rodriguez, M. C. Martin, F. Esteban, J. L. Garcia-Allut, M. J. Burgueno, M. Mourelle, J. Monasterio, A. Angles, J. L. Boveda, A. Salgado, R. M. Segura, R. Sauri, B. Beck, R. C. Schimmer, T. Pasch, P. A. Ward, D. Gruson, G. Hilbert, C. Roux, V. Coulon, M. Juzan, P. Laffort, E. Parrens, N. Gualde, G. Gbikpi-Benissan, J. P. Cardinaud, Hanping Shi, Renbao Xu, Han Gao, T. Marenović, D. Miloŝević, Z. Brkan, M. Ŝurbatović, K. Gundelach, L. Engelmann, U. Pilz, M. Werner, J. Reiger, F. Tatzber, A. Oberbichler, G. Grimm, M. Gama de Abreu, M. Kirschfink, M. Quintel, D. M. Albrecht, M. Ragaller, H. Nakae, S. Koike, A. Mavrommatis, Th. Theodoridis, G. Stavropoulos, S. Zakynthinos, A. Orfanidou, D. Sfyras, V. Christopoulou-Kokkinou, Ch. Roussos, A. Właszczyk, B. Adamik, M. Zimecki, A. Kübler, P. S. Berezowicz, V. Vasilcov, N. Kelina, M. Gengin, S. Mitroshina, L. Filippova, O. Levachova, R. Gürlich, P. Maruna, and J. Čermák
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Critical Care and Intensive Care Medicine - Published
- 1996
15. Posters
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Fronc Ŝifrer, Igor Drinovec, G. Thomson, L. Baker, E. Mawby, R. M. Leach, P. J. Jensen, G. Michagin, P. K. Andersen, J. Peláez, M. J. Asensio, M. Jiménez, S. Yus, P. Villa, C. Vaquero, M. Imhoff, J. H. Lehner, D. Löhlein, G. Vignali, A. Guadagnucci, M. Mariotti, A. Baratta, A. Vignali, A. Rutili, G. Tulli, C. Sanft, C. Spies, G. Oschmann, W. Schaffartzik, T. Gondos, M. Arkosy, M. Jović, Z. Popović, B. Radomir, V. Ilić, G. Panić, M. Babić, A. Popović, M. Bojić, E. Pierucci, C. Ghermandi, A. Morigi, R. Morgagni, M. Nastasi, R. Rossi, G. Martinelli, S. Faenza, F. Cuccolini, E. Sarti, B. O’Hare, P. Betit, J. E. Thompson, D. L. Wessel, T. J. Kuhn, B. L. Bauer, C. J. Broomhead, S. J. Wright, K. J. Kiff, P. S. Withington, L. Strunin, J. L. G. Amaral, J. -J. Rouby, L. Gallart, M. Munechika, P. Coriat, F. Michard, M. Wysocki, H. Millet, M. A. Wolff, B. Herman, M. Peyerl, O. Gödje, T. Fischlein, U. Pfeiffer, B. Reichart, C. G. Krenn, A. Baker, P. Krafft, E. Narzt, C. K. Spiss, H. Steltzer, H. Theilen, M. Ragaller, D. M. Albrecht, J. Llagunes, J. C. Catala, J. I. Marques, J. J. Pena, D. Barbas, F. Aguar, F. Grau, I. Navarrete-Sánchez, H. Ruiz-Bailén, F. Guerrero-López, H. Colmenero-Ruiz, E. Fernández-Hondéjar, G. Vázquez-Hata, F. J. Lamb, A. Rhodes, D. Duane, R. M. Grounds, and E. D. Bennett
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Critical Care and Intensive Care Medicine - Published
- 1996
16. Coupling Between Local Cerebral Blood Flow and Metabolism After Hypertonic/Hyperoncotic Fluid Resuscitation from Hemorrhage in Conscious Rats
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Wolfgang Kuschinsky, Klaus van Ackern, D. M. Albrecht, and Klaus F. Waschke
- Subjects
Male ,Resuscitation ,medicine.medical_treatment ,Hypertonic Solutions ,Hemodynamics ,Hemorrhage ,Blood volume ,Deoxyglucose ,Hydroxyethyl starch ,Hydroxyethyl Starch Derivatives ,Rats, Sprague-Dawley ,Animals ,Medicine ,Carbon Radioisotopes ,Saline ,business.industry ,Brain ,Blood flow ,Rats ,Glucose ,Anesthesiology and Pain Medicine ,Cerebral blood flow ,Cerebrovascular Circulation ,Anesthesia ,Autoradiography ,Fluid Therapy ,Isotonic Solutions ,business ,Perfusion ,Antipyrine ,medicine.drug - Abstract
The effects of small volume hypertonic/hyperoncotic fluid resuscitation from hemorrhage on brain metabolism and blood flow were evaluated by autoradiographic techniques with high spatial resolution. The data were compared to fluid resuscitation with a volume equal to shed blood of isotonic 6% hydroxyethyl starch solution (HES) and a control group without hemorrhage and fluid resuscitation (n = 6 in each group). In conscious rats, volume-controlled hemorrhage for 30 min (30 mL/kg body weight, resulting in a blood loss of approximately 50% of the circulating blood volume) was followed by intravenous infusion of a hypertonic/hyperoncotic saline hydroxyethyl starch solution (HTHO ; 7.5% saline/10% hydroxyethyl starch, 4.0 mL/kg body weight). Local cerebral blood flow (LCBF) and local cerebral glucose utilization (LCGU) were measured in 34 brain structures 2 h after fluid resuscitation by means of the quantitative autoradiographic iodo [ 14 C]antipyrine and 2-[ 14 C]-deoxy-D-glucose methods. Compared to the untreated control group, LCBF increased significantly in all brain regions analyzed after fluid resuscitation with HTHO (mean, +63%) or HES (mean, +56%). The increases in LCBF after fluid resuscitation were sufficient to restore cerebral oxygen delivery to the level calculated for the un-treated control group. LCGU was unchanged after fluid resuscitation. The close relationship between LCGU and LCBF observed in the control group (r = 0.95) was preserved after hemorrhage and fluid resuscitation with HTHO (r = 0.97) and HES (r = 0.96), although the LCBF-to-LCGU ratio was reset to a higher level (1.5 mL/μmol in the control group and 2.7 mL/μmol after fluid resuscitation with HTHO and HES, P < 0.05). We conclude that the increase in LCBF compensates for the reduction of arterial oxygen content to maintain cerebral oxygen delivery. Therefore, small volume resuscitation appears to be as effective as resuscitation with large volumes of isotonic HES in meeting the circulatory and metabolic demands of the brain tissue within the first 2 h after fluid resuscitation from hemorrhage.
- Published
- 1996
17. Intraoperativer Myokardinfarkt - sind unsere präoperativen Risikoevaluierungsmaßnahmen ausreichend?
- Author
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D. M. Albrecht, S. Geiger, and Maximilian Ragaller
- Subjects
Anesthesiology and Pain Medicine ,Emergency Medicine ,General Medicine ,Critical Care and Intensive Care Medicine - Published
- 2004
18. Anwendung der dekompressiven Kraniektomie als Behandlungsalternative bei erhöhtem intrakraniellen Druck
- Author
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J. Hampl, S.-A. May, G. Schackert, S. Adam, S. Geiger, Maximilian Ragaller, and D. M. Albrecht
- Subjects
Anesthesiology and Pain Medicine ,Emergency Medicine ,General Medicine ,Critical Care and Intensive Care Medicine - Published
- 2004
19. Autoradiographic determination of regional cerebral blood flow and metabolism in conscious rats after fluid resuscitation from haemorrhage with a haemoglobin-based oxygen carrier
- Author
-
Klaus F. Waschke, Wolfgang Kuschinsky, K. van Ackern, and D. M. Albrecht
- Subjects
Blood Glucose ,Male ,Resuscitation ,Partial Pressure ,chemistry.chemical_element ,Hemodynamics ,Blood Pressure ,Hemorrhage ,Oxygen ,Rats, Sprague-Dawley ,Blood Substitutes ,Blood product ,Animals ,Medicine ,Body fluid ,business.industry ,Brain ,Rats ,Anesthesiology and Pain Medicine ,Cerebral blood flow ,chemistry ,Cerebrovascular Circulation ,Anesthesia ,Autoradiography ,Hemoglobin ,business ,Perfusion - Abstract
The effects of resuscitation fluids on the brain have been investigated in previous studies by global measurements of cerebral blood flow and metabolism. In this study we have examined the effects of a novel haemoglobin-based oxygen carrier on local cerebral blood flow (LCBF) and local cerebral glucose utilization (LCGU) after resuscitation from a volume-controlled haemorrhage of 30 min (3.0 ml/100 g body weight) with ultrapurified, polymerized, bovine haemoglobin (UPBHB). LCBF and LCGU were measured in 34 brain structures of conscious rats 2 h after resuscitation using quantitative iodo(14C)antipyrine and 2-(14C)-deoxy-D-glucose methods. The data were compared with a control group without haemorrhage and fluid resuscitation. In the haemorrhage group, LCBF increased after resuscitation by 12-56% in the different brain structures (mean 36%). LCGU changed less (0 to +18%, mean +9%). In the control group there was a close relationship between LCGU and LCBF (r = 0.95). After fluid resuscitation the relationship was preserved (r = 0.95), although it was reset at a higher ratio of LCBF to LCGU (P0.05). We conclude that fluid resuscitation of a 30 min volume-controlled haemorrhage using the haemoglobin-based oxygen carrier, UPBHB, induced a moderate degree of heterogeneity in the resulting changes of LCGU and LCBF. Local disturbances of cerebral blood flow or metabolism were not observed.
- Published
- 1994
20. Lack of Dependence of Cerebral Blood Flow on Blood Viscosity after Blood Exchange with a Newtonian O2 Carrier
- Author
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D. M. Albrecht, K. van Ackern, G. Hagen, Klaus F. Waschke, H. Krieter, and Wolfgang Kuschinsky
- Subjects
Male ,medicine.medical_specialty ,Polymers ,Blood viscosity ,Cardiac index ,Blood substitute ,Rats, Sprague-Dawley ,Hemoglobins ,Viscosity ,Blood Substitutes ,Internal medicine ,medicine ,Newtonian fluid ,Animals ,Hemodilution ,business.industry ,Blood Viscosity ,Rats ,Shear rate ,Blood pressure ,Endocrinology ,Neurology ,Cerebral blood flow ,Cerebrovascular Circulation ,Anesthesia ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Whether the increase in cerebral blood flow measured after hemodilution is mediated by a decrease in blood viscosity or in oxygen delivery to the brain is debated. In the present study, blood was replaced by an oxygen-carrying blood substitute, ultrapurified, polymerized, bovine hemoglobin (UPBHB). In contrast to normal blood, UPBHB yields a constant and defined viscosity in the brain circulation, since its viscosity is not dependent on the shear rate. CBF was determined after blood exchange with UPBHB in one group of conscious rats (UPBHB group) and in another group of blood-exchanged conscious rats in which viscosity was increased fourfold by the addition of 2% polyvinylpyrrolidone (PVP), mw 750,000 (UPBHB-PVP group). Local CBF (LCBF) was measured in 34 brain structures by means of the quantitative iodo(14C)antipyrine method. After blood replacement, systemic parameters such as cardiac index, arterial blood pressure, blood gases, and acid-base status were not different between the UPBHB and the UPBHB-PVP groups. In particular, arterial oxygen content was similar in both groups. Compared with a control group without blood exchange, LCBF was increased after blood exchange in the different brain structures by 60–102% (UPBHB group) and by 33–101% (UPBHB-PVP group). Mean CBF was increased by 77% in the UPBHB group and by 69% in the UPBHB-PVP group. No significant differences were observed in the values of LCBF or mean CBF between the UPBHB group and the UPBHB-PVP group. The results show that a fourfold variation in the viscosity of a Newtonian blood substitute does not result in differences in CBF values. It is concluded that blood viscosity is less important to CBF than hitherto postulated.
- Published
- 1994
21. Inadvertent infusion of a high dose of potassium chloride via a thoracic epidural catheter
- Author
-
R. J. Litz, I. Kreinecker, M. Hübler, and D. M. Albrecht
- Subjects
Anesthesiology and Pain Medicine - Published
- 2001
22. [Regional anaesthesia as advantage in competition between hospitals. Strategic market analysis]
- Author
-
A R, Heller, K R, Bauer, M, Eberlein-Gonska, D M, Albrecht, and T, Koch
- Subjects
Economic Competition ,Anesthesia, Conduction ,Anesthesiology ,Germany ,Insurance, Health, Reimbursement ,Costs and Cost Analysis ,Humans ,Legislation, Hospital ,Economics, Hospital ,Length of Stay ,Diagnosis-Related Groups - Abstract
The German Social Act V section sign 12 is aimed towards competition, efficiency and quality in healthcare. Because surgical departments are billing standard diagnosis-related group (DRG) case costs to health insurance companies, they claim best value for money for internal services. Thus, anaesthesia concepts are being closely scrutinized. The present analysis was performed to gain economic arguments for the strategic positioning of regional anaesthesia procedures into clinical pathways.Surgical procedures, which in 2005 had a relevant caseload in Germany, were chosen in which regional anaesthesia procedures (alone or in combination with general anaesthesia) could routinely be used. The structure of costs and earnings for hospital services, split by types and centres of cost, as well as by underlying procedures are contained in the annually updated public accessible dataset (DRG browser) of the German Hospital Reimbursement Institute (InEK). For the year 2005 besides own data, national anaesthesia staffing costs are available from the German Society of Anaesthesiology (DGAI). The curve of earnings per DRG can be calculated from the 2005 InEK browser. This curve intersects by the cost curve at the point of national mean length of stay. The cost curve was calculated by process-oriented distribution of cost centres over the length of stay and allows benchmarking within the national competitive environment. For comparison of process times data from our local database were used. While the InEK browser lacks process times, the cost positions 5.1-5.3 (staffing costs anaesthesia) and the national structure adjusted anaesthesia staffing costs 2005 as published by the DGAI, were used to calculate nationwide mean available anaesthesia times which were compared with own process times.Within the portfolio diagram of lengths of stay for each DRG and process times most procedures are located in the economic lower left, in particular those with high case mix (length of stay and anaesthesia times below reimbursement relevant national mean). The driver of increased earnings is shortening length of stay. Our use of regional anaesthesia is 5 to 10-fold higher than national benchmarks and may contribute to our advantageous position in national competition. The annual increases in profit per DRG range between EUR 1,706 and EUR 467,359 and compensate by far the investment of regional anaesthesia derived pain management, besides the advantage of increased patient satisfaction and avoidance of complications.Regional anaesthesia is a considerable value driver in clinical pathways by shortening length of stay. The present analysis further demonstrates that time for regional block performance is covered by anaesthesia reimbursement within the DRG costing schedule.
- Published
- 2009
23. Doppler CO2-test in patients with vertebrobasilar isehemia
- Author
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M. Müller, D. M. Albrecht, P. Schmidt, M. v. Maravic, Detlef Kömpf, C. v. Maravic, and Ch. Kessler
- Subjects
Vertebral artery ,Ischemia ,symbols.namesake ,Vertebrobasilar ischemia ,medicine.artery ,Vertebrobasilar Insufficiency ,medicine ,Basilar artery ,Homeostasis ,Humans ,Aged ,Aged, 80 and over ,Neurologic Examination ,business.industry ,Brain ,Cerebral Infarction ,General Medicine ,Carbon Dioxide ,Middle Aged ,medicine.disease ,Echoencephalography ,Transcranial Doppler ,Neurology ,Embolism ,Ischemic Attack, Transient ,Basilar Artery ,Anesthesia ,cardiovascular system ,symbols ,sense organs ,Neurology (clinical) ,medicine.symptom ,business ,Doppler effect ,Hypercapnia ,Blood Flow Velocity ,Brain Stem - Abstract
The pathogenesis of vertebrobasilar ischemia (VBI) is still uncertain. Embolism and systemic hypotension have been discussed as possible causes. We evaluated the basilar arteries of 35 VBI-patients by transcranial Doppler-sonography at rest and under hypercapnic conditions and compared these findings with the basilar flow velocities in 10 healthy volunteers matched by age. We found no difference between the controls and the VBI-patients for the basilar flow velocities at rest. Under hypercapnia (end-tidal CO2-concentration 8.5%), the basilar blood flow velocities in the healthy controls increased by an average of 53.0% but only by 32.3% in the VBI-patients (p less than 0.005). The reduction of CO2 dependent vasomotor reactivity was observed in all VBI-patients, except in patients with infarction in the posterior cerebral artery area, possibly indicating a different pathogenic mechanism of stroke. The results in all other patients revealed no obvious correlation to the clinical course or angiographic or dopplersonographic findings. As CO2 dependent vasomotor reactivity and brain perfusion pressure dependent cerebral autoregulation have similar mechanisms, we conclude that systemic hypotension might play an important part in VBI.
- Published
- 1991
24. Efficacy and Safety of the Platelet-Activating Factor Receptor Antagonist BN 52021 (Ginkgolide B) in Patients with Severe Sepsis : A Randomised, Double-Blind, Placebo-Controlled, Multicentre Trial
- Author
-
M. Kieser, D. Krausch, H. J. Bender, D. M. Albrecht, P. Funk, I. Marzi, T. Menges, W. Kox, K. van Ackern, H. D. Schmidt, N. Victor, H. Hof, and S. Köhler
- Subjects
medicine.medical_specialty ,business.industry ,medicine.drug_class ,Mortality rate ,Antagonist ,General Medicine ,Placebo ,Receptor antagonist ,Pharmacotherapy ,Internal medicine ,Intensive care ,Anesthesia ,medicine ,Pharmacology (medical) ,Platelet-activating factor receptor ,Adverse effect ,business - Abstract
Objective: To evaluate the efficacy and safety of the natural platelet-activating factor receptor antagonist, BN 52021 (ginkgolide B) in the treatment of patients with severe sepsis related to Gram-negative and mixed bacterial infection. Design and setting: Prospective, randomised, double-blind, placebo-controlled, multicentre study carried out in 13 academic medical intensive care centres in Germany with up to 14 patients per centre. Patients: 88 patients with severe sepsis under standard medical and surgical care: nine patients with pure Gram-positive infection, 79 patients with Gram-negative or mixed bacterial infections (subgroup for which efficacy was to be established). Interventions: Patients were randomised to receive either placebo or BN 52021 1.25 mg/kg body weight intravenously every 12h over a 4-day period in addition to their standard medical and surgical care. Main outcome measures and results: The primary efficacy variable was the 28-day all-cause mortality rate. The treatment groups were similar with respect to demographic data and prognostic factors influencing the outcome except for bodyweight and adequacy of antibiotic therapy. Analysis of patients with Gram-negative or mixed bacterial infection, for which efficacy was to be established, resulted in a 28-day all-cause mortality of 42.5% in the placebo group (n = 40; 17 deaths) versus 38.5% in the BN 52021 group (n = 39; 15 deaths). Among all randomised patients, the 28-day all-cause mortality rate was 40.9% in the placebo group (n = 44; 18 deaths) and 38.6% in the BN 52021 group (n = 44; 17 deaths). There were no differences in frequency and severity of adverse events between the two treatment groups. Conclusions: Four-day administration of BN 52021 failed to demonstrate a statistically significant reduction in mortality in patients with severe sepsis suspected or confirmed to be related to infections other than Gram-positive bacterial infection.
- Published
- 2007
25. [Efficient organization in public health. What needs to be done?]
- Author
-
D M, Albrecht and P C, Scriba
- Subjects
Health Services Needs and Demand ,Cost Control ,National Health Programs ,Germany ,Health Care Reform ,Population Dynamics ,Hospital Shared Services ,Internal Medicine ,Humans ,Health Care Costs ,Aged ,Forecasting - Published
- 2007
26. Verfahren zur Membranoxygenation von Blut über hydrophile Polymermembranen
- Author
-
Berwald S, U. Tschö, J. U. Bleyl, Carsten Werner, Körber H, Maximilian Ragaller, D. M. Albrecht, and Jacobasch Hj
- Subjects
Hydrophilic polymers ,Membrane ,Chemical engineering ,Chemistry ,Biomedical Engineering ,Oxygenation - Published
- 1998
27. [Developing model of university medicine in Dresden]
- Author
-
D M, Albrecht and H D, Saeger
- Subjects
Hospitals, University ,Models, Educational ,Faculty, Medical ,Education, Medical, Graduate ,Germany ,Models, Organizational ,Costs and Cost Analysis ,Humans ,Clinical Competence ,Quality of Health Care - Published
- 2006
28. [Reduction in the aggressiveness of ventilation by inhalation of perfluorohexane after therapy of oleic acid-induced respiratory failure]
- Author
-
J-U, Bleyl, U, Tschö, M, Regner, O, Vicent, M, Hübler, M G, de Abreu, T, Koch, D M, Albrecht, and M, Ragaller
- Subjects
Fluorocarbons ,Pulmonary Circulation ,Respiratory Distress Syndrome ,Sheep ,Pulmonary Gas Exchange ,Hemodynamics ,Respiratory Mechanics ,Animals ,Respiration, Artificial ,Oleic Acid - Abstract
The application of perfluorohexane (PFH) vapor led to an improvement of oxygenation and mechanical lung function in a model of oleic acid-induced ARDS in sheep. The aim of this study was to investigate the effects of PFH on gas exchange over an extended time period and to reduce the invasiveness of ventilation.ARDS was induced in sheep ( n=12) by injecting 0.1 ml/kg body weight oleic acid intravenously. Six sheep were treated for 30 min with 18 vol.% PFH (PFH-Tx) and followed up over a time period of 240 min while untreated sheep ( n=6) served as controls. Subsequently the F(I)O(2) was reduced to generate a p(a)O(2) between 100-140 mmHg. Gas exchange, respiratory and hemodynamic data were collected at regular intervals. Data were analysed using covariance analysis.PFH treatment led to an improvement in oxygenation ( p0.01) and in mechanical lung function ( p0.01). Furthermore, mean pulmonary artery pressure ( p0.01) and shunt ( p0.01) were lower in PFH-Tx. F(I)O(2) could be reduced in all PFH-treated animals ( p0.01).Treatment of oleic acid-induced lung injury with PFH vapor improved oxygenation and mechanical lung function over a extended time period allowing a reduction in the invasiveness of ventilation.
- Published
- 2004
29. Performance of the partial CO2 rebreathing technique under different hemodynamic and ventilation/perfusion matching conditions
- Author
-
Tilo Winkler, Dieter Weismann, D. M. Albrecht, Torsten Pahlitzsch, and Marcelo Gama de Abreu
- Subjects
medicine.medical_specialty ,Cardiac output ,Sheep ,business.industry ,Respiration ,Hemodynamics ,Oxygen–haemoglobin dissociation curve ,Blood flow ,Lung injury ,Carbon Dioxide ,Critical Care and Intensive Care Medicine ,Ventilation/perfusion ratio ,Anesthesia ,Internal medicine ,Breathing ,Cardiology ,medicine ,Ventilation-Perfusion Ratio ,Arterial blood ,Animals ,Humans ,Female ,business - Abstract
Objective The partial CO2 rebreathing technique has been demonstrated to accurately measure the effective pulmonary capillary blood flow (PCBF) in different clinical situations. Usually, PCBF is calculated from changes in CO2 elimination (JOURNAL/ccme/04.02/00003246-200302000-00037/ENTITY_OV0312/v/2017-07-20T221246Z/r/image-pngco2) and end-tidal partial pressure of CO2 (Petco2), which can be obtained noninvasively. In this study, we investigated the performance of the partial CO2 rebreathing technique under different conditions of ventilation/perfusion matching and hemodynamic states. In addition, we investigated whether the determination of arterial blood gases combined with mathematical modeling of gas exchange can improve the performance of this method. Design Prospective, controlled animal laboratory study. Setting Experimental research facility of a university hospital. Subjects Sixteen female sheep weighing 45–55 kg. Interventions Cardiac output and ventilation/perfusion matching were manipulated during three phases: phase I, variation in cardiac output to achieve normal, hyperdynamic and hypodynamic states; phase II, increase of alveolar deadspace and variation in cardiac output; phase III, lung injury and increased alveolar deadspace. Partial CO2 rebreathing maneuvers were performed to obtain variations in JOURNAL/ccme/04.02/00003246-200302000-00037/ENTITY_OV0312/v/2017-07-20T221246Z/r/image-pngco2 and Petco2 between a nonrebreathing (NR) and a rebreathing (R) period. Measurements and Main Results PCBF was measured by the rebreathing method as PCBF = −ΔJOURNAL/ccme/04.02/00003246-200302000-00037/ENTITY_OV0312/v/2017-07-20T221246Z/r/image-pngco2/ f (Pc′co2(R), Pc′co2(NR), Hb), where f is the CO2 dissociation curve in blood, Pc′co2 is the end-capillary partial pressure of CO2, Δ is the variation between NR and R periods, and Hb is hemoglobin concentration. Pc′co2 was estimated from Petco2 according to two algorithms. In the so-called “noninvasive algorithm,” Pc′co2 = Petco2, with Petco2(NR) and Petco2(R) being determined as the mean Petco2 value of the last 60 secs preceding rebreathing and within 15–30 secs of rebreathing, respectively. In the “semi-invasive algorithm,” Pc′co2(NR) was estimated as the Paco2, and Pc′co2(R) was estimated as follows: First, a monoexponential function was fitted to Petco2 values during rebreathing and the asymptote represented Petco2(R). Second, the Pc′co2(R) to Petco2(R) difference was calculated by means of a bicompartmental, tidal model of gas exchange, which showed that such differences decrease with the degree of rebreathing. PCBF values obtained with both algorithms were compared with thermodilution cardiac output minus intrapulmonary shunt flow. Bias and precision calculations with the noninvasive algorithm in phases I, II, and III were, respectively, −1.0 ± 1.9, −2.1 ± 2.6, and −2.4 ± 1.2 L/min. The semi-invasive algorithm had an overall better performance in the phases investigated: −1.2 ± 1.9, −0.6 ± 2.0, and −0.2 ± 3.0 L/min, respectively. The noninvasive algorithm showed a slight tendency to overestimate lower reference PCBF values and, importantly, to underestimate higher PCBF values in all three phases (r = −.66, p Conclusions Although PCBF is systematically underestimated during hyperdynamic cardiac output states and high alveolar deadspaces, the performance of the partial CO2 rebreathing technique can be improved by means of arterial blood gas sampling and an algorithm that takes in account the effects of nonequilibration of Petco2 during rebreathing and the variation of Pc′co2 to Petco2 differences from the nonrebreathing to the rebreathing period. Such an algorithm may prove useful under moderately increased alveolar deadspace and normal to hypodynamic cardiac output states.
- Published
- 2003
30. [Anesthesia for transurethral bladder resection]
- Author
-
R J, Litz and D M, Albrecht
- Subjects
Contraindications ,Urinary Bladder ,Humans ,Urologic Surgical Procedures ,Anesthesia, Spinal ,Spinal Puncture - Published
- 2002
31. An approach to quality management in anaesthesia: a focus on perioperative care and outcome
- Author
-
K G, Dahmen and D M, Albrecht
- Subjects
Risk Management ,Outcome and Process Assessment, Health Care ,Quality Assurance, Health Care ,Anesthesiology ,Germany ,Outcome Assessment, Health Care ,Humans ,Anesthesia ,Anesthesia Department, Hospital ,Perioperative Care - Abstract
Health care systems throughout the world are faced with continuously rising health care expenditure. In Germany, a fee per capita system will be introduced by 2003 to keep the budgets for hospital care within limits. As a result, numbers of hospital beds and hospitals will be cut in the coming years. On the other hand, more and more patients and health care providers are asking if they are really receiving an adequate value for their money in the treatment they receive. All this will have a strong impact on the anaesthesiologist's work and her/his perception of the different facets of quality. Quality has various aspects for the anaesthesiologist. The patient as a customer should not incur any detrimental effects after a surgical procedure, and is accompanied by the anaesthesiologist throughout the perioperative setting. The surgeon needs optimal conditions to perform a procedure. The hospital must balance equally costs and income; this requires optimal operating room utilization. Finally, health insurance companies and the government are responsible for covering the cost of treatment according to the quality of the care delivered. Quality assessment concerning structure, process and outcome has to take these demands into account. Continuous quality improvement in the spirit of Deming's 'plan-do-check-act cycle' has to be part of anaesthesiologist's everyday routine. In future, the traditional barriers between the specialities treating a patient will be disrupted when reimbursement for treatment is made according to quality and efficacy of treatment.
- Published
- 2002
32. A comparison of five solutions of local anaesthetics and/or sufentanil for continuous, postoperative epidural analgesia after major urological surgery
- Author
-
Oliver W. Hakenberg, K. H. Sengebusch, D. M. Albrecht, I. Kreinecker, Matthias Hübler, M. D. Frank, and Rainer J. Litz
- Subjects
Male ,medicine.medical_specialty ,Visual analogue scale ,Nausea ,medicine.drug_class ,Sufentanil ,Sedation ,Blood Pressure ,Double-Blind Method ,Heart Rate ,Heart rate ,medicine ,Humans ,Ropivacaine ,Anesthetics, Local ,Aged ,Pain Measurement ,Bupivacaine ,Aged, 80 and over ,Pain, Postoperative ,business.industry ,Local anesthetic ,Carbon Dioxide ,Middle Aged ,Amides ,Surgery ,Analgesia, Epidural ,Analgesics, Opioid ,Drug Combinations ,Pharmaceutical Solutions ,Anesthesiology and Pain Medicine ,Anesthesia ,Respiratory Mechanics ,Urologic Surgical Procedures ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
BACKGROUND AND OBJECTIVE The aim of the present study was to compare and assess the quality of analgesia, the safety and the side-effects after the use of a continuous, thoracic epidural infusion of sufentanil (5 microg h(-1)), 0.25% bupivacaine (10 mL h(-1)), 0.2% ropivacaine (10 mL h(-1)) alone or in combination in patients who had undergone major urological surgery. This prospective, randomized, double-blinded study investigated the efficacy of thoracic epidural infusions after major urological surgery. METHODS Patients received a 72-h continuous infusion (10 mL h(-1)) of 0.25% bupivacaine (B), 0.2% ropivacaine (R), 0.25% bupivacaine with 0.5 microg mL(-1) sufentanil (BS), 0.2% ropivacaine with 0.5 microg mL(-1) sufentanil (RS) or 0.5 microg mL(-1) sufentanil only (S). The analysis included 109 patients. RESULTS The mean visual analogue scale (VAS) scores for pain were highest in the groups R and S (P < 0.001). The PaCO2 values were significantly higher in the groups RS and S (P = 0.003). Motor block occurred more frequently in the groups B and BS than in the other groups (P < 0.001). Sedation, nausea and pruritus were more common in the groups that received sufentanil. CONCLUSIONS A continuous, epidural infusion with these drugs was safe and effective in our patients. The combination of 0.2% ropivacaine plus sufentanil appeared preferable because of the low incidence of motor block.
- Published
- 2001
33. [Thoracic epidural anesthesia]
- Author
-
D M, Albrecht
- Subjects
Anesthesia, Epidural ,Humans - Published
- 2001
34. [Combined anesthesia with epidural catheter. A retrospective analysis of the perioperative course in patients ungoing radical prostatectomy]
- Author
-
A R, Heller, R J, Litz, I, Djonlagic, A, Manseck, T, Koch, M P, Wirth, and D M, Albrecht
- Subjects
Anesthesia, Epidural ,Male ,Prostatectomy ,Pain, Postoperative ,Postoperative Complications ,Tachycardia ,Hypertension ,Humans ,Anesthesia, General ,Length of Stay ,Middle Aged ,Intraoperative Complications ,Retrospective Studies - Abstract
Patients requiring radical prostatectomy (rPE), including retroperitoneal lymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in terms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hospital were retrospectively reviewed. Patients were divided in those who received: 1. general anaesthesia (GA) alone, 2. a combination of lumbar epidural anaesthesia (LEA) + GA or, 3. thoracic epidural anaesthesia (TEA) + GA. General anaesthesia was performed as balanced anaesthesia, and epidural administered local anaesthetics were bupivacaine 0.25% or ropivacaine 0.2%, 8-12 ml/h. In terms of intra- and postoperative numbers of tachycardiac and hypertensive episodes, a reduced stress response was observed under epidural anaesthesia (EA). Moreover, the weaning duration was shorter under EA and onset of gastrointestinal motility was found earlier ([h] GA: 50.6 +/- 11.1/LEA: 39.3 +/- 13.6/TEA: 33.8 +/- 13.0). Furthermore, a trend to rarer phases of postoperative vomiting and a significant decrease of in hospital stay of about one day ([d] GA: 12.4 +/- 5.8/LEA: 11.1 +/- 3.1/TEA: 11.5 +/- 3.8) was observed. The duration of personnel binding in the OR did not differ significantly between GA and TEA ([min] GA: 222.9 +/- 43.5/LEA: 238.2 +/- 41.8/TEA: 227.0 +/- 46.2), but ICU stay was shortened under TEA. Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO2 and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.
- Published
- 2001
35. Perfluorohexane attenuates proinflammatory and procoagulatory response of activated monocytes and alveolar macrophages
- Author
-
Thea Koch, Marianne Grosser, A. Hofer, Maximilian Ragaller, Thomas Luther, D. M. Albrecht, Matthias Kotzsch, and Dirk Haufe
- Subjects
Lipopolysaccharides ,Liquid Ventilation ,Lipopolysaccharide ,Enzyme-Linked Immunosorbent Assay ,Lung injury ,Pharmacology ,Monocytes ,Proinflammatory cytokine ,chemistry.chemical_compound ,Phagocytosis ,medicine ,Macrophage ,Humans ,Perfluorohexane ,Fluorocarbons ,business.industry ,Reverse Transcriptase Polymerase Chain Reaction ,Tumor Necrosis Factor-alpha ,Monocyte ,Pulmonary Alveoli ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,chemistry ,Immunology ,Tumor necrosis factor alpha ,Pulmonary alveolus ,business ,Interleukin-1 - Abstract
Background A number of studies have demonstrated the effectiveness of liquid ventilation with perfluorocarbons in improving pulmonary function in acute respiratory distress syndrome. Although it is known that perfluorocarbon-associated gas exchange facilitates lung mechanics and oxygenation, the complete mechanism by which perfluorocarbons exert their beneficial effects in acute lung injury still remains unclear. Possibly, an influence of perfluorocarbons on proinflammatory and procoagulant features of monocytic cells present in the alveolar space, such as alveolar macrophages (AMs), may be involved. Therefore, we examined in an in vitro model the effects of perfluorocarbon on both activated mononuclear blood cells (MBCs) and AMs by monitoring the expression of interleukin (IL)-1 beta, tumor necrosis factor (TNF)alpha, and tissue factor (TF). Methods Mononuclear blood cells, obtained from peripheral blood of healthy volunteers, or AMs from diagnostic bronchoalveolar lavage were stimulated by incubation with lipopolysaccharide in the presence of different amounts of perfluorohexane, which was devoid of cytotoxicity. Results Using both video-enhanced contrast and electron microscopy, the authors observed that perfluorohexane droplets were phagocytosed by activated monocytes as well as by in vitro--cultured AMs within 1--3 h. After lipopolysaccharide stimulation of monocytes or AMs, we observed a down-regulation of TF mRNA and a significant inhibition (P < 0.05) of cellular TF antigen by perfluorohexane. In addition, the concentration of both IL-1 beta and TNF alpha in the supernatant of lipopolysaccharide-stimulated MBC was significantly decreased (P < 0.01) by perfluorohexane compared with controls without perfluorohexane. By preincubation of lipopolysaccharide-containing medium with perfluorohexane, the authors could exclude that the inhibitory effect of perfluorohexane was caused by binding or sequestering limited amounts of lipopolysaccharide. Conclusion Taken together, our results demonstrate an interference of perfluorohexane with the expression of the procoagulant protein TF on monocytes and AMs as well as with the release of proinflammatory cytokines by MBCs. These effects may contribute to the protective role of liquid ventilation with perfluorocarbons in injuries associated with local activation of inflammatory processes.
- Published
- 2001
36. Effects of vaporized Perfluorohexane on neutrophil-mediated Lung Injury
- Author
-
Axel R. Heller, T. Koch, R. W.H. Funk, D. M. Albrecht, J. U. Bleyl, Dirk Haufe, and M. Heintz
- Subjects
chemistry.chemical_compound ,Pathology ,medicine.medical_specialty ,chemistry ,business.industry ,Emergency Medicine ,Medicine ,Lung injury ,Critical Care and Intensive Care Medicine ,business ,Perfluorohexane - Published
- 2001
37. [The effect of local anesthetics on blood coagulation]
- Author
-
M, Hübler and D M, Albrecht
- Subjects
Anesthesia, Epidural ,Risk ,Humans ,Anesthetics, Local ,Blood Coagulation Disorders ,Blood Coagulation - Published
- 2000
38. [Anesthesia in vascular surgery. II]
- Author
-
M, Ragaller and D M, Albrecht
- Subjects
Humans ,Anesthesia ,Anesthesia, General ,Vascular Surgical Procedures - Published
- 2000
39. [Central and peripheral anesthesia--reevaluation and differentiation]
- Author
-
D M, Albrecht
- Subjects
Anesthesia, Conduction ,Humans ,Anesthesia, General - Published
- 2000
40. [From isoflurane to perfluorohexane? Perfluorocarbons--therapeutic strategies in acute lung failure]
- Author
-
M, Ragaller, J U, Bleyl, T, Koch, and D M, Albrecht
- Subjects
Fluorocarbons ,Respiratory Distress Syndrome ,Isoflurane ,Anesthetics, Inhalation ,Humans ,Respiration, Artificial - Abstract
The introduction of Perfluorochemicals into medicine and especially into the treatment of severe lung injury is a fascinating scientific task. Many recall the famous experiments from Clark et al. in 1966 when he demonstrated "liquidventilation with perfluorocarbons" in the mammal species for the first time. After this hallmark, perfluorocarbons were subsequently introduced in research of acute lung injury by the techniques of Total- and Partial-Liquid-Ventilation (TLV; PLV). Perfluorocarbons (saturated organofluorids) have unique chemical and physical properties which made them attractive substances for intraalveolar application. The strong C-F bindings in the perfluorocarbon molecules are responsible for their chemical stability, biochemical inertness, high capacity to dissolve respiratory gases, low surface tension and high vapor pressures. Furthermore, the high density of the PFC lead to radio-opacity and their distribution to dependent lung areas. The efficacy of PFC liquid, applied by TLV/PLV has been demonstrated in numerous animal studies using different models of acute lung injury. Currently, several mechanisms of action of perfluorocarbon fluids in acute lung injury are discussed: recruitment of atelectatic alveoli, prevention of endexpiratory collapse of alveoli ("liquid PEEP"), redistribution of perfusion, oxygen transport, surfactant like effects and decrease of inflammation. Since total liquid ventilation has been used only in experimental models of lung injury, partial liquid ventilation has been introduced successfully into clinical trials (phase I-II). However, the results of the first randomised, controlled study of PLV in 90 adult patients suffering from severe respiratory failure (ALI/ARDS) showed no differences between PLV and conventional treatment. Furthermore, the instillation of relatively large amounts of liquid into the lungs poses several technical challenges and may be associated with complications such as liquithoraces, pneumothoraces and hypoxia. Since mammal lungs are evolutionary specialised to gas exchange using atmospheric oxygen, the application of liquids, even if they transport respiratory gases very well is not physiologic. To overcome these unwanted side effects, we developed a technique of perfluorocarbon vaporisation in analogy to the application of inhalation anaesthetic agents. After resolving some technical issues, this application technique was used successfully in an animal model of acute lung injury. Vaporisation of perfluorohexane in a concentration of 18 Vol.% of inspired gas improved significantly oxygenation and lung compliance. Though these results are promising, mechanisms of action, dose-efficacy relation, surfactant-perfluorocarbon interaction or anti-inflammatory effects of vaporised perfluorohexane are still unclear. These questions need to be clarified before this technique can be applied clinically. However, the inhalation of vapor, a technique already familiar to anaesthesiologists should avoid risks of large amounts of fluids in the bronchoalveolar space. Furthermore, this technique can be administered by established anaesthetic equipment with the advantage of exact dosing, continuous monitoring, and demand application in a way near to clinical routine.
- Published
- 2000
41. Hemodynamic effects of hypertonic hydroxyethyl starch 6% solution and isotonic hydroxyethyl starch 6% solution after declamping during abdominal aortic aneurysm repair
- Author
-
D. M. Albrecht, Maximilian Ragaller, Michael Müller, A. Strecker, T W Segiet, K Ellinger, and J. U. Bleyl
- Subjects
Male ,Resuscitation ,Hypertonic Solutions ,Cardiac index ,Volume overload ,Hemodynamics ,Hydroxyethyl starch ,Critical Care and Intensive Care Medicine ,Hydroxyethyl Starch Derivatives ,Aortic aneurysm ,Double-Blind Method ,Medicine ,Humans ,Prospective Studies ,Pulmonary wedge pressure ,Aged ,business.industry ,Middle Aged ,Water-Electrolyte Balance ,medicine.disease ,Constriction ,Abdominal aortic aneurysm ,Anesthesia ,Emergency Medicine ,Fluid Therapy ,Female ,Hypotension ,Isotonic Solutions ,business ,medicine.drug ,Aortic Aneurysm, Abdominal - Abstract
Fluid resuscitation with hypertonic hydroxyethyl starch solutions (HES) is effective in haemorrhagic shock due to the rapid mobilisation of fluids into the intravascular compartment. Declamping of the abdominal aorta with acute redistribution of blood into the vessels of the lower body half causes declamping-induced hypotension. Usually large amount of fluids or vasopressors are necessary to restore hemodynamic stability. Therefore, infusion of a hypertonic colloid solution may be an attractive option to achieve hemodynamic stability. This study was conducted to determine the amount of fluid of either hypertonic HES (HES 6%;7.2% NaCl) or isotonic HES (HES 6%;0.9% NaCl) needed to attain best wedge pressure (PCWP) cardiac index (CI) relation after declamping. Thirty-two high-risk patients undergoing elective abdominal aneurysm resection were enrolled in a prospective, randomised, double blinded study. The individual optimised PCWP/CI relation was determined after induction of anaesthesia. After declamping, both solutions were titrated in small boluses of 100 mL until the previously determined best wedge was reached. The amount of fluid after declamping was significantly reduced in the hypertonic HES- group 162 mL vs. 265 mL in the control group (P < 0.05). Resuscitation time was shortened, and cardiac index was slightly higher in the treatment group. The use of hypertonic HES-solution after aortic declamping led to a significant reduction of fluids necessary to attain optimised PCWP/CI relation. In this clinical trial with moderate blood loss in high-risk patients, hypertonic HES applied in a titrated fashion restored hemodynamic stability faster and without volume overload.
- Published
- 2000
42. Gynäkologie und Geburtshilfe
- Author
-
P. Mallmann, Barbara Beland, T. Wagner, J.-U. Bleyl, M. Popp, D. M. Albrecht, D. Fingerhut, G. Burgard, V. Hempel, H. Schmidt, B. K. Krämer, and K. P. Ittner
- Abstract
Die fur den diensthabenden Anasthesisten relevanten Themen der Gynakologie und Geburtshilfe werden in diesem Kapitel erortert.
- Published
- 2000
43. [Thrombocyte aggregation inhibitors during regional anesthesia]
- Author
-
J U, Bleyl and D M, Albrecht
- Subjects
Anesthesia, Conduction ,Contraindications ,Humans ,Orthopedic Procedures ,Platelet Aggregation Inhibitors - Published
- 1999
44. [Combined anesthesia procedures]
- Author
-
R J, Litz, J U, Bleyl, M, Frank, and D M, Albrecht
- Subjects
Anesthesia, Epidural ,Anesthesia, Conduction ,Humans ,Anesthesia, General - Abstract
The additive properties of general and regional anesthetic techniques are brought together in combined anesthesia to minimise side effects of the individual techniques. Despite a wide experience with both used as single anesthetic techniques, no definite recommendations regarding indications, general contraindications and procedure exist for their combination. Beneficial effects on haemodynamics, respiratory function, intestinal motility and postoperative stress response have been demonstrated for a combination of general anesthesia and thoracic epidural anesthesia (TEA). In addition TEA is favourable in the management of postoperative pain, which has advantageous effects on convalescence especially in a high risk patient group. Nevertheless, until now no reduction of perioperative morbidity and mortality has been demonstrated. Since the combination of two anesthesia techniques theoretically increases the rate of complication, the expected benefit for the patient must predominate. To estimate the risks and benefits of combined anesthesia, the anesthesiologist must be familiar with each single method, as well as with the synergistic effects of both techniques in order to evaluate the individual indication.
- Published
- 1999
45. Views on the future anesthesia working environment
- Author
-
T, Koch and D M, Albrecht
- Subjects
Ventilators, Mechanical ,Managed Care Programs ,Nitrous Oxide ,Fee-for-Service Plans ,Anesthesia, General ,Ambulatory Surgical Procedures ,Anesthesiology ,Computer Systems ,Monitoring, Intraoperative ,Anesthetics, Inhalation ,Hospital Information Systems ,Medical Laboratory Science ,Humans ,Anesthesia, Inhalation ,Forecasting ,Monitoring, Physiologic - Published
- 1999
46. [Animal experiment for testing the application of perfluorocarbon-assisted membrane oxygenation]
- Author
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J U, Bleyl, H, Körber, M, Ragaller, C, Werner, U, Tschö, S, Bernwald, D M, Albrecht, and H J, Jacobasch
- Subjects
Fluorocarbons ,Extracorporeal Membrane Oxygenation ,Sheep ,Blood Substitutes ,Models, Cardiovascular ,Animals ,Equipment Design ,Oxygenators, Membrane - Published
- 1998
47. [Procedure for membrane oxygenation of blood over hydrophilic polymer membranes]
- Author
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H, Körber, J, Bleyl, C, Werner, M, Ragaller, S, Berwald, U, Tschö, H J, Jacobasch, and D M, Albrecht
- Subjects
Oxygen ,Extracorporeal Membrane Oxygenation ,Models, Cardiovascular ,Silicone Elastomers ,Humans ,Biocompatible Materials ,Membranes, Artificial ,Equipment Design ,Carbon Dioxide ,Cellulose ,Polypropylenes ,Oxygenators, Membrane - Published
- 1998
48. [Bedside pulmonary blood flow measurement by partial CO2 rebreathing]
- Author
-
M G, de Abreu and D M, Albrecht
- Subjects
Inhalation ,Animals ,Humans ,Carbon Dioxide ,Cardiac Output ,Pulmonary Artery ,Blood Flow Velocity ,Respiratory Function Tests - Published
- 1998
49. Blood compatible polymers in intensive care units: state of the art and current aspects of biomaterials research
- Author
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M, Ragaller, C, Werner, J, Bleyl, S, Adam, H J, Jacobasch, and D M, Albrecht
- Subjects
Clinical Trials as Topic ,Intensive Care Units ,Polymers ,Humans ,Biocompatible Materials ,Artificial Organs ,Blood Coagulation ,Systemic Inflammatory Response Syndrome - Abstract
The use of artificial organs in cases of acute renal failure, acute respiratory distress syndrome (ARDS) and multiorgan dysfunction syndrome (MODS) has lead to a significant reduction of mortality. However, the interaction between body and biomaterials results in the activation of the coagulation system and in the induction of systemic inflammatory response syndrome. The necessary anticoagulation may be contraindicated and may even further increase the risk for the patient. This article evaluates the currently applied polymeric materials used in intensive care units (ICU) and gives a possible outlook into future developments. It is emphasized that systematic interdisciplinary research of physicians and biomaterial scientists is essential for the successful development of new polymers with improved biocompatibility. For this purpose a brief overview of analytical techniques for surface characterization is given, and future developments to a fully biocompatible polymer are described.
- Published
- 1998
50. [The PTT--limit for regional anesthesia?]
- Author
-
S, Geiger, G, Siegert, and D M, Albrecht
- Subjects
Anesthesia, Conduction ,Heparin ,Anticoagulants ,Humans ,Partial Thromboplastin Time - Published
- 1997
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