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Short term non-invasive ventilation post-surgery improves arterial blood-gases in obese subjects compared to supplemental oxygen delivery - a randomized controlled trial
Martin Zoremba, Gerald Kalmus, Domenique Begemann, Leopold Eberhart, Norbert Zoremba, Hinnerk Wulf, Frank Dette
BMC Anesthesiology , 2011, DOI: 10.1186/1471-2253-11-10
Abstract: After ethics committee approval and informed consent, we prospectively studied 60 obese patients (BMI 30-45) undergoing minor peripheral surgery. Half were randomly assigned to receive short term NIV during their PACU stay, while the others received routine treatment (supplemental oxygen via venturi mask). Premedication, general anaesthesia and respiratory settings were standardized. We measured arterial oxygen saturation by pulse oximetry and blood gas analysis on air breathing. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 1 h, 2 h, 6 h and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t-test analysis. Statistical significance was considered to be P < 0.05.There were no differences at the first assessment. During the PACU stay, pulmonary function in the NIV group was significantly better than in the controls (p < 0.0001). Blood gases and the alveolar to arterial oxygen partial pressure difference were also better (p < 0.03), but with the addition that overall improvements are of questionable clinical relevance. These effects persisted for at least 24 hours after surgery (p < 0.05).Early initiation of short term NIV during in the PACU promotes more rapid recovery of postoperative lung function and oxygenation in the obese. The effect lasted 24 hours after discontinuation of NIV. Patient selection is necessary in order to establish clinically relevant improvements.DRKS00000751; http://www.germanctr.de webciteAcute respiratory failure is a major complication within the early post-operative period [1]. In patients with hypercapnic [2] or non-hypercapnic [3] acute respiratory failure, non-invasive ventilation (NIV) can reduce intubation rate, morbidity, mortality and the overall and intensive care unit (ICU) lengths of stay. NIV is thus well established in clinical practice. It is mostly applied in an
The effects of levosimendan on brain metabolism during initial recovery from global transient ischaemia/hypoxia
Roehl Anna B,Zoremba Norbert,Kipp Markus,Schiefer Johannes
BMC Neurology , 2012, DOI: 10.1186/1471-2377-12-81
Abstract: Backround Neuroprotective strategies after cardiopulmonary resuscitation are currently the focus of experimental and clinical research. Levosimendan has been proposed as a promising drug candidate because of its cardioprotective properties, improved haemodynamic effects in vivo and reduced traumatic brain injury in vitro. The effects of levosimendan on brain metabolism during and after ischaemia/hypoxia are unknown. Methods Transient cerebral ischaemia/hypoxia was induced in 30 male Wistar rats by bilateral common carotid artery clamping for 15 min and concomitant ventilation with 6% O2 during general anaesthesia with urethane. After 10 min of global ischaemia/hypoxia, the rats were treated with an i.v. bolus of 24 μg kg-1 levosimendan followed by a continuous infusion of 0.2 μg kg-1 min-1. The changes in the energy-related metabolites lactate, the lactate/pyruvate ratio, glucose and glutamate were monitored by microdialysis. In addition, the effects on global haemodynamics, cerebral perfusion and autoregulation, oedema and expression of proinflammatory genes in the neocortex were assessed. Results Levosimendan reduced blood pressure during initial reperfusion (72 ± 14 vs. 109 ± 2 mmHg, p = 0.03) and delayed flow maximum by 5 minutes (p = 0.002). Whereas no effects on time course of lactate, glucose, pyruvate and glutamate concentrations in the dialysate could be observed, the lactate/pyruvate ratio during initial reperfusion (144 ± 31 vs. 77 ± 8, p = 0.017) and the glutamate release during 90 minutes of reperfusion (75 ± 19 vs. 24 ± 28 μmol·L-1) were higher in the levosimendan group. The increased expression of IL-6, IL-1 TNFα and ICAM-1, extend of cerebral edema and cerebral autoregulation was not influenced by levosimendan. Conclusion Although levosimendan has neuroprotective actions in vitro and on the spinal cord in vivo and has been shown to cross the blood–brain barrier, the present results showed that levosimendan did not reduce the initial neuronal injury after transient ischaemia/hypoxia.
The use of the Airtraq? optical laryngoscope for routine tracheal intubation in high-risk cardio-surgical patients
Gereon Sch?lte, Ulrike Scheid, Steffen Rex, Mark Coburn, Britta Fiedler, Rolf Rossaint, Norbert Zoremba
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-425
Abstract: 123 consecutive ASA III patients undergoing elective coronary artery bypass grafting were routinely intubated with the Airtraq? laryngoscope. Induction of anesthesia was standardized according to our institutional protocol. All tracheal intubations were performed by six anesthetists trained in the use of the Airtraq? prior.Overall success rate was 100% (n = 123). All but five patients trachea could be intubated in the first attempt (95,9%). 5 patients were intubated in a 2nd (n = 4) or 3rd (n = 1) attempt. Mean intubation time was 24.3 s (range 16-128 s). Heart rate, arterial blood pressure and SpO2 were not significantly altered. Minor complications were observed in 6 patients (4,8%), i.e. two lesions of the lips and four minor superficial mucosal bleedings. Intubation duration (p = 0.62) and number of attempts (p = 0.26) were independent from BMI and Mallampati score.Tracheal intubation with the Airtraq? optical laryngoscope was feasible, save and easy to perform in high-risk patients undergoing cardiac surgery. In all patients, a sufficient view on the vocal cords could be obtained, independent from BMI and preoperative Mallampati score.DRKS 00003230Tracheal intubation is still the golden standard of securing the airway under clinical and preclinical conditions. In case of resuscitation, respiratory failure, unconsciousness and loss of a patent airway it is life saving. Since its introduction in 1941, the Macintosh laryngoscope has been the most popular device used for intubation worldwide.However, tracheal intubation using this laryngoscope has been demonstrated to fail in up to 35% of patients with an unpredicted difficult airway [1,2]. Problems in securing the airway are still the main contributors to anesthesia-related morbidity and mortality [3]. Therefore, a wide variety of alternatives to the Macintosh laryngoscope have been introduced into clinical routine, including the Miller-, McCoy-, and Bullard-laryngoscope. Since 1982 Archie Brain's supra glottic la
Short-term elevation of intracranial pressure does neither influence duodenal motility nor frequency of bolus transport events: a porcine model
Joerg Schnoor, Norbert Zoremba, Marcus C Korinth, Bjoern Kochs, Jiri Silny, Rolf Rossaint
BMC Emergency Medicine , 2006, DOI: 10.1186/1471-227x-6-1
Abstract: During general anaesthesia, 11 pigs (32–37 kg, German Landrace) were instrumented with both a luminal catheter for impedancometry and a luminal catheter for microdialysis into the proximal duodenum. Additionally, a catheter was inserted into the left ventricle to increase the intracranial pressure from baseline up to 50 mmHg in steps of 10 mmHg each hour by injection of artificial cerebrospinal fluid. At the same time, duodenal motility was recorded continuously. Duodenal luminal lactate, pyruvate, and glucose concentrations were measured during physiological state and during elevated intracranial pressure of 10, 20, 30, 40, and 50 mmHg in six pigs. Five pigs served as controls.Although there was a trend towards shortened migrating motor cycle (MMC) length in pigs with raised ICP, the interdigestive phase I–III and the MMC cycle length were comparable in the groups. Spontaneous MMC cycles were not disrupted during intracranial hypertension. The mean concentration of lactate and glucose was comparable in the groups, while the concentration of pyruvate was partially higher in the study group than in the controls (p < 0.05). This was associated with a decrease in lactate to pyruvate ratio (p < 0.05).The present study suggests that a stepwise and hourly increase of the intracranial pressure of up to 50 mmHg, does not influence duodenal motility activity in a significant manner. A considerable deterioration of the duodenal mucosal blood flow was excluded by determining the lactate to pyruvate ratio.Raised intracranial pressure (ICP) is described of being associated with a delay in gastric emptying, which may affect toleration of enteral feeding [1,2]. In rats, increased ICP reduced gastric emptying, which seemed to be mediated by the vagus nerve [3]. In patients with a significant brain trauma associated with a decrease of Glasgow Coma Scale level, gastric dysrhythmia was found [4]. Trauma victims with raised ICP also displayed abnormal biphasic response demonstrating a
Does a 4 diagram manual enable laypersons to operate the laryngeal mask supreme?? A pilot study in the manikin
Gereon Sch?lte, Christian Stoppe, Rolf Rossaint, Laura Gilles, Maike Heuser, Steffen Rex, Mark Coburn, Norbert Zoremba, Annette Rieg
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-21
Abstract: An instruction manual of four illustrations with speech bubbles displaying the correct use of the LMAS was designed. Laypersons were handed a bag containing a LMAS, a bag mask valve device (BMV), a syringe prefilled with air and the instruction sheet, and were asked to perform and ventilate the manikin as displayed. Time to ventilation was recorded and degree of success evaluated.A total of 150 laypersons took part. Overall 145 participants (96.7%) inserted the LMAS in the manikin in the right direction. The device was inserted inverted or twisted in 13 (8.7%) attempts. Eight (5.3%) individuals recognized this and corrected the position. Within the first 2 minutes 119 (79.3%) applicants were able to insert the LMAS and provide tidal volumes greater than 150 ml (estimated dead space). Time to insertion and first ventilation was 83.2 ± 29 s. No significant difference related to previous BLS training (P = 0.85), technical education (P = 0.07) or gender could be demonstrated (P = 0.25).In manikin laypersons could insert LMAS in the correct direction after onsite instruction by a simple manual with a high success rate. This indicates some basic procedural understanding and intellectual transfer in principle. Operating errors (n = 91) were frequently not recognized and corrected (n = 77). Improvements in labeling and the quality of instructional photographs may reduce individual error and may optimize understanding.Layperson resuscitation plays an important role in providing lifesaving cardiopulmonary resuscitation (CPR) and bridging the interval to the arrival of healthcare professionals. However, only 50% of laypersons actually administer "first aid" in such situations [1,2]. Reasons given are various and include a lacking sense of personal responsibility when there are many other people "on site", an aversion to strangers' bodily fluids and the percieved risk of infection during "mouth to mouth" ventilation. Individuals may be discouraged from administering CPR by a la
Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin
Gereon Sch?lte, Christian Stoppe, Meral Aktas, Mark Coburn, Steffen Rex, Marlon Schwarz, Rolf Rossaint, Norbert Zoremba
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-60
Abstract: Four different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardized training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to assess the devices and to answer some general questions about BLS.The longest time to insertion was observed for Cobra (31.9 ± 27.9 s, range: 9-120, p < 0.0001; all means ± standard deviation). There was no significant difference between the insertion times of the other three devices. Fewest insertion attempts were needed for the FT (1.07 ± 0.26), followed by the LMA (1.23 ± 0.52, p > 0.05), the LT (1.36 ± 0.61, p < 0.05) and the Cobra (1.45 ± 0.7, p < 0.0001). Ventilation was achieved on the first attempt significantly more often with the FT (p < 0.001) compared to the other devices. Nearly 90% of the participants were in favor of implementing supraglottic airway devices in first aid algorithms and classes.Laypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered.The securing of the airway and ventilation of the lungs is of paramount importance following initial chest compressions during cardiopulmonary resuscitation (CPR). In the preclinical setting, physical contact with the patient (in particular their mouth) presents a strong deterrent to many lay responders. Disgust and fear of infection, associated with contact with bodily fluids are frequently cited as preventing immediate care [1-3]. This may coincide with a fear of incorrect mouth-to-mouth ventilation and potential malpractice consequences.To facilitate
The Impact of Thermal Modeling on Limiting RF-EMF  [PDF]
Norbert Leitgeb
Journal of Electromagnetic Analysis and Applications (JEMAA) , 2013, DOI: 10.4236/jemaa.2013.54022

The paper quantitatively assesses the relationship between specific energy absorption rates (SAR) of radio frequency (RF) electromagnetic fields (EMF) and resulting intracorporal tissue temperature changes (ΔT) at whole body exposure of a small person to resonant RF EMF. Applied thermal modeling allowed accounting also for dynamic thermoregulatory responses. As expected from physical laws the correlation of all local SAR values and ΔT data was fairly good. However, at local level SAR proved to be only weakly associated with ΔT. Even if averaged, over any 10 g tissue the ratio ΔT10g/SAR10g still varied by almost two orders of magnitudes. Blood perfusion was found to play a major role in affecting local temperature changes and caused even net cooling. The results demonstrate that local SAR is a poor surrogate for local temperature change, and that conventional static thermal modeling underestimates body core temperature. Results demonstrated that recommended reference levels of RF EMF fail to reliably prevent from exceeding yet legally binding basic restrictions not only with regard to whole-body SAR

Improved diagnosis of human joint  [PDF]
Norbert Leitgeb
Open Journal of Clinical Diagnostics (OJCD) , 2013, DOI: 10.4236/ojcd.2013.34030
Abstract: Today, among the general population the prevalence of joint disorders is increasing even at younger ages. Since therapeutic means are sparse, early awareness of potential health problems is the most important to timely start adequate prevention. The presented improved approach of acoustic joint assessment (ACOJA) is based on subsequently measured acoustic signals emitted by joints at two different mechanical load conditions with the same measurement setup, and analysing the related relative spectral signal changes. While this approach applies to almost any joint, this paper concentrates on demonstrating the capability of this approach at hip joints. It could be demonstrated that the ACOJA method is sensible enough to allow even quantification of age-related degradations at hip normal biological human joints. It allows even identifying and accounting for gender-related differences in hip joint status. This allows concluding that ACOJA will contribute to enlarge the medical possibilities of non-invasive joint diagnostics.
Synoptic Analysis of Epidemiologic Evidence of Brain Cancer Risks from Mobile Communication  [PDF]
Norbert Leitgeb
Journal of Electromagnetic Analysis and Applications (JEMAA) , 2014, DOI: 10.4236/jemaa.2014.614043
Abstract: In the radio frequency (RF) range concern about long-term health risks from electromagnetic fields (EMF) is enhanced by contradictory results and conclusions from epidemiologic studies. A new approach of a synoptic analysis of all available data from epidemiological studies published since 2001 was performed. This approach provided new insight with regard to a potential link between mobile phone use and brain cancer. Two quite different data pools could be identified with numerous studies from one research group opposing all other studies. However, it could be shown that with the number of exposed cases both data pools exhibit a clear trend of risk estimates (odds ratios) towards the final result, namely a reduced cancer risk of OR = 0.8, though from either side of the zero-risk line. The analysis of potential long-term effects indicated by a dosedependence revealed diverging results with different dose metrics. Overall, the synoptic analysis supports reassuring rather than alarming conclusions on RF EMF health risks from mobile telecommunication.
Childhood Leukemia Not Linked with ELF Magnetic Fields  [PDF]
Norbert Leitgeb
Journal of Electromagnetic Analysis and Applications (JEMAA) , 2014, DOI: 10.4236/jemaa.2014.67017

The discussion whether extremely low frequency (ELF) magnetic fields (MF) are causally linked with childhood leukemia is ongoing for almost four decades. Results of epidemiologic studies have indicated such an association might exist and led to IARC’s classification of ELF MF as possibly carcinogenic (class 2B). Although in the meanwhile many epidemiologic studies and meta-analyses of selected studies are available, this did not change the situation. By a new approach of pooling all epidemiologic data, this paper shows that it is possible to come to a convincing conclusion which explains controversial results and reports dose-response relationship, and provides answers to striking facts such as that epidemiologic results on childhood leukemia are independent from field source or exposure metric of whatever kind with no specific favorite. The analysis revealed that the assumption of a causal link between ELF MF exposure and childhood leukemia is no longer plausible and hence that ELF MF’s classification as possibly carcinogenic needs revision.

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