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Hans-Jürgen Seyfarth, Jochen Gille, Armin Sablotzki, Stefan Gerlach, Michael Malcharek, Andreas Gosse, Ralf H Gahr, Elke Czeslick
INTRODUCTION: It is known that pulmonary hypertension is associated with worse outcome in both cardiac and non-cardiac surgery. The aims of our retrospective analysis were to evaluate the outcomes of our patients with pulmonary hypertension undergoing major orthopedic surgery and to give experience-based recommendations for the perioperative management. MATERIAL AND METHODS: From 92 patients with pulmonary hypertension undergoing different kinds of surgical procedures from 2011-2014 in a tertiary academic hospital we evaluated 16 patients with major orthopedic surgery for perioperative morbidity and mortality...
2015: GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW
Michael J Malcharek, Manuel Bartz, Birgit Rogos, Lutz Günther, Armin Sablotzki, Jochen Gille, Gerhard Schneider
BACKGROUND: Two methods of topical anaesthesia for awake fibreoptic intubation (FOI) in patients at risk of secondary cervical injury were compared: the translaryngeal injection (TLI) technique and the Enk Fibreoptic Atomizer. OBJECTIVE: The objective of this study was to determine which system of topical anaesthesia provides the fastest and most comfortable awake FOI, using the oral approach. DESIGN: A randomised controlled study. SETTING: A single centre trial between 2009 and 2011...
September 2015: European Journal of Anaesthesiology
Jochen Gille, Nicole Bauer, Michael J Malcharek, Adrian Dragu, Armin Sablotzki, Hischam Taha, Elke Czeslick
Initial management of the severely injured routinely includes sedation and mechanical ventilatory support. However, nonjudiciously applied mechanical ventilatory support can itself lead to poorer patient outcomes. In an attempt to reduce this iatrogenic risk, a standardized, in-house, five-point protocol providing clinical guidance on the use and duration of ventilation was introduced and analyzed, and the impact on patient outcomes was assessed. In 2007, a protocol for early spontaneous breathing was introduced and established in clinical practice...
May 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
M J Malcharek, V Herbst, G J Bartz, A M Manceur, J Gille, G Hennig, A Sablotzki, G Schneider
BACKGROUND: A controversy exists regarding which monitoring technique is superior in cases in which general anesthesia (GA) is necessary for carotid endarterectomy (CEA). Multimodal evoked potential (mEP) monitoring was investigated under GA during CEA and compared with a historical control group undergoing neurological evaluations awake under loco-regional anesthesia (LA). METHODS: We retrospectively studied 651 patients undergoing elective CEA. In groupHISTORY (N...
October 2015: Minerva Anestesiologica
Stefanie Pilge, Matthias Kreuzer, Veliko Karatchiviev, Eberhard F Kochs, Michael Malcharek, Gerhard Schneider
BACKGROUND: It is claimed that bispectral index (BIS) and state entropy reflect an identical clinical spectrum, the hypnotic component of anaesthesia. So far, it is not known to what extent different devices display similar index values while processing identical electroencephalogram (EEG) signals. OBJECTIVE: To compare BIS and state entropy during analysis of identical EEG data. Inspection of raw EEG input to detect potential causes of erroneous index calculation...
May 2015: European Journal of Anaesthesiology
M J Malcharek, S Loeffler, D Schiefer, M A Manceur, A Sablotzki, J Gille, S Pilge, G Schneider
OBJECTIVE: This study aimed to evaluate differences in transcranial electrical motor evoked potential (tcMEP) amplitudes between desflurane/remifentanil and propofol/remifentanil anesthesia treatment plans in patients without preexisting motor deficits (PMDs) undergoing carotid endarterectomy (CEA). METHODS: This prospective trial included 21 patients who were randomly assigned to an effect group (Group(DESFLURANE); n=14) or a control group (Group(STANDARD-PROPOFOL); n=7)...
September 2015: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Michael J Malcharek, Andrea Kulpok, Vedran Deletis, Sedat Ulkatan, Armin Sablotzki, Gerd Hennig, Jochen Gille, Stefanie Pilge, Gerhard Schneider
BACKGROUND: Methods for detecting intraoperative cerebral ischemia arising from internal carotid artery (ICA) cross-clamping during carotid endarterectomy (CEA) should be sensitive, specific, and rapid to prevent intraoperative stroke. We had 3 objectives pertaining to this: (1) investigation of the rates of success of multimodal evoked potential (mEP) monitoring using a combination of median nerve (m) somatosensory (SS) EPs, tibial nerve SSEPs (tSSEPs), and transcranial electrical stimulated motor EPs (tcMEPs); (2) evaluation of the rates of false-negative mEP results; and (3) analysis of the relationship between different time periods associated with ICA cross-clamping and the postoperative outcome of motor function in patients with significant changes in mEP monitoring...
June 2015: Anesthesia and Analgesia
Jochen Gille, Armin Sablotzki, Michael Malcharek, Thomas Raff, Martin Mogk, Torsten Parentin
INTRODUCTION: For critically ill patients, the use of regional citrate anticoagulation as part of continuous renal replacement therapy (CRRT) has become increasingly common in recent years. However, there are scarce data on the use of this technique in patients with burns. The aim of this study was to examine the effectiveness, feasibility and complications of regional citrate anticoagulation for CRRT in burn patients, as well as the effects on coagulation and the electrolyte and acid-base balance...
December 2014: Burns: Journal of the International Society for Burn Injuries
Jochen Gille, Birgit Klezcewski, Michael Malcharek, Thomas Raff, Martin Mogk, Armin Sablotzki, Hischam Taha
BACKGROUND: A variety of crystalloids are available during fluid resuscitation of the severely burnt patient. There is a paucity of literature evidence on the comparative influence of these with regard to clinical outcomes. Significant differences in crystalloids may be clinically relevant given the large volumes employed during shock resuscitation. METHODS: The study compared two groups of severely burnt patients (TBSA 20-70%). Prospectively 40 consecutive patients treated with Ringer's acetate (RA group) against a retrospective control group of 40 patients treated with Ringer's lactate (RL group)...
August 2014: Burns: Journal of the International Society for Burn Injuries
Michael J Malcharek, Kai Rockmann, Ralph Zumpe, Oliver Sorge, Viktor Winter, Armin Sablotzki, Gerhard Schneider
BACKGROUND: We compared two methods of asleep fibreoptic intubation in patients at risk of secondary cervical injury: the Aintree Intubation Catheter via a classic laryngeal mask airway (cLMA) versus the Fastrach technique via the intubating laryngeal mask airway (iLMA). OBJECTIVE: To test which system has the highest rate of successful intubations in the clinical setting. DESIGN: A randomised controlled study. SETTING: Single-centre, between 2007 and 2010...
March 2014: European Journal of Anaesthesiology
M J Malcharek, S Ulkatan, V Marinò, M Geyer, E Lladó-Carbó, G Perez-Fajardo, B Arranz-Arranz, J Climent, F Aloj, E Franco, L Chiacchiari, A Kulpok, A Sablotzki, G Hennig, V Deletis
OBJECTIVE: This study was to investigate the utility of motor evoked potential monitoring elicited by transcranial electrical stimulation (tcMEP) during CEA in addition to the established median nerve somatosensory evoked potentials (mSSEPs). METHODS: We retrospectively reviewed data from 600 patients undergoing CEA under general anesthesia with monitoring of mSSEPs and tcMEPs in a multicenter study. MSSEP and tcMEP parameters were recorded during internal carotid artery (ICA) cross clamping and compared with the postoperative motor outcome, demographic and patient history data...
May 2013: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Jochen Gille, Hans-Jürgen Seyfarth, Stefan Gerlach, Michael Malcharek, Elke Czeslick, Armin Sablotzki
Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in noncardiac surgical procedures. Patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty units involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intraoperative management should focus on avoiding all circumstances that could contribute to exacerbating pulmonary hypertension (hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia)...
2012: Anesthesiology Research and Practice
Michael Joerg Malcharek, Birgit Rogos, Stefan Watzlawek, Oliver Sorge, Armin Sablotzki, Jochen Gille, C Philip Larson
BACKGROUND: This study was designed to document the feasibility of self-positioning after awake fiberoptic intubation of the trachea using primarily effective topical anesthesia rather than sedation. METHODS: We investigated 14 patients (ASA physical status 1 to 3) with a neurosurgical diagnosis of cervical instability or at risk of secondary cervical injury, who were scheduled for awake fiberoptic intubation and self-positioning prone. Topical anesthesia was accomplished using an oropharyngeal spray of lidocaine alone or in combination with a transtracheal injection of lidocaine for awake fiberoptic intubation and self-positioning prone...
July 2012: Journal of Neurosurgical Anesthesiology
Michael Jörg Malcharek, Janett Landgraf, Gerd Hennig, Oliver Sorge, Juliane Aschermann, Armin Sablotzki
OBJECTIVE: The reliability of intra-operative recordings of trigeminal scalp-induced somatosensory-evoked potentials (T-SSEP) is controversial. This investigation aimed to provide evidence that T-SSEP recordings are stable using standardised neurophysiological methodology and anaesthesiological regime. METHODS: We investigated 99 patients undergoing carotid endarterectomy under total intravenous anaesthesia (propofol/remifentanil infusion). Long-latency T-SSEPs were recorded from the scalp after simultaneously stimulating 2nd and 3rd branches of the trigeminal nerve...
May 2011: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Christian Schachtrup, Stefan Malcharek, Jack J Haitsma, Burkhard Lachmann, Yuji Owada, Bert Binas, Hisatake Kondo, Bernd Rüstow, Hans-Joachim Galla, Friedrich Spener
Lung surfactant is a lipid-protein-film covering the inner alveolar surface. We have previously shown that double knock-out (d-ko) mice lacking both the epidermal-type (E-) and the heart-type (H-) fatty acid binding protein (FABP) exhibit a defect of surfactant synthesis in alveolar type II cells that can be corrected by feeding pioglitazone, a drug that activates peroxisome proliferator-activated receptor gamma (PPARgamma). Here, we demonstrate first that healthy surfactant at collapse pressure produces protrusions composed of bilayers but not folds, second that the d-ko effect profoundly perturbs lipid/hydrophobic protein composition, pressure-area isotherm, and structural organisation of the surfactant at nanoscale, parameters that are critical for the normal breathing cycle...
June 2008: Biochimica et Biophysica Acta
Ulrich Altrup, Marc Häder, José Luis Hernández Cáceres, Stefan Malcharek, Michaela Meyer, Hans-Joachim Galla
Mechanisms of epileptiform activity in a model nervous system (buccal ganglia of Helix pomatia) are presented. The ganglia contain the identified giant neurons B1 through B4. For epileptiform activity, pentylenetetrazol (1 mmol/L to 40 mmol/L) or etomidate (12.5 micromol/L to 500 micromol/L) were applied. Membrane pressure was measured using a Wilhelmy film balance. In electrophysiological experiments, both drugs induced several effects in all studied neurons: membrane resistance increased, down-stroke of action potentials declined, and all types of chemical synaptic potentials decreased (the latter concerns pentylenetetrazol only)...
November 29, 2006: Brain Research
Stefan Malcharek, Andreas Hinz, Lutz Hilterhaus, Hans-Joachim Galla
The influence of cholesterol and POPE on lung surfactant model systems consisting of DPPC/DPPG (80:20) and DPPC/DPPG/surfactant protein C (80:20:0.4) has been investigated. Cholesterol leads to a condensation of the monolayers, whereas the isotherms of model lung surfactant films containing POPE exhibit a slight expansion combined with an increased compressibility at medium surface pressure (10-30 mN/m). An increasing amount of liquid-expanded domains can be visualized by means of fluorescence light microscopy in lung surfactant monolayers after addition of either cholesterol or POPE...
April 2005: Biophysical Journal
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