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  • 1
    Electronic Resource
    Electronic Resource
    Minimum local analgesic dose of plain ropivacaine vs. ropivacaine combined with sufentanil during epidural analgesia for labour (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 56 (2001), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We have used the up-and-down allocation technique to assess the relative analgesic potencies of epidural ropivacaine alone and ropivacaine combined with sufentanil 0.75 µg.ml−1 in 42 women requesting epidural analgesia in the first stage of labour. Parturients were randomly allocated to one of the two epidural solutions in a double-blind manner. The concentration of local anaesthetic was determined by the response of the previous parturient: an effective concentration (pain ≤ 10 mm on a 10-cm visual analogue pain score within 30 min) resulted in a 0.01% decrease in the concentration of ropivacaine for the next parturient, an ineffective concentration resulted in a 0.01% increase. Minimum local analgesic concentration of ropivacaine alone was 0.13% (95% CI 0.12–0.13%) compared with 0.09% (95% CI 0.08–0.1%) for ropivacaine with sufentanil (p 〈 0.00001).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2001.02050.x
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  • 2
    Electronic Resource
    Electronic Resource
    Impact of a multimodal anti-emetic prophylaxis on patient satisfaction in high-risk patients for postoperative nausea and vomiting (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Postoperative nausea and vomiting (PONV) are frequent and unpleasant symptoms. This prospective study aimed to assess the efficacy of a multimodal approach to prevent PONV, and patient satisfaction using the willingness-to-pay method. Two validated risk scores were applied to forecast the individual risk for PONV in 900 consecutive patients of whom 108 were identified as high-risk patients (predicted risk: 79–87%). High-risk patients received multimodal anti-emetic prophylaxis: total intravenous anaesthesia with propofol, high fractional inspired oxygen (80%), omission of nitrous oxide, dexamethasone 8 mg, haloperidol 10 µg.kg−1, and tropisetron 2 mg. Of the remaining patients with low or moderate risk for PONV, a random sample of 71 females received balanced propofol-desflurane anaesthesia without prophylactic anti-emetics. All patients were interviewed 2 and 24 h after surgery for occurrence of nausea and vomiting. Patient satisfaction was measured using the willingness-to-pay method. The incidence of PONV (95%-confidence interval) in the control-group was 41% (29–51%), slightly lower than predicted by the risk scores (53–57%). The multimodal anti-emetic approach reduced the predicted risk (79–87%) in the high risk-group to 7% (3–14%). This was associated with a high willingness-to-pay median (25th/75th percentile) of £84 (£33–184) in the multimodal anti-emetic grouped compared to £14 (£4–30) in the control group. A multimodal anti-emetic approach can considerably reduce the incidence of PONV in high-risk patients and is associated with a high patient satisfaction as measured by the willingness-to-pay method.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2002.02822.x
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  • 3
    Electronic Resource
    Electronic Resource
    The pharmacokinetics of caudal ropivacaine 0.2% in children (2000)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 55 (2000), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study evaluates the pharmacokinetics of ropivacaine in children after caudal epidural injection. Twenty male children undergoing inguinal hernia repair were enrolled after ethics committee approval and informed parental consent, and were grouped according to age (10 ‘infants’ aged less than 1 year and 10 ‘toddlers’ aged 1–5 years). After induction of general anaesthesia, caudal epidural injection using ropivacaine 0.2% 1 ml.kg−1 was performed. Plasma concentrations of ropivacaine in the first 2 h after injection were determined by reversed-phase high-pressure liquid chromatography. Caudal blockade with ropivacaine 2 mg.ml−1 resulted in mean (SD) peak plasma concentrations of 0.73 [0.27]µg.ml−1 in infants and 0.49 [0.21]µg.ml−1 in toddlers (p 〈 0.01). Maximum plasma concentrations occurred after a median [range] period of 60 [15–90] min and 52.5 [30–120] min in infants and toddlers, respectively. Two infants (weighing 3.8 and 5.0 kg) showed the highest individual maximum plasma concentrations: 1.31 and 1.11 µg.ml−1. No clinical signs of local anaesthetic toxicity were observed. The results of the present investigation suggest that, from a pharmacokinetic point of view, caudal blockade using ropivacaine 0.2% 1 ml.kg−1 can be regarded as a safe technique in children, i.e. in infants as well as in toddlers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2000.01537.x
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  • 4
    Electronic Resource
    Electronic Resource
    The molecular determinants of sunburn cell formation (2001)
    Copenhagen : Munksgaard International Publishers
    Experimental dermatology 10 (2001), S. 0 
    Details
    ISSN: 1600-0625
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Sunburn cell (SBC) formation in the epidermis is a characteristic consequence of ultraviolet radiation (UVR) exposure at doses around or above the minimum erythema dose. SBC have been identified morphologically and biologically as keratinocytes undergoing apoptosis. There is evidence that SBC formation is a protective mechanism to eliminate cells at risk of malignant transformation. The level of DNA photodamage is a major determinant of SBC induction by a process controlled by the tumor suppressor gene p53. However, extra-nuclear events also contribute to SBC formation, such as the activation of death receptors including CD95/Fas. UVR triggers death receptors either by direct activation of these surface molecules or by inducing the release of their ligands such as CD95 ligand or tumor necrosis factor. Oxidative stress also appears to be involved, probably via mitochondrial pathways, resulting in the release of cytochrome C. Pathways which modify SBC formation are now extensively studied given the importance of apoptosis in eliminating irreparably damaged cells. A greater understanding of the mechanisms that induce and prevent UVR-induced apoptosis will contribute to our understanding of mechanisms relevant in genomic integrity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1034/j.1600-0625.2001.010003155.x
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  • 5
    Electronic Resource
    Electronic Resource
    Ist die Inzidenz postoperativen Erbrechens abhängig vom operativen Eingriff? Erwiderung auf einen Leserbrief in Der Anaesthesist (2000) 49:227–229 (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 911-912 
    Details
    ISSN: 1432-055X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070048
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  • 6
    Electronic Resource
    Electronic Resource
    Stellvertreterentscheidungen in Gesundheitsfragen und Vorausverfügungen von Patienten Eine praxisorientierte Übersicht zu rechtlichen und ethischen Problemen bei der Behandlung nicht einwilligungsfähiger Personen (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 657-674 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Behandlungseinwilligung ; Stellvertreterentscheidungen in Gesundheitsfragen ; Betreuungsrecht ; Epidemiologisch-pragmatische Probleme ; Patientenverfügungen ; Ethik in der Medizin ; Key words Informed consent ; Surrogate decision-making in health care ; Durable power of attorney ; Epidemiologic and pragmatic problems ; ;Advance directives ; Medical ethics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Except in emergencies, the medical treatment of incompetent patients also has to be based upon an informed consent between the physician and a legitimated legal representative (durable power of attorney). Consequently, the German ‘Betreuungsrecht’ advices persons to designate in advance such a proxy or surrogate. However, an additional court-decision is demanded, if a medical measure poses significant risks for the future health or the life of the incompetent patient. On the base of the available epidemiologic data we illustrate that neither our medical nor our legal system could realistically cope with the practical consequences of this legislation: The vast majority of our present decisions in such cases is not covered by a legally valid informed consent, which implies possible forensic consequences. This article provides relevant clinical and legal advice on how to protect the legitimate interests of all concerned within the present framework, which should urgently be revised.
    Notes: Zusammenfassung Elektive Heileingriffe bei nicht-einwilligungsfähigen Patienten bedürfen einer rechtswirksamen Einwilligung, die im Allgemeinen bei einem hierzu ausdrücklich legitimierten Stellvertreter einzuholen ist. Daher empfiehlt auch das deutsche Betreuungsrecht, durch eine Vorausverfügung einen Betreuer oder Vorsorgebevollmächtigten für den Fall der eigenen Einwilligungsunfähigkeit zu benennen. Zusätzlich wird jedoch auch eine vormundschaftsgerichtliche Genehmigung gefordert, wenn “die begründete Gefahr besteht, dass der Betreute aufgrund der Maßnahme stirbt oder einen schweren und länger dauernden gesundheitlichen Schaden erleidet”. Auf Grundlage der verfügbaren epidemiologischen Daten belegen wir, dass diese gesetzliche Vorgabe weder im Bereich der Justizverwaltungen und Gerichte noch der Medizin praktisch realisierbar ist: Die große Mehrheit entsprechender Therapieentscheidungen ist daher in Deutschland derzeit nicht durch rechtswirksame Einwilligungen gedeckt – mit potentiell weitreichenden forensischen Konsequenzen. Dieser Artikel gibt klinische und juristische Hinweise, wie die legitimen Interessen aller Beteiligten derzeit am ehesten gewahrt werden können. Die momentane Rechtslage sollte dringend reformiert werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070083
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