105 results on '"Heier T"'
Search Results
2. Alfentanil during rapid sequence induction with thiopental 4 mg/kg and rocuronium 0.6 mg/kg: tracheal intubation conditions
- Author
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Abou-Arab, M. H., Feiner, J. R., Spigset, O., and Heier, T.
- Published
- 2015
- Full Text
- View/download PDF
3. Control of a mechatronic adaptive engine mount - implemantation and results
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Heier, T. and Bertram, T.
- Published
- 2010
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4. Sex-related differences in the relationship between acceleromyographic adductor pollicis train-of-four ratio and clinical manifestations of residual neuromuscular block: a study in healthy volunteers during near steady-state infusion of mivacurium
- Author
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Heier, T., Feiner, J. R., Wright, P. M. C., Ward, T., and Caldwell, J. E.
- Published
- 2012
- Full Text
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5. Opioids and rapid-sequence induction
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El-Orbany, M., Abou-Arab, M. H., Heier, T., and Caldwell, J. E.
- Published
- 2007
6. Dose of alfentanil needed to obtain optimal intubation conditions during rapid-sequence induction of anaesthesia with thiopentone and rocuronium
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Abou-Arab, M. H., Heier, T., and Caldwell, J. E.
- Published
- 2007
7. The effect of different doses of alfentanil on the intubation conditions during rapid sequence induction with thiopental and rocuronium: 123
- Author
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Abou-Arab, M and Heier, T
- Published
- 2005
8. Rocuronium and cisatracurium-positive skin tests in non-allergic volunteers: determination of drug concentration thresholds using a dilution titration technique
- Author
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BERG, C. M., HEIER, T., WILHELMSEN, V., and FLORVAAG, E.
- Published
- 2003
9. Double-blind comparison of the variability in spontaneous recovery of cisatracurium- and vecuronium-induced neuromuscular block in adult and elderly patients
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Pühringer, F. K, Heier, T, Dodgson, M, Erkola, O, Goonetilleke, P, Hofmockel, R, Gaetke, M. R, Mortensen, C. R, Upadhyaya, B, and Eriksson, L. I
- Published
- 2002
10. Does discontinuation of desflurane at the time of neostigmine administration speed recovery from cisatracurium block compared to that with a propofol-based technique?
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Kirkegaard-Nielsen, H., Caldwell, J. E., Abengochea, A., Berry, P. D., and Heier, T.
- Published
- 2001
11. Anaphylactic reactions during induction of anaesthesia using rocuronium for muscle relaxation: A report including 3 cases
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Heier, T. and Guttormsen, A. B.
- Published
- 2000
12. A comparison of train-of-four monitoring: Mechanomyography at the thumb vs acceleromyography at the big toe
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Heier, T. and Hetland, S.
- Published
- 1999
13. 1 MAC-incision sevoflurane prevents explicit awareness during surgical skin incision and tracheal intubation
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Mollestad, K. E., Heier, T., Steen, P. A., and Raeder, J. C.
- Published
- 1998
14. Awareness in anaesthesia: Incidence, consequences and prevention
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Heier, T. and Steen, P. A.
- Published
- 1996
15. Assessment of anaesthesia depth
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Heier, T. and Steen, P. A.
- Published
- 1996
16. Influence of N-fertilization and Fungicide Strategies on Fusarium Head Blight Severity and Mycotoxin Content in Winter Wheat
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Heier, T., primary, Jain, S. K., additional, Kogel, K.-H., additional, and Pons-Kuhnemann, J., additional
- Published
- 2005
- Full Text
- View/download PDF
17. A comparison of train-of-four monitoring: Mechanomyography at the thumb vs acceleromyographyat the big toe
- Author
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Heier, T., primary and Hetland, S., additional
- Published
- 1999
- Full Text
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18. MILD HYPOTHERMIA ALTERS THE PHARMACOKINETICS BUT NOT THE PHARMACODYNAMICS OF VECURONIUM
- Author
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Heier, T., primary, Caldwell, J. E., additional, McCarthy, G., additional, Lin, S., additional, Szenohradszky, J., additional, Sharma, M. L., additional, Gruenke, L. D., additional, Schroeder, M., additional, Sessler, D. I., additional, and Miller, R. D., additional
- Published
- 1994
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19. Safety and efficacy of sugammadex for the reversal of rocuronium-induced neuromuscular blockade in cardiac patients undergoing noncardiac surgery.
- Author
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Dahl V, Pendeville PE, Hollmann MW, Heier T, Abels EA, Blobner M, Dahl, Vegard, Pendeville, Philippe E, Hollmann, Markus W, Heier, Tom, Abels, Esther Am, and Blobner, Manfred
- Abstract
Background and Objective: The present randomized, safety-assessor blinded, placebo-controlled trial was designed to assess safety and efficacy of sugammadex, a novel selective relaxant-binding agent, in patients with underlying cardiovascular disease undergoing noncardiac surgery.Methods: Overall, 116 patients (New York Heart Association class II-III) were randomized and received sugammadex 2.0 mg kg (n = 38), sugammadex 4.0 mg kg (n = 38) or placebo (n = 40) for reversal of rocuronium-induced neuromuscular blockade at reappearance of T2. Safety variables included heart rate, blood pressure and electrocardiogram characteristics, including rate-corrected QT (QTc Fridericia and QTc Bazett) interval. Efficacy was evaluated as time to recovery of the T4/T1 ratio to 0.9 after administration of sugammadex or placebo.Results: There were no significant differences between groups in terms of QTc (Fridericia) interval. Three serious adverse events, one in each treatment group, considered to be possibly drug-related according to the investigator, were cases of mild QTc (Bazett) interval prolongation. Blood pressure and heart rate decreased after initiation of anaesthesia and remained stable in all groups up to 10 min after administration of study drug. Blood pressure was significantly higher (P < 0.05) in both sugammadex dose groups compared with placebo at 30 min. The decrease in heart rate from baseline (prestudy drug) was significantly greater in the 2.0 mg kg sugammadex group at 2 and 5 min, and, for both sugammadex groups, the increase at 30 min was greater compared with placebo. Both sugammadex doses resulted in considerably shorter time to recovery of the T4/T1 ratio to 0.9 compared with placebo.Conclusion: The findings indicate sugammadex 2.0 and 4.0 mg kg can be given safely and effectively for the reversal of rocuronium-induced neuromuscular blockade in patients with cardiovascular disease undergoing noncardiac surgery. [ABSTRACT FROM AUTHOR]- Published
- 2009
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20. Impact of hypothermia on the response to neuromuscular blocking drugs.
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Heier T, Caldwell JE, Heier, Tom, and Caldwell, James E
- Published
- 2006
21. A861 VASOCONSTRICTION AND VECURONIUM NEUROMUSCULAR BLOCKADE IN HUMANS
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Heier, T., primary, Sessier, D. I., additional, Caldwell, J. E., additional, and Miller, R. D., additional
- Published
- 1990
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22. THE NEUROMUSCULAR EFFECTS OF DESFLURANE (I-653) IN HUMAN VOLUNTEERS
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Caldwell, J E, primary, Laster, M J, additional, Heier, T, additional, Eger, E I, additional, Weiskopf, R B, additional, and Miller, R D, additional
- Published
- 1990
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23. MILD INTRAOPERATIVE HYPOTHERMIA INCREASES DURATION OF ACTION AND RECOVERY TIME OF VECURONIUM
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Heier, T, primary, Caldwell, J E, additional, Sessler, D I, additional, and Miller, R D, additional
- Published
- 1990
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24. Efficacy of tactile-guided reversal from cisatracurium-induced neuromuscular block.
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Kirkegaard H, Heier T, Caldwell JE, Kirkegaard, Hans, Heier, Tom, and Caldwell, James E
- Published
- 2002
25. Hemoglobin desaturation after succinylcholine-induced apnea: a study of the recovery of spontaneous ventilation in healthy volunteers.
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Heier, T, Feiner, J R, Lin, J, Brown, R, and Caldwell, J E
- Published
- 2001
26. The relationship between adductor pollicis twitch tension and core, skin, and muscle temperature during nitrous oxide-isoflurane anesthesia in humans.
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Heier, T, Caldwell, J E, Sessler, D I, Kitts, J B, and Miller, R D
- Published
- 1989
27. Atracurium Compared with Suxamethonium for Outpatient Laparoscopy
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Dodgson, M.S., primary, Heier, T., additional, and Steen, P.A., additional
- Published
- 1986
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28. INTRAOPERATIVE THERMOREGULATORY VASOCONSTRICTION DECREASES ADDUCTOR POLLICIS MUSCLE TEMPERATURE; ADDUCTOR POLLICIS MUSCLE COOLING DECREASES TWITCH TENSION
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Heier, T, primary, Kitts, J B, additional, FFARCS, JE Caldwell, additional, Sessler, D I, additional, and Miller, R D, additional
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- 1988
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29. LOCAL COOLING DECREASES ADDUCTOR POLLICIS TWITCH TENSION DURING NITROUS OXIDE-ISOFLURANE ANESTHESIA IN HUMANS
- Author
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Heier, T, primary, Caldwell, J E, additional, Sessler, D I, additional, and Miller, R D, additional
- Published
- 1989
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30. PHARMACOKINETICS OF ATRACURIUM IN ELDERLY AND YOUNG ADULTS
- Author
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Kitts, J B, primary, Fisher, D M, additional, Canfell, P C, additional, Spellman, M J, additional, FFARCS, JE Caldwell, additional, Heier, T, additional, and Miller, R D, additional
- Published
- 1988
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31. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study
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Kirmeier E. a, Eriksson L. I. c, Lewald H. a, Jonsson Fagerlund, M. c Hoeft, A. f Hollmann, M. g Meistelman, C. e Hunter, J. M. d Ulm, K. b Blobner, M. aEmail Author, Abad Gurumeta, A. Abernethy, C. Abigail, P. Achaibar, K. Adam, E. Afshari, Agudelo Montoya, M. E. Akgün, F. N. Aletti, G. Alkış, N. Allan, K. Allan, A. Allaouchiche, B. Allcock, C. Almasy, E. Amey, I. Amigoni, M. Andersen, E. Andersson, P. Anipchenko, N. Antunes, P. Armstrong, E. Aslam, T. N. Aslin, B. Assunção, J. P. Ausserer, J. Avvai, M. Awad, Ayas Montero, B. Ayuso, M. Azevedo, P. Badarau, V. Badescu, Baiardo Redaelli, M. Baird, C. Baird, Y. Baker, T. Balaji, P. Bălan, C. Balandin, A. Balescu-Arion, C. Baliuliene, Baltasar Isabel, J. Baluch, S. N. Bandrabur, D. Bankewitz, C. Barber, K. Barbera, F. Barcraft-Barnes, H. Barletti, V. Barnett, G. Baron, K. Barros, A. Barsan, V. Bartlett, P. Batistaki, C. Baumgarten, G. Baytas, V. Beauchamp, Becerra Cayetano, I. A. Bell, S. Bellandi, M. Belletti, Belmonte Cuenca, J. Benitez-Cano, A. Beretta, L. Berger, M. Bergmann, N. Bergmark, Bermudez Lopez, M. Bernotaite, M. Beurskens, C. Bidd, H. Bifulco, F. Bignami, E. Bilic, A. Bilskiene, D. Bischoff, P. Bishop, L. Bjonness, T. Blaylock, H. Blethyn, K. Blincoe, T. Blokhin, I. Blunt, N. Boer, C. Bois, G. Bonicolini, E. Booth, J. Borecka-Kedzierska, M. Borstnar, K. Borys, M. Boselli, E. Bouvet, L. Bouwman, A. Bowen, L. Bowrey, S. Boxall, L. Božić, T. Bradley, T. Branco, T. Brazzi, L. Brazzoni, M. Brear, T. Brogly, N. Brohi, F. Broms, J. Bubliauskas, A. Bucolo, G. E. Buerkle, H. Buggy, D. Buhre, W. Bukauskas, T. Butturini, F. Byttner, Cabrera Díaz, I. Calderon, A. Calhau, R. Callejo, A. Cammu, G. Campesato, M. Can, Ö. S. Candeias, M. Cantor, A. Carise, E. Carmona, C. Carreteiro, J. Carrieri, C. Carter, A. Casal, M. Casanova, I. Cascella, M. Casero, L. M. Casiraghi, G. M. Castelo-Branco, Castro Arranz, C. Cernea, D. D. Cervantes, J. Chandler, B. Charnock, R. Chatzimicali, A. Chinery, E. Chishti, A. Chondhury, P. Christie, E. Christodoudiles, G. Ciardo, S. Cimpeanu, L. Cindea, I. Cinnella, G. Clark, S. Clayton, M. Cocu, S. Collyer, T. Colvin, C. Cope, S. Copeta, F. Copotoiu, S. -M., Correia de Barros, F. Corso, R. M. Cortegiani, A. Costa, G. Cowton, A. Cox, N. Craig, J. Cricca, V. Cronin, J. Cunha, M. Cuomo, A. Curley, K. Czuczwar, M. Dabrowska, D. Damster, Danguy des Déserts, M. Daniliuc, A. Danninger, T. Darwish, I. Dascalu, C. Davies, K. Davies, De Boer, De Flaviis, De Selincourt, G. Deana, C. Debaene, B. Debreceni, G. Dedhia, Delgado Garcia, Della Rocca, G. Delroy-Buelles, L. Desai, T. Dhillon, Di Giacinto, Di Mauro, Diaz Gomez, T. V. Dimitrovski, A. Dinic, V. Dîrzu, D. -S., Divander M. B., Dolinar J., Domingues S., Doolan J., Downes C., Dragoescu N. A., Droc G., Dum E., Dumitrescu A., Duncan L., Dzurňáková P., Eberl S., Edwards J., Edwards M., Ekelund K., Ekengren P., Elghouty E., Ellerkmann R., Ellis H., Elme A., Ernst T., Errando C. L., Estenes S., Ewaldsson C., Farid N., Featherstone J., Febres D., Fedorov S., Feggeler J., Feijten P., Fellmann T., Fernandez Candil, Fernandez Castineira, Fernández Castineira, J. Fernando, A. Ferrando, C. Ferreira, L. Ferreira, P. Feyling, A. Filipescu, D. Fleischer, A. Floris, L. Foerster, U. Fox, B. Franke, U. Frasca, D. Frey, C. Frost, V. Fullin, G. Fumagalli, J. Furneval, J. Fusari, M. Gallacher, S. Galushka, S. Gambale, G. Gambino, I. Garcia-Perez, M. L. Garg, S. Garlak, J. Gavranovic, Z. Gavrilov, R. Gaynor, Gecaj Gashi, A. Georghiou, M. Gerjevic, B. Gferer, G. Giarratano, A. Gibson, A. Gievski, V. Giles, J. Gillberg, L. Gilowska, Gilsanz Rodriguez, F. Gioia, A. Giovannoni, C. Girotra, V. Gkinas, D. Gkiokas, G. Godoroja, D. Goebel, U. Goel, V. Gonzalez, M. Goranovic, T. Gornik-Wlaszczuk, E. Gosavi, S. Gottfridsson, P. Gottschalk, A. Granell, M. Granstrom, A. Grassetto, A. Greenwood, A. Grigoras, I. Grintescu, I. Gritsan, A. Gritsan, G. Grynyuk, A. Guadagnin, G. M. Guarnieri, M. Güçlü, Guerrero Diez, M. Gunenc, F. Günther, U. Gupta, P. Guttenthaler, V. Hack, Y. Hafisayena, A. Hagau, N. Haldar, J. Hales, D. Hancı, V. Hanna-Jumma, S. Harazim, H. Harlet, P. Harper, D. Harris, B. Harvey, O. Hashimi, M. Hawkins, L. Hayes, C. Heaton, J. Heier, T. Helliwell, L. Hemmes, S. Henderson, K. Hermanides, J. Hermanns, Herrera Hueso, B. Hestenes, S. Hettiarachchi, R. Highgate, J. Hodgson, K. Hoelbling, D. Holland, J. Horhota, L. Hormis, A. Hribar, R. Hua, A. Humphreys, S. Humphries, R. Humpliková, S. Hunt, J. Husnain, A. Hussein, A. Hyams, B. Iannuccelli, F. Ilette, K. Ilyas, C. Inan, T. India, I. Ionițăv, V. Irwin, F. Jain, V. Janez, B. Jankovic, R. Jenkins, S. Jenko, M. Jimenez, Jiménez Gomez, B. Joachim, S. Joelsson-Alm, E. John, J. Jonikaite, L. Jovic, M. Jungwirth, B. Junke, E. Kabakov, B. Kadaoui, S. -D., Kanski A., Karadag S., Karbonskiene A., Karjagin J., Kasnik D., Katanolli F., Katsika E., Kaufmann K., Keane H., Kelly M., Kent M., Keraitiene G., Khudhur A., Khuenl-Brady K., Kidd L., King S., Kirchgäßner K., Klancir T., Klucniks A., Knotzer J., Knowlden P., Koers L., Kompan J., Koneti K. K., Kooij F., Koolen E., Koopman - van Gemert, A. W. M. M. Kopp, K. Korfiotis, D. Korolkov, O. Kosinová, M. Köstenberger, M. Kotzinger, O. Kovačević, M. Kranke, P. Kranke, E. Kraus, C. Kraus, S. Kubitzek, C. Kucharski, R. Kucukguclu, S. Kudrashou, A. Kumar, V. Kummen, L. Kunit, C. Kushakovsky, V. Kuvaki, B. Kuzmanovska, B. Kyttari, A. Landoni, G. Lau, G. Lazarev, K. Legett, S. Legrottaglie, A. M. Leonardi, S. Leong, M. Lercher, H. Leuvrey, M. Leva, B. Levstek, M. Limb, J. Lindholm, E. Linton, F. Liperi, C. Lipski, F. Lirk, P. Lisi, A. Lišková, Lluch Oltra, A. Loganathan, V. Lombardi, S. Lopez, Lopez Rodríguez, M. Lorenzini, L. Lowicka, M. Lugovoy, A. Luippold, M. Lumb, A. Macas, A. Macgregor, M. Machado, H. Maciariello, M. Madeira, I. Maitan, S. Majewski, J. Maldini, B. Malewski, G. Manfredini, L. Männer, O. Marchand, B. Marcu, A. Margalef, J. Margarson, M. Marinheiro, L. Markic, Markovic Bozic, J. Marrazzo, F. Martin, Martin Ayuso, M. Martinez, E. Martino, E. A. Martinson, V. Marusic-Gaser, K. Mascarenhas, C. Mathis, C. Matsota, P. Mavrommati, Mazul Sunko, B. McCourt, K. McGill, N. McKee, R. Meço, B. C. Meier, S. Melbourne, S. Melbybråthen, G. Meli, A. Melia, A. Melotti, R. M. Menga, M. R. Mercer, P. Merotra, S. Mescolini, S. Metterlein, T. Michalov, M. Michlig, S. Midgley, S. Milić, M. Milojevic, M. Miñana, A. Minto, G. Mirabella, L. Mirea, L. Mittelstädt, L. Moeglen, A. Moise, A. Mokini, Z. Molin, A. Moltó, L. Monea, M. C. Montalto, F. Montgomery, J. Montgomery, C. Montillo, G. Moore, S. Moore, F. Moreira, Z. Moreno, T. Moreno, R. Moret, E. Moreton, S. Morgan, Moro Velasco, C. Morri, D. Moull, A. Moura, F. Mráz, P. Mrozek, K. Mukhtar, K. Muniyappa, S. Murray, H. Murthy, B. V. Mushambi, M. Nadolski, M. Nardelli, P. Nardin, Navarro Pérez, R. Naveiro, A. Negri, Nesek Adam, V. Neskovic, V. Neuwersch, S. Neves, M. Nguyen, Ní Eochagáin, A. Nicholas, C. Nightingale, J. Norrie, K. Novak-Jankovic, V. Novakova, A. Novillo, M. Numan, S. Oduro-Dominah, L. Oldner, A. Oliveira, I. Ologoiu, D. Oloktsidou, I. O'Reilly, R. Orlando, A. Ovezov, A. Ozbilgin, S. Paal, Padin Barreiro, L. Palugniok, R. Papaioannou, A. Papapostolou, K. Paranthaman, Pardey Bracho, G. Parente, S. Parfeni, A. Pasin, L. Passey, S. Pastor, E. Patch, S. Patil, A. Paunescu, M. -A., Pehboeck D., Pereira M., Pereira C., Perez Caballero, Pérez García, Pérez Soto, Perez Tejero, G. Perez-Cerda, F. Pesenti, A. Petta, R. Philippe, S. Pickering, Pico Veloso, J. Pina, P. Pinho-Oliveira, V. Pinol, S. Pinto, R. Pistidda, L. Pitterle, M. Piwowarczyk, P. Plotnikova, O. Pohl, H. Poldermann, J. Polkovicová, L. Pompei, L. Popescu, M. Popović, Pota V, Potocnik M., Potręć B., Potter A., Pramod N., Prchalova M., Preckel B., Pugh R., Pulletz M., Radoeshki A., Rafi A., Ragazzi R., Raineri Santi, M. Rajamanickam, T. Rajput, Z. Ramachandran, R. Ramasamy, R. Ramessur, S. Rao, R. Rasmussen, A. Rato, A. Razaque, Real Navacerrada, M. I. Reavley, C. Reid, J. Reschreiter, H. Rial, Ribas Carrasco, P. Ribeiro, S. Rich, N. Richardson, L. Rimaitis, K. Rimaitis, M. Ringvold, E. -M., Ripke F., Ristescu I., Ritchie K., Ródenas F., Rodrigues P., Rogers E., Rogerson D., Romagnoli S., Romero E., Rondovic G., Rose B. O., Roth W., Rotter, M. -T., Rousseau G., Rudjord A., Rueffert H., Rundgren M., Rupprecht K., Rushton A., Russotto V., Rypulak E., Ryszka M., Sà J., Sà Couto, P. Saby, S. Sagic, J. Saleh, O. Sales, Sánchez Sánchez, Y. Sanghera, Şanli Karip, Santiveri Papiol, F. J. Santos, S. Sarno, S. Saul, D. Saunders, D. Savic, N. Scalco, L. Scanlon, D. Schaller, S. Schax, C. Scheffer, G. J. Schening, A. Schiavone, V. Schmidt-Ehrenberg, F. Schmidt-Mutter, C. Schönberg, C. Schopflin, C. Schreiber, J. -U., Schultz M., Schurig M., Scott C., Sebestian S., Sehgal S., Sem V., Semenas E., Serafini E., Serchan P., Shields M., Shobha R., Shosholcheva M., Siamansour T., Siddaiah N., Siddiqi K., Sinclair R., Singh P., Singh R., Sinha A., Skinner A., Smee E., Smekalova O., Smith N., Smith T., Smitz C., Smole D., Sojčić N., Soler Pedrola, M. Somanath, S. Sonksen, J. Sorella, M. C. Sörmus, A. Soro, M. Soto, C. Spada, A. Spadaro, S. Spaeth, J. Sparr, H. Spielmann, A. Spindler-Vesel, A. Stamelos, Stancombe L, L. Stanculescu, A. Standl, T. Standley, T. Stanek, O. Stanisavljević, S. Starczewska, M. Stäuble, C. Steen, J. Stefan, O. M. Stell, E. Stera, C. Stevens, M. Stoerckel, M. Stošić, B. Stourac, P. Stroumpoulis, K. Struck, Suarez de la Rica, A. Sultanpori, Sundara Rajan, R. Suying, O. Svensen, C. Swan, L. Syrogianni, P. Sysiak, J. Szederjesi, J. Taddei, Tan Hao, E. Tanou, V. Tarabová, Tardaguila Sancho, P. Tarroso, M. Tartaglione, M. Taylor, E. Tbaily, L. Telford, R. Terenzoni, M. Theodoraki, K. Thornley, H. Tiganiuc, L. Toim, H. Tomescu, D. Tommasino, C. Toni, J. Toninelli, A. Toretti, I. Townley, S. Trepenaitis, D. Trethowan, B. Tsaousi, G. Tsiftsi, A. Tudor, A. Turan, G. Turhan, S. Ç. Unic-Stojanovic, D. Unterbuchner, C. Unzueta, C. Uranjek, J. Ursic, T. Vaida, Valldeperas Ferrer, Valldeperas Hernandez, M. I. Valsamidis, Van Beek, Van dasselaer, Van Der Beek, Van Duivenvoorde, van Klei, W. A., Van Poorter, Van Zaane, Van Zundert, Van Zyl, Vargas Munoz, A. M. Varsani, N. Vasconcelos, P. Vassilakis, G. Vecchiatini, T. Vecera, L. Vercauteren, M. Verdouw, B. Verheyen, V. Verri, Vicari Sottosanti, L. G. Vico, Vidal Mitjans, P. Vilardi, A. Vissicchio, D. Vitale, G. Vitković, B. Vizcaychipi, M. P. Voicu, A. Voje, M. Volfová, I. Volta, C. A., Von Lutterotti, von Tiesenhausen, A. Vrecic-Slabe, S. Vukcevic, D. Vukovic, R. Vullo, P. A. Wade, A. Wallberg, H. Wallden, J. Wallner, Walther Sturesson, L. Watson, D. Weber, Wegiel Leskiewiq, A. Weller, D. Wensing, C. Werkmann, M. Westberg, H. Wikström, E. Williams, B. Wilson, R. Wirth, S. Wittmann, M. Wood, L. Wright, S. Zachoval, C. Zambon, M. Zampieri, S. Zampone, S. Zangrillo, A. Zani, G. Zavackiene, A. Zieglerder, R. Zonneveldt, H. Zsisku, L. Zucker, T. -P., Żukowski M., Zuleika M., Zupanĕiĕ D., Kirmeier, E. a., Eriksson, L. I. c., Lewald, H. a., Jonsson, Fagerlund, Hoeft, M. c., Hollmann, A. f., Meistelman, M. g., Hunter, C. e., Ulm, J. M. d., Blobner, K. b., M., aEmail Author, Abad, Gurumeta, A., Abernethy, C., Abigail, P., Achaibar, K., Adam, E., Afshari, Agudelo, Montoya, M. E., Akgün, F. N., Aletti, G., Alkış, N., Allan, K., Allan, A., Allaouchiche, B., Allcock, C., Almasy, E., Amey, I., Amigoni, M., Andersen, E., Andersson, P., Anipchenko, N., Antune, P., Armstrong, E., Aslam, T. N., Aslin, B., Assunção, J. 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Marku, Kotzinger, Oskar, Kovačević, Marko, Kranke, Peter, Kranke, Eva, Kraus, Christiane, Kraus, Stephanie, Kubitzek, Christiane, Kucharski, Rafal, Kucukguclu, Semih, Kudrashou, Allaksandr, Kumar, Vinayak, Kummen, Live, Kunit, Cornelia, Kushakovsky, Vlad, Kuvaki, Bahar, Kuzmanovska, Biljana, Kyttari, Aikaterina, Landoni, Giovanni, Lau, Gary, Lazarev, Konstantin, Legett, Samantha, Legrottaglie, Anna Maria, Leonardi, Silvia, Leong, Maria, Lercher, Helene, Leuvrey, Matthieu, Leva, Brigitte, Levstek, Meta, Limb, Jame, Lindholm, Espen, Linton, Fiona, Liperi, Corradero, Lipski, Fabian, Lirk, Philipp, Lisi, Alberto, Lišková, Katarina, Lluch Oltra, Aitana, Loganathan, Vinothan, Lombardi, Stefania, Lopez, Eloisa, Lopez Rodríguez, Maria, Lorenzini, Laura, Lowicka, Malgorzata, Lugovoy, Alexander, Luippold, Madeleine, Lumb, Andrew, Macas, Andriu, Macgregor, Mark, Machado, Humberto, Maciariello, Maria, Madeira, Isabel, Maitan, Stefan, Majewski, Jacek, Maldini, Branka, Malewski, Georgia, Manfredini, Livia, Männer, Olja, Marchand, Bahareh, Marcu, Alexandra, Margalef, Jordi, Margarson, Michael, Marinheiro, Lucia, Markic, Ana, Markovic Bozic, Jasmina, Marrazzo, Francesco, Martin, Jane, Martin Ayuso, Maria, Martinez, Esteher, Martino, Enrico Antonio, Martinson, Victoria, Marusic-Gaser, Katarina, Mascarenhas, Catia, Mathis, Cindy, Matsota, Paraskevi, Mavrommati, Eleni, Mazul Sunko, Branka, McCourt, Killian, McGill, Neil, McKee, Raymond, Meço, Başak Ceyda, Meier, Sonja, Melbourne, Susan, Melbybråthen, Grethe, Meli, Andrea, Melia, Aiden, Melotti, Rita Maria, Menga, Maria Rosaria, Mercer, Pauline, Merotra, Susan, Mescolini, Silvia, Metterlein, Thoma, Michalov, Martin, Michlig, Sam, Midgley, Susan, Milić, Morena, Milojevic, Milan, Miñana, Amanda, Minto, Gary, Mirabella, Lucia, Mirea, Liliana, Mittelstädt, Ludger, Moeglen, Aude, Moise, Alida, Mokini, Zhirajr, Molin, Anna, Moltó, Lui, Monea, Maria Concetta, Montalto, Francesca, Montgomery, Jane, Montgomery, Claire, Montillo, Gerardo, Moore, Sally, Moore, Faye, Moreira, Zelia, Moreno, Tania, Moreno, Ricardo, Moret, Enrique, Moreton, Sarah, Morgan, Marianne, Moro Velasco, Concepción, Morri, Davide, Moull, Alice, Moura, Fernando, Mráz, Peter, Mrozek, Katarzyna, Mukhtar, Karim, Muniyappa, Sudeshkumar, Murray, Heather, Murthy, Burra VS, Mushambi, Mary, Nadolski, Maria, Nardelli, Pasquale, Nardin, Giordano, Navarro Pérez, Rosalía, Naveiro, Andrea, Negri, Manuela, Nesek Adam, Visnja, Neskovic, Vojislava, Neuwersch, Stefan, Neves, Miriam, Nguyen, Bavinh, Ní Eochagáin, Aisling, Nicholas, Caroline, Nightingale, Jeremy, Norrie, Kylie, Novak-Jankovic, Vesna, Novakova, Andrea, Novillo, Marta, Numan, Sandra, Oduro-Dominah, Louise, Oldner, Ander, Oliveira, Isabel, Ologoiu, Daniela, Oloktsidou, Irini, O'Reilly, Rosalind, Orlando, Alessandro, Ovezov, Alexey, Ozbilgin, Sule, Paal, Peter, Padin Barreiro, Lidia, Palugniok, Ryszard, Papaioannou, Alexandra, Papapostolou, Konstantino, Paranthaman, Prabhakar, Pardey Bracho, Gilda, Parente, Suzana, Parfeni, Alexandru, Pasin, Laura, Passey, Samuel, Pastor, Ernesto, Patch, Sarah, Patil, Andan, Paunescu, Marilena-Alina, Pehboeck, Daniel, Pereira, Manuela, Pereira, Carla, Perez Caballero, Paula, Pérez García, Aníbal, Pérez Soto, Antonia, Perez Tejero, Gisela, Perez-Cerda, Francisco, Pesenti, Antonio, Petta, Rocco, Philippe, Simon, Pickering, David, Pico Veloso, Jandro, Pina, Pedro, Pinho-Oliveira, Vítor, Pinol, Santiago, Pinto, Rita, Pistidda, Laura, Pitterle, Manuela, Piwowarczyk, Paweł, Plotnikova, Olga, Pohl, Holger, Poldermann, Jorinde, Polkovicová, Lucia, Pompei, Livia, Popescu, Mihai, Popović, Radmila, Pota, Vincenzo, Potocnik, Miriam, Potręć, Beata, Potter, Alison, Pramod, Nalwaya, Prchalova, Martina, Preckel, Benedikt, Pugh, Richard, Pulletz, Mark, Radoeshki, Aleksandar, Rafi, Amir, Ragazzi, Riccardo, Raineri Santi, Maurizio, Rajamanickam, Tamiselvan, Rajput, Zahra, Ramachandran, Rajeskar, Ramasamy, Radhika, Ramessur, Suneil, Rao, Roshan, Rasmussen, Ander, Rato, André, Razaque, Usman, Real Navacerrada, M. Isabel, Reavley, Caroline, Reid, Jame, Reschreiter, Henrik, Rial, Erick, Ribas Carrasco, Patricia, Ribeiro, Sandy, Rich, Nathalie, Richardson, Lydia, Rimaitis, Kestuti, Rimaitis, Mariu, Ringvold, Else-Marie, Ripke, Fabian, Ristescu, Irina, Ritchie, Keith, Ródenas, Frederic, Rodrigues, Patrícia, Rogers, Emma, Rogerson, David, Romagnoli, Stefano, Romero, Esther, Rondovic, Goran, Rose, Bernd Oliver, Roth, Winfried, Rotter, Marie-Therese, Rousseau, Guy, Rudjord, Ander, Rueffert, Henrik, Rundgren, Malin, Rupprecht, Korbinian, Rushton, Andrew, Russotto, Vincenzo, Rypulak, Elżbieta, Ryszka, Maciej, Sà, Jacinta, Sà Couto, Paula, Saby, Sandrine, Sagic, Jelena, Saleh, Omar, Sales, Gabriele, Sánchez Sánchez, Yván, Sanghera, Sumayer, Şanli Karip, Ceren, Santiveri Papiol, Francisco Javier, Santos, Sofia, Sarno, Stephen, Saul, Daniel, Saunders, David, Savic, Nenad, Scalco, Loïc, Scanlon, Deborah, Schaller, Stefan, Schax, Christoph, Scheffer, Gert Jan, Schening, Anna, Schiavone, Vincenzo, Schmidt-Ehrenberg, Florian, Schmidt-Mutter, Catherine, Schönberg, Christina, Schopflin, Christian, Schreiber, Jan-Uwe, Schultz, Marcu, Schurig, Marlen, Scott, Carmen, Sebestian, Siby, Sehgal, Selena, Sem, Victoria, Semenas, Egidiju, Serafini, Elena, Serchan, Pashalitsa, Shields, Martin, Shobha, Ramakrishnan, Shosholcheva, Mirjana, Siamansour, Tanja, Siddaiah, Narendra, Siddiqi, Khalid, Sinclair, Rhona, Singh, Permendra, Singh, Rajendra, Sinha, Aneeta, Sinha, Ashok, Skinner, Amanda, Smee, Elizabeth, Smekalova, Olga, Smith, Neil, Smith, Thoma, Smitz, Carine, Smole, Daniel, Sojčić, Nataša, Soler Pedrola, Maria, Somanath, Sameer, Sonksen, Julian, Sorella, Maria Christina, Sörmus, Alar, Soro, Marina, Soto, Carmen, Spada, Anna, Spadaro, Savino, Spaeth, Johanne, Sparr, Harald, Spielmann, Annika, Spindler-Vesel, Alenka, Stamelos, Matthaio, Stancombe L, Liucia, Stanculescu, Andreea, Standl, Thoma, Standley, Tom, Stanek, Ondrej, Stanisavljević, Snežana, Starczewska, Malgorzata, Stäuble, Christiane, Steen, Julie, Stefan, Oana Maria, Stell, Elizabeth, Stera, Caterina, Stevens, Marku, Stoerckel, Marlène, Stošić, Biljana, Stourac, Petr, Stroumpoulis, Konstantino, Struck, Rafael, Suarez de la Rica, Alejandro, Sultanpori, Altaf, Sundara Rajan, Rajinikanth, Suying, Ong, Svensen, Christer, Swan, Louise, Syrogianni, Paulina, Sysiak, Justyna, Szederjesi, Jano, Taddei, Stefania, Tan Hao, Ern, Tanou, Virginia, Tarabová, Katarina, Tardaguila Sancho, Paula, Tarroso, Maria, Tartaglione, Marco, Taylor, Emma, Tbaily, Lee, Telford, Richard, Terenzoni, Massimo, Theodoraki, Kassiani, Thornley, Helen, Tiganiuc, Liviu, Toim, Hardo, Tomescu, Dana, Tommasino, Concezione, Toni, Jessica, Toninelli, Arturo, Toretti, Ilaria, Townley, Stephen, Trepenaitis, Dariu, Trethowan, Brian, Tsaousi, Georgia, Tsiftsi, Aikaterini, Tudor, Adrada, Turan, Güldem, Turhan, Sanem Çakar, Unic-Stojanovic, Dragana, Unterbuchner, Christoph, Unzueta, Carmen, Uranjek, Jasna, Ursic, Tomaz, Vaida, Simona, Valldeperas Ferrer, Silvia, Valldeperas Hernandez, Maria Inmaculada, Valsamidis, Dimitri, Van Beek, Rienk, Van dasselaer, Nick, Van Der Beek, Tim, Van Duivenvoorde, Yoni, van Klei, Wilton A., Van Poorter, Fran, Van Zaane, Ba, Van Zundert, Tom, Van Zyl, Rebekka, Vargas Munoz, Ana Milena, Varsani, Nimu, Vasconcelos, Pedro, Vassilakis, Georgio, Vecchiatini, Tommaso, Vecera, Lubomir, Vercauteren, Marcel, Verdouw, Ba, Verheyen, Veerle, Verri, Marco, Vicari Sottosanti, Luigi Giancarlo, Vico, Manuel, Vidal Mitjans, Patricia, Vilardi, Anna, Vissicchio, Daniela, Vitale, Giovanni, Vitković, Bibiana, Vizcaychipi, Marcela Paola, Voicu, Alexandra, Voje, Minca, Volfová, Ivana, Volta, Carlo Alberto, Von Lutterotti, Theresa, von Tiesenhausen, Anna, Vrecic-Slabe, Simona, Vukcevic, Dejan, Vukovic, Rade, Vullo, P. Agostina, Wade, Andrew, Wallberg, Hanna, Wallden, Jakob, Wallner, Johann, Walther Sturesson, Louise, Watson, Davina, Weber, Stefan, Wegiel Leskiewiq, Anna, Weller, Debbie, Wensing, Carine, Werkmann, Marku, Westberg, Henrik, Wikström, Erik, Williams, Benedict, Wilson, Robin, Wirth, Steffen, Wittmann, Maria, Wood, Laura, Wright, Stella, Zachoval, Christian, Zambon, Massimo, Zampieri, Silvia, Zampone, Salvatore, Zangrillo, Alberto, Zani, Gianluca, Zavackiene, Asta, Zieglerder, Raphael, Zonneveldt, Harry, Zsisku, Lajo, Zucker, Tom-Philipp, Żukowski, Maciej, Zuleika, Mehrun, and Zupanĕiĕ, Darja
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Pulmonary and Respiratory Medicine ,pulmonary complications, muscle relaxants, Post-anaesthesia complications ,Neuromuscular Blockade ,pulmonary complication, muscle relaxant ,neuromuscular block ,postoperative pulmonary complication ,business.industry ,Retrospective cohort study ,post-operative pulmonary complications ,Neuromuscular monitoring ,Neuromuscular Blocking Agents ,Sugammadex ,NO ,Anaesthesia ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Anesthesia ,Medicine ,General anaesthesia ,Neuromuscular Agents ,030212 general & internal medicine ,MED/41 - ANESTESIOLOGIA ,Prospective cohort study ,business ,medicine.drug - Abstract
Background: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications. Funding: European Society of Anaesthesiology.
- Published
- 2019
32. Pharmacokinetics of propofol in severely obese surgical patients.
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Braathen MR, Rigby-Jones AE, Ræder J, Spigset O, and Heier T
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- Humans, Adult, Male, Female, Middle Aged, Young Adult, Obesity, Morbid surgery, Body Mass Index, Cholecystectomy, Laparoscopic, Obesity, Remifentanil pharmacokinetics, Models, Biological, Body Weight, Propofol pharmacokinetics, Propofol blood, Anesthetics, Intravenous pharmacokinetics, Anesthetics, Intravenous blood, Bariatric Surgery
- Abstract
Background: Existing PK models of propofol include sparse data from very obese patients. The aim of this study was to develop a PK model based on standardised surgical conditions and spanning from normal-weight up to, and including, a high number of very obese patients., Methods: Adult patients scheduled for laparoscopic cholecystectomy or bariatric surgery were studied. Anaesthesia was induced with propofol 2 mg/kg adjusted body weight over 2 min followed by 6 mg/kg/h adjusted body weight over 30 min. For the remainder of the operation anaesthesia was maintained with sevoflurane. Remifentanil was dosed according to clinical need. Eight arterial samples were drawn in a randomised block sampling regimen over a span of 24 h. Time-concentration data were analysed by population PK modelling using non-linear mixed-effects modelling., Results: Four hundred and seventy four serum propofol concentrations were collected from 69 patients aged 19-60 years with a BMI 21.6-67.3 kg/m
2 . Twenty one patients had a BMI above 50 kg/m2 . A 3-compartment PK model was produced wherein three different body weight descriptors and sex were included as covariates in the final model. Total body weight was found to be a covariate for clearance and Q3; lean body weight for V1, V2 and Q2; predicted normal weight for V3 and sex for V1. The fixed allometric exponent of 0.75 applied to all clearance parameters improved the performance of the model. Accuracy and precision were 1.4% and 21.7% respectively in post-hoc performance evaluation., Conclusion: We have developed a new PK model of propofol that is suitable for all adult weight classes. Specifically, it is based on data from an unprecedented number of individuals with very high BMI., (© 2024 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)- Published
- 2024
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33. Dose requirements of alfentanil to eliminate autonomic responses during rapid-sequence induction with thiopental 4 mg/kg and rocuronium 0.6 mg/kg.
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Abou-Arab MH, Rostrup M, and Heier T
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- Adolescent, Adult, Autonomic Nervous System physiopathology, Dose-Response Relationship, Drug, Female, Humans, Male, Middle Aged, Prospective Studies, Rocuronium, Young Adult, Alfentanil pharmacology, Androstanols pharmacology, Anesthetics, Intravenous pharmacology, Autonomic Nervous System drug effects, Neuromuscular Nondepolarizing Agents pharmacology, Thiopental pharmacology
- Abstract
Study Objective: Opioids are integral part of anesthesia induction, but information on optimal dosing is limited. We aimed to determine doses of alfentanil needed to eliminate increases in 5 autonomic response variables (plasma concentrations of epinephrine, norepinephrine and vasopressin, arterial blood pressure [ABP], and heart rate) during rapid-sequence induction of anesthesia with thiopental 4 mg/kg and rocuronium 0.6 mg/kg., Design: Prospective, randomized, observer-blinded, interventional clinical study., Setting: Large academic institution., Patients: Eighty-four healthy patients, aged 18 to 55 years, received 1 of 7 assessor-blinded doses of alfentanil (0, 10, 20, 30, 40, 50, and 60 μg/kg) together with thiopental 4 mg/kg and rocuronium 0.6 mg/kg, administered in rapid succession (15 seconds). Laryngoscopy was initiated 40 seconds after rocuronium, and tracheal intubation was concluded within 15 seconds thereafter., Measurements: An indwelling radial artery catheter was used for hemodynamic monitoring and blood sampling. Relationships between alfentanil dose and response variables were tested with linear regression, and the influence of covariates (sex, body weight, and age) was determined. Alfentanil dose needed to prevent increases in ABP >10% above baseline with 95% probability was estimated with logistic regression., Main Results: Significant relationships were determined between alfentanil dose and response variables. Clinically interesting influence of covariates was not found. Alfentanil 55 μg/kg was needed to prevent increases in ABP postintubation >10% above baseline with 95% probability. One individual needed a bolus of vasopressor postintubation., Conclusions: Optimal control of autonomic responses during rapid-sequence induction was achieved with clinically relevant doses of alfentanil in healthy patients anesthetized with thiopental 4 mg/kg and rocuronium 0.6 mg/kg., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2016
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34. Reversal of experimental paralysis in a human by intranasal neostigmine aerosol suggests a novel approach to the early treatment of neurotoxic envenomation.
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Lewin MR, Bickler P, Heier T, Feiner J, Montauk L, and Mensh B
- Abstract
Key Clinical Message: Neurotoxic snake envenomation can result in respiratory failure and death. Early treatment is considered important to survival. Inexpensive, heat-stable, needle-free, antiparalytics could facilitate early treatment of snakebite and save lives, but none have been developed. An experiment using aerosolized neostigmine to reverse paralysis suggests how early interventions could be developed.
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- 2013
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35. Measurement of early bone loss around an uncemented femoral stem.
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Bøe B, Heier T, and Nordsletten L
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- Adult, Female, Follow-Up Studies, Hip Prosthesis adverse effects, Humans, Male, Time Factors, Absorptiometry, Photon methods, Arthroplasty, Replacement, Hip adverse effects, Bone Density, Bone Resorption etiology, Femur physiopathology
- Abstract
Background and Purpose: Dual-energy X-ray absorptiometry (DXA) is a precise method to study changes in bone mineral density (BMD), including the pattern of bone remodeling around an implant. Results from implant studies are usually presented as changes in BMD as a function of time. The baseline and reference value for such calculations is the first measurement after the operation. The baseline measurement has been performed at different time points in different studies. If there is rapid bone loss immediately after an operation, this will influence the reference value and hence the results. To evaluate DXA as a method, we studied the very early changes by doing 3 DXA measurements within the first 2 weeks after surgery., Patients and Methods: We included 23 hips in 23 patients who were operated with an uncemented total hip prosthesis (THP). Each Gruen region was measured with DXA at 1, 5, and 14 days, and 3 and 12 months after the operation. 16 of the patients completed all 5 follow-ups., Results: There was no detectable change in BMD in the first 14 days after the operation. In all zones, the lowest BMD was measured after 3 months., Interpretation: We conclude that DXA measurements done within 14 days after the operation can be used as reference measurements for later follow-up studies.
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- 2011
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36. A prospective randomized study comparing electrochemically deposited hydroxyapatite and plasma-sprayed hydroxyapatite on titanium stems.
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Bøe BG, Röhrl SM, Heier T, Snorrason F, and Nordsletten L
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- Absorptiometry, Photon, Adult, Aged, Aged, 80 and over, Bone Density, Bone Remodeling, Female, Follow-Up Studies, Hip Prosthesis, Humans, Male, Middle Aged, Osteoarthritis, Hip surgery, Prospective Studies, Prosthesis Design, Prosthesis Failure, Surface Properties, Titanium, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Hip methods, Coated Materials, Biocompatible chemistry, Durapatite chemistry
- Abstract
Background and Purpose: Plasma-sprayed hydroxyapatite (HA) is a successful coating for fixation of uncemented femoral stems. There may be alternative coatings with advantages in bone remodeling and transport of bone-active substances. We investigated whether an electrochemically deposited hydroxyapatite, Bonemaster (BM), might be a safe alternative in total hip arthroplasty. Our hypothesis was that the new coating would not be inferior to the conventional one., Patients and Methods: 50 patients (55 hips) were included. The stem was tapered and porous-coated proximally. On top of the porous coating was either HA or BM. Patients were evaluated postoperatively and after 3, 6, 12, and 24 months to measure fixation by radiostereometric analysis (RSA), bone mineral density by dual-energy X-ray absorptiometry (DXA), and conventional radiography. Clinical evaluation was performed with Harris hip score and Oxford hip score, both preoperatively and after 2 years., Results: After 2 years, the stems had subsided 0.25 (HA) and 0.28 (BM) mm and there were no statistically significant differences between the groups in any direction, regarding both migration and rotation. The BM group retained significantly more bone than the HA group in Gruen zone 1 during the first 2 years. The Harris and Oxford hip scores were similar in both groups., Interpretation: Electrochemically deposited hydroxyapatite on an uncemented stem does not appear to be inferior to plasma-sprayed HA regarding clinical and radiological results, bone remodeling, and micromotion after 2 years follow-up.
- Published
- 2011
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37. Relationship between normalized adductor pollicis train-of-four ratio and manifestations of residual neuromuscular block: a study using acceleromyography during near steady-state concentrations of mivacurium.
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Heier T, Caldwell JE, Feiner JR, Liu L, Ward T, and Wright PM
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- Adolescent, Adult, Anesthesia Recovery Period, Deglutition drug effects, Deglutition physiology, Female, Functional Residual Capacity, Hand Strength physiology, Humans, Jaw physiology, Male, Mivacurium, Movement drug effects, Muscle, Skeletal drug effects, Residual Volume, Respiratory Function Tests, Speech drug effects, Tongue physiology, Vision, Ocular drug effects, Young Adult, Electromyography, Isoquinolines, Muscle, Skeletal physiology, Neuromuscular Blockade, Neuromuscular Nondepolarizing Agents
- Abstract
Background: Baseline acceleromyographic adductor pollicis train-of-four (TOF) ratio varies significantly between individuals and is often greater than unity. Thus, normalization of acceleromyography data is necessary. The relationship between normalized acceleromyographic TOF ratio, lung volumes, and clinical signs of residual neuromuscular block was studied., Methods: In 12 healthy volunteers, three steady-state levels of neuromuscular block were achieved with mivacurium infusions. TOF ratio was measured acceleromyographically at the adductor pollicis using a preload. Lung volume measurements and a series of clinical tests were made at each stable block and reconciled to the normalized TOF measures., Results: None experienced airway obstruction or arterial oxygen desaturation, even at normalized TOF ratio less than 0.4. Functional residual capacity remained unchanged whereas vital capacity decreased linearly with decreasing TOF ratio. The ability to protrude the tongue was preserved at all times. The ability to clench the teeth was lost in one volunteer at normalized TOF ratio of 0.84 but retained in four at normalized TOF ratio less than 0.4. Four volunteers lost the ability both to raise the head more than 5 s and to swallow, with the most sensitive individual demonstrating these effects at normalized TOF ratio of 0.60. At mean normalized TOF ratio of 0.42, the mean handgrip strength was approximately 20% of baseline value., Conclusion: Lung vital capacity decreased linearly with decreasing TOF ratio. Responses to clinical tests of muscle function varied to a large extent among individuals at comparable TOF ratios. None of the volunteers had significant clinical effects of neuromuscular block at normalized acceleromyographic TOF ratio greater than 0.90.
- Published
- 2010
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38. [Muscle relaxants].
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Heier T
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- History, 20th Century, Humans, Motor Endplate drug effects, Neuromuscular Nondepolarizing Agents adverse effects, Neuromuscular Nondepolarizing Agents history, Preanesthetic Medication, Receptors, Cholinergic drug effects, Succinylcholine administration & dosage, Succinylcholine adverse effects, Succinylcholine history, Tubocurarine administration & dosage, Tubocurarine adverse effects, Tubocurarine history, Neuromuscular Nondepolarizing Agents administration & dosage
- Abstract
Background: Muscle relaxants were introduced into clinical anaesthesia for the first time in 1942. The purpose of this article is to provide an overview of the history of muscle relaxants, their mode of action and their role in current anaesthetic practice., Material and Method: The review is based on clinical experience, own research and a non-systematic literature search using PubMed., Results: A muscle relaxant is either suxamethonium (curacit) or one of many curare compounds. One of the curare drugs was brought to Europe from South America in the 1700 s and the active substance (called d-tubocurarine) was isolated in 1935. This type of drug paralyses striated muscles that are under voluntary control by interfering with the normal signalling system between nerve and muscle. Muscle relaxants provide optimal relaxation of skeletal muscles during surgical procedures, an effect that otherwise may require the use of high doses of anaesthetic drugs. However, muscle relaxants are not anaesthetic drugs, do not affect consciousness and have no pain relieving effect. A muscle relaxant that works optimally in all clinical settings has unfortunately not been developed so far., Interpretation: Muscle relaxants are generally safe drugs when used appropriately, but especially suxamethonium may have serious side effects. A muscle relaxant is regularly used during induction of anaesthesia, but less during surgery, because modern anaesthetics possess some muscle relaxing effect.
- Published
- 2010
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39. Dose of alfentanil needed to obtain optimal intubation conditions during rapid-sequence induction of anaesthesia with thiopentone and rocuronium.
- Author
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Abou-Arab MH, Heier T, and Caldwell JE
- Subjects
- Adolescent, Adult, Androstanols, Anesthetics, Intravenous, Blood Pressure drug effects, Dose-Response Relationship, Drug, Double-Blind Method, Female, Heart Rate drug effects, Humans, Male, Middle Aged, Neuromuscular Nondepolarizing Agents, Rocuronium, Thiopental, Alfentanil administration & dosage, Analgesics, Opioid administration & dosage, Anesthesia, Intravenous methods, Intubation, Intratracheal methods
- Abstract
Background: The primary aim of the present study was to determine the dose of alfentanil that must be added to a rapid-sequence induction (RSI) regimen using thiopentone and rocuronium to obtain optimal intubation conditions in >95% of the individuals., Methods: A total of 60 ASA I patients were randomly allocated to five different alfentanil dose groups (0, 15, 30, 45, or 60 microg kg-1). A blinded dose of alfentanil followed by thiopentone 4 mg kg-1 and rocuronium 1 mg kg-1 was administered in rapid succession, and tracheal intubation was attempted 40 s thereafter. The relationship between the alfentanil dose and the probability of optimal intubation conditions was determined by non-linear logistic regression analysis. Blood pressure (BP) changes were recorded continuously using an intra-arterial catheter., Results: The success rate of optimal intubation conditions increased with increasing doses of alfentanil. The alfentanil dose needed to obtain optimal intubation conditions in >95% of the patients was 36.4 (CI 33.4-39.4) microg kg-1. In 12 patients, the systolic BP declined to <90 mm Hg during the 3 min immediately after intubation., Conclusion: Adding 36-40 microg kg-1 alfentanil to a regimen of thiopentone and rocuronium during RSI of anaesthesia may significantly increase the success rate of optimal intubation conditions. Significant hypotension requiring vasopressor treatment may occur.
- Published
- 2007
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40. The endophytic fungus Piriformospora indica reprograms barley to salt-stress tolerance, disease resistance, and higher yield.
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Waller F, Achatz B, Baltruschat H, Fodor J, Becker K, Fischer M, Heier T, Hückelhoven R, Neumann C, von Wettstein D, Franken P, and Kogel KH
- Subjects
- Ascorbic Acid metabolism, Glutathione metabolism, Oxidation-Reduction, Plant Diseases microbiology, Plant Leaves physiology, Basidiomycota physiology, Crops, Agricultural physiology, Hordeum physiology, Mycorrhizae physiology, Salts metabolism, Symbiosis physiology
- Abstract
Disease resistance strategies are powerful approaches to sustainable agriculture because they reduce chemical input into the environment. Recently, Piriformospora indica, a plant-root-colonizing basidiomycete fungus, has been discovered in the Indian Thar desert and was shown to provide strong growth-promoting activity during its symbiosis with a broad spectrum of plants. Here, we report on the potential of P. indica to induce resistance to fungal diseases and tolerance to salt stress in the monocotyledonous plant barley. The beneficial effect on the defense status is detected in distal leaves, demonstrating a systemic induction of resistance by a root-endophytic fungus. The systemically altered "defense readiness" is associated with an elevated antioxidative capacity due to an activation of the glutathione-ascorbate cycle and results in an overall increase in grain yield. Because P. indica can be easily propagated in the absence of a host plant, we conclude that the fungus could be exploited to increase disease resistance and yield in crop plants.
- Published
- 2005
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- View/download PDF
41. The influence of mild hypothermia on the pharmacokinetics and time course of action of neostigmine in anesthetized volunteers.
- Author
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Heier T, Clough D, Wright PM, Sharma ML, Sessler DI, and Caldwell JE
- Subjects
- Adult, Anesthesia, Female, Humans, Male, Neostigmine pharmacokinetics, Hypothermia, Induced, Neostigmine pharmacology, Neuromuscular Nondepolarizing Agents antagonists & inhibitors, Parasympathomimetics pharmacology, Vecuronium Bromide antagonists & inhibitors
- Abstract
Background: The pharmacokinetics, maximum effect, and time course of action of neostigmine were studied in seven human volunteers., Methods: Each volunteer was studied twice, during both normothermia and hypothermia. Anesthesia was induced with 30 microg/kg alfentanil and 3 mg/kg propofol, and was maintained with 60-70% nitrous oxide and 0.7-0.9% isoflurane. The mechanical response of the adductor pollicis to train-of-four stimulation of the ulnar nerve was recorded, and central body temperature maintained stable at either less than 34.5 degrees C or greater than 36.5 degrees C by surface cooling or warming. Before neostigmine administration, a stable 5% twitch height was obtained by an infusion of vecuronium, and the infusion rate remained unchanged thereafter. Neostigmine, 70 microg/kg, was then infused over 2 min, and blood samples for estimation of neostigmine concentrations were collected at intervals for 240 min., Results: With hypothermia, the central volume of distribution of neostigmine decreased by 38%, and onset time of maximum effect increased (4.6 vs. 5.6 min). Hypothermia did not change the clearance (696 ml/min), maximum effect, or duration of action of neostigmine., Conclusions: The efficacy of neostigmine as an antagonist of vecuronium-induced neuromuscular block is not altered by mild hypothermia.
- Published
- 2002
- Full Text
- View/download PDF
42. The effects of clonidine on human digital vasculature.
- Author
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Talke PO, Caldwell JE, Richardson CA, and Heier T
- Subjects
- Adult, Alfentanil administration & dosage, Analysis of Variance, Anesthesia, General, Anesthetics, Inhalation administration & dosage, Anesthetics, Intravenous administration & dosage, Blood Pressure drug effects, Clonidine administration & dosage, Clonidine blood, Consciousness, Cross-Over Studies, Female, Heart Rate drug effects, Humans, Infrared Rays, Injections, Intravenous, Male, Middle Aged, Monitoring, Physiologic, Nitrous Oxide administration & dosage, Plethysmography methods, Propofol administration & dosage, Sympathetic Nervous System drug effects, Sympathetic Nervous System physiology, Vasoconstrictor Agents administration & dosage, Vasoconstrictor Agents blood, Vasodilator Agents administration & dosage, Vasodilator Agents blood, Vasodilator Agents pharmacology, Clonidine pharmacology, Fingers blood supply, Vasoconstrictor Agents pharmacology
- Abstract
Large concentrations of alpha(2) agonists cause vasoconstriction. However, the threshold of the vasoconstrictive effect in humans is not known. We studied seven volunteers to determine the lower limit of the vasoconstrictive effect of clonidine. Subjects were studied while they were awake, and they were anesthetized with propofol/alfentanil/N(2)O. Arterial blood pressure was continuously monitored via radial arterial catheter and vasoconstriction via finger volume plethysmography measuring infrared light transmitted through a fingertip (LTF). Clonidine was administered, targeting plasma clonidine concentrations of 0.3, 0.45, 0.68, 1.0, 1.5, and 2.25 ng/mL. The maximum change from preclonidine values for systolic blood pressure (SBP) and LTF was analyzed by using repeated measures analysis of variance. In awake subjects, clonidine (2.25 ng/mL) decreased LTF by 14%+/-13% and SBP from 141+/-7 to 110+/-15 mm Hg (P<0.0001). In contrast, clonidine (2.25 ng/mL) increased LTF in anesthetized subjects by 21%+/-16% and SBP from 91+/-7 to 106+/-19 mm Hg (P<0.0001). We conclude that the same dose of clonidine that decreased blood pressure and caused vasodilation in awake subjects had the opposite effect in anesthetized subjects with reduced sympathetic tone, increasing blood pressure and causing vasoconstriction in human digital vasculature. Our findings suggest that the lower threshold for clonidine-induced vasoconstriction in human digital vasculature is 1.0 ng/mL.
- Published
- 2000
- Full Text
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43. Temperature-dependent pharmacokinetics and pharmacodynamics of vecuronium.
- Author
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Caldwell JE, Heier T, Wright PM, Lin S, McCarthy G, Szenohradszky J, Sharma ML, Hing JP, Schroeder M, and Sessler DI
- Subjects
- Adult, Alfentanil, Anesthesia, Inhalation, Anesthetics, Intravenous, Body Temperature, Female, Humans, Male, Metabolic Clearance Rate, Models, Biological, Propofol, Sex Factors, Vecuronium Bromide blood, Hypothermia metabolism, Neuromuscular Nondepolarizing Agents pharmacokinetics, Neuromuscular Nondepolarizing Agents pharmacology, Vecuronium Bromide pharmacokinetics, Vecuronium Bromide pharmacology
- Abstract
Background: The authors evaluated the influence of temperature on the pharmacokinetics and pharmacodynamics of vecuronium because mild core hypothermia doubles its duration of action., Methods: Anesthesia was induced with alfentanil and propofol and maintained with nitrous oxide and isoflurane in 12 healthy volunteers. Train-of-four stimuli were applied to the ulnar nerve, and the mechanical response of the adductor pollicis was measured. Volunteers were actively cooled or warmed until their distal esophageal temperatures were in one of four ranges: < 35.0 degrees C, 35.0-35.9 degrees C, 36.0-36.9 degrees C, and > or = 37.0 degrees C. With temperature stabilized, vecuronium was infused at 5 microg x kg(-1) x min(-1) until the first response of each train-of-four had decreased by 70%. Arterial blood (for vecuronium analysis) was sampled at intervals until the first response recovered to at least 90% of its prevecuronium level. Vecuronium, 20 microg x kg(-1) x min(-1), was then infused for 10 min, and arterial blood was sampled at intervals for up to 7 h. Population-based nonlinear mixed-effects modeling was used to examine the effect of physical characteristics and core temperature on vecuronium pharmacokinetics and pharmacodynamics., Results: Decreasing core temperature over 38.0-34.0 degrees C decreases the plasma clearance of vecuronium (11.3% per degrees C), decreases the rate constant for drug equilibration between plasma and effect site (0.023 min(-1) per degrees C), and increases the slope of the concentration-response relationship (0.43 per degrees C)., Conclusions: Our results show that reduced clearance and rate of effect site equilibration explain the increased duration of action of vecuronium with reducing core temperature. Tissue sensitivity to vecuronium is not influenced by core temperature.
- Published
- 2000
- Full Text
- View/download PDF
44. Rapid tracheal intubation with large-dose rocuronium: a probability-based approach.
- Author
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Heier T and Caldwell JE
- Subjects
- Adult, Blood Pressure drug effects, Dose-Response Relationship, Drug, Electric Stimulation, Female, Heart Rate drug effects, Humans, Logistic Models, Male, Middle Aged, Physical Stimulation, Probability Theory, Rocuronium, Androstanols adverse effects, Intubation, Intratracheal methods, Neuromuscular Nondepolarizing Agents adverse effects
- Abstract
Unlabelled: There are situations in anesthesia in which it may be desirable to achieve rapid tracheal intubation with perfect conditions, i.e., no coughing or straining. To determine the dose of rocuronium that gives a high probability of achieving perfect conditions for rapid (within 60 s) tracheal intubation, we administered a range of doses of rocuronium, some larger than used previously. Sixty adults, anesthetized with thiopental 4 mg/kg IV and alfentanil 10 microg/kg IV, received rocuronium 0.4 to 2.0 mg/kg IV. We used logistic regression to define the relationship of rocuronium dose to probability of achieving perfect intubation conditions. We estimated the doses giving 90% and 95% probability of achieving perfect intubation and used resampling to determine confidence limits for these estimates. Rocuronium 1.85 and 2.33 mg/kg gave, respectively, 90% and 95% probability of perfect intubation conditions. The confidence limits (5th and 95th percentile) for these estimates were 1.15 to 2.31 and 1.23 to 3.22 mg/kg, respectively. In conclusion, it is possible to achieve perfect intubation conditions with large doses of rocuronium, but the long duration of action and expense may limit the usefulness of the technique., Implications: We found that it is possible to have a 90% probability of achieving perfect conditions for rapid tracheal intubation with large (up to 2.0 mg/kg) doses of rocuronium. These large doses of rocuronium may be useful in, for instance, head trauma or open globe injuries if succinylcholine is contraindicated.
- Published
- 2000
- Full Text
- View/download PDF
45. [Intraspinal hematoma after thoracic epidural analgesia].
- Author
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Hetland S, Berg-Johnsen J, Heier T, and Nakstad PH
- Subjects
- Adolescent, Aged, Female, Hematoma, Epidural, Cranial diagnostic imaging, Humans, Magnetic Resonance Imaging, Male, Myelography, Subarachnoid Hemorrhage diagnostic imaging, Subarachnoid Hemorrhage etiology, Analgesia, Epidural adverse effects, Hematoma, Epidural, Cranial etiology
- Abstract
In one year three patients were operated on for spinal haematomas following thoracic epidural analgesia. All three patients experienced back pain and developed progressive paraparesis, one in connection with insertion of the catheter and two after its removal. A spinal block was visualized using MRI in two patients and myelography in one. The patients were operated on with posterior decompression. In two patients an epidural haematoma was evacuated. Both patients recovered neurologic function, one completely. The third patient, who had a subarachnoidal hemorrhage and an intramedullar haematoma, remained paralytic.
- Published
- 1998
46. Mild intraoperative hypothermia does not change the pharmacodynamics (concentration-effect relationship) of vecuronium in humans.
- Author
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Heier T, Caldwell JE, Sharma ML, Gruenke LD, and Miller RD
- Subjects
- Adult, Anesthesia, General, Anesthesia, Inhalation, Elective Surgical Procedures, Fentanyl, Humans, Intraoperative Period, Isoflurane, Middle Aged, Nitrous Oxide, Hypothermia, Induced, Neuromuscular Junction drug effects, Vecuronium Bromide pharmacokinetics
- Abstract
To investigate the effect of mild hypothermia on the neuromuscular junction sensitivity to vecuronium, we determined the pharmacodynamics (concentration-effect relationship) of vecuronium in 10 patients (ASA physical class I or II; age range, 21-46 yr; weight range, 54-104 kg), during isoflurane-nitrous oxide-fentanyl anesthesia. Five were cooled to a mean temperature of 34.4 degrees C and five were maintained normothermic at a mean temperature of 36.8 degrees C. Neuromuscular function was monitored by measuring the evoked mechanical response of the adductor pollicis muscle after supramaximal train-of-four stimulation of the ulnar nerve at the wrist. Vecuronium, 3 micrograms.kg-1.min-1, was infused for 10 min, venous blood sampled for 60 min, and twitch tension and plasma concentration data were used to determine pharmacodynamic variables in each patient. Results for the hypothermic and normothermic groups were compared by Mann-Whitney U-test. There were no differences in any pharmacodynamic variable between the hypothermic and normothermic patients. For the hypothermic and normothermic patients, respectively, steady-state plasma concentrations of vecuronium producing 50% neuromuscular block (Css50) were 73 +/- 13 ng/mL (mean +/- SD) and 79 +/- 31 ng/mL; the rate constants for equilibration of vecuronium between the plasma and the neuromuscular junction (Keo) were 0.27 +/- 0.14 per min-1 and 0.26 +/- 0.11 per min, and the power functions representing the slope of the concentration-effect relationship (gamma) were 5.7 +/- 1.9 and 4.4 +/- 1.8.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1994
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- View/download PDF
47. The effect of hypothermia on adductor pollicis twitch tension during continuous infusion of vecuronium in isoflurane-anesthetized humans.
- Author
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Heier T, Caldwell JE, Eriksson LI, Sessler DI, and Miller RD
- Subjects
- Adult, Female, Humans, Infusions, Intravenous, Male, Anesthesia, Hypothermia, Induced, Isoflurane, Muscle Contraction drug effects, Muscles drug effects, Muscles physiology, Vecuronium Bromide administration & dosage
- Abstract
The effect of total body cooling on force of contraction of the adductor pollicis was determined during a constant rate infusion of vecuronium. Anesthesia was induced with thiopental and maintained with isoflurane/nitrous oxide in eight volunteers (study group) and seven surgical patients (control group). After train-of-four (TOF) stimulation of the ulnar nerve, we measured the amplitude of the first response (T1) in the train and the ratio of the fourth-to-first response (TOF ratio). Vecuronium was then administered as an intravenous (i.v.) bolus, 25 micrograms/kg, followed by continuous i.v. infusion, 25 micrograms.kg-1 x h-1; central body (core) temperature was maintained stable for 60 min, at the end of which T1 and TOF responses were constant. In the study group, core temperature was then reduced (using circulating-water blankets) by a mean of 2.6 degrees C, decreasing the T1 and TOF ratio, respectively, by 19% and 18% per degrees C reduction in adductor pollicis temperature. Normothermia was maintained in the control group for a mean of 111 min, with no significant change in T1 and TOF responses. We conclude that, during a constant-rate infusion of vecuronium, the magnitude of neuromuscular block increases significantly when adductor pollicis temperature decreases secondary to core cooling.
- Published
- 1994
- Full Text
- View/download PDF
48. Thermoregulatory vasoconstriction during isoflurane anesthesia minimally decreases cutaneous heat loss.
- Author
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Sessler DI, McGuire J, Hynson J, Moayeri A, and Heier T
- Subjects
- Adult, Anesthesia, Inhalation, Blood Pressure drug effects, Body Temperature, Female, Heart Rate drug effects, Humans, Male, Monitoring, Physiologic, Skin Temperature drug effects, Vasoconstriction drug effects, Body Temperature Regulation drug effects, Isoflurane pharmacology
- Abstract
The authors tested the extent to which thermoregulatory vasoconstriction decreases cutaneous heat loss during isoflurane anesthesia. Thermoregulatory vasoconstriction was provoked by central hypothermia in five nonsurgical volunteers given isoflurane anesthesia. Peripheral arteriovenous shunt flow was quantified using forearm-fingertip skin-surface temperature gradients and volume plethysmography. Capillary blood flow on the chest was evaluated using laser Doppler flowmetry. The central temperature triggering peripheral vasoconstriction (the thermoregulatory threshold) was 34.6 +/- 0.4 degrees C. Central body temperature decreased less than or equal to 0.2 degrees C in the period from 1 h preceding onset of significant vasoconstriction until 1.5 h afterward. Chest skin-surface blood flow decreased 21% during the period from 2 h before to 1 h after significant fingertip vasoconstriction. In contrast, fingertip blood flow decreased approximately 50-fold in the same period. The correlation between fingertip blood flow and skin-temperature gradient was excellent. Total heat loss decreased approximately 26% (25.3 +/- 3.9 W) in the period from 2 h before significant peripheral vasoconstriction to 1 h afterward. Loss from the arms and legs (upper arm, lower arm, thigh, and calf) decreased approximately 24% in the same period. Heat loss from the trunk and head decreased only 14%; in contrast, loss from the hands and feet decreased approximately 57%. There were no clinically important changes in blood pressure or heart rate during vasoconstriction, but oxyhemoglobin saturation (measured by pulse oximetry) increased slightly. These data suggest that thermoregulatory vasoconstriction only minimally decreases cutaneous heat loss.
- Published
- 1992
- Full Text
- View/download PDF
49. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans.
- Author
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Heier T, Caldwell JE, Sessler DI, and Miller RD
- Subjects
- Adult, Anesthesia Recovery Period, Female, Humans, Intraoperative Period, Male, Middle Aged, Time Factors, Anesthesia, Inhalation, Hypothermia, Induced, Isoflurane, Neuromuscular Junction drug effects, Nitrous Oxide, Vecuronium Bromide pharmacology
- Abstract
We compared the duration of action and recovery times for vecuronium in normothermic and mildly hypothermic patients. Ten patients were actively cooled to a central body temperature near 34.5 degrees C, and ten were maintained at a normothermic central temperature (greater than 36.5 degrees C); temperature was measured in the distal esophagus. Vecuronium 0.1 mg/kg was administered as an intravenous (iv) bolus to all patients, and the evoked mechanical response to train-of-four stimulation was recorded. Five hypothermic and five normothermic patients were allowed to recover spontaneously. In the remaining five in each group, neostigmine (40 micrograms/kg) and atropine (20 micrograms/kg) was administered when the first twitch (T1) height spontaneously recovered to 10% of control (T1 = 10% of the pre-vecuronium twitch tension). Vecuronium's duration of action (from injection of drug until T1 = 10%) was 28 +/- 4 and 62 +/- 8 min during normothermia and hypothermia, respectively (P less than 0.05). The corresponding values for spontaneous recovery from T1 = 10% to TOF ratio greater than 75% were 37 +/- 15 and 80 +/- 24 min (P less than 0.05), and for neostigmine-induced recovery were 10 +/- 3 and 16 +/- 11 min (difference not significant). We conclude that mild hypothermia increases the duration of action of and time for spontaneous recovery from vecuronium-induced neuromuscular blockade.
- Published
- 1991
- Full Text
- View/download PDF
50. The neuromuscular effects of desflurane, alone and combined with pancuronium or succinylcholine in humans.
- Author
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Caldwell JE, Laster MJ, Magorian T, Heier T, Yasuda N, Lynam DP, Eger EI 2nd, and Weiskopf RB
- Subjects
- Adult, Desflurane, Dose-Response Relationship, Drug, Humans, Isoflurane administration & dosage, Isoflurane pharmacology, Male, Pancuronium administration & dosage, Reference Values, Succinylcholine administration & dosage, Surgical Procedures, Operative, Anesthesia, Inhalation, Isoflurane analogs & derivatives, Neuromuscular Junction drug effects, Pancuronium pharmacology, Succinylcholine pharmacology
- Abstract
The neuromuscular effects of desflurane administered alone were studied in ten healthy human volunteers aged 20-27 yr. Also, the dose-response relationships of pancuronium and succinylcholine in surgical patients during anesthesia with desflurane (n = 13) were compared to those during isoflurane anesthesia (n = 14). In the volunteers, we measured the mechanical response of the adductor pollicis muscle to stimulation of the ulnar nerve in a train-of-four (TOF) sequence at 2 Hz and at tetanic frequencies of 50, 100, and 200 Hz, each administered for 5 s. Amplitudes of the first response (T1) in each TOF sequence and the ratios of the fourth TOF response (T4) to the first were similar at 3, 6, and 9% desflurane and decreased significantly only at 12% (P less than 0.05). Desflurane concentrations of 3-12% caused tetanic fade (greater than 10% decrement in amplitude) at 50, 100, and 200 Hz. The addition of N2O and the duration of anesthetic exposure did not alter desflurane's neuromuscular effects. The only neuromuscular variable influenced by CO2 was T1 amplitude, which decreased as arterial CO2 tension (PaCO2) increased. The doses of pancuronium that depressed T1 amplitude by 50% (ED50) were similar during anesthesia with 1.25 MAC desflurane, 10.5 +/- 2.8 micrograms/kg (mean +/- SD) and 1.25 MAC isoflurane, 12.3 +/- 5.0 micrograms/kg. The ED50 doses of succinylcholine were similar during anesthesia with desflurane 132 +/- 76 micrograms/kg and isoflurane 123 +/- 36 micrograms/kg. We conclude that desflurane significantly depresses neuromuscular function and augments the action of pancuronium and succinylcholine to a degree similar to that of isoflurane.
- Published
- 1991
- Full Text
- View/download PDF
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