91 research outputs found
Validity of cycle test in air compared to underwater cycling.
No full textAccording to international guidelines, fitness to dive is generally assessed using a bicycle stress test (BST) in air. To date, there is no study explicitly addressing the question whether the results of a BST in air really predict performance status under water. Therefore, the aim of the present study was twofold: first, to design an experimental setting allowing the examination of physical performance status under water, and second, to examine whether there is an association of response to exercise in air compared to exercise under water using self contained underwater breathing apparatus (SCUBA). We constructed and evaluated a measurement technique for a bicycle ergometry and for gas analysis under water. Part of the work was the development of a new valve system which allowed to collect the exhaled air in total and to transport it to the spirometer next to the pool. Twenty-eight healthy male divers underwent a BST. Compared to a given workload in air, gross capacity decreased significantly by about 50% underwater. High performance in air was associated with a high performance underwater. The examinations were carried out without any complications. In conclusion, our experimental setting allowed the safe and reliable examination of physical performance status under water. First results indicate that the results of a BST in air correlate well with the cardio-circulatory performance status underwater. A subsequent study with a larger sample size will enable us to more precisely model this correlation
Validity of cycle test in air compared to underwater cycling.
No full textAccording to international guidelines, fitness to dive is generally assessed using a bicycle stress test (BST) in air. To date, there is no study explicitly addressing the question whether the results of a BST in air really predict performance status under water. Therefore, the aim of the present study was twofold: first, to design an experimental setting allowing the examination of physical performance status under water, and second, to examine whether there is an association of response to exercise in air compared to exercise under water using self contained underwater breathing apparatus (SCUBA). We constructed and evaluated a measurement technique for a bicycle ergometry and for gas analysis under water. Part of the work was the development of a new valve system which allowed to collect the exhaled air in total and to transport it to the spirometer next to the pool. Twenty-eight healthy male divers underwent a BST. Compared to a given workload in air, gross capacity decreased significantly by about 50% underwater. High performance in air was associated with a high performance underwater. The examinations were carried out without any complications. In conclusion, our experimental setting allowed the safe and reliable examination of physical performance status under water. First results indicate that the results of a BST in air correlate well with the cardio-circulatory performance status underwater. A subsequent study with a larger sample size will enable us to more precisely model this correlation
Opioid-free anaesthesia: Pro: damned if you don't use opioids during surgery.
No full textThis Editorial is part of a Pro and Con debate and is accompanied by the following articles: Veyckemans F. Opioid-free anaesthesia. Still a debate? Eur J Anaesthesiol 2019; 36:245–246. and Lirk P, Rathmell JP. Opioid-free anaesthesia. Con: it is too early to adopt opioid-free anaesthesia today. Eur J Anaesthesiol 2019; 36:250–254
Local anesthetics: New insights into risks and benefits
No full textConventional local anesthetics in contemporary use block the voltage-gated sodium channel by binding to a specific site on the inner facet of the channel pore. Only little fractions of local anaesthetic are thought to participate in nerve blockade, the rest is absorbed into surrounding tissues or the systemic circulation. The first major outcome of this thesis is that clinically relevant concentrations of local anaesthetics exert demethylating effects on specific breast cancer cells, and seem to enhance demethylating properties of prototype epigenetic chemotherapeutic, 5-aza, in an additive fashion. These effects could be of substantial importance in perioperative medicine, with focus on tumour surgery and pain prevention. The second main topic of this thesis was nerve injury and regional anesthesia in healthy and diabetic neuropathic nerves. In a large animal model of regional anesthesia, experimental needle trauma as well as intraneural injection of small volumes of saline resulted in severely impaired nerve function, arguing against intraneural injection as proposed by some authors. In another line of evidence, experimental sciatic nerve block in a rodent model of Type II diabetes lasted substantially longer in late diabetic neuropathy as compared to healthy animals. However, our results do not support the hypothesis that nerve block in diabetic patients increases nerve injury after peripheral nerve block. The use of regional anaesthesia should always be preceded by a weighing of potential risks and proven benefits. Regional anaesthesia continues to play a major role in perioperative medicine, but its role keeps getting more defined and less noncommittal
Mechanisms of neuro- and cytotoxicity of local anesthetics and their adjuvants
No full textPlaatselijke verdovingsmiddelen zetten een mechanisme in gang waarbij zenuwcellen zichzelf vernietigen. Dit kan leiden tot zenuwschade. Stevens wilde achterhalen hoe die zenuwschade ontstaat. Hij toont aan dat alle gangbare plaatselijke verdovingsmiddelen een soort zelfmoordmechanisme van zenuwcellen in gang zetten. Om de kans op deze schade te beperken, worden plaatselijke verdovingsmiddelen vaak met andere middelen gemengd. Het merendeel van deze middelen is onschadelijk. Stevens spoorde twee middelen op die de zenuwschade verergerden. Het onderzoek is uitgevoerd in celculturen, maar Stevens raadt nu al aan om deze middelen niet bij plaatselijke verdoving te gebruiken
Persejajaran Unsur-unsur Autochton dalam Cerita Panji Angreni dengan Cerita PantunMundinglaya Dikusumah
No full textPanji Angreni is a popular Panji story while the others besides Mundignlaya Dikusumah poem story a well known Sunda poesm, besides Lutung Kesarung, Ciung Wanara, and Nyi Sumur Bandung. Lirk common poems, Mundinglaya Dikusumah story belongs to a series of sacred stories or legends and is connected with traditional ceremonies such as children circumcision or marriage. The connection between Panji story with Padjajaran King. Fact of that Prabu Surya Amiluhur as a figure Panji story, will be the King of Padjajaran in the future. Poerbatjaraka and Berf claimed that Panji stories have historical background Poerbatjaraka placed the figure, in the era of Kediri while Berg placed them during the region of Hayam Wuruk in Majapahit Kingdom by Hayam Wuruk King. Rases Anthropology Structure Analysis of Panji Angreni Story and Mundinglaya Dikusumah poem story explained that both of the stories contained autochton principles which include; a)Totemisme, b) Classification System, c) Myte, 4) Cross Caussine, e) Stamheros and f) Intitation
Persejajaran Unsur-unsur Autochton dalam Cerita Panji Angreni dengan Cerita PantunMundinglaya Dikusumah
No full textPanji Angreni is a popular Panji story while the others besides Mundignlaya Dikusumah poem story a well known Sunda poesm, besides Lutung Kesarung, Ciung Wanara, and Nyi Sumur Bandung. Lirk common poems, Mundinglaya Dikusumah story belongs to a series of sacred stories or legends and is connected with traditional ceremonies such as children circumcision or marriage. The connection between Panji story with Padjajaran King. Fact of that Prabu Surya Amiluhur as a figure Panji story, will be the King of Padjajaran in the future. Poerbatjaraka and Berf claimed that Panji stories have historical background Poerbatjaraka placed the figure, in the era of Kediri while Berg placed them during the region of Hayam Wuruk in Majapahit Kingdom by Hayam Wuruk King. Rases Anthropology Structure Analysis of Panji Angreni Story and Mundinglaya Dikusumah poem story explained that both of the stories contained autochton principles which include; a)Totemisme, b) Classification System, c) Myte, 4) Cross Caussine, e) Stamheros and f) Intitation
PROSPECT guideline for total hip arthroplasty: a systematic review and procedure‐specific postoperative pain management recommendations
No full textThe aim of this systematic review was to develop recommendations for the management of postoperative pain after primary elective total hip arthroplasty, updating the previous procedure-specific postoperative pain management (PROSPECT) guidelines published in 2005 and updated in July 2010. Randomised controlled trials and meta-analyses published between July 2010 and December 2019 assessing postoperative pain using analgesic, anaesthetic, surgical or other interventions were identified from MEDLINE, Embase and Cochrane databases. Five hundred and twenty studies were initially identified, of which 108 randomised trials and 21 meta-analyses met the inclusion criteria. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, peripheral nerve blocks (femoral nerve block; lumbar plexus block; fascia iliaca block), single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia also improved pain. Limited or inconsistent evidence was found for all other approaches evaluated. Surgical and anaesthetic techniques appear to have a minor impact on postoperative pain, and thus their choice should be based on criteria other than pain. In summary, the analgesic regimen for total hip arthroplasty should include pre-operative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal anti-inflammatory drugs, continued postoperatively with opioids used as rescue analgesics. In addition, intra-operative intravenous dexamethasone 8-10 mg is recommended. Regional analgesic techniques such as fascia iliaca block or local infiltration analgesia are recommended, especially if there are contra-indications to basic analgesics and/or in patients with high expected postoperative pain. Epidural analgesia, femoral nerve block, lumbar plexus block and gabapentinoid administration are not recommended as the adverse effects outweigh the benefits. Although intrathecal morphine 0.1 mg can be used, the PROSPECT group emphasises the risks and side-effects associated with its use and provides evidence that adequate analgesia may be achieved with basic analgesics and regional techniques without intrathecal morphine.sponsorship: PROSPECT is supported by an unrestricted grant from the European Society of Regional Anaesthesia and Pain Therapy. In the past, PROSPECT has received unrestricted grants from Pfizer Inc. New York, NY, USA and Grunenthal, Aachen, Germany. GJ has received honoraria from Baxter and Pacira Pharmaceuticals. FB has received honoraria from Pfizer, The Medicine Company, Abbott France and Nordic Pharma France. HK has received honoraria from Pfizer and Grunenthal. SS's institution has received research and travel funding and speaking and consulting honoraria from bioCSL, Eli Lilly, Indivior, iX Biopharma and Pfizer. NR has received honoraria from Baxter and Sintetica. MVdV received honoraria from Sintetica, Grunenthal, Vifor Pharma, MSD, Nordic Pharma, CLS Behring, Janssen Pharmaceuticals, Heron Therapeutics and Aquettant. No other or competing interests declared. (European Society of Regional Anaesthesia and Pain Therapy, Pfizer Inc. New York, NY, USA, Grunenthal, Aachen, Germany, bioCSL, Eli Lilly, Indivior, iX Biopharma, Pfizer)status: Publishe
Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: A qualitative systematic review of analgesic efficacy for acute postoperative pain
No full text10.1213/ANE.0b013e3181cf9281Anesthesia and Analgesia11041170-1179AACR
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