154 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
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
Rektum kanserlerinde preoparatif radyokemoterapi ile postoperatif radyokemoterapi tedavisinin hastalık rekürrensi ve sağkalım açısından karşılaştırılması
No full textAMAÇ Lokal ileri rektum kanserinde (LİRK) preoperatif uzun dönem kemoradyoterapi ile postoperatif kemoradyoterapiyi karşılaştıran 2 prospektif randomize çalışma mevcut olup, lokoregional rekürrens (LR) ve sağ kalım sonuçları çelişmektedir. Çalışmanın temel amacı LİRK de preoperatif ve postoperatif kemoradyoterapinin hastalık rekürrensi ve sağkalımlara etkilerini karşılamaktır. MATERYAL METOD Klinik olarak LİRK tanısı alan 336 hasta prospektif olarak preoperatif veya postoperatif (177 vs 159 hasta) kemoradyoterapi gruplarına ayrıldı. Preoperatif gruptaki hastalara total 50.4 Gy (28 fraksiyon) radyoterapi ve eş zamanlı 2 siklus KT yi (5-florourasil- lökoverin) takiben küratif TME uygulandı. Postoperatif gruba operasyondan 4 hafta sonra benzer protokol verildi. Gruplara 4 kür adjuvant KT eklendi. BULGULAR Ortalama 60,4 ay takip sonrası, LR'nin 5 yıllık kümülatif indeksi preoperatif grupta % 7.4 ve postoperatif grupta % 13.4 idi (p= 0.021). 5 yıllık kanser spesifik sağkalım preoperatif grupta % 87.5 ve postoperatif grupta % 80 idi (p= 0.022). Total sağkalım % 79.5 vs %74.7 (p= 0.064), hastalıksız sağkalım % 75.2 vs % 64.8 (p= 0.062), KRT ye bağlı geç toksisite % 7.4 vs % 13.2 (p= 0.002) idi. Tedaviye uyum preoperatif grupta yüksektir (p< 0.001). SONUÇ Preoperatif kemoradyoterapi, postoperatif kemoradyoterapi ile karşılaştırıldığında lokal kontrol, tedavi uyumluluğu, kanser spesifik sağkalım ve geç toksisite açısından belirgin olarak iyileşme sağladı. Sonuçlar aynı zamanda, preoperatif tedavi için olası bir genel ve hastalıksız sağkalım fayda öneriyordu. Patolojik tam yanıt sağlanan hastalarda hastalıksız sağ kalım anlamlı oranda artmaktadır
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
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
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
Development of evidence-based recommendations for procedure-specific pain management: PROSPECT methodology
No full textEffective peri-operative pain management is a prerequisite for optimal recovery after surgery. Despite published evidence-based guidelines from several professional groups, postoperative pain management remains inadequate. The procedure-specific pain management (PROSPECT) collaboration consists of anaesthetists and surgeons with broad international representation that provide healthcare professionals with practical and evidence-based recommendations formulated in a way that facilitates clinical decision-making across all stages of the peri-operative period on a procedure-specific basis. The aim of this manuscript is to provide a detailed description of the current PROSPECT methodology with the intention of providing the rigour and transparency in which procedure-specific pain management recommendations are developed. The high methodological standards of the recommendations should improve the quality of clinical practice.sponsorship: PROSPECT is supported by an unrestricted grant from the European Society of Regional Anaesthesia and Pain Therapy (ESRA). 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. MVdV has received honoraria from Sintetica, Grunenthal, Vifor Pharma, MSD, Nordic Pharma, Janssen Pharmaceuticals, Heron Therapeutics and Aquettant. EP-Z has received honoraria from Mundipharma, Grunenthal, MSD, Janssen-Cilag GmbH, Fresenius Kabi and AcelRx. HB has received honoraria from Abbvie, Aspen, Orion. No other competing interests declared (European Society of Regional Anaesthesia and Pain Therapy (ESRA), Pfizer Inc. (New York, NY, USA), Grunenthal, Aachen, Germany)status: Publishe
- …
