Thomas J. Luger

Investigating the time course of morphological changes in experimental traumatic brain injury (TBI) in vivo helps to clarify the mechanism of TBI and develop new therapeutic modalities. We examined the morphological changes in experimental TBI, using magnetic resonance imaging (MRI) in a rat model. We produced lateral fluid percussion injury (LFP) and midline fluid percussion injury (MFP) in rats, using the Yamaki fluid percussion device. The rats were divided into four groups: LFP, MFP, sham LFP, and sham MFP. MRI was performed with a 4.7-T magnetic resonance apparatus 2 days and 90 days after the induction of injury. T1-, T2-, and T2- weighted images were obtained using a surface coil. Hemorrhage, contusion, and brain edema in LFP models were detected on the 2nd day after injury, and the necrotic tissue was absorbed and replaced by cerebrospinal fluid on the 90th day. In MFP animals, we detected a small hemorrhage in the corpus callosum with minimal brain edema around the hemorrhage on the 2nd day after injury, and on the 90th day, enlarged ventricles and cisterns were observed, indicating brain atrophy. MRI, therefore, is useful for plotting morphological changes in experimental TBI in vivo. We report the novel and clinically important finding of brain atrophy after experimental TBI.

Abstract: This paper investigates the possible antinociceptive effect of systemically administered ciprofloxacin and gentamicin and its influence on intrathecal morphine-induced antinociception. Using thermal nociceptive tests (hot-plate test and tail-flick test) and a motor function test (catalepsy test) in male Sprague-Dawley rats (n=5–9/dose), the following observations were made: ciprofloxacin administered intraperitoneally in the dose range 4–64 mg/kg demonstrated a modest antinociceptive effect in both nociceptive tests. Solvent of ciprofloxacin (intraperitoneally) and saline (intraperitoneally), given as a control, showed no effect. Gentamicin, administered at a dose of 0.1–4 mg/kg intraperitoneally, demonstrated a significant (P<0.05) antinociceptive effect in the tail-flick test but not in the hot-plate test. However, opioid antagonists caused no significant change in the antibiotics. Furthermore, ciprofloxacin intraperitoneally produced a significant left-shift in the hot-plate test (ED50 saline-morphine=2.86 [CI 95%: 2.2, 4.32]μg; ED50 ciprofloxacin-morphine=0.87 (CI 95% 0.68, 1.21) μg, P<0.05) and in the tail-flick test (ED50 saline-morphine=1.98 (CI 95%: 1.21, 2.84) μg; ED50 ciprofloxacin-morphine=0.37 (CI 95%: 0.23, 0.44) μg; P<0.05) for intrathecal morphine-induced antinociception. From a comparison of these data with the predicted ciprofloxacin-morphine value (hot-plate test: 1.61 (CI 95%: 1.18, 2.51]μg; tail-flick test: 0.82 (CI 95%: 0.52, 1.92) μg) we estimate that ciprofloxacin and morphine produce at least additive effects (P>0.05). This was reversed with intraperitoneal naloxone (P<0.05). Gentamicin intraperitoneally did not influence the antinociception achieved with intrathecal administration of morphine (hot-plate test: ED50 gentamicin-morphine=2.71 (CI 95%: 2.35; 3.2) μg; tail-flick test: ED50 gentamicin-morphine=2.43 (CI 95%: 1.58; 5.22]μg; P>0.05). These data show that intraperitoneal administration of ciprofloxacin and gentamicin produces a modest antinociceptive effect in the hot-plate test and tail-flick test. Ciprofloxacin, but not gentamicin, can interact at least additively to increased naloxone-reversible morphine intrathecal antinociception. Differences in the ability to penetrate the blood-brain barrier between the two antibiotics could explain the lack of effect from gentamicin in the hot plate and on morphine-induced antinociception.

Objectives: To evaluate the quality of pain assessment by emergency medical services (EMS) in out-of-hospital emergencies. Methods: A prospective study was conducted on a convenience sample of patients during a one-year observation period. Pain ratings assessed by emergency patients were documented at three different intervals during the emergency call, and compared with concomitant assessments by EMS providers. A visual analog scale (VAS) and a verbal pain scale (VPS) were used for pain assessment. Repeated-measures ANOVA and Dunnett's t-test were used for data analysis. Results: Fifty-one out of 70 eligible patients met inclusion criteria. In most emergency patients the intensity of pain was underestimated by EMS, especially when pain was severe (p = 0.0001). During the course of transport, both pain and pain assessment by EMS improved significantly (p = 0.0001). The VAS and VPS were significantly correlated (p = 0.0001). Conclusions: EMS providers significantly underestimate their patients' pain severity. EMS providers should be more attentive to their patients' complaints and comfort.

Introduction In practice, trauma and orthopedic surgery during spinal anesthesia are often performed with routine urethral catheterization of the bladder to prevent an overdistention of the bladder. However, use of a catheter has inherent risks. Ultrasound examination of the bladder (Bladderscan®) can precisely determine the bladder volume. Thus, the aim of this study was to identify parameters indicative of urinary retention after low-dose spinal anesthesia and to develop a simple algorithm for patient care. Materials and methods This prospective pilot study approved by the Ethics Committee enrolled 45 patients after obtaining their written informed consent. Patients who underwent arthroscopic knee surgery received low-dose spinal anesthesia with 1.4 ml 0.5% bupivacaine at level L3/L4. Bladder volume was measured by urinary bladder scanning at baseline, at the end of surgery and up to 4 h later. The incidence of spontaneous urination versus catheterization was assessed and the relative risk for catheterization was calculated. Mann–Whitney test, χ² test with Fischer Exact test and the relative odds ratio were performed as appropriate. *P < 0.05. Results Seventy percent of the patients were able to void spontaneously; in 30%, a Foley catheter had to be inserted because bladder volume exceeded 500 ml and/or urination was insufficient (P < 0.01). Bladder volume differed independently of the fluid infused. Additionally, patients with a bladder volume >300 ml postoperatively had a 6.5-fold greater likelihood for urinary retention. Conclusion In the management of patients with short-lasting spinal anesthesia for arthroscopic knee surgery we recommend monitoring bladder volume by Bladderscan® instead of routine catheterization. Anesthesiologists or nurses under protocol should assess bladder volume preoperatively and at the end of surgery. If bladder volume is >300 ml, catheterization should be performed in the OR. Patients with a bladder volume of <300 ml at the end of surgery may be transferred to the ward or recovery room. In these patients, bladder volume must be checked at least every 60 min for a maximum of 3 h or until spontaneous voiding is possible or bladder volume is >500 ml.

Purpose To compare patient outcomes for positive pressure ventilation (PPV) and spontaneous ventilation (SV) in non-paralysed patients with the LMA using either isoflurane or sevoflurane anaesthesia. Methods: One hundred and sixty four adult patients were studied. Anaesthesia was with fentanyl/propofol and N2O 66% in O2 with 0.75 MAC isoflurane or sevoflurane and either PPV or SV Positive pressure ventilation was with tidal volumes of 6–8 ml·kg−1. Peak airway pressures were < 15 cm H2O. Patients were evaluated for airway problems, cardiorespiratory effects, and anaesthesia emergence times. Results There were no failed episodes of PPV or SV Gastric insufflation was not detected by epigastric auscultation. Airway problems and cardiovascular effects were similar among groups. During maintenance: SpO2 was greater in the PPV group than in the SV group (98.4 vs 97%,P < 0.001); also, (PETCO2) (34 vs 43 mmHg) and the respiratory rate (RR) (15 vs 19 min−1) were higher and the minute ventilation(MV) (5.7 vs 7.2 L) were lower in the SV groups (P < 0.0001). Shorter times to LMA removal and orientation were observed in the sevoflurane groups (P < 0.0001). Conclusions Patient outcome is similar for SV and PPV in non-paralysed adult patients with the LMA. Isoflurane and sevoflurane at 0.75 MAC provide suitable conditions for maintenance and emergence, but emergence is more rapid with sevoflurane. Objectif Comparer l’évolution du patient lors de la ventilation en pression positive (VPP) et de la ventilation spontanée (VS) chez des patients non curarisés utilisant l’anesthésie avec ML sous isoflurane ou sévoflurane. Méthodes On a étudié cent soixante-quatre patients adultes. Lanesthésie s’est faite avec le fentanyl et le propofol et N2O à 66 % dans O2 avec une CAM d’isoflurane ou de sévoflurane à 0,75 et la VPP ou la VS. La ventilation en pression positive était maintenue à des volumes courants de 6–8 ml·kg−1. Les pressions de pointe ventilatoires étaient < 15 cm H2O. On a évalué chez les patients les problèmes des voies aériennes, les effets cardiorespiratoires et les temps de réveil. Résultats Il n’y a eu aucun échec de la VPP ou de la VS. On n’a pas détecté d’insufflation gastrique à l’auscultation épigastrique. Les problèmes des voies aériennes et les effets cardiovasculaires étaient semblables dans les deux groupes. Pendant le maintien de l’anesthésie, la SpO2 était plus élevée dans le groupe sous VPP que dans le groupe en VS (98,4 vs 97 %,P < 0,001); on a aussi noté que la (PETCO2) (34 vs 43 mmHg) et la fréquence respiratoire (FR) (15 vs 19 min−1) étaient plus élevées et que la ventilation minute (VM) (5,7 vs 7,2 L) était plus basse dans le groupe en VS (P < 0,0001). On a observé des temps de retrait du ML et de retour à la conscience plus courts dans le groupe qui a reçu du sévoflurane (P < 0,0001). Conclusion Avec l’utilisation du ML, l’évolution des patients adultes non curarisés est similaire pour la VS et la VPR Lisoflurane et le sévoflurane, avec une CAM de 0,75, fournissent des conditions adéquates de maintien de l’anesthésie et de réveil, bien que le réveil soit plus rapide avec le sévoflurane.

Twenty patients with generalized sepsis were studied prospectively to evaluate the effects of recombinant human growth hormone (rhGH) administration. Five patients had developed sepsis after major abdominal surgery, 15 patients after multiple trauma with head injury (HTI-ISS 38 +/- 2 and Glasgow Coma Scale 4 +/- 1). The urea production rate (UPR) could be significantly reduced by the intramuscular administration of 1.5 IU of rhGH/kg bodyweight (BW) per day (UPR day: 5, 62 +/- 6.7 gm/d vs. UPR day: 10, 42.6 +/- 5.9 gm/d). The catabolic index of Bistrian (BI) was significantly lower after rhGH therapy on day 10 compared to day 5. IGF-1 increased significantly after the administration of rhGH. The nitrogen balance, however, did not become positive, despite the administration of rhGH. The changes in sepsis were estimated by the scoring system according to Elebute and Stoner on days 3, 5, 7, 10, and 13. In those patients who were available for post-treatment evaluation the parameters had returned to baseline values after the withdrawal of rhGH. Results indicate that this therapy might ameliorate the nitrogen intake, but has no influence on the course of sepsis. Compared to previously published results in nonseptic patients, the somatomedin inhibitors as well as the split-products of the complement system and the metabolites of arachidonic acid may have been responsible for this weak effect of rhGH and IGF-1 in septicemia.

Bag-valve-mask ventilation in an unprotected airway is often applied with a high flow rate or a short inflation time and, therefore, a high peak airway pressure, which may increase the risk of stomach inflation and subsequent pulmonary aspiration. Strategies to provide more patient safety may be a reduction in inspiratory flow and, therefore, peak airway pressure. The purpose of this study was to evaluate the effects of bag-valve-mask ventilation vs. a resuscitation ventilator on tidal volume, peak airway pressure, and peak inspiratory flow rate in apneic patients. In a crossover design, 40 adults were ventilated during induction of anesthesia with either a bag-valve-mask device with room air, or an oxygen-powered, flow-limited resuscitation ventilator. The study endpoints of expired tidal volume, minute volume, respiratory rate, peak airway pressure, delta airway pressure, peak inspiratory flow rate and inspiratory time fraction were measured using a pulmonary monitor. When compared with the resuscitation ventilator, the bag-valve-mask resulted in significantly higher (mean+/-SD) peak airway pressure (15.3+/-3 vs. 14.1+/-3 cm H2O, respectively; p=0.001) and delta airway pressure (14+/-3 vs. 12+/-3 cm H2O, respectively; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), but significantly lower oxygen saturation (95+/-3 vs. 98+/-1%, respectively; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). No patient in either group had clinically detectable stomach inflation. We conclude that the resuscitation ventilator is at least as effective as traditional bag-valve-mask or face mask resuscitation in this population of very controlled elective surgery patients.

Abstract Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI), significantly potentiates analgesia when administered in animals together with opioids. The aim of the present study was to investigate the effects of fluvoxamine on sufentanil antinociception and tolerance. Following animal care committee approval, the effects of continuous infusions of fluvoxamine and sufentanil were studied in behavioural tests (hot-plate test, tail-flick test, catalepsy test) in Sprague-Dawley rats with a jugular vein catheter. Saline was administered as a control. The time-effect curves for continuous intravenous sufentanil indicate dose-related antinociception and rapid development of tolerance in the hot-plate and tail-flick tests. Co-administration of fluvoxamine with continuous sufentanil enhances antinociception and attenuates development of tolerance, most clearly seen in the tail-flick test. Fluvoxamine alone and saline were not effective. No animal showed catalepsy. As a side effect we observed a marked loss of body weight. The IC50 values of sufentanil binding with and without fluvoxamine addition are 0.56$pL0.17 nM and 0.3$pL0.15 nM, respectively, indicating no direct effect on the occupancy of sufentanil on the μ-receptor by this serotonin reuptake inhibitor. In conclusion, we were able to show that the combination of an opioid with an SSRI at low doses improves analgesia and decreases development of tolerance in nociceptive tests in rats. The clinical implications of these promising results in an animal model, however, await further investigation.

Remifentanil is increasingly used in the context of anesthesia, e.g., in patients presenting for MRI examinations, not only as an analgesic but also to replace nitrous oxide. Therefore, a comparative analysis of the effects of commonly used doses of remifentanil and of nitrous oxide on cerebral hemodynamics is warranted. The present study used contrast-enhanced magnetic resonance (MR) perfusion measurement to compare the effects of nitrous oxide (N(2)O/O(2) = 50%; n = 9) and remifentanil (0.1 microg/kg/min; n = 10) on regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), and regional mean transit time (rMTT) in spontaneously breathing human volunteers. Remifentanil increased rCBF above all in basal ganglia, whereas in supratentorial gray matter the increase in rCBF was equal or even more pronounced when using nitrous oxide. In contrast, nitrous oxide produced a greater increase in rCBV in gray-matter regions than did remifentanil. In summary, nitrous oxide increased rCBV in all gray-matter regions more than did remifentanil. However, the increase in rCBF, especially in basal ganglia, was typically less pronounced than during infusion of remifentanil.

Einleitung: Internationale Sportereignisse mit Massenansammlungen von Menschen, wie z. B. Olympische Spiele, Fußballwelt- und Europameisterschaften oder Winterspiele, verlangen von den medizinischen Teams ein hohes Maß an Planung zur Realisierung des Einsatzes vor Ort. Wir beschreiben hier einen dynamischen Ansatz in der Planung und Durchführung dieses notfallmedizinischen Managements, welches ein einheitliches medizinisches Management für Zuschauer und Athleten vorsah. Material und Methode: Um die medizinischen und organisatorischen Erfordernisse bei großen Sportereignissen beurteilen zu können, evaluierten wir die prähospitalen Daten der medizinischen Versorgung und Organisation bei der Winteruniversiade 2005 in Innsbruck/Seefeld mit 88.073 Teilnehmern. Ergebnisse: Im Vergleich zu einem Standardkonzept, das eine getrennte notfall- und sportmedizinische prähospitale Versorgung vorgesehen hätte, benötigten wir für die dynamische prähospitale Versorgung eine geringere Anzahl von Personal und Anwesenheitsstunden (Notärzte: −2,8/Tag; Notfallsanitäter: −7,2/Tag; Rettungsfahrzeuge: −16,5 h/Tag; Notfallkoffer: −3/Tag), um eine schnelle medizinische Versorgung der Patienten zu ermöglichen (Zeit vom eingegangenen Notruf bis zum Beginn der medizinischen Versorgung: „indoor“ 2,2±1,1 min, „outdoor“: 4,3±1,5 min). Insgesamt benötigten 221 Personen eine medizinische Versorgung, von denen 116 einen Notfall hatten, die einen Notarzt erforderte (Traumen 66,4%; internistische Erkrankungen 22,4%; Transportrate ins Krankenhaus 56,03%). Die Sportler hatten eine medizinische Notfallfrequenz von 4,4%, gefolgt von den Freiwilligen mit 2,7%, den Offiziellen mit 2,1% und den Zuschauern mit 0,007%. Alpiner Skilauf (Wahrscheinlichkeit eines Notfalls pro 100 Personen: 4,2; Häufigkeit: 46,6%), Biathlon (6,3; 33,3%) und Eishockey (7,6; 25,9%) hatten die größte Anzahl an NACA-III- und -IV-Notfällen. Eiskunstlauf weist die höchste Wahrscheinlichkeit eines Notfalls pro 100 Personen (9,0) auf, jedoch die geringste Anzahl an NACA-III- und -IV-Notfällen (8,3%). Keine Unfälle wurden im Skeleton und in der nordischen Kombination verzeichnet. Schlussfolgerungen: Dieses dynamische Konzept einer prähospitalen medizinischen Versorgung von Patienten bei (Sport)veranstaltungen mit Massenansammlungen von Menschen zeigte Vorteile in Organisation, Flexibilität, Mobilität und Teamwork. Managementrichtlinien sollen diskutiert werden. Introduction: International sports events with mass gatherings, like the Olympic Games or the European Soccer Championship, make high demands on well-trained medical teams and on planning and realization. We describe a novel approach in planning and emergency services management. Material and methods: For comparing the impact of a different medical response organizational approach for large scale events we evaluated the data on prehospital medical care provided during the World University Winter Games in Innsbruck/Seefeld 2005 with 88.073 participants. Results: By using a dynamic medical care concept with a medical command team we needed a smaller number of personnel and attendance hours per day (physicians −2.8; emergency medical technicians −7.2; ambulance cars −16.5 hours; emergency bags: −3) to provide adequate medical care, as compared to a previous standard concept. At the venues medical treatment was given to 221 persons within 2.2±0.1 min, of whom 116 had an emergency that had to be treated by a physician (trauma 66.4%; internal medicine 22.4%; transportation rate 56.03%). Athletes had an overall use rate of 4.4%, followed by volunteers at 2.7%, officials 2.1% and spectators 0.007%. Alpine skiing (probability: 4.2; 46.6%), biathlon (probability: 6.3; 33.3%) and ice hockey (probability: 7.6; 25.9%) had the largest number of NACA III and IV emergencies according to the National Advisory Committee for Aeronautics (NACA) classifications. Figure skating had the highest probability (probability: 9.0), but the smallest number of NACA III and IV emergencies (8.3%). No accidents were seen in skeleton or nordic combined. Conclusion: This dynamic medical care concept showed advantages in organization, flexibility, mobility and teamwork. Thus, management guidelines are discussed.

Einleitung: Internationale Sportereignisse mit Massenansammlungen von Menschen, wie z. B. Olympische Spiele, Fußballwelt- und Europameisterschaften oder Winterspiele, verlangen von den medizinischen Teams ein hohes Maß an Planung zur Realisierung des Einsatzes vor Ort. Wir beschreiben hier einen dynamischen Ansatz in der Planung und Durchführung dieses notfallmedizinischen Managements, welches ein einheitliches medizinisches Management für Zuschauer und Athleten vorsah. Material und Methode: Um die medizinischen und organisatorischen Erfordernisse bei großen Sportereignissen beurteilen zu können, evaluierten wir die prähospitalen Daten der medizinischen Versorgung und Organisation bei der Winteruniversiade 2005 in Innsbruck/Seefeld mit 88.073 Teilnehmern. Ergebnisse: Im Vergleich zu einem Standardkonzept, das eine getrennte notfall- und sportmedizinische prähospitale Versorgung vorgesehen hätte, benötigten wir für die dynamische prähospitale Versorgung eine geringere Anzahl von Personal und Anwesenheitsstunden (Notärzte: −2,8/Tag; Notfallsanitäter: −7,2/Tag; Rettungsfahrzeuge: −16,5 h/Tag; Notfallkoffer: −3/Tag), um eine schnelle medizinische Versorgung der Patienten zu ermöglichen (Zeit vom eingegangenen Notruf bis zum Beginn der medizinischen Versorgung: „indoor“ 2,2±1,1 min, „outdoor“: 4,3±1,5 min). Insgesamt benötigten 221 Personen eine medizinische Versorgung, von denen 116 einen Notfall hatten, die einen Notarzt erforderte (Traumen 66,4%; internistische Erkrankungen 22,4%; Transportrate ins Krankenhaus 56,03%). Die Sportler hatten eine medizinische Notfallfrequenz von 4,4%, gefolgt von den Freiwilligen mit 2,7%, den Offiziellen mit 2,1% und den Zuschauern mit 0,007%. Alpiner Skilauf (Wahrscheinlichkeit eines Notfalls pro 100 Personen: 4,2; Häufigkeit: 46,6%), Biathlon (6,3; 33,3%) und Eishockey (7,6; 25,9%) hatten die größte Anzahl an NACA-III- und -IV-Notfällen. Eiskunstlauf weist die höchste Wahrscheinlichkeit eines Notfalls pro 100 Personen (9,0) auf, jedoch die geringste Anzahl an NACA-III- und -IV-Notfällen (8,3%). Keine Unfälle wurden im Skeleton und in der nordischen Kombination verzeichnet. Schlussfolgerungen: Dieses dynamische Konzept einer prähospitalen medizinischen Versorgung von Patienten bei (Sport)veranstaltungen mit Massenansammlungen von Menschen zeigte Vorteile in Organisation, Flexibilität, Mobilität und Teamwork. Managementrichtlinien sollen diskutiert werden. Introduction: International sports events with mass gatherings, like the Olympic Games or the European Soccer Championship, make high demands on well-trained medical teams and on planning and realization. We describe a novel approach in planning and emergency services management. Material and methods: For comparing the impact of a different medical response organizational approach for large scale events we evaluated the data on prehospital medical care provided during the World University Winter Games in Innsbruck/Seefeld 2005 with 88.073 participants. Results: By using a dynamic medical care concept with a medical command team we needed a smaller number of personnel and attendance hours per day (physicians −2.8; emergency medical technicians −7.2; ambulance cars −16.5 hours; emergency bags: −3) to provide adequate medical care, as compared to a previous standard concept. At the venues medical treatment was given to 221 persons within 2.2±0.1 min, of whom 116 had an emergency that had to be treated by a physician (trauma 66.4%; internal medicine 22.4%; transportation rate 56.03%). Athletes had an overall use rate of 4.4%, followed by volunteers at 2.7%, officials 2.1% and spectators 0.007%. Alpine skiing (probability: 4.2; 46.6%), biathlon (probability: 6.3; 33.3%) and ice hockey (probability: 7.6; 25.9%) had the largest number of NACA III and IV emergencies according to the National Advisory Committee for Aeronautics (NACA) classifications. Figure skating had the highest probability (probability: 9.0), but the smallest number of NACA III and IV emergencies (8.3%). No accidents were seen in skeleton or nordic combined. Conclusion: This dynamic medical care concept showed advantages in organization, flexibility, mobility and teamwork. Thus, management guidelines are discussed.

Hyperbaric prilocaine 2% is a medium long-acting spinal anaesthetic. There are few data on time to recovery and rate of urinary retention after spinal administration of hyperbaric prilocaine 2%. This prospective study was carried out to evaluate the time to spontaneous micturition, quantify the rate of necessary bladder catheterizations, and identify the risk factors for urinary retention after intrathecal prilocaine administration. ASA I/II patients (16-80 yr) undergoing ambulatory lower limb surgery were enrolled and received spinal anaesthesia using hyperbaric prilocaine 2% (60 mg). Ringer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s lactate was administered for peroperative volume replacement. Bladder ultrasound was performed hourly until spontaneous micturition or catheterization, when bladder filling reached 600 ml, and they were unable to urinate spontaneously. Eighty-six patients completed the study (49 males and 37 females). Mean (sd) fluid administration was 1200 (499) ml until either micturition or catheterization; 37.8% of the women and 12.2% of the men required catheterization (P=0.009). Mean (sd) time between spinal anaesthesia and catheterization was 190 (88) min, and 260 (61) min to micturition (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). Age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;40 or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;60 yr and female gender were predisposing factors for urinary retention. After spinal anaesthesia with hyperbaric prilocaine 2% (60 mg) for ambulatory lower limb surgery, 23% of patients required postoperative urinary catheterization. Postoperative bladder ultrasound and early catheterization are essential to avoid bladder distension and facilitate discharge in patients after intrathecal prilocaine 2% administration in ambulatory surgery.

Hintergrund Für ein internationales sportliches Großereignis könnten Einsatzdaten früherer Großambulanzen Indikatoren für die Abschätzung des Patientenaufkommens darstellen. Material und Methoden Die Einsatzzahlen für die Patientenversorgung in den Einsatzabschnitten bei der Fußballeuropameisterschaft 2008 (Host City Innsbruck) werden mit Ambulanzen früherer Jahren verglichen und in Relation zu Kenngrößen der Veranstaltungen gesetzt. Ergebnisse Insgesamt 909 Patienten wurden präklinisch versorgt (Trauma: 51,7%; Innere Medizin: 33,8%; National Advisory Committee for Aeronautics (NACA)-Score: I=75%, II=19,4%, III=5,6%; Transportquote=20,8%). Die Art der präklinischen Versorgung und die Transportindikation werden dargestellt. In der Gegenüberstellung zu früheren Großveranstaltungen an den selben Veranstaltungsstätten konnten vergleichbare Versorgungsraten (EURO vs. Kontrolle: 1,8±0,3 zu 1,5±0,5 Patienten/10.000/h) und Abtransportraten (0,2±0,07 zu 0,3±0,1) beobachtet werden. Schlussfolgerung Einsatzdaten aus früheren vergleichbaren lokalen Großambulanzen sind gute Indikatoren für die Abschätzung des Patientenaufkommens und der Transportquote bei internationalen Großveranstaltungen. We correlated data on out-of-hospital medical care provided at the EURO 2008 in Innsbruck (465.000 participants, 909 treated prehospital; indications: trauma 51.7%, internal medicine 33.8%; transportation rate 20.8%) and at previous comparable events. Diagnosis, transportation and treatment are detailed. Compared to previous events, no significant differences were noted (EURO vs. previous events: medical care 1,8±0,3 to 1,5±0,5 patients/10.000/h; transportations: 0,2±0,07 to 0,3±0,1). Thus, comparing parameters from previous sports events and mass gatherings at the same venue seems to be an additional efficient predictor for planning.

We evaluated whether unilateral low-dose spinal anesthesia may reduce the likelihood of postoperative urinary retention. Forty patients scheduled for knee arthroscopy randomly received bilateral (n = 20) or unilateral (n = 20) spinal anesthesia with 6-mg hyperbaric bupivacaine 0.5%. The incidence of urinary retention (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;500 mL) assessed with an ultrasound device (Bladderscan) and subsequent temporary catherization was 7/20 patients in the bilateral versus 6/20 in the unilateral group (not significant). We concluded that unilateral low-dose spinal anesthesia does not further decrease the likelihood of urinary retention. Our results demonstrate the value and necessity of monitoring bladder volume postoperatively.

In the fast-growing geriatric population, we are confronted with both osteoporosis, which makes fixation of fractures more and more challenging, and several comorbidities, which are most likely to cause postoperative complications. Several models of shared care for these patients are described, and the goal of our systematic literature research was to point out the differences of the individual models. A systematic electronic database search was performed, identifying articles that evaluate in a multidisciplinary approach the elderly hip fracture patients, including at least a geriatrician and an orthopedic surgeon focused on in-hospital treatment. The different investigations were categorized into four groups defined by the type of intervention. The main outcome parameters were pooled across the studies and weighted by sample size. Out of 656 potentially relevant citations, 21 could be extracted and categorized into four groups. Regarding the main outcome parameters, the group with integrated care could show the lowest in-hospital mortality rate (1.14%), the lowest length of stay (7.39 days), and the lowest mean time to surgery (1.43 days). No clear statement could be found for the medical complication rates and the activities of daily living due to their inhomogeneity when comparing the models. The review of these investigations cannot tell us the best model, but there is a trend toward more recent models using an integrated approach. Integrated care summarizes all the positive features reported in the various investigations like integration of a Geriatrician in the trauma unit, having a multidisciplinary team, prioritizing the geriatric fracture patients, and developing guidelines for the patients’ treatment. Each hospital implementing a special model for geriatric hip fracture patients should collect detailed data about the patients, process of care, and outcomes to be able to participate in audit processes and avoid peerlessness.

... The literature contains only few publications on catamaran sailing [3]. Additionally, the power of our study design is not as strong ... eight crewmembers of the Transatlantic Challenge 2007 (TAC 07), namely Christina, Silvia, Martin 1, Martin 2, Klaus, Christian, Peter, and especially ...

Background Fragility fractures are a major health care problem worldwide. The proportion of the geriatric population and the overall life expectancy will increase. Hip fractures are the most common fragility fractures needing surgery and nowadays treatment concepts are changing. We studied the long-term functional outcome and their influencing factors in patients treated without any interdisciplinary aspects. Design and setting A retrospective cohort study with functional long-term follow-up examination was carried out in a level one trauma centre on hip fracture patients 80 years old and above treated without any formalized interdisciplinary aspects (“usual care”). Patients Of 281 consecutive patients who were treated 2005 and 2006 with usual care, 246 patients with a mean age of 86.8 years met our inclusion criteria. 69.1% died within the study period of 4.9 years. On the remaining patients, the residential status, the Barthel Index and the Parker Score were assessed. Results The mean Barthel Index was 49.6 and the mean Parker Score was 2.7. More than one-fourth of the survivors were found to be bedridden and 45% were not able to walk outside. 88% are bound to one floor and only 8% are able to walk unaided. Patients with more comorbidities and patients with subsequent fractures had significant higher mortality rates. Patients with trochanteric fractures had significant better functional outcome scores compared to patients with femoral neck fractures. Nursing home residents showed significant higher mortality rates and lower functional outcome scores. Patients who were transferred to a nearby acute geriatric hospital for further treatment had significantly higher functional outcome scores. Conclusion This paper shows the frustrating long-term outcome of geriatric hip fracture patients but it also suggests that an early geriatric intervention may lead to better function.

Geriatric fractures are an increasing medical problem worldwide. This article wants to give an overview on the literature concerning the outcome to be expected in geriatric fracture patients and what can be done to improve it. In literature, excess mortality rates vary from 12% to 35% in the first year after a hip fracture, and also, other geriatric fractures seem to reduce the patient’s remaining lifetime. Geriatric fractures and, in particular, hip fractures constitute a major source of disability and diminished quality of life in the elderly. Age, gender, comorbid conditions, prefracture functional abilities, and fracture type have an impact on the outcome regarding ambulation, activities of daily living, and quality of life. Comprehensive orthogeriatric comanagement might improve the outcome of geriatric fracture patients. For the future, well designed, large prospective randomized controlled trials with clear outcome variables are needed to finally prove the effectiveness of existing concepts.

The influence of the mode of anaesthesia on outcome of geriatric patients with hip fractures is a controversial issue in the medical literature. In the light of an ageing society, a conclusive answer to this question is of growing importance. The purpose of this review was to assess the effect of neuroaxial and general anaesthesia on mortality and morbidity in geriatric patients sustaining a hip fracture. Following a current literature search within the Pubmed and Cochrane database (1967–2010), 34 randomised controlled trials, 14 observational studies and eight reviews/meta-analysis publications were included. Potentially outcome-influencing factors such as mortality, deep vein thrombosis, pulmonary embolism, postoperative confusion and other anaesthesia-related outcomes were evaluated. After analysing the current literature with 56 references, covering 18,715 patients with hip fracture, it can be concluded that spinal anaesthesia is associated with significantly reduced early mortality, fewer incidents of deep vein thrombosis, less acute postoperative confusion, a tendency to fewer myocardial infarctions, fewer cases of pneumonia, fatal pulmonary embolism and postoperative hypoxia. General anaesthesia has the advantages of having a lower incidence of hypotension and a tendency towards fewer cerebrovascular accidents compared to neuroaxial anaesthesia. Otherwise, general anaesthesia and respiratory diseases were significant predictors of morbidity in hip fracture patients. These data suggest that regional anaesthesia is the preferred technique, but the limited evidence available does not permit a definitive conclusion to be drawn for mortality or other outcomes. For hip fracture surgery, the choice of anaesthesia (general or neuroaxial) is made by the anaesthesiologist and is based on the patient’s preference, comorbidities, potential general postoperative complications and the clinical experience of the anaesthesiologist. The overall therapeutic approach in hip fracture care should be determined jointly by the orthopaedic surgeon, the geriatrician and the anaesthesiologist (multidisciplinary approach).