Prämedikationsqualität und Patientenzufriedenheit nach Prämedikation mit Midazolam, Clonidin oder Placebo: Randomisierte Doppelblindstudie mit altersangepasster Dosierung

Zusammenfassung: Hintergrund: Die Prämedikation hat u.a. zum Ziel, Angstgefühle und innere Unruhe vor einem chirurgischen Eingriff zu lindern und gleichzeitig möglichst wenig unerwünschte Wirkungen zu verursachen. Es gibt bisher keine Untersuchungen, die die Wirkungen und Nebenwirkungen von Clonidin (Catapresan®), Midazolam (Dormicum®) und Placebo in altersabhängig unterschiedlicher Dosierung verglichen und deren Akzeptanz beim Patienten untersucht haben. Patienten und Methoden: In dieser randomisierten, placebokontrollierten Studie wurden 139 erwachsene Patienten untersucht und 60min vor der Narkoseeinleitung mit Clonidin, Midazolam oder Placebo prämediziert. Angst, Sedierungstiefe und Nebenwirkungen wurden an 6 aufeinanderfolgenden Zeitpunkten erfasst. Ergebnisse: Midazolam zeigte eine stärkere anxiolytische und sedative Wirkung als Clonidin. Die Prämedikation mit Midazolam verminderte die Sauerstoffsättigung. Es gab keine klinisch relevanten Veränderungen in der Hämodynamik in allen Gruppen. Midazolam und Clonidin verminderten das Risiko für "postoperative nausea and vomiting" (PONV). Midazolam zeigte die geringsten Nebenwirkungen. Placebo wurde von den Patienten weitaus am schlechtesten beurteilt, im Gegensatz zu Clonidin und Midazolam, das am besten beurteilt wurde. Schlussfolgerung: Die sedierende und anxiolytische Wirkung von Midazolam ist stärker als diejenige von Clonidin. Midazolam wurde von den Patienten besser angenommen als Clonidin, Clonidin siginfikant besser als Placebo. Die meisten Patienten würden Midazolam wieder wähle

Changes in axonal excitability of primary sensory afferents with general anaesthesia in humans

Background Intraoperative monitoring of neuronal function is important in a variety of surgeries. The type of general anaesthetic used can affect the interpretation and quality of such recordings. Although the principal effects of general anaesthetics are synaptically mediated, the extent to which they affect excitability of the peripheral afferent nervous system is unclear. Methods Forty subjects were randomized in a stratified manner into two groups, anaesthetized with either propofol or sevoflurane. The threshold tracking technique (QTRAC®) was used to measure nerve excitability parameters of the sensory action potential of the median nerve before and after induction of general anaesthesia. Results Several parameters of peripheral sensory afferent nerve excitability changed after induction of general anaesthesia, which were similar for both propofol and sevoflurane. The maximum amplitude of the sensory nerve action potential decreased in both groups (propofol: 25.3%; sevoflurane: 29.5%; both P<0.01). The relative refractory period [mean (sd)] also decreased similarly in both groups [propofol: −0.6 (0.7) ms; sevoflurane: −0.3 (0.5) ms; both P<0.01]. Skin temperature at the stimulation site increased significantly in both groups [propofol: +1.2 (1.0)°C; sevoflurane: +1.7 (1.4)°C; both P<0.01]. Conclusions Small changes in excitability of primary sensory afferents after the induction of anaesthesia with propofol or sevoflurane were detected. These effects, which were non-specific and are possibly explained by changes observed in temperature, demonstrate possible anaesthetic effects on intraoperative neuromonitorin

Production of Radiobromide: new Nickel Selenide target and optimized separation by dry distillation

Introduction Radioisotopes of bromine are of special interest for nuclear medical applications. The positron emitting isotopes 75Br (T½ = 1.6 h; β+ = 75.5 %) and 76Br (T½ = 16.2 h; β+ = 57 %) have suitable decay properties for molecular imaging with PET, while the Auger electron emitters 77Br (T½ = 57.0 h) and 80mBr (T½ = 4.4 h) as well as the β−-emitter 82Br (T½ = 35.3 h) are useful for internal radiotherapy. 77Br is additionally suited for SPECT. The isotopes 75Br, 76Br and 77Br are usually produced at a cyclotron either by 3He and α-particle induced reactions on natural arsenic or by proton and deuteron induced reactions on enriched selenium isotopes [1]. As target mate-rials for the latter two reactions, earlier ele-mental selenium [2] and selenides of Cu, Ag, Mn, Mo, Cr, Ti, Pb and Sn were investigated [cf. 3–7]. Besides several wet chemical separation techniques the dry distillation of bromine from the irradiated targets was investigated, too [cf. 2, 4, 5]. However, the method needs further development. Nickel selenide was investigated as a promising target to withstand high beam currents, and the dry distillation technique for the isolation of n.c.a. radiobromine from the target was optimized. Material and Methods Crystalline Nickel-(II) selenide (0.3–0.5 g) was melted into a 0.5 mm deep cavity of a 1 mm thick Ni plate covered with a Ni grid. NiSe has a melting point of 959 °C. For development of targeting and the chemical separation, natural target material was used. Irradiations of NiSe were usually performed with protons of 17 MeV using a slanting water cooled target holder at the cyclotron BC1710 [8]. For radiochemical studies a beam current of 3 µA and a beam time of about 1 h were appropriate. To separate the produced no-carrier-added (n.c.a.) radiobromine from the target material a dry distillation method was chosen. The apparatus was developed on the basis of a dry distillation method for iodine [cf. 9,10] and optimized to obtain the bromine as n.c.a. [*Br]bromide in a small volume of sodium hydroxide solution. Changing different components of the apparatus, the dead volume could be minimized and an almost constant argon flow as carrier medium was realized. Various capillaries of platinum, stainless steel and quartz glass with different diameters and lengths were tested to trap the radiobromine. Results and Conclusion Nickel selenide proved successful as target material for the production of radiobromine by proton irradiation with 17 MeV protons. The target was tested so far only at beam currents up to 10 µA, but further investigations are ongoing. The optimized dry distillation procedure allows trapping of 80–90 % of the produced radiobromine in a capillary. For this purpose quartz glass capillaries proved to be most suitable. After rinsing the capillary with 0.1 M NaOH solution the activity can be nearly completely obtained in less than 100 µL solution as [*Br]bromide immediately useable for radiosynthesis. So, the overall separation yield was estimated to 81 ± 5 %. The radionuclidic composition and activity of the separated radiobromide was measured by γ-ray spectrometry. Due to the use of natural selenium the determination of the isotopic purity was not meaningful, but it could be shown that the radiobromine was free from other radioisotopes co-produced in the target material and the backing. The radiochemical purity as well as the specific activity were determined by radio ionchromatography. Further experiments using NiSe produced from nickel and enriched selenium are to be per-formed. The isotopic purity of the produced respective radiobromide, the production yield at high beam currents and the reusability of the target material have to be studied

Stochastic orbital migration of small bodies in Saturn's rings

Many small moonlets, creating propeller structures, have been found in Saturn's rings by the Cassini spacecraft. We study the dynamical evolution of such 20-50m sized bodies which are embedded in Saturn's rings. We estimate the importance of various interaction processes with the ring particles on the moonlet's eccentricity and semi-major axis analytically. For low ring surface densities, the main effects on the evolution of the eccentricity and the semi-major axis are found to be due to collisions and the gravitational interaction with particles in the vicinity of the moonlet. For large surface densities, the gravitational interaction with self-gravitating wakes becomes important. We also perform realistic three dimensional, collisional N-body simulations with up to a quarter of a million particles. A new set of pseudo shear periodic boundary conditions is used which reduces the computational costs by an order of magnitude compared to previous studies. Our analytic estimates are confirmed to within a factor of two. On short timescales the evolution is always dominated by stochastic effects caused by collisions and gravitational interaction with self-gravitating ring particles. These result in a random walk of the moonlet's semi-major axis. The eccentricity of the moonlet quickly reaches an equilibrium value due to collisional damping. The average change in semi-major axis of the moonlet after 100 orbital periods is 10-100m. This translates to an offset in the azimuthal direction of several hundred kilometres. We expect that such a shift is easily observable.Comment: 13 pages, 6 figures, submitted to A&A, comments welcom

In vitro factor XIII supplementation increases clot firmness in Rotation Thromboelastometry (ROTEM®)

Factor XIII (F XIII) is an essential parameter for final clot stability. The purpose of this study was to determine the impact of the addition of factor (F)XIII on clot stability as assessed by Rotation Thromboelastometry (ROTEM(R)). In 90 intensive care patients ROTEM(R) measurements were performed after in vitro addition of F XIII 0.32 IU, 0.63 IU, 1.25 IU and compared to diluent controls (DC; aqua injectabile) resulting in approximate F XIII concentrations of 150, 300 and 600%. Baseline measurements without any additions were also performed. The following ROTEM(R) parameters were measured in FIBTEM and EXTEM tests: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), maximum lysis (ML), maximum clot elasticity (MCE) and a-angle (aA). Additionally, laboratory values for FXIII, fibrinogen (FBG), platelets and haematocrit were contemporaneously determined. In the perioperative patient population mean FBG concentration was elevated at 5.2 g/l and mean FXIII concentration was low at 62%. The addition of FXIII led to a FBG concentration-dependent increase in MCF both in FIBTEM and EXTEM. Mean increases in MCF (FXIII vs. DC) of approximately 7 mm and 6 mm were observed in FIBTEM and EXTEM, respectively. F XIII addition also led to decreased CFT, increased aA, and reduced ML in FIBTEM and EXTEM. In vitro supplementation of FXIII to supraphysiologic levels increases maximum clot firmness, accelerates clot formation and increases clot stability in EXTEM and FIBTEM as assayed by ROTEM(R) in perioperative patients with high fibrinogen and low FXIII levels

Characteristics of GaAsSb single quantum well lasers emitting near 1.3 {micro}m

The authors report data on GaAsSb single quantum well lasers grown on GaAs substrates. Room temperature pulsed emission at 1.275 {micro}m in a 1,250 {micro}m-long device has been observed. Minimum threshold current densities of 535 A/cm{sup 2} were measured in 2000 {micro}m long lasers. The authors also measured internal losses of 2--5 cm{sup {minus}1}, internal quantum efficiencies of 30-38% and characteristic temperature T{sub 0} of 67--77 C. From these parameters a gain constant G{sub 0} of 1,660 cm{sup {minus}1} and a transparency current density J{sub tr} of 134 A/cm{sup 2} were calculated. The results indicate the potential for fabricating 1.3 {micro}m VCSELs from these materials

Cross section measurements on 61Cu for proton beam monitoring above 20 MeV

Introduction All experimental studies involving charged particle induced nuclear reactions require a precise knowledge of monitor reactions. A number of well described proton induced monitor reactions exist in the lower energy range [1], which is covered by most medical cyclotrons. Concerning proton energies above 20 MeV, however, the accuracy of the monitor reactions declines as cross section data becomes scarcer. Furthermore, the growing interest in precise determination of projectile energies by comparing of ratios of monitor reaction cross sections demands new measurements and evaluations of known data for high threshold monitor radionuclides. In this work cross section measurements on the formation of 61Cu were done and energy de-pendent radionuclide ratios were calculated. Material and Methods For investigation of the natCu(p,x)61Cu reaction copper foils of natural isotopic composition (Goodfellow Ltd.) were irradiated. The targets were of 10 and 20 μm thickness, having a diameter of 15 mm. Proton bombardments up to 45 MeV incident energy were done in the stacked-foil arrangement at the accelerator JULIC of the Nuclear Physics Institute (IKP) of the Forschungszentrum Jülich. In addition to an internal irradiation possibility the cyclotron is equipped with an external target station which was used for most experiments. It can adapt standard and slanting solid target holders and is equipped with a water cooled four sector collimator and additional helium cooling of the entry foil. Several irradiations were executed. In each stack, besides copper samples, aluminium absorbers and additional nickel monitor foils were also placed, the latter for the determination of the respective beam current. The produced radioactivity of 61Cu was analysed non-destructively using HPGe γ-ray detectors (EG&G Ortec). Results and Conclusion Reaction cross sections of the natCu(p,x)61Cu process up to 45 MeV were measured and com-pared with existing data from the literature (FIG. 2). Except for the data of Williams et al. our results are in good agreement, showing a maxi-mum of about 165 mbarn at 37.5 MeV proton energy. The overall uncertainty of the new cross section data is between 8 and 10 %. In FIG. 3, the excitation functions of the relevant monitor reactions on Cu are shown. In combination with the excitation function of the natCu(p,xn)62Zn reaction, isotope ratios were calculated which can be used for determination of the proton energy within a target stack in the energy range of 22–40 MeV as described by Piel et al. [3]. FIGURE 4 shows the cross section ratio in dependence of the proton energy. Above this energy, 65Zn could be used to generate isotope ratios for energy determination, although the long half-life (T½ = 244.3 d) of that radionuclide may be a problem. Additional cross section measurements are planned in order to further strengthen the data base of this potential monitor reaction. The results of this work shall be evaluated in the framework of an ongoing Coordinated Research Project of the IAEA

Relative concentrations of haemostatic factors and cytokines in solvent/detergent-treated and fresh-frozen plasma

Background Indications, efficacy, and safety of plasma products are highly debated. We compared the concentrations of haemostatic proteins and cytokines in solvent/detergent-treated plasma (SDP) and fresh-frozen plasma (FFP). Methods Concentrations of the following parameters were measured in 25 SDP and FFP samples: fibrinogen (FBG), factor (F) II, F V, F VII, F VIII, F IX, F X, F XIII, von Willebrand factor (vWF), D-Dimers, ADAMTS-13 protease, tumour necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, and IL-10. Results Mean FBG concentrations in SDP and FFP were similar, but in FFP, the range was larger than in SDP (P<0.01). Mean F II, F VII, F VIII, F IX, and F XIII levels did not differ significantly. Higher concentrations of F V (P<0.01), F X (P<0.05), vWF (P<0.01), and ADAMTS-13 (P<0.01) were found in FFP. With the exception of F VIII and F IX, the range of concentrations for all of these factors was smaller (P<0.05) in SDP than in FFP. Concentrations of TNF-α, IL-8, and IL-10 (all P<0.01) were higher in FFP than in SDP, again with a higher variability and thus larger ranges (P<0.01). Conclusions Coagulation factor content is similar for SDP and FFP, with notable exceptions of less F V, vWF, and ADAMTS-13 in SDP. Cytokine concentrations (TNFα, IL-8, and IL-10) were significantly higher in FFP. The clinical relevance of these findings needs to be established in outcome studie

Influence of airway‐occluding instruments on airway pressure during jet ventilation for rigid bronchoscopy

We measured changes in airway pressure (Paw) caused by microsurgical instruments introduced into a rigid bronchoscope during high frequency jet ventilation (HFJV). With approval of the institutional Ethics Committee, 10 adults undergoing elective tracheobronchial endoscopy and endosonography during general anaesthesia were investigated. Inflation of an endosonography probe balloon in the left main stem bronchus caused airway obstruction. Pressure measurements proximal and distal to the obstruction were compared after three degrees of obstruction (0%, 50% and 90%) and with two different driving pressure settings. Airway obstruction increased the mean (sd) peak inspiratory pressure (PIP) from 7.5 (2.6) to 9.5 (3.5) mm Hg for 2 atm (P=0.0008) and from 9.7 (3.7) to 13.0 (5.1) mm Hg for 3 atm (P=0.0001). Airway obstruction did not alter peripheral PIP (7.2 (4.1) to 7.1 (3.7) mm Hg for 2 atm and 8.8 (4.3) to 9.4 (5.2) mm for 3 atm), but resulted in an end‐expiratory pressure (EEP) beyond the narrowing being significantly greater than in the unobstructed airway (2.5 (3.4) to 5.5 (3.7) mm Hg for 2 atm; P=0.0005) and 3.2 (3.6) to 8.0 (4.3) mm for 3 atm; P<0.0001). Severe airway narrowing increases inspiratory pressure proximal and expiratory pressure distal to the obstruction in relation to the applied driving pressure. Since the distal EEP never exceeded PIP, even near‐total airway obstruction should not cause severe lung distension or barotrauma in subjects with normal lungs. Br J Anaesth 2000; 85: 463-

Migration of a moonlet in a ring of solid particles : Theory and application to Saturn's propellers

Hundred meter sized objects have been identified by the Cassini spacecraft in Saturn's A ring through the so-called "propeller" features they create in the ring. These moonlets should migrate, due to their gravitational interaction with the ring ; in fact, some orbital variation have been detected. The standard theory of type I migration of planets in protoplanetary disks can't be applied to the ring system, as it is pressureless. Thus, we compute the differential torque felt by a moonlet embedded in a two-dimensional disk of solid particles, with flat surface density profile, both analytically and numerically. We find that the corresponding migration rate is too small to explain the observed variations of the propeller's orbit in Saturn's A-ring. However, local density fluctuations (due to gravity wakes in the marginally gravitationally stable A-ring) may exert a stochastic torque on a moonlet. Our simulations show that this torque can be large enough to account for the observations, depending on the parameters of the rings. We find that on time scales of several years the migration of propellers is likely to be dominated by stochastic effects (while the former, non-stochastic migration dominates after ~ 10^{4-5} years). In that case, the migration rates provided by observations so far suggests that the surface density of the A ring should be of the order of 700 kg/m^2. The age of the propellers shouldn't exceed 1 to 100 million years, depending on the dominant migration regime.Comment: 17 pages, 5 figures, submitted to Astronomical Journal on february, the 23