Thomas Uhlig

Quality of life in aortic valve replacement: pulmonary autografts versus mechanical prostheses

OBJECTIVES We sought to determine whether the quality of life (QoL) is different in patients after aortic valve replacement with mechanical prostheses or pulmonary autografts. BACKGROUND Quality of life after mechanical valve replacement may be affected by the risk of thromboembolism and anticoagulation, and after autograft implantation, by the risk of degeneration and re-operation especially of the homograft. METHODS Two groups of 40 patients each--one after the autograft procedure (group I) and one after mechanical valve implantation (group II)--were matched for age, gender and length of follow-up. At latest follow-up, all patients underwent routine echocardiography, the short-form health survey (SF-36) QoL survey and an extensive psychological investigation. RESULTS Patients with an autograft showed better QoL scales, as compared with mechanical valve recipients. The difference was significant for both the physical (72.72+/-20.00 vs. 60.27+/-26.07, p = 0.021) and psychological health sum scores (74.71+/-21.03 vs. 64.71+/-23.49, p = 0.046) and for the subtests of physical functioning (73.72+/-22.44 vs. 62.77+/-25.42, p = 0.049), physical pain (88.39+/-19.13 vs. 73.36+/-27.08, p < or = 0.006), general health perception (64.37+/-17.88 vs. 51.86+/-22.86, p < or = 0.008) and health change (61.89+/-18.94 vs. 50.11+/-24.37, p = 0.02). The QoL variables did not correlate to pressure gradients, ejection fraction and New York Heart Association functional class. Psychometric tests revealed no meaningful differences between the groups. CONCLUSIONS This study provides some evidence that patients with pulmonary autografts have greater benefit in terms of QoL, as compared with recipients of mechanical valve substitutes.

Remifentanil-propofol versus sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial.

Background and objective: Remifentanil has unique pharmacokinetics that might allow faster recovery after neurosurgery. We investigated the effects of a propofol/sufentanil versus a remifentanil/propofol regimen on the primary end-point tracheal extubation time. Methods: In the Neurosurgery Department of a University Hospital, 36 patients awaiting craniotomy for supratentorial tumour resection were randomly assigned to one of two study groups. In the sufentanil/propofol group, anaesthesia was induced with 0.5 μg kg−1 sufentanil and 1-2 mg kg−1 propofol. Propofol infusion and boluses of sufentanil were administered for maintenance. In the remifentanil/propofol group, anaesthesia was started with an infusion of remifentanil (0.2-0.35 μg kg−1 min−1) and a bolus of propofol (1.5-2 mg kg−1). Patients received a propofol infusion and a remifentanil infusion for maintenance of anaesthesia. Recovery times were taken from cessation of the propofol infusion. In addition, data about self-reported nausea and vomiting, pain and analgesic requirements were collected. Results: Patients in the remifentanil/propofol group were extubated earlier (mean times 6.4 (±SD 4.7) versus 14.3 (±9.2) min; P = 0.003). The two groups were similar with respect to postoperative nausea and vomiting, and patient-reported pain scores. Fifty per cent of the remifentanil/propofol patients and 88% of the sufentanil/propofol patients required no analgesics within 1 h after operation (P =0.03). Conclusions: The remifentanil/propofol regimen provided quicker recovery. The two regimens were similar in terms of postoperative nausea and vomiting and patient-reported pain scores, but patients in the remifentanil/propofol group required more analgesics within 1 h postoperatively.

Personality traits, coping styles, and mood in patients awaiting lumbar‐disc surgery

The objective of this study was to characterize personality traits, coping styles, and mood state in patients with lumbar-disc disorders. In two studies (N = 112; N = 84) patients expecting lumbar-disc surgery were compared to patients awaiting another kind of surgery. Personality traits and coping styles were assessed with a personality inventory (FPI-R) and a stress-coping questionnaire (SVF). Mood was measured several times before surgery using a multidimensional self-report inventory [BSKE (EWL)]. The same inventory was used by anesthetists to rate the patients mood. Heart rate and blood pressure also were measured. The groups did not differ with regard to personality traits, coping styles, self-reported mood state, or somatic variables. The physicians rated lumbar-disc patients as being in a better mood than control patients. Significant correlations between self-ratings and physician ratings were not observed. The results characterize lumbar-disc patients as a subgroup that is not different from other surgery patients and, therefore, does not need a specific form of psychological management prior to surgery. The importance of using patients expecting another type of surgery as a control group rather than healthy individuals is clearly demonstrated.

Effects of Opipramol as an Evening Anaesthesiologic Premedication

To date, opipramol has not been examined within the context of evening premedication in anaesthesiology. A suitable drug for such an application should induce anxiolytic and sleep-favouring effects. Due to its pharmacological properties, one would expect opipramol to lead to these effects. In order to test this possibility, 72 female patients were randomly assigned to 50 mg opipramol, 100 mg opipramol, or placebo (n = 24 patients per group) in the evening prior to surgery in a double-blind trial. Effects were recorded in the morning prior to the operation by means of self-rating questionnaires, regarding the patients’ current subjective state and their judgement of the quality of sleep during the night before. The self-rating was done by the Multidimensional Mood Inventory BSKE (EWL), by use of the Multidimensional Somatic Symptom List (MSKL), and by use of the Würzburg Sleep Questionnaire. Further dependent variables were heart rate and blood pressure. Opipramol significantly improved sleep quality. Especially the frequency of awakening at night was reduced. These effects could be observed predominantly after 100 mg opipramol. At this dosage, inner excitement was reduced as well. The autonomic variables remained uninfluenced. There were no adverse events and no hints for interactions with anaesthesiology.

Zolpidem and Promethazine in Pre-Anaesthetic Medication

This study dealt with the question: What are the effects of different doses of the benzodiazepine-like agent zolpidem and the phenothiazine derivative promethazine on mood in pre-anaesthetic medication? Subjects were 192 female and male patients awaiting elective surgery. Two drugs were administered to the patients in the evening before anaesthesia according to a 3 × 2 factorial randomized double-blind design. The first drug factor was zolpidem (8.03 vs. 16.06 mg) versus placebo. These drugs were combined with the second drug factor, either promethazine (50 mg) or placebo. In summary, the results confirm the hypothesis that zolpidem 8.03 mg can induce paradoxical effects, especially of anxiety, 1 h after application. When the dosage is doubled, no adverse effects are found, but there are no effects different from placebo either. Men could probably be described as a risk population for the adverse effects of zolpidem 8.03 mg. Furthermore, selective deactivating effects of promethazine 50 mg were shown in this study. In addition to these anaesthesiological aspects, this study showed promethazine to be useful as a research tool, suitable as a reference drug to detect deactivating effects. The multidimensional self-report inventory BSKE(EWL) (Befindlichkeitsskalierung durch Kategorien und Eigenschaftswörter) detected the expected drug effects, indicating that this instrument is suitable for further pharmacopsychological research.

Effects of intra-aortic balloon counterpulsation on parameters of tissue oxygenation.

Background and objective: To investigate the effects of intra‐aortic balloon pump therapy on parameters of global and regional oxygenation in patients undergoing cardiac surgery. Methods: As part of a large surveillance study in cardiac surgery patients (n = 266) we retrospectively analyzed the course of 28 patients requiring intra‐aortic balloon pump therapy. Patients were grouped according to the time point of pump insertion (during weaning from cardiopulmonary bypass: group early intra‐aortic balloon pumping (n = 17); after admission to the intensive care unit: group late intra‐aortic balloon pumping (n = 9). Haemodynamic and tonometric variables, arterial lactate, and use of catecholamines were measured hourly. Measurements and results: Cardiac index increased in both groups after intra‐aortic balloon pump insertion (2.2 ± 0.5 baseline; 3.4 ± 0.8 L min−1 m−2 4 h later (group early intra‐aortic balloon pumping); 2.8 ± 0.5 baseline, 3.6 ± L min−1 m−2 4 h later (group later intra‐aortic balloon pumping), each P < 0.05), there were no differences between groups. Arterial lactate values increased in group later intra‐aortic balloon pumping after pump insertion to a maximum 2 h later (8.4 ± 6.1 mmol L−1 baseline; 12.7 ± 7.4 mmol L−1, P < 0.05), and decreased continuously afterwards. The difference of arterial and gastric CO2 showed a sharp decrease after pump insertion in group later intra‐aortic balloon pumping (26.4 ± 9.8 baseline; 7.0 ± 11.1 mmHg, P < 0.05). There were no differences between groups. Epinephrine doses were higher in group later intra‐aortic balloon pumping (P < 0.05). Conclusions: Intra‐aortic balloon pump therapy improved global and regional splanchnic oxygenation in cardiac surgery patients with low‐cardiac‐output syndrome. Gastro‐intestinal tonometry could provide additional information concerning tissue oxygenation. Patients with later intra‐aortic balloon pump insertion needed more catecholamine therapy to achieve similar haemodynamic values.

Erprobung einer Anordnung zur Prüfung alterskorrelierter Prozesse unter Belastung

Zusammenfassung: Ziel der Untersuchung, die wesentlich durch Studien von Molander und Backman (1994) angeregt wurde, ist die experimentelle Prufung einer sportbezogenen Wettkampfbedingung als Belastungssituation. Es sollte damit die Voraussetzung geschaffen werden, alterskorrelierte Prozesse unter Belastung anzugehen. 72 mannliche Freizeittennisspieler zwischen 20-79 Jahren, die in drei gleichweite Altersintervalle geschichtet waren, wurden dazu in einem Trainingsspiel und einem Wettkampfmatch hinsichtlich Selbstbeurteilungen zum aktuellen Befinden und zur Stresverarbeitung, vegetativer Mase und Verhaltensdaten aus der Spielsituation verglichen. Die Ergebnisse zeigen, das das Wettbewerbmatch nur fur 20-39jahrige eine emotional dysphorische Belastungssituation ist, die mit Leistungseinbusen einhergeht. Jungere Spieler geben nach einem Match weniger effektive Stresverarbeitungsmasnahmen an als altere. Die Befunde entsprechen nicht dem Modell von Molander und Backman.