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  1. Article ; Online: Prehospital blood transfusion: who benefits?

    Thies, Karl-Christian / Ruetzler, Kurt

    The Lancet. Haematology

    2022  Volume 9, Issue 4, Page(s) e238–e239

    MeSH term(s) Blood Transfusion ; Emergency Medical Services ; Humans ; Retrospective Studies
    Language English
    Publishing date 2022-03-07
    Publishing country England
    Document type Journal Article ; Comment
    ISSN 2352-3026
    ISSN (online) 2352-3026
    DOI 10.1016/S2352-3026(22)00074-6
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  2. Article ; Online: Tension pneumocephalus.

    Khanna, Sandeep / Trombetta, Carlos / Ruetzler, Kurt / Argalious, Maged

    Brazilian journal of anesthesiology (Elsevier)

    2023  Volume 73, Issue 6, Page(s) 834–835

    MeSH term(s) Humans ; Pneumocephalus/diagnostic imaging ; Pneumocephalus/etiology ; Postoperative Complications ; Tomography, X-Ray Computed
    Language English
    Publishing date 2023-07-28
    Publishing country Brazil
    Document type Journal Article
    ISSN 2352-2291
    ISSN (online) 2352-2291
    DOI 10.1016/j.bjane.2023.07.005
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  3. Article ; Online: Challenges of obesity in today's surgical healthcare.

    Müller, Carolin / Rosen, Michael J / Ruetzler, Kurt

    Journal of clinical anesthesia

    2023  Volume 92, Page(s) 111213

    MeSH term(s) Humans ; Obesity/complications ; Obesity/surgery ; Delivery of Health Care
    Language English
    Publishing date 2023-07-18
    Publishing country United States
    Document type Editorial
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2023.111213
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  4. Article ; Online: Intraoperative hypotension and delirium.

    Müller-Wirtz, Lukas M / Ruetzler, Kurt / Rössler, Julian

    Journal of clinical anesthesia

    2023  Volume 89, Page(s) 111153

    MeSH term(s) Humans ; Hypotension/diagnosis ; Hypotension/etiology ; Postoperative Complications ; Delirium/etiology
    Language English
    Publishing date 2023-05-26
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2023.111153
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  5. Article ; Online: Perioperative bleeding and outcomes after noncardiac surgery.

    Smilowitz, Nathaniel R / Ruetzler, Kurt / Berger, Jeffrey S

    American heart journal

    2023  Volume 260, Page(s) 26–33

    Abstract: Background: Perioperative bleeding is a common and potentially life-threatening complication after surgery. We sought to identify the frequency, patient characteristics, causes, and outcomes of perioperative bleeding in patients undergoing noncardiac ... ...

    Abstract Background: Perioperative bleeding is a common and potentially life-threatening complication after surgery. We sought to identify the frequency, patient characteristics, causes, and outcomes of perioperative bleeding in patients undergoing noncardiac surgery.
    Methods: In a retrospective cohort study of a large administrative database, adults aged ≥45 years hospitalized for noncardiac surgery in 2018 were identified. Perioperative bleeding was defined using ICD-10 diagnosis and procedure codes. Clinical characteristics, in-hospital outcomes, and first hospital readmission within 6 months were assessed by perioperative bleeding status.
    Results: We identified 2,298,757 individuals undergoing noncardiac surgery, among which 35,429 (1.54%) had perioperative bleeding. Patients with bleeding were older, less likely to be female, and more likely to have renal and cardiovascular disease. All-cause, in-hospital mortality was higher in patients with vs without perioperative bleeding (6.0% vs 1.3%; adjusted OR [aOR] 2.38, 95% CI 2.26-2.50). Patients with vs without bleeding had a prolonged inpatient length of stay (6 [IQR 3-13] vs 3 [IQR 2-6] days, P < .001). Among those who were discharged alive, hospital readmission was more common within 6 months among patients with bleeding (36.0% vs 23.6%; adjusted HR 1.21, 95% CI 1.18-1.24). The risk of in-hospital death or readmission was greater in patients with vs without bleeding (39.8% vs 24.5%; aOR 1.33, 95% CI 1.29-1.38). When stratified by revised cardiac risk index , there was a stepwise increase in surgical bleeding risk with increasing perioperative cardiovascular risks.
    Conclusions: Perioperative bleeding is reported in 1 out of every 65 noncardiac surgeries, with a higher incidence in patients at elevated cardiovascular risk. Among postsurgical inpatients with perioperative bleeding, approximately 1 of every 3 patients died during hospitalization or were readmitted within 6-months. Strategies to reduce perioperative bleeding are warranted to improve outcomes following non-cardiac surgery.
    MeSH term(s) Adult ; Humans ; Female ; Male ; Retrospective Studies ; Hospital Mortality ; Hemorrhage/etiology ; Cardiovascular Diseases/epidemiology ; Hospitalization ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors ; Surgical Procedures, Operative/adverse effects
    Language English
    Publishing date 2023-02-16
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 80026-0
    ISSN 1097-6744 ; 0002-8703
    ISSN (online) 1097-6744
    ISSN 0002-8703
    DOI 10.1016/j.ahj.2023.02.008
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  6. Article ; Online: Die perioperative Hyperoxie – mehr Schaden als Nutzen?

    Stuby, Johann / Kaserer, Alexander / Ott, Sascha / Ruetzler, Kurt / Rössler, Julian

    Die Anaesthesiologie

    2023  Volume 72, Issue 5, Page(s) 342–347

    Abstract: Background: The ideal perioperative oxygen concentration is controversial and study results are inconsistent.: Objective: Current knowledge on the beneficial and adverse effects of perioperative hyperoxia.: Material and methods: Narrative review ... ...

    Title translation Perioperative hyperoxia-More harmful than beneficial?
    Abstract Background: The ideal perioperative oxygen concentration is controversial and study results are inconsistent.
    Objective: Current knowledge on the beneficial and adverse effects of perioperative hyperoxia.
    Material and methods: Narrative review RESULTS: Perioperative hyperoxia is unlikely to increase the incidence of atelectasis, pulmonary or cardiovascular complications or mortality. Few and small potential beneficial effects, such as reduction of surgical wound infections or postoperative nausea and vomiting have been demonstrated. According to the current state of evidence, it is recommended to avoid perioperative hyperoxia and to aim for normoxia instead.
    MeSH term(s) Humans ; Hyperoxia/etiology ; Surgical Wound Infection/complications ; Postoperative Nausea and Vomiting/complications ; Lung ; Pulmonary Atelectasis/complications
    Language German
    Publishing date 2023-04-21
    Publishing country Germany
    Document type English Abstract ; Journal Article ; Review
    ISSN 2731-6866
    ISSN (online) 2731-6866
    DOI 10.1007/s00101-023-01274-4
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  7. Article ; Online: Pro-Con Debate: Prehospital Blood Transfusion-Should It Be Adopted for Civilian Trauma?

    Dudaryk, Roman / Heim, Catherine / Ruetzler, Kurt / Pivalizza, Evan G

    Anesthesia and analgesia

    2022  Volume 134, Issue 4, Page(s) 678–682

    Abstract: Exsanguination is the leading cause of death in severely injured patients; nevertheless, prehospital blood transfusion (PHT) remains a controversial topic. Here, we review the pros and cons of PHT, which is now routine in treatment of military trauma ... ...

    Abstract Exsanguination is the leading cause of death in severely injured patients; nevertheless, prehospital blood transfusion (PHT) remains a controversial topic. Here, we review the pros and cons of PHT, which is now routine in treatment of military trauma patients in the civilian setting. While PHT may improve survival in those who suffer blunt injury or require prolonged transport from the site of injury, PHT for civilian trauma generally is not supported by high-quality evidence. This article was originally presented as a pro-con debate at the 2020 meeting of the European Society of Anesthesiology and Intensive Care.
    MeSH term(s) Blood Transfusion ; Emergency Medical Services ; Exsanguination ; Humans ; Wounds and Injuries/diagnosis ; Wounds and Injuries/therapy ; Wounds, Nonpenetrating
    Language English
    Publishing date 2022-03-17
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000005747
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  8. Article: Honey bee venom re-challenge during specific immunotherapy: prolonged cardio-pulmonary resuscitation allowed survival in a case of near fatal anaphylaxis.

    Micaletto, Sara / Ruetzler, Kurt / Bruesch, Martin / Schmid-Grendelmeier, Peter

    Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology

    2022  Volume 18, Issue 1, Page(s) 44

    Abstract: Background: Specific immunotherapy for patients with honey bee hypersensitivity is commonly applied. Re-challenge with venom is performed to prove protection in individual cases.: Case presenation: We report a case of near fatal anaphylaxis with ... ...

    Abstract Background: Specific immunotherapy for patients with honey bee hypersensitivity is commonly applied. Re-challenge with venom is performed to prove protection in individual cases.
    Case presenation: We report a case of near fatal anaphylaxis with asystole for 24 min in a 35-years-old patient with mastocytosis after honey bee sting challenge, despite 5-years of specific immunotherapy. Successful cardio-pulmonary resuscitation was applied for 32 min.
    Conclusion: This intervention demonstrates, that in anaphylaxis with cardio-vascular arrest, prolonged cardio-pulmonary resuscitation for up to 40 min may be appropriate to overcome the half-life of massively released histamine. Failure of specific immunotherapy was possibly due to sensitization to the allergen Api m10, potentially underrepresented in commercial honey bee venom extracts. Molecular analyses may provide additional clues to the potentially unsuccessful outcome of venom specific immunotherapy, especially in high-risk patients such as mastocytosis.
    Language English
    Publishing date 2022-06-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2434973-2
    ISSN 1710-1492 ; 1710-1484
    ISSN (online) 1710-1492
    ISSN 1710-1484
    DOI 10.1186/s13223-022-00687-x
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  9. Article ; Online: Association of Intravenous Neostigmine and Anticholinergics or Sugammadex with Postoperative Delirium: A Retrospective Cohort Study.

    Rössler, Julian / Abramczyk, Emily / Paredes, Stephania / Anusic, Nikola / Pu, Xuan / Maheshwari, Kamal / Turan, Alparslan / Ruetzler, Kurt

    Anesthesia and analgesia

    2024  

    Abstract: Background: Administration of cholinesterase inhibitors in combination with anticholinergic drugs for reversal of neuromuscular blocks may precipitate delirium through impairment of central cholinergic transmission, which could be avoided by using ... ...

    Abstract Background: Administration of cholinesterase inhibitors in combination with anticholinergic drugs for reversal of neuromuscular blocks may precipitate delirium through impairment of central cholinergic transmission, which could be avoided by using sugammadex. Therefore, we tested the primary hypothesis that postoperative delirium is less common when neuromuscular block is reversed with sugammadex than with neostigmine combined with glycopyrrolate or atropine.
    Methods: We conducted a single-center retrospective cohort study, analyzing all adult patients having general anesthesia for noncardiac surgery who received neostigmine or sugammadex from January 2016 to March 2022. Inverse propensity score weighting and propensity score calibration were used to adjust for appropriate confounders. Our primary outcome was presence of delirium within the first 4 days after surgery, defined as at least 1 positive brief Confusion Assessment Method (bCAM) screening. The secondary outcome was the presence of early delirium within 24 hours of surgery.
    Results: Among 49,468 cases in our analysis, 6881 received sugammadex and 42,587 received neostigmine. After propensity weighting, the incidence of delirium was 1.09% in the sugammadex group and 0.82% in the neostigmine group. The odds of postoperative delirium did not differ between the sugammadex and neostigmine groups, with an estimated odds ratio (95% confidence interval) of 1.33 (0.91-1.95), P = .147. A sensitivity analysis restricted to only include cases with at least 6 bCAM measurements over postoperative day (POD) 1 to 4 had consistent results, as sugammadex compared with neostigmine was associated with an estimated odds ratio for postoperative delirium of 1.20 (0.82-1.77), P = .346. Sugammadex was significantly associated with an increased incidence of early postoperative delirium, with an estimated odds ratio of 1.71 (1.07-2.72), P = .025. Further analysis showed no treatment-by-age interaction for either postoperative delirium (P = .637) or postoperative early delirium (P = .904).
    Conclusions: Compared to neostigmine, use of sugammadex for reversal of neuromuscular block was not associated with an increased risk of postoperative delirium in this retrospective single-center study. Though sugammadex was associated with a statistically significant increased risk of postoperative early delirium, the difference was small and not clinically relevant, and may reflect the presence of unknown confounders.
    Language English
    Publishing date 2024-03-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000006939
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  10. Article ; Online: Anesthetic management in patients having catheter-based thrombectomy for acute pulmonary embolism: A narrative review.

    Rössler, Julian / Cywinski, Jacek B / Argalious, Maged / Ruetzler, Kurt / Khanna, Sandeep

    Journal of clinical anesthesia

    2023  Volume 92, Page(s) 111281

    Abstract: Pulmonary embolism is the third leading cause of cardiovascular death. Novel percutaneous catheter-based thrombectomy techniques are rapidly becoming popular in high-risk pulmonary embolism - especially in the presence of contraindications to ... ...

    Abstract Pulmonary embolism is the third leading cause of cardiovascular death. Novel percutaneous catheter-based thrombectomy techniques are rapidly becoming popular in high-risk pulmonary embolism - especially in the presence of contraindications to thrombolysis. The interventional nature of these procedures and the risk of sudden cardiorespiratory compromise requires the presence of an anesthesiologist. Facilitating catheter-based thrombectomy can be challenging since qualifying patients are often critically ill. The purpose of this narrative review is to provide guidance to anesthesiologists for the assessment and management of patients having catheter-based thrombectomy for acute pulmonary embolism. First, available techniques for catheter-based thrombectomy are reviewed. Then, we discuss definitions and application of common risk stratification tools for pulmonary embolism, and how to assess patients prior to the procedure. An adjudication of risks and benefits of anesthetic strategies for catheter-based thrombectomy follows. Specifically, we give guidance and rationale for use monitored anesthesia care and general anesthesia for these procedures. For both, we review strategies for assessing and mitigating hemodynamic perturbations and right ventricular dysfunction, ranging from basic monitoring to advanced inodilator therapy. Finally, considerations for management of right ventricular failure with mechanical circulatory support are discussed.
    MeSH term(s) Humans ; Thrombolytic Therapy/methods ; Treatment Outcome ; Thrombectomy/adverse effects ; Thrombectomy/methods ; Pulmonary Embolism/surgery ; Catheters ; Acute Disease ; Anesthetics
    Chemical Substances Anesthetics
    Language English
    Publishing date 2023-10-07
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2023.111281
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