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Article ; Online: EUS-guided coil injection therapy in the management of gastric varices: the first U.S. multicenter experience (with video).

2023 Volume 99, Issue 1, Page(s) 31–37

Abstract: ... with particular expertise. The aim of this study was to report the first U.S. multicenter experience of EUS-COIL ... of bleeding who underwent EUS-COIL at 10 U.S. tertiary care centers between 2018 and 2022. Baseline patient ... This U.S. multicenter experience on EUS-COIL for GV confirms high technical and clinical success with low ...

Abstract	Background and aims: Despite the significant morbidity associated with gastric variceal bleeding, there is a paucity of high-quality data regarding optimal management. EUS-guided coil injection therapy (EUS-COIL) has recently emerged as a promising endoscopic modality for the treatment of gastric varices (GV), particularly compared with traditional direct endoscopic glue injection. Although there are data on the feasibility and safety of EUS-COIL in the management of GV, these have been limited to select centers with particular expertise. The aim of this study was to report the first U.S. multicenter experience of EUS-COIL for the management of GV. Methods: This retrospective analysis included patients with bleeding GV or GV at risk of bleeding who underwent EUS-COIL at 10 U.S. tertiary care centers between 2018 and 2022. Baseline patient and procedure-related information was obtained. EUS-COIL entailed the injection of .018 inch or .035 inch hemostatic coils using a 22-gauge or 19-gauge FNA needle. Primary outcomes were technical success (defined as successful deployment of coil into varix under EUS guidance with diminution of Doppler flow), clinical success (defined as cessation of bleeding if present and/or absence of bleeding at 30 days' postintervention), and intraprocedural and postprocedural adverse events. Results: A total of 106 patients were included (mean age 60.4 ± 12.8 years; 41.5% female). The most common etiology of GV was cirrhosis (71.7%), with alcohol being the most common cause (43.4%). Overall, 71.7% presented with acute GV bleeding requiring intensive care unit stay and/or blood transfusion. The most common GV encountered were isolated GV type 1 (60.4%). A mean of 3.8 ± 3 coils were injected with a total mean length of 44.7 ± 46.1 cm. Adjunctive glue or absorbable gelatin sponge was injected in 82% of patients. Technical success and clinical success were 100% and 88.7%, respectively. Intraprocedural adverse events (pulmonary embolism and GV bleeding from FNA needle access) occurred in 2 patients (1.8%), and postprocedural adverse events occurred in 5 (4.7%), of which 3 were mild. Recurrent bleeding was observed in 15 patients (14.1%) at a mean of 32 days. Eighty percent of patients with recurrent bleeding were successfully re-treated with repeat EUS-COIL. No significant differences were observed in outcomes between high-volume (>15 cases) and low-volume (<7 cases) centers. Conclusions: This U.S. multicenter experience on EUS-COIL for GV confirms high technical and clinical success with low adverse events. No significant differences were seen between high- and low-volume centers. Repeat EUS-COIL seems to be an effective rescue option for patients with recurrent bleeding GV. Further prospective studies should compare this modality versus other interventions commonly used for GV.
MeSH term(s)	Humans ; Female ; Middle Aged ; Aged ; Male ; Gastrointestinal Hemorrhage/therapy ; Gastrointestinal Hemorrhage/drug therapy ; Esophageal and Gastric Varices/therapy ; Esophageal and Gastric Varices/complications ; Hemostasis, Endoscopic/adverse effects ; Cyanoacrylates ; Retrospective Studies ; Prospective Studies ; Treatment Outcome ; Endosonography/adverse effects
Chemical Substances	Cyanoacrylates
Language	English
Publishing date	2023-07-31
Publishing country	United States
Document type	Video-Audio Media ; Multicenter Study ; Journal Article
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1016/j.gie.2023.07.043
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Zs.MO 519: Show issues

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Article ; Online: Impact of High Deductible Health Plans on U.S. Adults With Chronic Pain.

Kennedy-Hendricks, Alene / Eddelbuettel, Julia C P / Bicket, Mark C / Meiselbach, Mark K / Hollander, Mara A G / Busch, Alisa B / Huskamp, Haiden A / Stuart, Elizabeth A / Barry, Colleen L / Eisenberg, Matthew D

American journal of preventive medicine

2023 Volume 65, Issue 5, Page(s) 800–808

Abstract: Introduction: Chronic pain affects an estimated 20% of U.S. adults. Because high-deductible ...

Abstract	Introduction: Chronic pain affects an estimated 20% of U.S. adults. Because high-deductible health plans have captured a growing share of the commercial insurance market, it is unknown how high-deductible health plans impact care for chronic pain. Methods: Using 2007-2017 claims data from a large national commercial insurer, statistical analyses conducted in 2022-2023 estimated changes in enrollee outcomes before and after their firm began offering a high-deductible health plan compared with changes in outcomes in a comparison group of enrollees at firms never offering a high-deductible health plan. The sample included 757,530 commercially insured adults aged 18-64 years with headache, low back pain, arthritis, neuropathic pain, or fibromyalgia. Outcomes, measured at the enrollee year level, included the probability of receiving any chronic pain treatment, nonpharmacologic pain treatment, and opioid and nonopioid prescriptions; the number of nonpharmacologic pain treatment days; number and days' supply of opioid and nonopioid prescriptions; and total annual spending and out-of-pocket spending. Results: High-deductible health plan offer was associated with a 1.2 percentage point reduction (95% CI= -1.8, -0.5) in the probability of any chronic pain treatment and an $11 increase (95% CI=$6, $15) in annual out-of-pocket spending on chronic pain treatments among those with any use, representing a 16% increase in average annual out-of-pocket spending over the pre-high deductible health plan offer annual average. Results were driven by changes in nonpharmacologic treatment use. Conclusions: By reducing the use of nonpharmacologic chronic pain treatments and marginally increasing out-of-pocket costs among those using these services, high-deductible health plans may discourage more holistic, integrated approaches to caring for patients with chronic pain conditions.
MeSH term(s)	Humans ; Adult ; Deductibles and Coinsurance ; Chronic Pain/therapy ; Analgesics, Opioid ; Health Expenditures ; Costs and Cost Analysis
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-05-13
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2023.05.008
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Article: Simplified Diet for nutrition management of phenylketonuria: A survey of U.S. metabolic dietitians.

Hansen, Joyanna / Hollander, Suzanne / Drilias, Nicoletta / Van Calcar, Sandra / Rohr, Fran / Bernstein, Laurie

JIMD reports

2020 Volume 53, Issue 1, Page(s) 83–89

Abstract: ... centers in the United States (U.S.), and clinical practice varies.: Aim: This study describes ... the clinical experience of metabolic dietitians in U.S.-based metabolic centers related to the use and ... to analyze responses.: Results: Sixty-three dietitians managing ≥5 patients with PKU in U.S.-based ...

Abstract	Background: Phenylketonuria (PKU) is an inherited metabolic disorder affecting the conversion of phenylalanine (Phe) to tyrosine. Medical nutrition therapy, consisting of a Phe-restricted diet with medical formula, is the primary treatment for PKU. The Simplified Diet is an approach to PKU nutrition management that allows certain fruits, vegetables, and low-protein foods to be eaten without measuring or tracking, referred to as free/uncounted foods. There is no consensus on how to implement this approach in metabolic centers in the United States (U.S.), and clinical practice varies. Aim: This study describes the clinical experience of metabolic dietitians in U.S.-based metabolic centers related to the use and implementation of the Simplified Diet. Methods: A survey was developed and sent out to metabolic dietitians to query current clinical practices related to the Simplified Diet. Descriptive statistics were used to analyze responses. Results: Sixty-three dietitians managing ≥5 patients with PKU in U.S.-based metabolic centers responded to the survey. Ninety-eight percent of survey respondents reported using some version of the Simplified Diet in clinical practice. The survey identified areas of strong agreement, including introduction of the Simplified Diet at 6 to 12 months of age. The survey also identified areas of widespread variability, including specific Phe or protein thresholds for free/uncounted foods, and whether or not to set daily quantity limits on these foods. Conclusions: Significant variability related to implementation of the Simplified Diet exists across U.S.-based metabolic centers. This practice variability may contribute to differences in the patient experience across centers and may indicate a need for development of clinical guidelines.
Language	English
Publishing date	2020-04-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2672872-2
ISSN	2192-8312 ; 2192-8304
ISSN (online)	2192-8312
ISSN	2192-8304
DOI	10.1002/jmd2.12106
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Book ; Online: Vier scenario’s voor de inrichting van Nederland in 2050

Hamers, David / Hammingh, Pieter / Kuiper, Rienk / van Dam, Frank / Dammers, Ed / Evenhuis, Emil / van Gaalen, Frank / de Hollander, Guus / van Hoorn, Anton / van Minnen, Jelle / Nabielek, Kersten / Pols, Leo / Rijken, Bart / Rood, Trudy / Snellen, Daniëlle / Dirkx, Joep / Wolters, Henk

Ruimtelijke Verkenning 2023

2023

Abstract: In de Ruimtelijke Verkenning 2023 heeft het PBL scenario’s ontwikkeld voor de inrichting van ...

Abstract	In de Ruimtelijke Verkenning 2023 heeft het PBL scenario’s ontwikkeld voor de inrichting van Nederland in 2050. In dit hoofdrapport worden vier mogelijke ruimtelijke toekomsten gepresenteerd. Dat zijn: Mondiaal Ondernemend (een toekomstscenario waarin grote bedrijven de lead hebben), Snelle Wereld (de nog verder toegenomen digitalisering doet afstanden verdwijnen), Groen Land (veel ruimte voor de natuur) en Regionaal Geworteld (burgers nemen het initiatief in hun eigen leefomgeving). Voor elk scenario zijn op basis van ruimtelijke modellering en ontwerpend onderzoek gedetailleerde kaarten van het bijbehorende Nederland van 2050 gemaakt. Deze scenariokaarten brengen in beeld welke gevolgen verschillende keuzes hebben.
Keywords	Life Science
Language	Dutch
Publisher	PBL Planbureau voor de Leefomgeving
Publishing country	nl
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Empowerment Self-Defense Prevents Rape: A Response to Kettrey et al.'s Meta-Analysis.

Hollander, Jocelyn A / Edwards, Katie M / McCaughey, Martha / Cermele, Jill / Ullman, Sarah E / Senn, Charlene Y / Beaujolais, Brieanne / Orchowski, Lindsay M / Peitzmeier, Sarah M

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2023 Volume 74, Issue 1, Page(s) 208–209

MeSH term(s)	Humans ; Rape/prevention & control ; Empowerment ; Meta-Analysis as Topic
Language	English
Publishing date	2023-12-14
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2023.08.009
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Article: Threshold evaluation for optimal number of endoscopic treatment sessions to achieve complete eradication of Barrett’s metaplasia

Mittal, Chetan / Muthusamy, V. Raman / Simon, Violette C. / Brauer, Brian C. / Mullady, Daniel K. / Hollander, Thomas / Sloan, Ian / Kushnir, Vladimir / Early, Dayna / Rastogi, Amit / Hammad, Hazem T. / Edmundowicz, Steven A. / Han, Samuel / Thaker, Adarsh M. / Ezekwe, Ezenwanyi / Wani, Sachin / Kwasny, Mary J. / Komanduri, Srinadh

Endoscopy

2022 Volume 54, Issue 10, Page(s) 927–933

Abstract: Background: Endoscopic eradication therapy (EET) is the standard of care for Barrett’s ...

Abstract	Background: Endoscopic eradication therapy (EET) is the standard of care for Barrett’s esophagus (BE)-associated neoplasia. Previous data suggest the mean number of EET sessions required to achieve complete eradication of intestinal metaplasia (CE-IM) is 3. This study aimed to define the threshold of EET sessions required to achieve CE-IM. Methods: The TREAT-BE Consortium is a multicenter outcomes cohort including prospectively enrolled patients with BE undergoing EET. All patients achieving CE-IM were included. Demographic, endoscopic, and histologic data were recorded at treatment onset along with treatment details and surveillance data. Kaplan–Meier analysis was performed to define a threshold of EET sessions, with 95 %CI, required to achieve CE-IM. A secondary analysis examined predictors of incomplete response to EET using multiple logistic regression and recurrence rates. Results: 623 patients (mean age 65.2 [SD 11.6], 79.6 % male, 86.5 % Caucasian) achieved CE-IM in a mean of 2.9 (SD 1.7) EET sessions (median 2) and a median total observation period of 2.7 years (interquartile range 1.4–5.0). After three sessions, 73 % of patients achieved CE-IM (95 %CI 70 %–77 %). Age (odds ratio [OR] 1.25, 95 %CI 1.05–1.50) and length of BE (OR 1.24, 95 %CI 1.17–1.31) were significant predictors of incomplete response. Conclusion: The current study found that a threshold of three EET sessions would achieve CE-IM in the majority of patients. Alternative therapies and further diagnostic testing should be considered for patients who do not have significant response to EET after three sessions.
Language	English
Publishing date	2022-02-08
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	80120-3
ISSN	1438-8812 ; 0013-726X
ISSN (online)	1438-8812
ISSN	0013-726X
DOI	10.1055/a-1765-7197
Database	Thieme publisher's database

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Zs.A 669: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Outcomes of endoscopic treatment of leaks and fistulae after sleeve gastrectomy: results from a large multicenter U.S. cohort.

Smith, Zachary L / Park, Kenneth H / Llano, Ernesto M / Donboli, Kianoush / Fayad, Lea / Han, Samuel / Kang, Lorna / Simril, Robert T / Patel, Riddhi / Hollander, Thomas / Rogers, Melinda C / Elmunzer, B Joseph / Siddiqui, Uzma D / Aadam, A Aziz / Mullady, Daniel K / Lang, Gabriel D / Das, Koushik K / Jamil, Laith H / Lo, Simon K /

Gaddam, Srinivas / Chapman, Christopher G / Keswani, Rajesh N / Wani, Sachin / Cote, Gregory A / Kumbhari, Vivek / Kushnir, Vladimir M

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

2019 Volume 15, Issue 6, Page(s) 850–855

Abstract: Background: Sleeve gastrectomy is the most commonly performed bariatric surgery in the United States. Leaks after sleeve gastrectomy (SGL) occur in 1% to 3% of patients. Endoscopic therapies are increasingly used for treatment of SGLs, but few data ... ...

Abstract	Background: Sleeve gastrectomy is the most commonly performed bariatric surgery in the United States. Leaks after sleeve gastrectomy (SGL) occur in 1% to 3% of patients. Endoscopic therapies are increasingly used for treatment of SGLs, but few data exist on their outcomes. Objectives: The aim of this study was to assess technical success, leak resolution, and reoperation rates of patients undergoing endoscopic therapy for repair SGLs. Setting: Eight high-volume academic endoscopy centers. Methods: Patients undergoing endoscopic therapy for SGLs from 2007 to 2017 were identified. Patients were excluded if the index endoscopic therapy for SGL was performed elsewhere or if no follow-up data were available. Leaks were classified as acute (≤7 d of SG), early (1-6 wk), late (7-12 wk), and chronic (>12 wk). Leak resolution was defined as lack of extraluminal air, extravasation on oral contrast radiography, cross-sectional imaging, or resolution of percutaneous drain output. Demographic and procedural data were recorded as rates of additional therapy, adverse events, and surgical revision. Results: A total of 85 patients met criteria for analysis (70 women, age 42.6 ± 10.8 yr). A total of 295 endoscopic sessions (median 3, range 1-14) were performed across the cohort. SGLs resolved after index endoscopic therapy in 43 (50.1%) patients. The primary outcome of endoscopic resolution of SGL was observed in 62 patients (72.9%). There were 34 (11.5%) PRAE (the majority occurring with self-expandable metal stents), all but 1 of which were managed endoscopically. Surgical revision was required in 23 (21.7%) patients. On univariate analyses independent variables associated with the need for surgical revision included both acute and chronic SGLs (P = .028), loculated subphrenic collections/abscesses (P = .03), and intraabdominal sepsis (P = .03). On multivariable logistic regression using statistically significant predictors from the univariate analyses, acute SGLs were significantly associated with a need for surgical revision (odds ratio 4.8, 95% confidence interval 1.2-18.9, P = .025). Conclusion: Endoscopic therapy for SGLs is associated with good clinical success, avoiding the need for surgical revision in 73% of patients, with an acceptable adverse event profile. Patients with acute or chronic SGLs and those with loculated abscesses or intraabdominal sepsis are more likely to undergo surgical revision. Endoscopic therapy is an appropriate first-line modality for the management of SGLs, especially those not classified as acute or chronic.
MeSH term(s)	Adolescent ; Adult ; Aged ; Anastomotic Leak/surgery ; Bariatric Surgery/adverse effects ; Endoscopy, Gastrointestinal ; Female ; Gastrectomy/adverse effects ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; United States ; Young Adult
Language	English
Publishing date	2019-04-17
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	2274243-8
ISSN	1878-7533 ; 1550-7289
ISSN (online)	1878-7533
ISSN	1550-7289
DOI	10.1016/j.soard.2019.04.009
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Book ; Online: Chancen und Herausforderungen der Verknüpfungen der Systeme in der Wasserwirtschaft (Wasser 4.0)

Holländer, Robert / Stumpf, Lukas / Lautenschläger, Sabine / Interwies, Eduard / Görlitz, Stefan / Pielow, Johann-Christian

Abschlussbericht

(Texte / Umweltbundesamt ; 2020, 29)

2021

Abstract: Digitalisierung hat sich zu einem Schlagwort entwickelt. Auch im Bereich der Wasserwirtschaft wird der Digitalisierung das Potenzial zugesprochen die Probleme der Zukunft meistern zu können. Im Rahmen dieses Forschungsvorhabens wurden die „Chancen und ... ...

Institution	Deutschland / Umweltbundesamt
Author's details	von Prof. Dr.-Ing. Robert Holländer, M. Sc. Lukas Stumpf, Institut für Infrastruktur und Ressourcenmanagement (IIRM), Universität Leipzig, Dr.-Ing. Sabine Lautenschläger (InfraRes GmbH, Leipzig), Eduard Interwies, Stefan Görlitz UInterSus – Sustainability Services, Berlin), Prof. Dr. jur. Joh.-Christian Pielow, Bochum ; im Auftrag des Umweltbundesamtes
Series title	Texte / Umweltbundesamt ; 2020, 29
Collection
Abstract	Digitalisierung hat sich zu einem Schlagwort entwickelt. Auch im Bereich der Wasserwirtschaft wird der Digitalisierung das Potenzial zugesprochen die Probleme der Zukunft meistern zu können. Im Rahmen dieses Forschungsvorhabens wurden die „Chancen und Herausforderungen der Verknüpfungen der Systeme in der Wasserwirtschaft“ untersucht. Dabei standen folgende Fragestellungen im Fokus: Wie und in welchem Umfang kann „Wasserwirtschaft 4.0“ in Deutschland zu Zielen des Umwelt- und Gewässerschutzes sowie der Nachhaltigkeit beitragen? In welchen Bereichen sind die größten Potenziale für Umwelt und Bürger zu erwarten? Welche politischen, administrativen und juristischen Rahmenbedingungen sind für die Gestaltung von „Wasserwirtschaft 4.0“ erforderlich? Worin liegen die aktuellen, zentralen Herausforderungen im Umgang mit der Digitalisierung?
Subject code	630
Language	German
Size	1 Online-Ressource (142 Seiten)
Publisher	Umweltbundesamt
Publishing place	Dessau-Roßlau
Publishing country	Germany
Document type	Book ; Online
Note	Enthält Zusammenfassungen in englischer und deutscher Sprache ; "Ressortforschungsplan des Bundesministeriums für Umwelt, Naturschutz und nukleare Sicherheit; Forschungskennzahl 3717 21 327 0" ; Aus dem Impressum: "Abschlussdatum: März 2019" ; Open Access
Remark	Elektronischer Volltext
HBZ-ID	HT021188442
DOI	10.4126/FRL01-006430913
Database	Repository for Life Sciences

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Book ; Online: Chancen und Herausforderungen der Verknüpfungen der Systeme in der Wasserwirtschaft (Wasser 4.0)

Holländer, Robert / Stumpf, Lukas / Lautenschläger, Sabine / Interwies, Eduard / Görlitz, Stefan / Pielow, Johann-Christian

Abschlussbericht

(Texte / Umweltbundesamt ; 2020, 29)

2021

Institution	Deutschland / Umweltbundesamt
Author's details	von Prof. Dr.-Ing. Robert Holländer, M. Sc. Lukas Stumpf, Institut für Infrastruktur und Ressourcenmanagement (IIRM), Universität Leipzig, Dr.-Ing. Sabine Lautenschläger (InfraRes GmbH, Leipzig), Eduard Interwies, Stefan Görlitz UInterSus – Sustainability Services, Berlin), Prof. Dr. jur. Joh.-Christian Pielow, Bochum ; im Auftrag des Umweltbundesamtes
Series title	Texte / Umweltbundesamt ; 2020, 29
Collection
Abstract	Digitalisierung hat sich zu einem Schlagwort entwickelt. Auch im Bereich der Wasserwirtschaft wird der Digitalisierung das Potenzial zugesprochen die Probleme der Zukunft meistern zu können. Im Rahmen dieses Forschungsvorhabens wurden die „Chancen und Herausforderungen der Verknüpfungen der Systeme in der Wasserwirtschaft“ untersucht. Dabei standen folgende Fragestellungen im Fokus: Wie und in welchem Umfang kann „Wasserwirtschaft 4.0“ in Deutschland zu Zielen des Umwelt- und Gewässerschutzes sowie der Nachhaltigkeit beitragen? In welchen Bereichen sind die größten Potenziale für Umwelt und Bürger zu erwarten? Welche politischen, administrativen und juristischen Rahmenbedingungen sind für die Gestaltung von „Wasserwirtschaft 4.0“ erforderlich? Worin liegen die aktuellen, zentralen Herausforderungen im Umgang mit der Digitalisierung?
Subject code	630
Language	German
Size	1 Online-Ressource (142 Seiten)
Publisher	Umweltbundesamt
Publishing place	Dessau-Roßlau
Publishing country	Germany
Document type	Book ; Online
Note	Enthält Zusammenfassungen in englischer und deutscher Sprache ; "Ressortforschungsplan des Bundesministeriums für Umwelt, Naturschutz und nukleare Sicherheit; Forschungskennzahl 3717 21 327 0" ; Aus dem Impressum: "Abschlussdatum: März 2019" ; Open Access
Remark	Elektronischer Volltext
HBZ-ID	HT021188442
DOI	10.4126/FRL01-006430913
Database	Repository for Life Sciences

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Article ; Online: 100 Hz-5 s tetanic stimulation to illustrate the presence of "residual paralysis" co-existing with accelerometric 0.90 train-of-four ratio-A proof-of-concept study.

Debaene, Bertrand / Frasca, Denis / Moreillon, Fabien / D'Hollander, Alain A

Anaesthesia, critical care & pain medicine

2021 Volume 40, Issue 4, Page(s) 100903

Abstract: ... was to evaluate, in patients receiving rocuronium, the degree of 100-Hz, 5-s tetanic fade present ... but before rocuronium injection, a 100-Hz, 5-s tetanus (TET0) was delivered to both ulnar nerves. Thereafter, TOF ... stimulations every 15 s were delivered to both arms until a TOF ratio > 0.90 was recorded; then, a 100-Hz, 5-s ...

Abstract	Background: An acceleromyographic train-of-four (TOF) ratio of 0.90 at extubation does not prevent postoperative pulmonary complications in surgical patients receiving non-depolarising muscle relaxants. This recent observation suggests that a more selective neuromuscular transmission monitoring parameter is mandatory to detect more precisely any remaining residual paralysis. The aim of our proof-of-concept study was to evaluate, in patients receiving rocuronium, the degree of 100-Hz, 5-s tetanic fade present when the acceleromyographic TOF ratio has recovered to 0.90. Methods: Twenty adult patients scheduled for surgery under general anaesthesia were included. Before anaesthesia induction, a TOF-Watch SX™ and a VISUAL-ITF© (a prototype monitor for recording isometric force) were positioned on both hands. After induction but before rocuronium injection, a 100-Hz, 5-s tetanus (TET0) was delivered to both ulnar nerves. Thereafter, TOF stimulations every 15 s were delivered to both arms until a TOF ratio > 0.90 was recorded; then, a 100-Hz, 5-s tetanus (TET1) was recorded on the VISUAL-ITF© monitor. The values of the tetanic parameters (force) recorded at TET0 and TET1 were compared using a Wilcoxon rank sum test. Results: Compared to TET0, tetanic parameters of TET1 were significantly lower (median [range]): maximal force 36.4 [19.2-82.6] vs. 25.5 [5.0-42.4] Newton (p < 0.005); residual force 36.2 [18.2-82.0] vs. 5.5 [0.20-38.3] Newton (p < 0.0001) and residual force/maximal force ratio 0.98 [0.89-0.99] vs. 0.17 [0.03-0.90] (p < 0.0001). Conclusion: Our results confirm that even when the acceleromyographic TOF ratios have recovered to above 0.90, the contralateral 100-Hz, 5-s tetanic stimulus may show tetanic fade characteristic of residual neuromuscular block, and may help improve the safety of tracheal extubation.
MeSH term(s)	Adult ; Electric Stimulation ; Hand ; Humans ; Mixed Function Oxygenases ; Neuromuscular Blockade ; Paralysis ; Proto-Oncogene Proteins ; Rocuronium ; Tetanus
Chemical Substances	Proto-Oncogene Proteins ; Mixed Function Oxygenases (EC 1.-) ; TET1 protein, human (EC 1.-) ; Rocuronium (WRE554RFEZ)
Language	English
Publishing date	2021-06-17
Publishing country	France
Document type	Journal Article
ISSN	2352-5568
ISSN (online)	2352-5568
DOI	10.1016/j.accpm.2021.100903
Database	MEDical Literature Analysis and Retrieval System OnLINE

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