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Artikel ; Online: Assessment of P-Glycoprotein Transport Activity at the Human Blood-Retina Barrier with (

Bauer, Martin / Karch, Rudolf / Tournier, Nicolas / Cisternino, Salvatore / Wadsak, Wolfgang / Hacker, Marcus / Marhofer, Peter / Zeitlinger, Markus / Langer, Oliver

Journal of nuclear medicine : official publication, Society of Nuclear Medicine

2016 Band 58, Heft 4, Seite(n) 678–681

Abstract: P-glycoprotein (ABCB1) is expressed at the blood-retina barrier (BRB), where it may control ...

Abstract	P-glycoprotein (ABCB1) is expressed at the blood-retina barrier (BRB), where it may control distribution of drugs from blood to the retina and thereby influence drug efficacy and toxicity.
Mesh-Begriff(e)	ATP Binding Cassette Transporter, Subfamily B, Member 1/blood ; ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism ; Adult ; Carbon Radioisotopes ; Healthy Volunteers ; Humans ; Male ; Positron-Emission Tomography ; Protein Transport ; Retina/metabolism ; Verapamil
Chemische Substanzen	ATP Binding Cassette Transporter, Subfamily B, Member 1 ; Carbon Radioisotopes ; Verapamil (CJ0O37KU29)
Sprache	Englisch
Erscheinungsdatum	2016-10-13
Erscheinungsland	United States
Dokumenttyp	Clinical Trial ; Journal Article
ZDB-ID	80272-4
ISSN	1535-5667 ; 0097-9058 ; 0161-5505 ; 0022-3123
ISSN (online)	1535-5667
ISSN	0097-9058 ; 0161-5505 ; 0022-3123
DOI	10.2967/jnumed.116.182147
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Augmented reality in ultrasound-guided regional anaesthesia: useful tool or expensive toy?

Marhofer, Peter / Eichenberger, Urs

British journal of anaesthesia

2023 Band 131, Heft 3, Seite(n) 442–445

Abstract: Use of augmented reality is increasingly applied in medical education and practice. The main advantage of this technology is the display of relevant information in the visual field of multiple operators. Here we provide a critical analysis of the ... ...

Abstract	Use of augmented reality is increasingly applied in medical education and practice. The main advantage of this technology is the display of relevant information in the visual field of multiple operators. Here we provide a critical analysis of the potential application of augmented reality in regional anaesthesia.
Mesh-Begriff(e)	Humans ; Augmented Reality ; Anesthesia, Conduction ; Ultrasonography ; Education, Medical ; Ultrasonography, Interventional
Sprache	Englisch
Erscheinungsdatum	2023-06-21
Erscheinungsland	England
Dokumenttyp	Editorial
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2023.05.022
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Liposomal Bupivacaine for Peripheral Nerve Blockade: A Randomized, Controlled, Crossover, Triple-Blinded Pharmacodynamic Study in Volunteers.

Zadrazil, Markus / Marhofer, Peter / Opfermann, Philipp / Schmid, Werner / Marhofer, Daniela / Zeilberger, Mira / Pracher, Lena / Zeitlinger, Markus

Anesthesiology

2024

Abstract: ... blockade was noted in 8/25 volunteers (32%) after liposomal and in 25/25 (100%) after plain bupivacaine (P ... in 4/5 hypothenar supply areas (P < 0.0001), and for time from onset to 80% or 20% in 1/5 areas (P < 0 ... 0.8772; P = 0.474). Self-assessment over 3.5 days did reveal, for liposomal bupivacaine only ...

Abstract	Background: Little is known about the pharmacodynamic characteristics of liposomal bupivacaine. Hypothesizing that we would not identify pharmacodynamic differences from plain bupivacaine during the initial period after administration, but would find better long-term pharmacodynamic characteristics, we designed a randomized, controlled, triple-blinded, single-center study in volunteers. Methods: Volunteers aged 18 to 55 years (body mass index: 18 to 35 kg/m²) received two ulnar nerve blocks under ultrasound guidance. Using a crossover design with a washout phase of ≥ 36 days, one block was performed with liposomal and one with plain bupivacaine. Which came first was determined by randomization. Sensory data were collected by pinprick testing and motor data by thumb adduction, either way in comparison with the contralateral arm. Endpoints included success, time to onset, and duration of blockade. Residual efficacy was assessed by the volunteers keeping a diary. Statistical analysis included Wilcoxon signed-rank and exact McNemar's tests, as well as a generalized estimation equation model. Results: Successful sensory blockade was noted in 8/25 volunteers (32%) after liposomal and in 25/25 (100%) after plain bupivacaine (P < 0.0001). Significant differences emerged for time to onset, defined as 0% response to pinpricking in 4/5 hypothenar supply areas (P < 0.0001), and for time from onset to 80% or 20% in 1/5 areas (P < 0.001; 0.001). Carry-over effects due to the randomized sequencing were unlikely (estimate: -0.6286; SE: 0.8772; P = 0.474). Self-assessment over 3.5 days did reveal, for liposomal bupivacaine only, intermittent but unpredictable episodes of residual sensory blockade. Conclusions: Our results show that liposomal bupivacaine is not a suitable 'sole' drug for intraoperative regional anesthesia. Findings of its limited long-term efficacy add to existing evidence that a moderate effect, at best, should be expected on postoperative pain therapy.
Sprache	Englisch
Erscheinungsdatum	2024-04-01
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0000000000004988
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Ad-hoc preoperative management and respiratory events in pediatric anesthesia during the first COVID-19 lockdown-an observational cohort study.

Zadrazil, Markus / Marhofer, Peter / Schmid, Werner / Marhofer, Melanie / Opfermann, Philipp

PloS one

2022 Band 17, Heft 8, Seite(n) e0273353

Abstract: ... for the primary outcome or event counts (p>0.05). Events were exceedingly rare even under general anesthesia (n ... management (p = 0.367) but more events based on younger patients (p = 0.007), endotracheal intubation (p = 0 ... 007), and bronchopulmonary procedures (p = 0.001).: Conclusions: Early assessment may not add ...

Abstract	Background: Early pre-anesthetic management for surgery is aimed at identifying risk factors, which notably in children are mostly airway related. The first COVID-19 lockdown opened a unique 'window of opportunity' to study what impact an ad-hoc management strategy would bring to bear on intraoperative respiratory events. Methods: In this observational cohort study we included all patients with an American Society of Anesthesiology (ASA) Physical Status of I or II, aged 0 to ≤18 years, who underwent elective surgery at our center during the first national COVID-19 lockdown (March 15th to May 31st, 2020) and all analogue cases during the same calendar period of 2017-2019. The primary outcome parameter was a drop in peripheral oxygen saturation (SpO2) below 90% during anesthesia management. The study is completed and registered with the German Clinical Trials Register, DRKS00024128. Results: Given 125 of 796 evaluable cases during the early 2020 lockdown, significant differences over the years did not emerge for the primary outcome or event counts (p>0.05). Events were exceedingly rare even under general anesthesia (n = 3) and non-existent under regional anesthesia (apart from block failures: n = 4). Regression analysis for SpO2 events <90% yielded no significant difference for ad-hoc vs standard preoperative management (p = 0.367) but more events based on younger patients (p = 0.007), endotracheal intubation (p = 0.007), and bronchopulmonary procedures (p = 0.001). Conclusions: Early assessment may not add to the safety of pediatric anesthesia. As a potential caveat for other centers, the high rate of anesthesia without airway manipulation at our center may contribute to our low rate of respiratory events.
Mesh-Begriff(e)	Anesthesia, Conduction ; Anesthesia, General/adverse effects ; COVID-19 ; Child ; Cohort Studies ; Communicable Disease Control ; Humans
Sprache	Englisch
Erscheinungsdatum	2022-08-18
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Observational Study
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0273353
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation.

Opfermann, Philipp / Schmid, Werner / Obradovic, Mina / Kraft, Felix / Zadrazil, Markus / Marhofer, Daniela / Marhofer, Peter

PloS one

2023 Band 18, Heft 7, Seite(n) e0288431

Abstract: ... N = 97/2060) among boys (p = 0.41). Residual pain was the main cause of failure, with rates of 4.5 ... 95%CI 2.9-6.6%) (N = 22/487) among girls and 3.0% (95%CI 2.3-3.8%) (N = 61/2060) among boys (p = 0 ... patients (p = 0.023). Male sex was significantly associated with higher odds (adjusted OR: 3.18; 95% CI: 1 ...

Abstract	Study objective: To identify sex differences associated with caudal epidurals, the most commonly used technique of pediatric regional anesthesia, based on individually validated data of ultrasound-guided blocks performed between 04/2014 and 12/2020. Methods: Prospectively collected and individually validated data of a cohort of children aged between 0-15 years was analyzed in a retrospective observational study. We included pediatric surgeries involving a primary plan of caudal epidural anesthesia under sedation (without airway instrumentation) and a contingency plan of general anesthesia. Sex-specific rates were analyzed for overall failure of the primary anesthesia plan, for residual pain, for block-related technical complications and for critical respiratory events. We used Fisher´s exact tests and multivariable logistic regressions were used to evaluate sex-specific associations. Results: Data from 487 girls and 2060 boys ≤15 years old (ASA status 1 to 4) were analyzed. The primary-anesthesia-plan failure rate was 5.5% (95%CI 3.8%-7.8%) (N = 27/487) among girls and 4.7% (95%CI 3.9%-5.7%) (N = 97/2060) among boys (p = 0.41). Residual pain was the main cause of failure, with rates of 4.5% (95%CI 2.9-6.6%) (N = 22/487) among girls and 3.0% (95%CI 2.3-3.8%) (N = 61/2060) among boys (p = 0.089). Block-related technical complications were seen at rates of 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls vs 2.5% (95%CI 0.5-2.7%) (N = 51/2060) among boys and, hence, significantly more often among male patients (p = 0.023). Male sex was significantly associated with higher odds (adjusted OR: 3.18; 95% CI: 1.12-9; p = 0.029) for such technical complications regardless of age, ASA status, gestational week at birth or puncture attempts. Critical respiratory events occurred at a 1.7% (95%CI 1.2%-2.3%) rate (N = 35/2060) twice as high among boys as 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls (p = 0.21). Conclusions: While the the primary-anesthesia-plan failure rate was equal for girls and boys, technical complications and respiratory events are more likely to occur in boys.
Mesh-Begriff(e)	Infant, Newborn ; Humans ; Male ; Child ; Female ; Infant ; Child, Preschool ; Adolescent ; Sex Characteristics ; Anesthesia, Epidural ; Anesthesia, Conduction ; Anesthesia, Caudal/methods ; Pain
Sprache	Englisch
Erscheinungsdatum	2023-07-13
Erscheinungsland	United States
Dokumenttyp	Observational Study ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0288431
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Ultrasound-Guided Dorsal Penile Nerve Block in Children: An Anatomical-Based Observational Study of a New Anesthesia Technique.

Zadrazil, Markus / Feigl, Georg / Opfermann, Philipp / Marhofer, Peter / Marhofer, Daniela / Schmid, Werner

Children (Basel, Switzerland)

2023 Band 11, Heft 1

Abstract: Dorsal penile nerve block stands out as one of the commonly employed regional anesthetic techniques in children. Despite the large body of experience, failure rates are still significant. We included 20 children (median (SD) age of 73 (31) months) ... ...

Abstract	Dorsal penile nerve block stands out as one of the commonly employed regional anesthetic techniques in children. Despite the large body of experience, failure rates are still significant. We included 20 children (median (SD) age of 73 (31) months) scheduled for circumcision without general anesthesia and secondary airway manipulation in a consecutive case series. Under ultrasound guidance and utilizing an in-plane needle guidance technique, the dorsal penile nerve block was administered with slight sedation, and spontaneous respiration was maintained in all cases. To investigate the underlying anatomy for dorsal penile nerve blockade, we dissected three cadavers. The primary study endpoint was the success rate of surgical blockade, meaning that the surgical procedure could be performed without additional general anesthesia and invasive airway management. The secondary endpoint was the requirement of analgesics until discharge from the post-anesthesia care unit. The primary endpoint was successfully met in all patients according to our strict definition without additional general anesthesia or airway manipulation. In addition, no child received analgesics until discharge from the recovery room. The anatomical investigation clarified the specific anatomy as baseline knowledge for an ultrasound-guided dorsal penile nerve blockade and enabled successful performance in 20 consecutive children where penile surgery was possible in light sedation without additional airway manipulation.
Sprache	Englisch
Erscheinungsdatum	2023-12-29
Erscheinungsland	Switzerland
Dokumenttyp	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children11010050
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: ADV6209 for Premedication in Pediatric Anesthesia: A Double-Blinded, Randomized Controlled Trial.

Zadrazil, Markus / Marhofer, Peter / Schmid, Werner / Marhofer, Daniela / Opfermann, Philipp

Pharmaceutics

2022 Band 14, Heft 10

Abstract: ADV6209, a new formulation of midazolam with the addition of γ-cyclodextrin for oral use, has recently been licensed as the first pediatric sedative in the European Union. We compared the clinical efficacy of ADV6209 to the standard formulation of ... ...

Abstract	ADV6209, a new formulation of midazolam with the addition of γ-cyclodextrin for oral use, has recently been licensed as the first pediatric sedative in the European Union. We compared the clinical efficacy of ADV6209 to the standard formulation of midazolam in premedication to reduce anxiety in children before anesthesia induction in a randomized, double-blinded controlled trial. Eighty children (ASA I/II; age: 2-8 years) scheduled for elective surgery were randomized to receive 0.25 mg kg
Sprache	Englisch
Erscheinungsdatum	2022-09-27
Erscheinungsland	Switzerland
Dokumenttyp	Journal Article
ZDB-ID	2527217-2
ISSN	1999-4923
ISSN	1999-4923
DOI	10.3390/pharmaceutics14102062
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Regional blocks carried out during general anesthesia or deep sedation: myths and facts.

Marhofer, Peter

Current opinion in anaesthesiology

2017 Band 30, Heft 5, Seite(n) 621–626

Abstract: Purpose of review: More patients will accept regional blocks if these are performed during sedation or general anesthesia. This review discusses regional anesthesia in sedated or anesthetized patients.: Recent findings: As complications of regional ... ...

Abstract	Purpose of review: More patients will accept regional blocks if these are performed during sedation or general anesthesia. This review discusses regional anesthesia in sedated or anesthetized patients. Recent findings: As complications of regional blocks are rare, regional anesthesia can be considered aswell-tolerated. Awake patients will notice only a minority of needle-to-nerve contacts, that renders the notion of a 'live monitor' obsolete. Using high-resolution ultrasound, the needle can be advanced to an extraepineural position for injection, thus strictly avoiding needle-to-nerve contact or intraepineural injection of local anesthetic. Rare cases of intoxication manifest more immediately when the patient is awake but some general anesthesia drugs reduce the seizure-inducing potency of local anesthetics, and hemodynamic signs of intoxication are also detectable under general anesthesia, allowing for faster cardiopulmonary resuscitation as the patient is anesthetized already. Summary: With the use of ultrasound guidance in skilled hands, it is a reasonable option to perform neuraxial and peripheral regional blocks in sedated or anesthetized patients. Performing the procedure safely and effectively requires an adequate level of experience with the specific block technique in question.
Sprache	Englisch
Erscheinungsdatum	2017-10
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	645203-6
ISSN	1473-6500 ; 0952-7907
ISSN (online)	1473-6500
ISSN	0952-7907
DOI	10.1097/ACO.0000000000000504
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Perioperative sedation requirements of infants aged 0 to 3 months subjected to lower-body surgery under caudal blockade: a randomized controlled trial.

Schmid, Werner / Marhofer, Peter / Kimberger, Oliver / Marhofer, Daniela / Kettner, Stephan

Minerva anestesiologica

2021 Band 88, Heft 1-2, Seite(n) 16–22

Abstract: ... Significantly (P=0.0001) less propofol was administered in the as-needed group (0.7±1.4 mg/kg ... of additional intraoperative sedation (0.5±0.8 mg/kg in 5 versus 0.6±1.0 mg/kg in four cases; P=0.76 ...

Abstract	Background: It remains unclear how much sedation is required for subumbilical surgery under caudal blockade, and sedatives may carry a poorly understood risk of late sequelae in infants. We designed a randomized controlled study to evaluate total propofol consumption and perioperative sedation quality with the avoidance of continuous perioperative sedation in infants undergoing surgery under caudal anesthesia. Methods: Thirty-two infants (age: 0-3 months) were randomized to one of two groups in which perioperative administration of propofol was provided either "as needed" or by continuous infusion (5 mg kg Results: Significantly (P=0.0001) less propofol was administered in the as-needed group (0.7±1.4 mg/kg) than in the continuous-infusion group (3.0±1.6 mg/kg). This difference was not reflected in different requirements of additional intraoperative sedation (0.5±0.8 mg/kg in 5 versus 0.6±1.0 mg/kg in four cases; P=0.76). Conclusions: As needed propofol administration offers no disadvantage in terms of intraoperative sedation, but significant dose reductions can be achieved by avoiding continuous propofol infusion.
Mesh-Begriff(e)	Anesthesia, Caudal ; Conscious Sedation ; Humans ; Hypnotics and Sedatives ; Infant ; Infant, Newborn ; Propofol
Chemische Substanzen	Hypnotics and Sedatives ; Propofol (YI7VU623SF)
Sprache	Englisch
Erscheinungsdatum	2021-08-02
Erscheinungsland	Italy
Dokumenttyp	Journal Article ; Randomized Controlled Trial
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.21.15716-5
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: The impact of biological sex in peripheral nerve blockade: A prospective pharmacodynamic, pharmacokinetic and morphometric study in volunteers.

Zadrazil, Markus / Marhofer, Peter / Columb, Malachy / Opfermann, Philipp / Schmid, Werner / Marhofer, Daniela / Stimpfl, Thomas / Reichel, Sabine / Al Jalali, Valentin / Zeitlinger, Markus

PloS one

2024 Band 19, Heft 1, Seite(n) e0297095

Abstract: ... Analyses included Mann-Whitney U-statistics with P<0.05 (two-sided) as significant.: Results: After 24 ... min in men (P = 0.49). Sensory onset time of blockade, and ultrasound visibility of nerves were also ... higher in women (P = 0.017). After a the planned power re-analysis after these 24 study paticipants ...

Abstract	Study objective: The impact of biological sex in peripheral regional anaesthesia is largely unknown. We therefore designed a prospective study in volunteers to investigate the impact of biological sex on pharmacodynamic, pharmacokinetic and morphometric characteristics for peripheral nerve blockade. Methods: The initial study plan was powered to include 90 volunteers to find a difference of 35 min in duration of sensory block (primary outcome variable) with 80% power and alpha error at 5%. After discussions in ethical review, a pilot study of 2 x 12 volunteers from each sex were studied. Female and male volunteers received ultrasound guided nerve blockade with 3.0 mL ropivacaine 7.5 mg mL-1. Sensory duration of blockade, as the primary outcome, was evaluated by pinprick testing. Secondary outcomes were sensory onset time of blockade, pharmacokinetic characteristics and the visibility of ulnar nerves using ultrasound. Analyses included Mann-Whitney U-statistics with P<0.05 (two-sided) as significant. Results: After 24 participants, the median (IQR) duration of sensory blockade was 450 (420; 503) min in women and 480 (450; 510) min in men (P = 0.49). Sensory onset time of blockade, and ultrasound visibility of nerves were also similar between the study groups. The total drug exposure across time (AUC0-infinity) was significantly higher in women (P = 0.017). After a the planned power re-analysis after these 24 study paticipants, which suggested that > 400 subjects would be required with 80% power and alpha error of 5% to find significance for the primary outcome parameter for marginal differences, we terminated the study at this point. Conclusions: We did not detect significant differences between female and male study participants in terms of pharmacodynamic and morphometric characteristics after ultrasound guided ulnar nerve blocks. Women did show significantly greater pharmacokinetic ropivacaine exposures. The results of this study indicate that peripheral regional block pharmacodynamic characteristics are independent of the biological sex, whereas pharmacokinetic parameters are sex-dependent.
Mesh-Begriff(e)	Humans ; Male ; Female ; Ropivacaine/pharmacology ; Prospective Studies ; Anesthetics, Local/pharmacology ; Pilot Projects ; Amides ; Peripheral Nerves/diagnostic imaging ; Nerve Block/methods ; Volunteers
Chemische Substanzen	Ropivacaine (7IO5LYA57N) ; Anesthetics, Local ; Amides
Sprache	Englisch
Erscheinungsdatum	2024-01-26
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0297095
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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