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Article ; Online: A critical appraisal of perioperative sleep apnoea management after nasal surgery: A review of up-to-date literature supplemented by findings of a retrospective observational study.

Duvekot, Anne / Klimek, Markus / Datema, Frank R

2024 , Page(s) 17504589231215941

Abstract: Objective: To review the current recommendations on postoperative precautions for obstructive sleep apnoea patients undergoing elective nasal surgery.: Design: Retrospective cohort study.: Setting: Department of Otorhinolaryngology and ... ...

Abstract	Objective: To review the current recommendations on postoperative precautions for obstructive sleep apnoea patients undergoing elective nasal surgery. Design: Retrospective cohort study. Setting: Department of Otorhinolaryngology and Anesthesiology/Intensive Care, University Teaching Hospital, Rotterdam, the Netherlands. Participants: The medical charts of 61 patients with sleep apnoea who were admitted to the post-anaesthesia care unit between 2016 and 2020, following nasal surgery were reviewed. Main outcome measures: Number of respiratory events during post-anaesthesia care unit admission that required medical intervention. Results: In all 61 patients, continuous positive airway pressure could not be used. In 13 patients (8%), decreased oxygen saturation levels were registered during the first postoperative night, and in five of these patients, supplemental oxygen was needed. No other respiratory incidents of medical interventions were registered. Conclusions: The number of clinically relevant respiratory events of obstructive sleep apnoea patients with bilateral nasal packing following nasal surgery is low. We suggest that the safety of less expensive and less scarce alternatives of postoperative observation should be explored.
Language	English
Publishing date	2024-01-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2226186-2
ISSN	2515-7949 ; 1750-4589
ISSN (online)	2515-7949
ISSN	1750-4589
DOI	10.1177/17504589231215941
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Zs.A 4006: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MG 83: Show issues

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Book ; Thesis: Untersuchungen zum Einfluß volatiler Anaesthetika auf die Freisetzung und den Metabolismus der Iodothyronine bei der Ratte in vitro und in vivo

Klimek, Markus

1997

Author's details	vorgelegt von Markus Klimek
Language	German
Size	107 S. : graph. Darst.
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Köln, Univ., Diss., 1997
HBZ-ID	HT008065665
Database	Catalogue ZB MED Medicine, Health

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Article ; Online: Development and external validation of a clinical prediction model for predicting quality of recovery up to 1 week after surgery.

van Beek, Stefan / Nieboer, Daan / Klimek, Markus / Stolker, Robert Jan / Mijderwijk, Hendrik-Jan

Scientific reports

2024 Volume 14, Issue 1, Page(s) 387

Abstract: The Quality of Recovery Score-40 (QoR-40) has been increasingly used for assessing recovery after patients undergoing surgery. However, a prediction model estimating quality of recovery is lacking. The aim of the present study was to develop and ... ...

Abstract	The Quality of Recovery Score-40 (QoR-40) has been increasingly used for assessing recovery after patients undergoing surgery. However, a prediction model estimating quality of recovery is lacking. The aim of the present study was to develop and externally validate a clinical prediction model that predicts quality of recovery up to one week after surgery. The modelling procedure consisted of two models of increasing complexity (basic and full model). To assess the internal validity of the developed model, bootstrapping (1000 times) was applied. At external validation, the model performance was evaluated according to measures for overall model performance (explained variance (R
MeSH term(s)	Humans ; Models, Statistical ; Prognosis ; Calibration
Language	English
Publishing date	2024-01-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-50518-1
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Article ; Online: Disciplinary rulings involving anesthesiologists: a 15-year analysis of cases in the Netherlands.

Duvekot, Maurits S A / Dronkers, Wouter J / Spoor, Jochem K H / Klimek, Markus

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2024

Language	English
Publishing date	2024-05-16
Publishing country	United States
Document type	Letter
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-024-02766-6
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Zs.A 109: Show issues

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Article ; Online: Drainage or lavage as a salvage manoeuvre after intrathecal drug errors: A systematic review with therapeutic recommendations.

Koning, Mark V / van der Zwan, Rene / Klimek, Markus

Journal of clinical anesthesia

2023 Volume 89, Page(s) 111184

Abstract: Study objective: Cerebrospinal fluid (CSF) drainage and lavage are reported to reduce drug exposure after inadvertant intrathecal drug administration errors. This reviews aims to provide recommendations for this salvage technique, with regard to ... ...

Abstract	Study objective: Cerebrospinal fluid (CSF) drainage and lavage are reported to reduce drug exposure after inadvertant intrathecal drug administration errors. This reviews aims to provide recommendations for this salvage technique, with regard to methodology, effectiveness and adverse events. Design: Systematic review. A search in the databases of Embase, Medline, Web of Science, Cochrane Central Register of Randomized Trials and Google Scholar was performed in 2022. Study eligibility criteria: All reports of individual patient data with CSF drainage or lavage with a percutaneous lumbar access for an intrathecal drug error were included. Measurements: The primary outcome is the description and count of CSF drainage or lavage, such as times and volume of drainage, volume of replacement and type of replacement fluid. Secondary outcomes are the effects, adverse events and overall outcome. Main results: 58 cases were found, of which 24 were paediatric cases. There was a large variance in methodology, with regard to volume t and type of replacement fluid. In 45% of the cases the intrathecal drug removal continued. The effects were specifically reported in 27 cases, all demonstrated drug removal based on drug concentrations in the CSF (n = 20) and clinical signs (n = 7). Adverse effects were sought for in 17 cases and found intracranial haemorrhage in 3 cases. No interventions were required for these adverse events and the only reported long-term sequelae in these three patients was short-term memory impairment up to 6 months after the event (n = 1). The overall outcome depended largely on the causative agent. Conclusions: This review shows that CSF drainage or lavage leads to intrathecal drug removal, but it is unsure if this intervention leads to improved overall patient outcome. Based on aggregated data from case reports, we provide recommendations that may guide clinicians. The risk-benefit ratio should be weighed on a case-to-case basis.
MeSH term(s)	Humans ; Child ; Therapeutic Irrigation/adverse effects ; Therapeutic Irrigation/methods ; Drainage/adverse effects
Language	English
Publishing date	2023-06-14
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	1011618-7
ISSN	1873-4529 ; 0952-8180
ISSN (online)	1873-4529
ISSN	0952-8180
DOI	10.1016/j.jclinane.2023.111184
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Zs.A 2622: Show issues

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Article ; Online: Genetic Polymorphism as a Possible Cause of Severe Postoperative Pain.

Govers, Bart / Matic, Maja / van Schaik, Ron H N / Klimek, Markus

Journal of clinical pharmacology

2023 Volume 64, Issue 3, Page(s) 378–381

MeSH term(s)	Humans ; Polymorphism, Genetic ; Pain, Postoperative/genetics ; Pharmacogenetics
Language	English
Publishing date	2023-10-25
Publishing country	England
Document type	Letter
ZDB-ID	188980-1
ISSN	1552-4604 ; 0091-2700 ; 0021-9754
ISSN (online)	1552-4604
ISSN	0091-2700 ; 0021-9754
DOI	10.1002/jcph.2367
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Uf I Zs.176: Show issues

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Article ; Online: Hyperlactatemia and other perioperative metabolic disturbances in neuroanesthesia.

Klimek, Markus / de Smalen, Peter / Janssen, Joost

Current opinion in anaesthesiology

2022 Volume 35, Issue 5, Page(s) 537–542

Abstract: Purpose of review: The concept of 'brain-body cross-talking' has gained growing interest in the last years. The understanding of the metabolic disturbances (e.g., hypernatraemia/hyponatraemia and hyperlactatemia) in neurosurgical patients has improved ... ...

Abstract	Purpose of review: The concept of 'brain-body cross-talking' has gained growing interest in the last years. The understanding of the metabolic disturbances (e.g., hypernatraemia/hyponatraemia and hyperlactatemia) in neurosurgical patients has improved during the last years. Recent findings: The impact of elevated lactate without acidosis in neurosurgical patients remains controversial. The pathophysiology of inappropriate secretion of antidiuretic hormone (SIADH) has become clearer, whereas the diagnosis of cerebral salt wasting should be used more carefully. Summary: These findings will contribute to a better understanding of the pathophysiology involved and enable better prevention and therapy where possible in clinical practice.
MeSH term(s)	Brain/metabolism ; Humans ; Hyperlactatemia/diagnosis ; Hyperlactatemia/etiology ; Hyperlactatemia/therapy ; Hyponatremia ; Inappropriate ADH Syndrome/diagnosis ; Inappropriate ADH Syndrome/metabolism
Language	English
Publishing date	2022-08-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645203-6
ISSN	1473-6500 ; 0952-7907
ISSN (online)	1473-6500
ISSN	0952-7907
DOI	10.1097/ACO.0000000000001180
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Zs.A 2564: Show issues

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Article ; Online: Methodological transparency of preoperative clinical practice guidelines for elective surgery. Systematic review.

Angel, Gustavo / Trujillo, Cristian / Mallama, Mario / Alonso-Coello, Pablo / Klimek, Markus / Calvache, Jose A

PloS one

2023 Volume 18, Issue 2, Page(s) e0272756

Abstract: Background: Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decreasing the risk of complications in health care. Numerous guidelines in the ... ...

Abstract	Background: Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decreasing the risk of complications in health care. Numerous guidelines in the field of perioperative care have been published in the previous decade but their methodological quality and transparency are relatively unknown. Objective: To critically evaluate the transparency and methodological quality of published CPG in the preoperative assessment and management of adult patients undergoing elective surgery. Design: Systematic review and methodological appraisal study. Data sources: We searched for eligible CPG published in English or Spanish between January 1, 2010, and June 30, 2022, in Pubmed MEDLINE, TRIP Database, Embase, the Cochrane Library, as well as in representatives' medical societies of Anaesthesiology and developers of CPG. Eligibility criteria: CPG dedicated on preoperative fasting, cardiac assessment for non-cardiac surgery, and the use of routine preoperative tests were included. Methodological quality and transparency of CPG were assessed by 3 evaluators using the 6 domains of the AGREE-II tool. Results: We included 20 CPG of which 14 were classified as recommended guidelines. The domain of "applicability" scored the lowest (44%), while the domains "scope and objective" and "editorial interdependence" received the highest median scores of 93% and 97% respectively. The remaining domains received scores ranging from 44% to 84%. The top mean scored CPG in preoperative fasting was ASA 2017 (93%); among cardiac evaluation, CPG for non-cardiac surgery were CCS 2017 (91%), ESC-ESA 2014 (90%), and AHA-ACC 2014 (89%); in preoperative testing ICSI 2020 (97%). Conclusions: In the last ten years, most published CPG in the preoperative assessment or management of adult patients undergoing elective surgery focused on preoperative fasting, cardiac assessment for non-cardiac surgery, and use of routine preoperative tests, present moderate to high methodological quality and can be recommended for their use or adaptation. Applicability and stakeholder involvement domains must be improved in the development of future guidelines.
MeSH term(s)	Adult ; Humans ; Databases, Factual ; Societies, Medical
Language	English
Publishing date	2023-02-24
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0272756
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Article ; Online: The Influence of Hypercapnia and Atmospheric Pressure on the Pao2/Fio2 Ratio-Pathophysiologic Considerations, a Case Series, and Introduction of a Clinical Tool.

Gilissen, Vincent J H S / Koning, Mark V / Klimek, Markus

Critical care medicine

2021 Volume 50, Issue 4, Page(s) 607–613

Abstract: Objectives: The ratio between Pao2 and Fio2 is used as a marker for impaired oxygenation and acute respiratory distress syndrome classification. However, any discrepancy between Fio2 and o2 fraction in the alveolus affects the Pao2/Fio2 ratio. ... ...

Abstract	Objectives: The ratio between Pao2 and Fio2 is used as a marker for impaired oxygenation and acute respiratory distress syndrome classification. However, any discrepancy between Fio2 and o2 fraction in the alveolus affects the Pao2/Fio2 ratio. Correcting the Pao2/Fio2 ratios using the alveolar gas equation may result in an improved reflection of the pulmonary situation. This study investigates the difference between standard and corrected Pao2/Fio2 in magnitude, its correlation with the mortality of acute respiratory distress syndrome classification, and trends over time. Design: A register and a retrospective study combined with the development of a mathematical model to determine the difference between standard and corrected Pao2/Fio2 ratio for various levels of Paco2 and atmospheric pressure. Setting: ICU in a secondary hospital in The Netherlands. Patients: Patients admitted to the ICU for pneumonia or acute respiratory distress syndrome. Register cohort: January 1, 2010, till March 1, 2020 (n = 1008). Retrospective cohort: March 1, 2020, till June 1, 2020 (n = 34). Measurements and main results: The register was used to determine the 7-day ICU mortality per acute respiratory distress syndrome classification based on the standard and corrected Pao2/Fio2 ratio. The retrospective dataset correlated the Paco2 with Pao2/Fio2 ratio over time in patients with assumed stable oxygenation. The model demonstrated an increased difference between the standard and corrected Pao2/Fio2 ratios by a lower Fio2 and atmospheric pressure and higher Pao2 and Paco2. Reclassification of severe acute respiratory distress syndrome resulted in an increase in mortality from 28.1% for standard Pao2/Fio2 to 30.6% for corrected Pao2/Fio2 ratios. Acute Physiology and Chronic Health Evaluation scores correlated better with 7-day ICU-mortality when corrected Pao2/Fio2 ratio was used for classification. For patients with Fio2 less than 50% (n = 55), change in Paco2 correlated with change in Pao2/Fio2 ratio (r = -0.388; p = 0.003). Interventions: A corrected Pao2/Fio2 ratio was calculated. Conclusions: Correcting the Pao2/Fio2 ratio for the alveolar gas equation predominantly affects patients with high ratios between Pao2 and Fio2 and Paco2 and at low atmospheric pressure. Using the corrected Pao2/Fio2 ratio for acute respiratory distress syndrome classification results in improved correlation with the 7-day ICU mortality and increases generalization among acute respiratory distress syndrome studies. The authors provide a free, web-based tool.
MeSH term(s)	Atmospheric Pressure ; Humans ; Hypercapnia ; Oxygen ; Respiratory Distress Syndrome/therapy ; Retrospective Studies
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2021-10-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005316
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Zs.A 1261: Show issues

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Article ; Online: How to Study the Brain While Anesthetizing It?! A Scoping Review on Running Neuroanesthesiologic Studies and Trials That Include Neurosurgical Patients.

Klimek, Markus / Gravesteijn, Benjamin Y / Costa, Andreia M / Lobo, Francisco A

World neurosurgery

2022 Volume 161, Page(s) 376–381

Abstract: This scoping review addresses the challenges of neuroanesthesiologic research: the population, the methods/treatment/exposure, and the outcome/results. These challenges are put into the context of a future research agenda for peri-/intraoperative ... ...

Abstract	This scoping review addresses the challenges of neuroanesthesiologic research: the population, the methods/treatment/exposure, and the outcome/results. These challenges are put into the context of a future research agenda for peri-/intraoperative anesthetic management, neurocritical care, and applied neurosciences. Finally, the opportunities of adaptive trial design in neuroanesthesiologic research are discussed.
MeSH term(s)	Anesthetics/therapeutic use ; Brain/surgery ; Humans ; Neurosciences ; Research Design ; Running
Chemical Substances	Anesthetics
Language	English
Publishing date	2022-05-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2021.08.069
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