Frank Grüne

Erasmus MC | Erasmus MC · Department of Anesthesiology

In the ResusNL 2022 edition: Breathe. How does the physiology of breathing work in sperm whales and crocodiles? How does our breathing adapt to extreme circumstances like diving or swimming? https://www.resusnl.com

Background: Intraoperative hypotension has been associated with postoperative morbidity and early mortality. Postoperative hypotension, however, has been less studied. This study examines postoperative hypotension, hypothesizing that both the degree of hypotension severity and longer durations would be associated with myocardial injury. Methods:...

Knowledge of the cerebral perfusion pressure (CPP) and its components are important in understanding and treating patients in the perioperative period. Unfortunately, traditional methods of intracranial pressure measurement are invasive and require the placement of an intracranial catheter. When calculating the CPP, the mean arterial pressure (MAP)...

Introduction: The effective cerebral perfusion pressure (CPPe), zero-flow pressure (ZFP), and resistance area product (RAP) are important determinants of cerebral blood flow. ZFP and RAP are usually estimated by linear regression analysis of pressure-velocity relationships of the middle cerebral artery. The aim of this study was to validate 4 othe...

Background Vascular transit time (VTT) is the propagation time of a pulse wave through an artery; it is a measure for arterial stiffness. Because reliable non-invasive VTT measurements are difficult, as an alternative we measure pulse transit time (PTT). PTT is defined as the time between the R-wave on electrocardiogram and arrival of the resulting...

PEP data supporting study findings. (SAV)

Background: Emerging evidence suggests that postoperative troponin release is a strong and independent predictor of short-term mortality. However, evaluating elevated troponins in patients with chronic kidney disease (CKD) is still controversial and is often disregarded. This study examines morbidity along with short- and long-term mortality risk...

Background: Myocardial injury after noncardiac surgery is common, although the exact pathophysiology is unknown. It is plausible that hypotension after surgery is relevant for the development of myocardial injury. The authors evaluated whether low mean arterial pressures (MAPs) after surgery are related to an increased incidence in postoperative c...

COMPANION ARTICLES N H Sperna Weiland J Hermanides M W Hollmann B Preckel W J Stok J J van Lieshout R V Immink A novel method for intraoperative assessment of cerebral autoregulation by paced breathing. Br J Anaesth 2017; 119: 1141--9 https://doi.org/10.1093/bja/aex333

We report a patient with a giant tracheoesophageal fistula (TEF) planned for reconstructive surgery. Because mechanical ventilation in any form was technically impossible, we successfully used veno-venous extracorporeal membrane oxygenation (VV-ECMO) without the need for mechanical ventilation.

Background: A relatively new uncalibrated arterial pressure waveform cardiac output (CO) measurement technique is the Pulsioflex-ProAQT® system. Aim of this study was to validate this system in cardiac surgery patients with a specific focus on the evaluation of a difference in the radial versus the femoral arterial access, the value of the auto-ca...

Objective Accumulating data have recently underlined argon´s neuroprotective potential. However, to the best of our knowledge, no data are available on the cerebrovascular effects of argon (Ar) in humans. We hypothesized that argon inhalation does not affect mean blood flow velocity of the middle cerebral artery (Vmca), cerebral flow index (FI), ze...

Study data file. No legend. (XLSX)

Effect of argon on parameters of blood gas analysis and haemodynamics. Baseline = inhalation of 70% N2 / 30% O2. Argon = inhalation with 70% Ar / 30% O2. The P values, which refer to the difference between two measurement points, were calculated using two-sided t-test for paired data (* P<0.05). Due to artefacts during blood pressure recording, dat...

Argon is the longest known rare gas of the group of noble gases. It can be obtained as a pure gas of pharmaceutical quality at low costs. Stable argon gas is known to be inert. It does not change vital parameters and has no anaesthetic properties at sea level. When argon is administered by inhalation it does not require complex ventilator settings....

Background: Compared to open thoracoabdominal aortic aneurysm (TAAA) repair, hybrid repair is thought to be less invasive with better perioperative outcomes. Due to the extent of the operation and long recovery period, studying perioperative results may not be sufficient for evaluation of the true treatment effect. The aim of this study is to eval...

Invited lecture over anesthesia & ECT. W 15; Room 2.14, 13.30-17.00h

The effects of isoflurane on the determinants of blood flow during Coronary Artery Bypass Graft (CABG) surgery are not completely understood. This study characterized the influence of isoflurane on the diastolic Pressure-Flow (P-F) relationship and Critical Occlusion Pressure (COP) during CABG surgery. Twenty patients undergoing CABG surgery were s...

Approximately 17 million inhabitants live in the Netherlands. The number of potential organ donors in 1999 was the lowest in Europe with only 10 donors per million inhabitants. Medical associations, public health services, health insurance companies and the government had to find common solutions in order to improve organ allocation, logistics of d...

Raw data CPP Measurments. All variables are presented clearly.

Raw data, with Isoflurane. All variables are presented clearly.

Raw data controls, no Isoflurane. All variables are clearly presented.

Raw data Indices, Isoflurane. All variables are clearly stated.

Raw data Indices TIVA, no Isoflurane. All variables are clearly presented.

Consort checklist 2010.

Flow diagram. Flow diagram.

In addition to cerebrovascular resistance (CVR) zero flow pressure (ZFP), effective cerebral perfusion pressure (CPPe) and the resistance area product (RAP) are supplemental determinants of cerebral blood flow (CBF). Until now, the interrelationship of PaCO2-induced changes in CBF, CVR, CPPe, ZFP, and RAP is not fully understood. In a controlled cr...

This presentation aims to summarise the physiological effects, potential harms and consequences of hyperventilation/hypocapnia. The normal range of the partial pressure of carbon dioxide (PaCO2) is 36–45 mmHg (4.8 – 6.0 kPa). The term tachypnea is commonly described by an increased respiratory rate >20/min, which could be induced by exercise, pregn...

This mini review aims to summarise the physiological effects, potential harms and consequences of hyperventilation/hypocapnia. The normal range of the partial pressure of carbon dioxide (PaCO2) is 36–45 mmHg (4.8 – 6.0 kPa). The term tachypnea is commonly described by an increased respiratory rate >20/min, which could be induced by exercise, pregna...

Cerebral perfusion pressure (CPP) is elevated in preeclampsia, and may predispose to cerebrovascular complications and progression to eclampsia. We estimated zero flow pressure (ZFP) and CPP using simultaneously obtained arterial blood pressure and middle cerebral artery blood flow velocity in 10 women with preeclampsia, all treated with methyldopa...

Hyperventilation is known to decrease cerebral blood flow (CBF) and to impair cerebral metabolism, but the threshold in patients undergoing intravenous anesthesia is unknown. The authors hypothesized that reduced CBF associated with moderate hyperventilation might impair cerebral aerobic metabolism in patients undergoing intravenous anesthesia. Thi...

The incidence of intraoperative hypotension is high. An evidence-based definition of intraoperative hypotension, however, is still a matter of debate. Major risk factors include patient age, an ASA physical status 3 or higher, a given combination of regional and general anaesthesia, the duration of surgery, and the emergency status. The haemodynami...

Background: In patients with cirrhosis, the synthesis of coagulation factors can fall short, reflected by a prolonged prothrombin time. Although anticoagulants factors are decreased as well, blood loss during orthotopic liver transplantation can still be excessive. Blood loss during orthotopic liver transplantation is currently managed by transfus...

BACKGROUND In day-case surgery, the effects of the anxiolytic lorazepam as premedication on the quality of postoperative recovery are unknown.OBJECTIVE To evaluate whether lorazepam as a premedication beneficially affects quality of recovery (primary outcome) and psychological manifestations (secondary outcome) after day-case surgery.DESIGNA random...

Fragestellung: Argon ist ein Inertgas, das im Unterschied zu Xenon unter normobaren Bedingungen praktisch keine anästhetischen oder sedierenden Eigenschaften aufweist. In einer Reihe jüngerer in-vitro und in-vivo Studien zeigte Argon organ-protektive Effekte, die eine zukünftige klinische Verwendung möglich erscheinen lassen. 1-5 Bislang besteht j...

Background: Inadvertent hyperventilation may be associated with unfavourable effects in patients under general anaesthesia and may worsen clinical outcomes1. Hyperventilation is known to decrease cerebral blood flow (CBF) and may thus impair cerebral metabolism. The respective threshold under intravenous anaesthesia is unknown. We hypothesized that...

Physiologische Aspekte Der arterielle Blutdruck ist seit Jahrzehnten ein unverzichtbarer Basisparameter in der perioperativen Überwachung des Kreislaufs. Dies ist nicht zuletzt darin begründet, dass der Blutdruck zu den vergleichsweise einfach quantifizierbaren Parameter des Herz-Kreislaufsystems zählt (nach Riva-Rocci, mittels Oszillometrie oder e...

In this review the preoperative risk assessment and prevention of complications in patients undergoing esophagectomy for cancer is discussed. Age, pulmonary and cardiovascular condition, nutritional status, and neoadjuvant chemo(radio)therapy are known predictive factors. None of these factors is a valid exclusion criterion for esophagectomy, but m...

The force of cardiac contraction is strongly influenced by myocardial fibre length at the beginning of systole. Because the length of cardiac sarcomers and muscle fibres primarily depends on the end-diastolic ventricular volume, filling pressures a priori can only act as indirect parameters of cardiac preload. Central venous pressure (CVP) gives in...

Fragestellung: Die TCD Indices von Pulsatilität (PI) und Resistance (RI) sollen den CVR reflektieren(1,2). Mit Hilfe von dynamischen zerebralen Druck-Fluss-(geschwindigkeits)-Graphiken kann der Nullflussdruck (ZFP) bestimmt werden (3,4,5). Deren Steigung (Slope) ist proportional zum CVR (6). In dieser Studie wurden Slope, PI und RI mit echten CVR-...

Standards, protocols and clinical practice guidelines are very important instruments of quality control in Anaesthesiology. Guidelines recommend what we can do, protocols and standards tell us stepwise how we have to perform certain interventions. Guideline development is a structured and transparent process. The system of rating and grading of med...

One of the most frequent actions of an anaesthesiologist during the daily routine is the (intravenous) administration of drugs. This action alone offers many risks (e.g. wrong drug, wrong route, wrong dosage, wrong situation), but even when all these things are done right, there still remains the risk of incidents provoked by the drugs used. In thi...

When performing a Medline search with the term ‘patient positioning,’ one will be surprised: There are many recent papers on patient positioning for all kinds of radiodiagnostic and radiotherapeutic procedures, and there are no fewer, but much older papers on positioning for surgical procedures. However, when reading these papers, only a small numb...

In 1993 the United Kingdom's National Health Service (NHS) formally introduced "Clinical Audit" as a quality improvement process. The idea was to improve patient care and outcomes by reviewing (i.e. auditing) current performance of, for example, a department against explicit criteria and implementing changes where necessary. In simple words, the ke...

Congrescentrum, 10-11 Mei 2007, Poster 16

Poster P32, Anesthesiologendagen 2007, Abstractband page 70

Most clinicians develop “routines”, “protocols”, “standards” or “configurations” for the evaluation and management of diseases they frequently encounter. Especially in anaesthesiology, doctors and nurses are used to working with those standards, dealing with such matters as venous access, spinal anaesthesia and airway management.

Without Abstract

An observational prospective cohort study was carried out on complication rates and time kinetics of phlebitis caused by short peripheral intravenous catheters (PIVCs) in inpatients on 15 hospital wards in four hospitals in Cologne, Germany. We observed 1,582 patients with 2,495 PIVCs daily using standardized questionnaires. Phlebitis was defined u...

The report describes a rare case of an iatrogenic arteriovenous fistula of the vertebral artery to the vertebral vein which arose after insertion of a central venous catheter via the jugular vein. We give special attention to the role of colour duplex sonography in the primary diagnosis of such fistulas. As can be seen from published reports with t...

The report describes a rare case of an iatrogenic arteriovenous fistula of the vertebral artery to the vertebral vein which arose after insertion of a central venous catheter via the jugular vein. We give special attention to the role of colour duplex sonography in the primary diagnosis of such fistulas. As can be seen from published reports with t...

Objective: This controlled study was designed to investigate 1.) the effects of 0,8% halothane and 2.) the effects of a variation in PaCO2 on the relation- ship between global cerebral blood flow (CBF) and middle cerebral artery flow velocity (CBFVMCA). Method: With ethical com- mittee approval and informed patient consent we investigated 10 patien...

Das Klinikum der Universität zu Köln führt seit einem Jahrzehnt eine Zentrale Notaufnahme (ZNA). Sie ist zuständig für jährlich ca. 16.000 Notfallpatienten, die privat das Klinikum aufsuchen, und für ca. 3.000 Patienten, die mit Rettungsmitteln über die Berufsfeuerwehr Köln und Umgebung per bodengebundenem (KTW, RTW und RTW mit Notarzt) oder luftge...

From April 21-25. 2001 in den Rhein-Main-Hallen, Wiesbaden Med Klin 2001: 96: 70

Fragestellung: Phlebitis ist die häufigste Komplikation bei periphervenösen Kathetern (PIVC), jedoch mit Angabe von unterschiedlichen Inzidenzen zwischen 7 –70%. Katheterinfektionen haben eine große Bedeutung hinsichtlich Morbidität und Patientenzufriedenheit im Krankenhaus. Der Einfluss der Liegedauer 3 und Hygienemaßnahmen 4 wird kontrovers disku...

http://www.aerzteblatt.de/archiv/16508/Qualitaetssicherung-in-Praxis-und-Spital-1-Europaeischer-Kongress-der-deutschsprachigen-Aerztegesellschaften-14-bis-16-Oktober-1999-Basel

http://www.dkitm5.mhn.de

http://www.dkitm5.mhn.de

http://www.aerzteblatt.de/archiv/16508/Qualitaetssicherung-in-Praxis-und-Spital-1-Europaeischer-Kongress-der-deutschsprachigen-Aerztegesellschaften-14-bis-16-Oktober-1999-Basel

Session 187 K Paper 1915

Eighteen clinical practice guidelines on interdisciplinary diagnostic issues were developed at the University Hospital of Cologne, Germany. The guideline committee is organized and directed by the quality control program, which also includes the local Cochrane initiative and a wide range of organizational topics. During guideline development, quest...

Unlabelled: In two consecutive studies (Study A and Study B), we evaluated the effects of increasing doses of HBOC-201, a bovine hemoglobin-based oxygen carrier, on hemodynamics and oxygen transport in patients undergoing preoperative hemodilution for elective abdominal aortic surgery. After the induction of anesthesia and the exchange of 1 L of b...

The effects of induced hypothermia in cardiac surgical patients are not yet fully understood. Despite numerous studies on the effects of acid-base management on organ blood flow, only little information is available on the effects of alpha-stat versus pH-stat management on systemic haemodynamics. We therefore compared the effect of alpha-stat and p...

Die Entwicklungen in der Intensivmedizin und die hieraus resultierenden verbesserten Überlebenschancen schwerstkranker und polytraumatisierter Patienten haben zu einer Zunahme von intubationsbedingten Trachealstenosen geführt. Ausgedehnte Substanzdefekte der Trachea werden auch bei Verletzungen sowie Tumorerkrankungen im Hals-und Brustbereich geseh...

We conducted a pilot study to evaluate the effects of HBOC-201, a bovine hemoglobin-based oxygen carrier, on hemodynamics in patients undergoing vascular reconstruction in the abdominal aortic region. Thirteen patients were randomly assigned to receive either 3 ml/kg body weight or 6% hydroxyethyl starch (HES). No significant changes were noticed i...

The cerebral haemodynamic effects of vasodilators are of clinical interest because a decrease in mean arterial pressure (MAP) might alter global cerebral blood flow (CBF). Luxury perfusion of the brain, contrast, might be unfavourable in patients with reduced intracranial compliance. Despite the widespread use of nitroglycerine (NTG), little is kno...

We conducted a pilot study to evaluate the effects of HBOC-201, a bovine hemoglobin-based oxygen carrier, on hemodynamics and oxygen transport in patients undergoing preoperative hemodilution for elective abdominal aortic surgery. After induction of anesthesia and isovolemic hemodilution with 1 L of lactated Ringer's solution, 13 patients were rand...

Euroanaesthesia 1996: Anaesthesia and Circulation, Stadthalle Göttingen, Germany

Ziel dieser prospektiven kontrollierten Studie war es, 1.) den Einfluß von Nitroglyzerin (NTG) auf den globalen zerebralen Blutfluß (CBF) und die zerebrovaskuläre CO2-Reaktivität zu untersuchen, und 2.) den Einfluß von NTG auf den Zusammenhang zwischen CBF und der Flußgeschwindigkeit in der A. cerebri media (VMCA) zu bestimmen. Bei 10 kardiochirurg...

We conducted a pilot study to evaluate the effects of HBOC-201, a bovine hemoglobin-based oxygen carrier, on hemodynamics and oxygen transport in patients undergoing preoperative hemodilution for elective abdominal aortic surgery. After induction of anesthesia and isovolemic hemodilution with 1 L of lactated Ringer's solution, 13 patients were rand...

BRAIN ´95 - XVIIth International Symposium on Cerebral Blood Flow and Metabolism. Cologne, 02.-06.07.1995

Transcranial Doppler sonography is increasingly used to monitor changes in cerebral perfusion intraoperatively. However, little information is available about the validity of velocity measurements as an index of cerebral blood flow (CBF). The purpose of this study was to compare invasive and Doppler-derived measurements of cerebral hemodynamic vari...

The aim of this study was to examine the influence of ketanserin, a 5-hydroxytryptamine antagonist antihypertensive agent, on the relationship between cerebral blood flow (CBF) and middle cerebral artery flow velocity (Vmean MCA) and to compare Doppler-sonographic indices of downstream resistance (pulsatility index, PI; resistance index, RI) with c...

The aim of this study was to examine the influence of ketanserin, a 5-hydroxytryptamine antagonist antihypertensive agent, on the relationship between cerebral blood flow (CBF) and middle cerebral artery flow velocity (Vmean MCA) and to compare Doppler-sonographic indices of downstream resistance (pulsatility index, PI; resistance index, RI) with c...