Siegfried Piepenbrock

Bio: Siegfried Piepenbrock is an academic researcher from Hannover Medical School. The author has contributed to research in topics: Transplantation & Propofol. The author has an hindex of 27, co-authored 133 publications receiving 3357 citations. Previous affiliations of Siegfried Piepenbrock include University of Jena & Hochschule Hannover.

The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia.

Abstract: BACKGROUND:The binding of fibrinogen and fibrin to platelets is important in normal hemostasis. The extent of platelet-fibrin interaction can be measured as the viscoelastic strength of clot by rotational thromboelastometry (ROTEM®). In this study, we investigated the effect of fibrinogen concentrat

Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study

Abstract: Complex cardiac surgery is frequently accompanied by excessive perioperative bleeding because of coagulation system impairment, inadequate surgical haemostasis, or both.1 Bleeding increases the risk of re-exploration, allogeneic blood transfusion, or perioperative myocardial infarction, and consequently, associated morbidity and mortality.2 Aortic valve operation and ascending aorta replacement (AV–AA) typically involves hypothermia, prolonged cardiopulmonary bypass (CPB), and large graft anastomoses, and is associated with an increased risk of intra- and postoperative blood loss and high transfusion rates.3,4 Conventional haemostatic therapy consists of transfusion of allogeneic blood products that include fresh-frozen plasma (FFP), platelet concentrate, and cryoprecipitate. However, although the use of these products was developed empirically, their haemostatic efficacy has not been evaluated thoroughly in the surgical setting.5,6 Haemocomplettan® P (brand name in Europe)/Riastap (brand name in USA) (CSL Behring, Marburg, Germany) is a highly purified, lyophilized, virus-inactivated fibrinogen concentrate obtained from human plasma that can be rapidly reconstituted without the need for thawing and cross-matching, which are necessary for FFP and cryoprecipitate. The administration of fibrinogen concentrate was originally reserved for replacement therapy in congenital fibrinogen deficiency, and in the USA, Riastap is only approved for this indication. In the meantime, European reports on haemostatic therapy with Haemocomplettan® P in acquired perioperative deficiency of fibrinogen have been published.7–11 Acquired fibrinogen deficiency occurring during and after CPB is associated with increased bleeding after cardiac surgery.12,13 However, the haemostatic efficacy of fibrinogen concentrate in correcting such deficiency in complex cardiac surgery has not been investigated to date. To reduce blood component transfusion in cardiac surgery, point-of-care methods such as thrombelastography/thromboelastometry have been applied in algorithms supporting bleeding management in relation to blood clotting quality.14–16 Thromboelastometry (ROTEM®; Pentapharm GmbH, Munich, Germany) assesses the viscoelasticity of whole blood. One of the ROTEM® tests, the FIBTEM test, provides prompt information on the clot strength specifically attributed to fibrin/fibrinogen using cytochalasin-D-induced inactivation of platelets in vitro.17 This test may be used to guide the administration of fibrinogen concentrate for prompt haemostatic therapy.9–11 We hypothesized that postoperative haemostasis could be improved by increasing plasma fibrinogen concentrations, since bleeding complications were observed to be lower in patients with high perioperative fibrinogen concentrations.12,13 The primary aim of this pilot study was to evaluate whether FIBTEM-guided intraoperative fibrinogen repletion was able to reduce the use of allogeneic blood products and postoperative bleeding in patients undergoing AV–AA.

The carina as a landmark in central venous catheter placement.

Abstract: Location of the tip of a central venous catheter (CVC) within the pericardium has been associated with potentially lethal cardiac tamponade. Because the pericardium cannot be seen on chest x-ray (CXR), an alternative radiographic marker is needed for correct placement of CVCs. The anatomy of the region was studied in 34 cadavers. The carina was a mean (SEM) distance of 0.4 (0.1) cm above the pericardial sac as it transverses the superior vena cava (SVC). In no case was the carina located below the pericardial sac. The carina is a reliable, simple anatomical landmark for the correct placement of CVCs. In almost all cases, the carina is radiologically visible even in poor quality, portable CXRs. CVC tips should be located in the SVC above the level of the carina in order to avoid cardiac tamponade.

Voltage-dependent block of neuronal and skeletal muscle sodium channels by thymol and menthol.

Abstract: SummaryBackground and objective:Thymol is a naturally occurring phenol derivative used in anaesthetic practice as a stabilizer and preservative of halothane, usually at a concentration of 0.01%. Although analgesic effects have long been described for thymol and its structural homologue menthol, a mo

Guidelines for the prevention of intravascular catheter-related infections, 2011

Abstract: Naomi P. O'Grady, M.D., Mary Alexander, R.N. Lillian A. Burns, M.T., M.P.H., C.I.C. E. Patchen Dellinger, M.D. Jeffery Garland, M.D., S.M. Stephen O. Heard, M.D. Pamela A. Lipsett, M.D. Henry Masur, M.D. Leonard A. Mermel, D.O., Sc.M. Michele L. Pearson, M.D. Issam I. Raad, M.D. Adrienne Randolph, M.D., M.Sc. Mark E. Rupp, M.D. Sanjay Saint, M.D., M.P.H. and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

practice Guidelines for Management of the Difficult airway An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway

Abstract: RACTICE Guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. In addition, Practice Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open-forum commentary, and clinical feasibility data. This document updates the “Practice Guidelines for Management of the Difficult Airway: An Updated Report by

Part 8: Adult Advanced Cardiovascular Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Abstract: The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.

1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR).

Abstract: BACKGROUNDThese Guidelines for Paediatric Parenteral Nutrition have been developed as a mutual project of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN; www.espghan.org) and the European Society for Clinical Nutrition and Metabolism (ESPEN; www.espen.org). T