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001-es BibID:BIBFORM102477
035-os BibID:(WoS)000811798000020 (Scopus)85132080816
Első szerző:Fülesdi Béla (aneszteziológus)
Cím:Quantitative Neuromuscular Monitoring : "Love All, Trust a Few, Do Wrong to None" / Fülesdi Béla, Brull Sorin J.
Dátum:2022
ISSN:0003-2999
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
BMI = body mass index
COVID-19 = coronavirus disase 2019
PTC = post-tetanic count
TOF = train of four
Megjelenés:Anesthesia And Analgesia. - 135 : 1 (2022), p. 35-38. -
További szerzők:Brull, Sorin J.
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2.

001-es BibID:BIBFORM082273
035-os BibID:(WoS)000490258700008 (Scopus)85073309664
Első szerző:Naguib, Mohamed
Cím:Heuristics, Overconfidence, and Experience With Management of Neuromuscular Block : self-Correction Is Unlikely / Mohamed Naguib, Sorin J. Brull, Jennifer M. Hunter, Aaron F. Kopman, Béla Fülesdi, Ken B. Johnson, Hal R. Arkes
Dátum:2019
ISSN:0003-2999
Tárgyszavak:Orvostudományok Klinikai orvostudományok szerkesztői levél
folyóiratcikk
Megjelenés:Anesthesia And Analgesia. - 129 : 5 (2019), p. e172-e173. -
További szerzők:Brull, Sorin J. Hunter, Jennifer M. Kopman, Aaron F. Fülesdi Béla (1961-) (aneszteziológus) Johnson, Ken B. Arkes, Hal R.
Internet cím:DOI
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3.

001-es BibID:BIBFORM077332
035-os BibID:(WoS)000480725200036 (Scopus)85064330216
Első szerző:Naguib, Mohamed
Cím:Anesthesiologists' Overconfidence in Their Perceived Knowledge of Neuromuscular Monitoring and Its Relevance to All Aspects of Medical Practice : an International Survey / Mohamed Naguib, Sorin J. Brull, Jennifer M. Hunter, Aaron F. Kopman, Béla Fülesdi, Ken B. Johnson, Hal R. Arkes
Dátum:2019
ISSN:0003-2999
Megjegyzések:BACKGROUND: In patients who receive a nondepolarizing neuromuscular blocking drug (NMBD) during anesthesia, undetected postoperative residual neuromuscular block is a common occurrence that carries a risk of potentially serious adverse events, particularly postoperative pulmonary complications. There is abundant evidence that residual block can be prevented when real-time (quantitative) neuromuscular monitoring with measurement of the train-of-four ratio is used to guide NMBD administration and reversal. Nevertheless, a significant percentage of anesthesiologists fail to use quantitative devices or even conventional peripheral nerve stimulators routinely. Our hypothesis was that a contributing factor to the nonutilization of neuromuscular monitoring was anesthesiologists' overconfidence in their knowledge and ability to manage the use of NMBDs without such guidance. METHODS: We conducted an Internet-based multilingual survey among anesthesiologists worldwide. We asked respondents to answer 9 true/false questions related to the use of neuromuscular blocking drugs. Participants were also asked to rate their confidence in the accuracy of each of their answers on a scale of 50% (pure guess) to 100% (certain of answer). RESULTS: Two thousand five hundred sixty persons accessed the website; of these, 1629 anesthesiologists from 80 countries completed the 9-question survey. The respondents correctly answered only 57% of the questions. In contrast, the mean confidence exhibited by the respondents was 84%, which was significantly greater than their accuracy. Of the 1629 respondents, 1496 (92%) were overconfident. CONCLUSIONS: The anesthesiologists surveyed expressed overconfidence in their knowledge and ability to manage the use of NMBDs. This overconfidence may be partially responsible for the failure to adopt routine perioperative neuromuscular monitoring. When clinicians are highly confident in their knowledge about a procedure, they are less likely to modify their clinical practice or seek further guidance on its use.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Anesthesia and Analgesia. - 128 : 6 (2019), p. 1118-1126. -
További szerzők:Brull, Sorin J. Hunter, Jennifer M. Kopman, Aaron F. Fülesdi Béla (1961-) (aneszteziológus) Johnson, Ken B. Arkes, Hal R.
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4.

001-es BibID:BIBFORM071847
035-os BibID:(WoS)000435465900014 (Scopus)85050117219
Első szerző:Naguib, Mohamed
Cím:Consensus Statement on Perioperative Use of Neuromuscular Monitoring / Naguib Mohamed, Brull Sorin J., Kopman Aaron F., Hunter Jennifer M., Fülesdi Béla, Arkes Hal R., Elstein Arthur, Todd Michael M., Johnson Ken B.
Dátum:2018
ISSN:0003-2999
Megjegyzések:A panel of clinician scientists with expertise in neuromuscular blockade (NMB) monitoring was convened with a charge to prepare a consensus statement on indications for and proper use of such monitors. The aims of this article are to: (a) provide the rationale and scientific basis for the use of quantitative NMB monitoring; (b) offer a set of recommendations for quantitative NMB monitoring standards; (c) specify educational goals; and (d) propose training recommendations to ensure proper neuromuscular monitoring and management. The panel believes that whenever a neuromuscular blocker is administered, neuromuscular function must be monitored by observing the evoked muscular response to peripheral nerve stimulation. Ideally, this should be done at the hand muscles (not the facial muscles) with a quantitative (objective) monitor. Objective monitoring (documentation of train-of-four ratio ?0.90) is the only method of assuring that satisfactory recovery of neuromuscular function has taken place. The panel also recommends that subjective evaluation of the responses to train-of-four stimulation (when using a peripheral nerve stimulator) or clinical tests of recovery from NMB (such as the 5-second head lift) should be abandoned in favor of objective monitoring. During an interim period for establishing these recommendations, if only a peripheral nerve stimulator is available, its use should be mandatory in any patient receiving a neuromuscular blocking drug. The panel acknowledges that publishing this statement per se will not result in its spontaneous acceptance, adherence to its recommendations, or change in routine practice. Implementation of objective monitoring will likely require professional societies and anesthesia department leadership to champion its use to change anesthesia practitioner behavior.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
electromyography
neuromuscular blockade
neuromuscular blocking drug
peripheral nerve stimulatotrain
train-of-fourratio
Megjelenés:Anesthesia And Analgesia. - 127 : 1 (2018), p. 71-80. -
További szerzők:Brull, Sorin J. Kopman, Aaron F. Hunter, Jennifer M. Fülesdi Béla (1961-) (aneszteziológus) Arkes, Hal R. Elstein, Arthur Todd, Michael M. Johnson, Ken B.
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5.

001-es BibID:BIBFORM087868
035-os BibID:(WoS)000529444900043 (Scopus)85082146494
Első szerző:Nemes Réka (aneszteziológus, intenzív terápiás szakorvos)
Cím:Awake Volunteer Pain Scores During Neuromuscular Monitoring / Réka Nemes, György Nagy, Glenn S. Murphy, Ilana I. Logvinov, Béla Fülesdi, J. Ross Renew
Dátum:2020
ISSN:0003-2999
Megjegyzések:BACKGROUND: There is a need for easy to use, reliable neuromuscular monitors (NMMs). This multicenter, prospective, unblinded study compared the discomfort associated with neurostimulation in unmedicated healthy volunteers when using the new electromyography (EMG)-based TetraGraph and acceleromyography (AMG)-based TOF-Watch NMMs. The secondary aim was to compare the repeatability of the train-of-four (TOF) ratios (TOFRs) obtained with the 2 devices. METHODS: The TOF measurements of 135 volunteers from 3 university hospitals were analyzed (age: 38.3 ? 12 years [mean ? standard deviation [SD]]; male/female ratio = 63:72). The left or right ulnar nerve was stimulated at the wrist in TOF mode with 20, 30, 40, and 50 mA stimulating current intensities with both devices in random order. The TOF-Watch used standard electrocardiography (ECG) electrodes (Red Dot; 3M Health Care) for nerve stimulation. The stimulating surface area of 1 ECG electrode is 113 mm2. The piezoelectric probe was attached to the thumb, and a hand adapter was used to ensure consistency of AMG measurements. The TetraGraph uses proprietary surface strip electrodes for nerve stimulation and muscle action potential recording, whose stimulating surface area is roughly twice as big as that of standard ECG electrodes (228.5 mm2). The volunteers were asked to rate the discomfort associated with neurostimulation on a 0?10 verbal numerical rating scale (VNRS) score anchored with 0 (no pain) and 10 (worst pain ever experienced). A linear mixed-effects model was used to evaluate the difference in VNRS scores between devices. P <.05 was accepted as the level of significance. RESULTS: In the linear mixed-effects model, there were no differences in VNRS scores between devices at any of the stimulating current intensities, P = .38. The median (range) VNRS scores obtained with TOF-Watch and TetraGraph devices were 2 (0?7) vs 2 (0?8) at 20 mA, 3 (1?9) vs 3 (1?9) at 30 mA, 5 (1?10) vs 5 (1?10) at 40 mA, and 5 (1?10) vs 6 (1?10) at 50 mA stimulating current intensities. The mean of the 1469 TOFRs obtained with TetraGraph was 100.43% ? 7.74% (standard error = 0.2%). Due to technical difficulties, the repeatability of the TOFRs could not be determined. CONCLUSIONS: Despite the different size and design of the stimulating electrodes, the 2 NMMs caused the same level of discomfort in unmedicated healthy volunteers.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Anesthesia and Analgesia. - 130 : 4 (2020), p. 941-948. -
További szerzők:Nagy György (1986-) (aneszteziológus, intenzív terápiás szakorvos) Murphy, Glenn S. Logvinov, Ilana I. Fülesdi Béla (1961-) (aneszteziológus) Renew, J. Ross
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6.

001-es BibID:BIBFORM088183
035-os BibID:(WoS)000571179600020 (Scopus)85090940132
Első szerző:Prielipp, Richard C.
Cím:Postoperative Opioid-Induced Respiratory Depression : 3 Steps Forward / Richard C. Prielipp, Bela Fulesdi, Sorin J. Brull
Dátum:2020
ISSN:0003-2999
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
opioid
Megjelenés:Anesthesia and Analgesia. - 131 : 4 (2020), p. 1007-1011. -
További szerzők:Fülesdi Béla (1961-) (aneszteziológus) Brull, Sorin J.
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7.

001-es BibID:BIBFORM012193
Első szerző:Tankó Béla (aneszteziológus)
Cím:The relative exposure of the operating room staff to sevoflurane during intracerebral surgery / Tankó Béla, Molnár Csilla, Büdi Tímea, Pető Csaba, Novák László, Fülesdi Béla
Dátum:2009
Megjegyzések:BACKGROUND: Our primary aim in this study was to investigate whether escape of the volatile anesthetic sevoflurane from the surgical site during craniotomy for tumor resection increases the exposure of the neurosurgeon to the anesthetic when compared with the anesthesiologist. METHODS: Initially, the release of sevoflurane from the surgical site was measured during 35 tumorectomies starting from opening to closure of the dura. Volatile anesthetic absorbers were placed at three detection sites: 1) the surgeon's breathing zone, 2) the anesthesiologist's breathing zone, and 3) the farthest corner of the operation room. In the second sampling series that included 16 patients, the detector that had been in the corner of the operating room in the first series was now placed in the vicinity of the patient's mouth (within 5 cm). Sevoflurane captured by the absorbers was quantified by an independent chemist using chromatography. RESULTS: Absorbers in the surgeon's breathing zone (0.24 +/- 0.04 ppm) captured a significantly lower amount of sevoflurane compared with absorbers in the anesthesiologist's breathing zone (1.40 +/- 0.37 ppm) and comparable with that in the farthest corner of the operation room (0.25 +/- 0.07 ppm). There was no correlation between the amount of absorbed sevoflurane and the size of craniotomy window, even when adjusting for the variation in duration of surgery. In the second series of sampling, absorbers in the proximity of the patient's mouth captured the highest amount of sevoflurane (1.54 +/- 0.55 ppm), followed by the anesthesiologist's (1.14 +/- 0.43 ppm) and the surgeon's (0.15 +/- 0.05 ppm) breathing zones. CONCLUSIONS: The close proximity of the surgeon's breathing zone to the craniotomy window does not appear to be a source of increased exposure to sevoflurane. The observed higher exposure of the anesthesiologist to sevoflurane in the operating room environment warrants further exploration.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
egyetemen (Magyarországon) készült közlemény
Megjelenés:Anesthesia and Analgesia. - 109 : 4 (2009), p. 1187-1192. -
További szerzők:Molnár Csilla (1962-) (aneszteziológus) Büdi Tímea (1981-) (aneszteziológus rezidens) Pető Csaba Novák László (1964-) (idegsebész) Fülesdi Béla (1961-) (aneszteziológus)
Internet cím:Intézményi repozitóriumban (DEA) tárolt változat
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8.

001-es BibID:BIBFORM077685
035-os BibID:(WoS)000450430400024 (Scopus)85056649292
Első szerző:Tassonyi Edömér (aneszteziológus)
Cím:Reversal of Deep Pipecuronium-Induced Neuromuscular Block With Moderate Versus Standard Dose of Sugammadex : a Randomized, Double-Blind, Noninferiority Trial / Edömér Tassonyi, László Asztalos, Zoltán Szabó-Maák, Réka Nemes, Adrienn Pongrácz, Szabolcs Lengyel, Béla Fülesdi
Dátum:2018
ISSN:0003-2999
Megjegyzések:BACKGROUND: Certain surgical interventions may require a deep neuromuscular block (NMB). Reversal of such a block before tracheal extubation is challenging. Because anticholinesterases are ineffective in deep block, sugammadex 4 mg/kg has been recommended for the reversal of rocuronium- or vecuronium-induced deep NMB. However, this recommendation requires opening 2 vials of 200 mg sugammadex, which results in an increase in drug costs. Therefore, we sought a less expensive solution for the induction and reversal of deep NMB. Although the optimal dose of sugammadex for antagonism of deep block from pipecuronium has not been established, data pertaining to moderate block are available. Accordingly, we hypothesized that sugammadex 2 mg/kg would be a proper dose to reverse deep pipecuronium block, enabling us to avoid cost increases. In the present study, we compared sugammadex 2 mg/kg with the standard dose of 4 mg/kg for reversal of deep block from pipecuronium. METHODS: This single-center, randomized, double-blind, 2 parallel-arms, noninferiority study comprised 50 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and pipecuronium. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch SX). Noninferiority margin was specified beforehand as an increase in reversal time of no >10% (corresponding to 1 minute for the primary outcome). When the block spontaneously recovered to posttetanic count 1, the patients randomly received sugammadex 2 or 4 mg/kg, and the time from the injection to the train-offour (TOF) ratio of 1.0 was measured. Primary outcome was the time to achieve the normalized TOF ratio of 0.9 in a particular patient. Residual or recurrent postoperative NMB was additional end point. RESULTS: Each patient recovered to the normalized TOF ratio of 0.9. In the 2 mg/kg group, reversal time was 1.73 ? 1.03 minutes (95% confidence interval [CI], 1.33?2.13; n = 25), and in the 4 mg/kg group, reversal time was 1.42 ? 0.63 minutes (mean ? standard deviation) (95% CI, 1.17?1.67; n = 25). The mean difference in reversal times between the 2 groups was 0.31 minutes (95% CI, ?0.18 to 0.8), and the upper limit of CI was below the noninferiority margin of 1 minute. Postoperative block did not occur. CONCLUSIONS: The effect of sugammadex 2 mg/kg was noninferior to that of 4 mg/kg in reversing posttetanic count-1 degree pipecuronium block. Sugammadex reversal of deep pipecuronium block appears to be effective. (Anesth Analg 2018;127:1344?50)
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Anesthesia And Analgesia. - 127 : 6 (2018), p. 1344-1350. -
További szerzők:Asztalos László (1985-) (aneszteziológus) Szabó-Maák Zoltán (1984-) (aneszteziológus, intenzív terápiás szakorvos) Nemes Réka (1985-) (aneszteziológus, intenzív terápiás szakorvos) Pongrácz Adrienn (1971-) (aneszteziológus, intenzív terápiás szakorvos) Lengyel Szabolcs (1971-) (biológus) Fülesdi Béla (1961-) (aneszteziológus)
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