Papers by Charles Hantler
Anesthesia & Analgesia, Sep 1, 1997
This study was conducted to determine the efficacy and safety of four intravenous (IV) doses of d... more This study was conducted to determine the efficacy and safety of four intravenous (IV) doses of dolasetron, an investigational 5-HT, receptor antagonist, for the treatment of postoperative nausea and /or vomiting (PONV) after outpatient surgery under general anesthesia. This multicenter, randomized, double-blind trial compared the antiemetic efficacy of 12.5,25,50, or 100 mg IV dolasetron with placebo over 24 h using complete response (no emetic episodes and no rescue medication), time to first emetic episode or rescue medication, and patient nausea and satisfaction with antiemetic therapy as rated by visual analog scale (VAS). Of 1557 patients enrolled, 620 patients were eligible for treatment. Complete response rates for all dolasetron doses-12.5 mg (35%), 25 mg (28%), 50 mg (29%), and 100 mg (29%)-were significantly more effective than placebo (ll%, P < 0.05). There was a significant gender interaction for complete response (P < S everal classes of drugs have been used to manage postoperative nausea and vomiting (PONV). Dopaminergic antagonists, antihistamines, and anticholinergics are used for both the prophylaxis and This study was supported by a grant from Hoechst Marion Roussel.
Anesthesia & Analgesia, Aug 1, 1996
Circulation, May 1, 1987
Catheter electrical ablation of ventricular tachycardia (VT) was attempted in 33 patients who had... more Catheter electrical ablation of ventricular tachycardia (VT) was attempted in 33 patients who had recurrent unimorphic VT refractory to 3.7 1.2 (mean + SD) antiarrhythmic drugs. Their mean age was 56 + 14 years. Twenty-two patients had coronary artery disease, six had other types of heart disease, and five had no structural heart disease. The mean left ventricular ejection fraction was 0.34 + 0.17. Thirty patients had only one documented morphologic type of spontaneous VT, whereas three patients had more than one. One to four shocks of 100 to 300 J each were delivered to the endocardial exit site of VT, as identified by endocardial activation mapping and pace-mapping. In each patient endocardial activation at the exit site of VT preceded the onset of the QRS complex (mean activation time-50 30 msec). Pace-mapping was possible in 26 patients, and in all but two patients the QRS complexes during VT and during pacing at the exit site of VT were very similar in at least 10 of 12 electrocardiographic leads. In 29 patients, shocks were delivered between an endocardial electrode (cathode) and a patch electrode on the chest wall (anode). Seven patients (including three who first received shocks using an external anode) whose VT originated in the septum received transseptal shocks between two electrodes positioned on either side of the septum. The procedure was successful in 15 patients (45%), who had no recurrence of VT either on no antiarrhythmic therapy or on the same regimen that was ineffective before ablation, over a follow-up period of 15.5 + 10 months (range 5 to 35). The ablation attempt was unsuccessful in 18 patients (55%). There were no significant differences in clinical and electrophysiologic variables between patients with and without a successful outcome. Seven nonfatal complications occurred in six patients: sustained nonclinical VT immediately after the shock, ventricular fibrillation on days S and 6 after ablation, neurologic deficits (n = 2), atrioventricular block (n = 2), and brachial artery thrombosis. In conclusion, catheter electrical ablation of VT has modest efficacy and is relatively safe in a selected group of patients who have predominantly one configuration of unimorphic VT.
Otolaryngology-Head and Neck Surgery, Aug 1, 1995
Cardiac transplantation is now the treatment of choice for many patients with end-stage cardiac d... more Cardiac transplantation is now the treatment of choice for many patients with end-stage cardiac disease. Cardiac transplant recipients, because they are immunosuppressed, will come to the otolaryngologist for treatment of chronic sinusitis. We present an interesting drug response that occurred in a heart~ung transplant recipient who required functional endoscopic sinus surgery. After an uneventful anesthetic induction, local anesthetic agent (3 ml of 1% lidocaine with 1:100,000 epinephrine) was injected into the nasal septurn. The patient responded with sustained sinus tachycardia (>140 beats/min for 20 minutes) without hypertension. This case is demonstrative of the potential complications that can be encountered during the surgical care of a cardiac transplant recipient. The following discussion will describe necessary precautions to be taken when caring for these patients including the preferred topical and injectable local anesthetic agents, anesthetic techniques, and infection prevention. In addition, the physiology of the denervated myocardium will be discussed.
Anesthesia & Analgesia, Aug 1, 1996
Clinics in anaesthesiology, Oct 1, 1986
Anesthesia & Analgesia, Sep 1, 1997
This study was conducted to determine the efficacy and safety of four intravenous (IV) doses of d... more This study was conducted to determine the efficacy and safety of four intravenous (IV) doses of dolasetron, an investigational 5-HT, receptor antagonist, for the treatment of postoperative nausea and /or vomiting (PONV) after outpatient surgery under general anesthesia. This multicenter, randomized, double-blind trial compared the antiemetic efficacy of 12.5,25,50, or 100 mg IV dolasetron with placebo over 24 h using complete response (no emetic episodes and no rescue medication), time to first emetic episode or rescue medication, and patient nausea and satisfaction with antiemetic therapy as rated by visual analog scale (VAS). Of 1557 patients enrolled, 620 patients were eligible for treatment. Complete response rates for all dolasetron doses-12.5 mg (35%), 25 mg (28%), 50 mg (29%), and 100 mg (29%)-were significantly more effective than placebo (ll%, P < 0.05). There was a significant gender interaction for complete response (P < S everal classes of drugs have been used to manage postoperative nausea and vomiting (PONV). Dopaminergic antagonists, antihistamines, and anticholinergics are used for both the prophylaxis and This study was supported by a grant from Hoechst Marion Roussel.
The New England Journal of Medicine, Mar 13, 2008
Awareness during anesthesia is a serious complication with potential long-term psychological cons... more Awareness during anesthesia is a serious complication with potential long-term psychological consequences. Use of the bispectral index (BIS), developed from a processed electroencephalogram, has been reported to decrease the incidence of anesthesia awareness when the BIS value is maintained below 60. In this trial, we sought to determine whether a BIS-based protocol is better than a protocol based on a measurement of end-tidal anesthetic gas (ETAG) for decreasing anesthesia awareness in patients at high risk for this complication. We randomly assigned 2000 patients to BIS-guided anesthesia (target BIS range, 40 to 60) or ETAG-guided anesthesia (target ETAG range, 0.7 to 1.3 minimum alveolar concentration [MAC]). Postoperatively, patients were assessed for anesthesia awareness at three intervals (0 to 24 hours, 24 to 72 hours, and 30 days after extubation). We assessed 967 and 974 patients from the BIS and ETAG groups, respectively. Two cases of definite anesthesia awareness occurred in each group (absolute difference, 0%; 95% confidence interval [CI], -0.56 to 0.57%). The BIS value was greater than 60 in one case of definite anesthesia awareness, and the ETAG concentrations were less than 0.7 MAC in three cases. For all patients, the mean (+/-SD) time-averaged ETAG concentration was 0.81+/-0.25 MAC in the BIS group and 0.82+/-0.23 MAC in the ETAG group (P=0.10; 95% CI for the difference between the BIS and ETAG groups, -0.04 to 0.01 MAC). We did not reproduce the results of previous studies that reported a lower incidence of anesthesia awareness with BIS monitoring, and the use of the BIS protocol was not associated with reduced administration of volatile anesthetic gases. Anesthesia awareness occurred even when BIS values and ETAG concentrations were within the target ranges. Our findings do not support routine BIS monitoring as part of standard practice. (ClinicalTrials.gov number, NCT00281489 [ClinicalTrials.gov].).
Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics, 1986
Southern Medical Journal, 1997
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Papers by Charles Hantler