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Biomedical subjects

A Kleinsasser

Publications and source records attributed to A Kleinsasser.

28 records · Page 2Linked to original sources
PubMed2000

Airway management during spaceflight: A comparison of four airway devices in simulated microgravity.

BACKGROUND: The authors compared airway management in normogravity and simulated microgravity with and without restraints for laryngoscope-guided tracheal intubation, the cuffed oropharyngeal airway, the standard laryngeal mask airway, and the intubating laryngeal mask airway. METHODS: Four trained anesthesiologist-divers participated in the study. Simulated microgravity during spaceflight was obtained using a submerged, full-scale model of the International Space Station Life Support Module and neutrally buoyant equipment and personnel. Customized, full-torso manikins were used for performing airway management. Each anesthesiologist-diver attempted airway management on 10 occasions with each device in three experimental conditions: (1) with the manikin at the poolside (poolside); (2) with the submerged manikin floating free (free-floating); and (3) with the submerged manikin fixed to the floor using a restraint (restrained). Airway management failure was defined as failed insertion after three attempts or inadequate device placement after insertion. RESULTS: For the laryngoscope-guided tracheal intubation, airway management failure occurred more frequently in the free-floating (85%) condition than the restrained (8%) and poolside (0%) conditions (both, P < 0.001). Airway management failure was similar among conditions for the cuffed oropharyngeal airway (poolside, 10%; free-floating, 15%; restrained, 15%), laryngeal mask airway (poolside, 0%; free-floating, 3%; restrained, 0%), and intubating laryngeal mask airway (poolside, 5%; free-floating, 5%; restrained, 10%). Airway management failure for the laryngoscope-guided tracheal intubation was usually caused by failed insertion (> 90%), and for the cuffed oropharyngeal airway, laryngeal mask airway, and intubating laryngeal mask airway, it was always a result of inadequate placement. CONCLUSION: The emphasis placed on the use of restraints for conventional tracheal intubation in microgravity is appropriate. Extratracheal airway devices may be useful when restraints cannot be applied or intubation is difficult.

Adult↗
PubMed1999

Pharmacokinetics of rocuronium bromide in obese female patients.

Following administration of 0.6 mg kg-1 rocuronium, the pharmacokinetics and the pharmacodynamics were studied in six obese and six control (normal weight) patients receiving balanced anaesthesia. Twelve gynaecological patients were allocated into two groups, according to body mass index (normal weight: body mass index: 20-24, obese weight: body mass index > 28). Venous plasma concentrations were determined by high-pressure liquid chromatography before administration of rocuronium, at 1, 2, 4, 6, 8, 10, 15, 20, 25, 30, 35, 40, 48, 60, 75, 120, 180, 240, 300, 360 and 420 min after administration of rocuronium and at recovery of single twitch to 25% and 75% of control twitch height. Onset time was shorter (NS) in the obese compared with normal weight (obese weight: 65 +/- 16, normal weight: 100 +/- 39 s, mean +/- SD). Duration 25% (obese weight: 29.5 +/- 5.3, normal weight: 28.4 +/- 5.3 min) and spontaneous recovery time (obese weight: 12.6 +/- 2.7, normal weight: 12.5 +/- 2.3 min) did not show any differences between the two groups. The pharmacokinetics of rocuronium were comparable in the two groups. The volume of distribution at steady state Vss (mL kg-1) was 208 +/- 56 in normal weight and 169 +/- 37 in obese weight. Distribution (T1/2 alpha) and elimination half-life (T1/2 beta) as well as mean residence time were 15.6 +/- 3.7, 70.3 +/- 23.9 and 53.2 +/- 9.8 min in normal weight and 16.9 +/- 3.8, 75.5 +/- 25.5 and 51.1 +/- 18.9 min in obese weight, respectively. Also, no differences were observed in plasma clearance (3.89 +/- 0.58 in normal weight and 3.62 +/- 1.42 mL kg-1 min-1 obese weight). This study indicates that the pharmoacodynamics and pharmacokinetics of rocuronium are in female patients not altered by obesity.

Adult↗
PubMed1999

Respirator triggering of electron beam computed tomography (EBCT): research on vital capacities.

In this project we evaluate the dynamic changes during expiration at different levels of positive-end-expiratory pressure (PEEP) in ventilated patients. We wanted to discriminate between normal lung function and acute respiratory distress syndrome (ARDS). After approval by the local Ethic Committee we studied two ventilated patients: (one with normal lung function and one with ARDS) We used the 50 ms scan mode of the EBCT. The beam was positioned 1 cm above the diaphragm while the table position remained unchanged. We developed an electronic trigger that utilizes the respirator's synchronizing signal to start the EBCT at the onset of expiration. During controlled mechanical expiration at two levels of PEEP (0 and 15 cm H2O), pulmonary aeration was rated as: well-aerated (-900HU to -500HU), poorly aerated (-500HU to -100HU) and non-aerated (-100HU to +100HU). Pathological and normal lung functions showed different dynamic changes. The different PEEP levels resulted in a significant change of pulmonary aeration in the same patient. Although we studied only two patients, respiratory triggered EBCT may be accurate in discriminating pathological changes due to the abnormal lung function in a mechanically ventilated patient.

Adult↗
PubMed1998

Cardiopulmonary effects of aerosolized prostaglandin E1 and nitric oxide inhalation in patients with acute respiratory distress syndrome.

Ten patients with acute respiratory distress syndrome (ARDS) received in random order nitric oxide (NO) inhalation, aerosolized prostaglandin E1 (PGE1), infusion of PGE1, or no intervention. Inhalation of either aerosolized PGE1 (10 +/- 1 ng/kg/min) or NO (7 +/- 1 ppm) reduced pulmonary vascular resistance (PVR) from 158 +/- 14 to 95 +/- 11 dyn . s/cm5/m2 (NO) and 100 +/- 12 dyn . s/cm5/m2 (aerosolized PGE1), and improved PaO2 from 78 +/- 3 to 96 +/- 5 mm Hg (NO) and 95 +/- 4 mm Hg (aerosolized PGE1) (p < 0.05), venous admixture (Q VA/Q T) from 45 +/- 2 to 36 +/- 2% (NO), and 36 +/- 2% (aerosolized PGE1) (p < 0.05), oxygen delivery (DO2) from 711 +/- 34 to 762 +/- 45 ml/min/m2 (NO) and 780 +/- 46 ml/min/m2 (aerosolized PGE1) (p < 0.05), and right ventricular ejection fraction (RVEF) from 32 +/- 6 to 37 +/- 5% (NO), and 36 +/- 4% (aerosolized PGE1) (p < 0.05) at a constant cardiac index (CI). Although infusion of PGE1 (12 +/- 1 ng/kg/min) caused a similar reduction in PVR as aerosolized PGE1 and NO inhalation, it improved RVEF and increased CI but decreased Q VA/Q T and PaO2. These results suggest that in ARDS patients inhalation of aerosolized PGE1 or NO in low concentrations equally improves PVR and gas exchange by selective vasodilation in ventilated areas.

Administration, Inhalation↗
PubMed1989

Do not resuscitate.

Explore the source record for details and available documents.

Attitude to Health↗
PubMedDate not supplied

So you can't afford a commercial package? Innovate, collaborate, improve.

Traditional classroom mandatory review classes do not actively involve the learner; require considerable instructor time for development, implementation, and tracking; and are costly to the institution. This article describes the creation and implementation of a computer-assisted instruction (CAI) mandatory review package using the medical center's intranet system. The CAI mandatory review package allows employees to complete mandatory review at a computer terminal at their worksite and at their convenience.

Attitude of Health Personnel↗
PubMedDate not supplied

Extended liver resection and hepatic ischemia in pigs: a new, potentially reversible model to induce acute liver failure and study artificial liver support systems.

BACKGROUND: Extended hepatectomy is a valid model for the study of acute liver failure. Since the porcine liver is comparable in size, morphology and anatomy to the human liver, we describe a technique employing hepatic ischemia and extended liver resection to induce acute liver failure in a porcine model as a means of studying bioartificial liver support. METHOD: A subtotal (75-80% resection) extended left hepatectomy was performed in 7 pigs after 60 min warm ischemia of the future remnant liver. After resection, the animals were given the best supportive care and observed until death. RESULTS: All animals died within 18-48 h, none as a result of surgical complications. Gross appearance of the liver showed severe steatosis of the right lateral lobe, and histology revealed severe coagulative necrosis of the whole lobule. CONCLUSION: This technique of extended liver resection after hepatic ischemia in the porcine model may be useful for studies of potentially reversible acute liver failure and experimental bioartificial support.

Animals↗