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Biomedical subjects

A M Broennle

Publications and source records attributed to A M Broennle.

10 recordsLinked to original sources
PubMed1993

Pediatric anesthesia and sedation.

Advances in pediatric anesthesia can contribute to improved care of children in other environments. As an example, drugs and dosages established in preoperative sedation of children provide a base for their application in sedation and pain relief of children undergoing painful procedures in the emergency unit, oncology treatment area, and radiology suite. Midazolam, ketamine, fentanyl, propofol, chloral hydrate, and pentobarbital are reviewed from the past year's pediatric literature. Adverse sequelae of sedation including hypoxemia and hypoventilation or apnea confirm the need for an individual whose responsibility is observation and support of the sedated child rather than performing the procedure, a principle that is the cornerstone of revised guidelines for the use of sedation in children. Monitoring techniques may similarly be developed in the operating suite then applied in emergency areas or critical care units. We examine a qualitative device for detecting carbon dioxide in the exhaled gases of an intubated child.

Anesthesia↗
PubMed1987

Postoperative apnea in preterm infants.

Preterm infants may become apneic during the immediate post-operative period. To define this risk, the authors studied prospectively the breathing patterns of 47 preterm infants less than 60 weeks postconception with pneumocardiograms before and after general inhalational anesthesia. Eighteen infants (37%) had prolonged apnea (greater than 15 s) postoperatively, and an additional seven infants (14%) had short apnea (6-15 s) postoperatively. An infant's risk of prolonged and short postoperative apnea was related to a young postconceptional age (P less than 0.05) and to a history of necrotizing enterocolitis (P less than 0.01). Furthermore, as the postconceptional age of the infant increased, the risk of postoperative apnea decreased proportionately (P less than 0.025). Among the 18 infants with prolonged apnea, 83% experienced multiple apneic episodes. Manual stimulation was required in order for breathing to return in 13 (72%) of the infants. Breathing resumed spontaneously in four (22%) of the infants, and one infant required mechanical ventilation due to repeated prolonged apnea. The first apneic event occurred within 2 h postoperatively in 13 of the infants (72%); the remaining five infants (28%) had their initial apneic episode as late as 12 h after operation. The postoperative time to the last prolonged apneic event was inversely related to the postconceptional age (P less than 0.01, r = -0.70) and extended up to 48 h postoperatively. The preoperative pneumocardiogram was not a reliable test for predicting postoperative apnea (sensitivity 56%, specificity 83%).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗
PubMed1987

Anesthesia for craniofacial procedures.

Anesthetic management of patients for craniofacial reconstruction is based on a careful preanesthethic evaluation emphasizing the airway, with examination for other associated anomalies. Specific perioperative issues include airway management, blood loss reduction and replacement, and control of brain volume. Good communication between the anesthesiologist and the craniofacial surgeon, with an understanding of each other's clinical concerns, is essential.

Anesthesia↗
PubMed1980

Improvements in craniofacial reconstruction: methods evolved in 235 consecutive patients.

Quality evaluation following craniofacial operative procedures is largely aesthetic and almost impossible to measure. Relapse rates are measurable, and morbidity and mortality can be determined. In our series, infections have decreased from 12.5 to 1.3 percent; operating times have been reduced from a mean of 7 1/2 to 4 hours; and blood loss has been reduced from 86 to 56 percent of the total blood volume. Methods we feel are largely responsible for these improvements are (1) maintaining separation of cranial from oronasal cavities, (2) modification of osteotomies around the orbits, (3) infant surgery and extensive use of craniectomy bone, (4) frequent use of onlay bone grafts, (5) a variety of lesser technical refinements, (6) antibiotic use and anesthetic modifications, and (7) consistent team organization. No deaths or blindness have occurred in any patients in the entire series.

Age Factors↗