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Biomedical subjects

B B Gutsche

Publications and source records attributed to B B Gutsche.

At least 37 records · Page 2Linked to original sources
PubMed1986

Estimation of human fetal-placental unit metabolic rate by application of the Bohr principle.

The Bohr Principle via continuous indirect calorimetry was used to estimate human fetal-placental unit metabolic rate in 12 normal women undergoing elective caesarean section under continuous lumbar epidural anaesthesia. Maternal oxygen consumption decreased after umbilical cord clamping and after placental removal. Fetal-placental unit oxygen consumption was 10.7 +/- 1.3 ml/min per kg (mean +/- SEM). Fetal oxygen consumption was 6.8 +/- 1.4 ml/min per kg. Placental oxygen consumption was 37 +/- 12 ml/min per kg. Fetal-placental unit carbon dioxide production was 9.2 +/- 1.2 ml/min per kg. These mean values agree favourably with measurements of uterine and fetal metabolism from other mammalian species. Maternal minute ventilation decreased with removal of the fetal-placental unit, and this decrease was found to be linearly related to the fetal-placental unit carbon dioxide production.

Adult↗
PubMed1983

Minute ventilation and oxygen consumption during labor with epidural analgesia.

Oxygen consumption (VO2) and minute ventilation (VE) were measured between and during uterine contractions in the first stage of labor before and after lumbar epidural analgesia (LEA) in 11 women who served as their own controls. VO2 and VE between contractions were essentially unchanged by LEA to a T10 or higher sensory level. Before LEA, both VO2 and VE were increased significantly during contractions by 63% and 74% respectively, whereas following LEA there was no significant increase in VO2 or VE during contractions. In the second stage of labor, VO2 and VE were measured in seven patients electing to have no analgesia or sedation and in 10 patients having complete pain relief produced by LEA. Measurements were obtained 5-10 min before delivery. During contractions with pushing, VO2 and VE were decreased by 25% and 31%, respectively, in patients having LEA as compared with patients having no analgesia or sedation. These results suggest that the increase in VO2 and VE are due primarily to pain associated with uterine contractions and that LEA decreased the work of breathing and the oxygen consumption of the parturient in both the first and second stages of labor.

Adult↗
PubMed1982

Fetal and neonatal hazards of maternal hydration with 5% dextrose before caesarean section.

In a prospective randomised study, 47 fasting women undergoing elective caesarean section received one of the following three glucose regimens for prevention of hypotension before administration of epidural bupivacaine to produce anaesthesia from the T4 sensory level: (i) 150 ml of 5% dextrose in water (D5W) and 1000 ml normal saline (7.5 g dextrose); (ii) 150 ml of D5W, 350 ml of 5% dextrose in normal saline (D5NS), and 650 ml of normal saline (25 g dextrose); (iii) 150 ml D5W and 1000 ml D5NS (57.5 g dextrose). The maternal blood sugar at delivery was significantly raised in patients receiving 25 and 57.5 g of dextrose. 57.5 g of dextrose also raised the mean umbilical cord venous levels of glucose to 11.7 mmol/l and of insulin to 70 +/- 7 microU/ml, while decreasing glucagon to 24 +/- 5.3 pg/ml and arterial pH to 7.19 +/- 0.015 compared with the levels with 7.5 g dextrose. The raised insulin level caused neonatal hypoglycaemia (1.8 +/- 0.22 mmol/l) and delayed release of glucagon at 2 hours of age. There was a higher incidence of neonatal jaundice in infants exposed to 57.5 g of dextrose than in those exposed to 7.5 g. The addition of large amounts of dextrose to intravenous fluids was harmful to the fetus and of no benefit to the mother. Until a safe rate of administration is established, it is recommended that dextrose infusions immediately before delivery be limited to no more than 6 g/h.

Anesthesia, Conduction↗
PubMed1981

Toxicity of lidocaine in adult, newborn, and fetal sheep.

The relative central nervous system and cardiovascular toxicity of lidocaine was compared in adult, newborn, and fetal sheep during continuous infusion of lidocaine into the jugular vein at the rate of 2 mg x kg-1 x min-1. An identical sequence of toxic manifestations occurred in the adult, newborn, and fetus: convulsions, hypotension, respiratory arrest, and circulatory collapse. Doses necessary to produce these manifestations were highest in fetuses and lowest in adults. For example, in order to elicit convulsions, 5.8 +/- 1.8 mg/kg of lidocaine was required in the adults, 18.4 +/- 2.2 in the newborns, and 41.9 +/- 6.0 in the fetuses. Measurements of lidocaine concentrations in blood demonstrated that these toxic symptoms occurred at levels which were not significantly different among the three groups. The results indicate that fetal and newborn lambs are no more sensitive to lidocaine toxicity than are adult sheep. The fact that the highest doses were required in the fetuses is probably related to the placental clearance of the drug into mothers and better fetal maintenance of arterial Po2 despite convulsions and respiratory arrest (cessation of breathing-like movements).

Animals↗