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Biomedical subjects

B Juhl

Publications and source records attributed to B Juhl.

At least 37 records · Page 2Linked to original sources
PubMed1993

Complications and late sequelae following nasotracheal intubation.

A total of 379 patients admitted to the ICU for mechanical ventilation were prospectively investigated for lesions on the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to 5 days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in 76 (20%) and 110 patients (29%), respectively. There were bleedings from the nasal cavity in 67 (19%) and fractures of the conchae in 40 patients (11%). Hoarseness was noted in 135 patients (42%). Inflammatory changes and ulcerations of the nostril and nasal septum were correlated to the duration of intubation. Among the 281 patients included in the follow-up study, 100 (35%) had symptoms from the nose and nasal cavity. Sixty-five (24%) had symptoms related to the ears, 56 (20%) to the maxillary sinus, 81 (29%) to the voice and 90 (32%) to the throat. Increasing duration of intubation was found to be correlated to persisting symptoms from the larynx. Former ulcerations of the nose were associated with a tendency to nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming studies.

Adolescent↗
PubMed1992

Computer-aided analysis of gastrointestinal pressure recordings. Comparison with manual scoring.

The aim of the present study was to compare computer-based and visual/manual scoring of pressure recordings from the gastric antrum and duodenum. The computer system was based on three separate principles of recognition: moving average, tracking base line, and threshold filters. Computer scoring resulted in the detection of more contractions than visual/manual scoring, owing to inclusion of artefacts of duration and amplitude above the selected thresholds. Owing to its unreliability, visual/manual scoring led to inclusion of some contractions of below-borderline amplitude or duration. The median difference in the frequency of contractions was, however, 0 min-1. There was close agreement on amplitudes of contractions. As the differences between visual/manual analysis and computer-aided scoring by the present system are of an unimportant magnitude and as computer-based scoring is consistent, we conclude that computer-aided analysis is preferable to visual/manual analysis.

Duodenum↗
PubMed1991

Is minitracheotomy a simple and safe procedure? A prospective investigation in the intensive care unit.

Patients with imminent respiratory failure due to sputum retention were assessed for minitracheotomy (MT). MT was considered potentially useful in 79 patients but only attempted in 73, 54 men and 19 women, aged 23-81 years (median 65 years). Insertion of the cannula failed in 4 cases. Sputum retention and atelectasis were successfully treated in 87% (N = 60). Treatment by MT in medical and neurological patients seems as effective as in surgical patients (success rate 81% versus 90%). The frequency of complications was 16%. Most complications were insignificant and occurred during cannulation, but a few severe complications were seen. To minimize the number of these it is essential that MT is done only by doctors who are familiar with the procedure. MT can be recommended for treatment of sputum retention and atelectasis in surgical and medical/neurological intensive care patients with preserved cough function.

Adult↗
PubMed1991

The effect of nasotracheal intubation on the paranasal sinuses. A prospective study of 434 intensive care patients.

A total of 434 patients admitted to the intensive care unit for mechanical ventilation were followed prospectively to investigate the influence of a nasotracheal tube on the paranasal sinuses. Twenty-five patients died before the examination was completed. The rest were examined for clinical symptoms of sinusitis. If sinusitis was suspected or the patients were intubated for 5 days or more, an x-ray of the sinuses was performed. In patients intubated for less than 5 days (N = 357), sinusitis was clinically suspected in three, but radiographically verified in only one. In patients intubated for 5 days or more (N = 47), 23 (49%) had affection of the paranasal sinuses. Patients needing a nasotracheal tube should be examined for sinusitis if they are intubated for more than 5 days or if unexplained fever, sepsis or purulent nasal secretion develops. If the suspicion is confirmed, the nasotracheal tube should be removed.

Adult↗
PubMed1991

Postoperative pulmonary complications and lung function in high-risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia.

The effect of three postoperative regimens of respiratory therapy on pulmonary complications and lung function was compared in high-risk patients. Fifty-one patients were randomized to: 1) conventional chest physiotherapy alone (PHYS), 2) chest physiotherapy and positive expiratory pressure (PEP), or 3) chest physiotherapy with both positive expiratory pressure and inspiratory resistance (RMT). Treatments were given twice daily by a physiotherapist and self-administered. The incidence of postoperative pulmonary complications (PPC) was respectively, 71%, 76% and 65% in the PHYS-, PEP- and RMT-groups. The incidence of PPC requiring treatment with antibiotic, bronchodilator or supplementary oxygen according to the existing clinical practice was 47%, 47% and 29%. The incidence of atelectasis was 65%, 64% and 60% and of pneumonia 29%, 35% and 6%. There was no difference between the groups, except for a tendency to a lower frequency of pneumonia in the RMT-group. Postoperatively forced vital capacity (FVC) decreased to mean 54%, forced expired volume in 1 s to 48% and functional residual capacity to 76% of preoperative values. Arterial oxygen tension (PaO2) declined to mean 8.1 kPa and arterial saturation (SaO2) to 89%. There was no difference between the groups except for FVC, PaO2 and SaO2 (P = 0.008, P = 0.008 and P = 0.002), which showed the least decrease in the RMT-group. None of the regimens could be considered as satisfactory concerning the prevention of PPC, but RMT seemed to be the most efficient. Insufficient self-administration of treatment was probably one of the causes of the overall high incidence of PPC in this study.

Abdomen↗
PubMed1990

[Long-term respirator treatment].

Long-term respirator treatment in the patients' own home is instituted increasingly frequently in patients with neuromuscular diseases. Positive pressure ventilation via a permanent tracheostomy is employed. Treatment is frequently commenced electively during hospitalization in particularly interested departments. Discharge to the patients' home is undertaken after thorough instruction of the patient himself, the family and the persons who help the patient with his other daily needs. Possible guidelines for establishing this form of treatment are outlined on the basis of literature from abroad.

Denmark↗
PubMed1990

[Sinusitis caused by nasotracheal intubation].

Sinusitis following nasotracheal intubation (NTI) is an almost overlooked complication. The pathogenesis is believed to be development of oedema of the nasal mucosa due to irritation by the tube in the nasal cavity. The size of the tube is probably not important, whereas the duration of intubation is of major importance. The infection is often caused by Gram-negative microorganisms. The frequency is found to be 0.3% in short term intubation (less than 5 days) and 40.4% in long term intubation (greater than 5 days). In neurosurgical patients treated with NTI sinusitis is found in 52% and 100% of the patients. In adults the indications for prolonged NTI instead of orotracheal intubation and early tracheostomy should be considered carefully. If fever or sepsis develops in patients treated with NTI, investigations for sinusitis should be included in the search for focus. When sinusitis has developed, the tube should be removed, and the patient tracheostomised. If this treatment fails, surgical drainage should be performed.

Humans↗
PubMed1989

[Obstruction of a naso-tracheal tube by an avulsed nasal concha].

Avulsion of a nasal concha by a nasotracheal tube obstructed the tube in a valvelike manner. The result was increased intrapulmonary pressure, hemodynamic instability, alveolar rupture, pneumomediastinum and pneumoperitoneum without pneumothorax. The case was successfully managed by removal of the nasotracheal tube and immediate oral reintubation.

Adult↗
PubMed1989

[Postoperative analgesia with morphine versus morphine and paracetamol. A double-blind clinically controlled study with a placebo].

The effect of paracetamol on the postoperative employment of morphine was investigated in a double-blind clinically controlled investigation with a placebo. The operations concerned were elective gynaecological laparotomies and hip replacements. During the first 60 hours postoperatively, the employment of morphine was reduced significantly in the patients who received paracetamol. Reductions of 16, 22 and 26% were concerned. The differences between the various types of operation were not significant. Patients for joint replacements who had been treated preoperatively with non-steroid anti-inflammatory preparations did not have any significantly greater consumption of morphine postoperatively but the reduction in consumption of morphine in the paracetamol group was significantly greater with a saving of 43%. Patients who had received treatment with morphine preparations preoperatively had significantly greater consumption of morphine postoperatively but the additive analgesic effect of paracetamol remained unchanged at approximately 25%.

Acetaminophen↗
PubMed1989

Ossification of the cricothyroid membrane following minitracheotomy.

We describe a case in which a repeat minitracheotomy (MT) could not be performed 2 months after the first. The cricothyroid membrane seemed calcified and histological examination showed scar formation with dystrophic calcification and heterotopic bone formation. Scar formation following MT may have caused these alterations making repeat access to the airway through the membrane impossible.

Carcinoma, Squamous Cell↗
PubMed1989

Complications during anaesthesia in patients with Duchenne's muscular dystrophy (a retrospective study)

The purpose of this retrospective study was to estimate the frequency and severity of anaesthetic complications in patients with Duchenne's muscular dystrophy (DMD). Forty-four boys with DMD were exposed to anaesthesia and surgery 84 times during a period of 22 years (1965-86). The procedures took place at 15 different hospitals. Retrospective examination of the case records showed: 19 cases with local analgesia without any complications, and 18 of 65 general anaesthetics with minor or more serious complications. In ten cases an increase in body temperature above 37.5 degrees C was seen, five had abdominal pain and dark-coloured urine after surgery, and three had a critical perioperative course with a resemblance to malignant hyperthermia. The complications were almost exclusively related to the use of succinylcholine. The use of succinylcholine was dispersed through all ages. Three out of the eight patients with severe complications occurred 1.5, 2.5 and 4 years before the neuromuscular disease was diagnosed. Thus an unusual course of anaesthesia in male children calls for further investigation. Although it has been stated before that succinylcholine is contraindicated in patients with Duchenne's muscular dystrophy, the drug continues to be used.

Adolescent↗
PubMed1989

Effects of general anaesthesia with halothane on antroduodenal motility, pH and gastric emptying rate in man.

Antroduodenal motility, pH and gastric emptying rate were measured in 11 patients undergoing orthopaedic or plastic surgery with general anaesthesia. Motility was measured by manometry and gastric emptying rate by the rate of paracetamol absorption. During anaesthesia, gastric emptying was delayed in eight patients. General anaesthesia with halothane reduced the duration of the interdigestive motility complex (P less than 0.01), mainly by a shortening of phase II (P less than 0.01) which correlated with the inhaled concentrations of halothane (P less than 0.01). Anaesthesia impeded the occurrence of antral contractions during phase II (P less than 0.01); the frequency of contractions was unchanged during anaesthesia, but decreased during the recovery period (P less than 0.01). The amplitudes of antral contractions diminished with anaesthesia (P less than 0.01), but increased after operation. The frequency of contractions in the duodenum was unchanged during phase II and reduced during phase III (P less than 0.01). Gastric pH increased during and after operation (P less than 0.01). General anaesthesia with halothane affects gastroduodenal motility especially during phase II, increases gastric pH and delays gastric emptying rate.

Adult↗
PubMed1989

Antroduodenal motility, pH and gastric emptying during balanced anaesthesia: comparison of pethidine and fentanyl.

In a randomized study of 22 patients, antroduodenal motility, pH and gastric emptying rate were measured during barbiturate anaesthesia with pethidine or fentanyl. Motility was measured by manometry and gastric emptying rate by the paracetamol absorption test. Anaesthesia reduced the duration of the interdigestive motility complexes with both analgesics (P less than 0.001), mainly by a shortening of phase II (P less than 0.01). The duration of phase II and III were shorter with pethidine, and pethidine reduced both the frequency and amplitudes of antral contractions during phase II (P less than 0.01). Fentanyl affected only the amplitudes. The phase III variables assessed were unchanged, apart from a decrease in the velocity of propagation of the motility complexes with pethidine (P less than 0.01). The gastric pH increased in both groups during and after operation (P less than 0.01). Gastric emptying rate was normal in 82% with fentanyl and in 60% with pethidine. Motility in the recovery period approached, but did not reach, preoperative values. Balanced anaesthesia with pethidine and fentanyl seem to have minor influence on gastroduodenal motility and gastric emptying rate.

Anesthesia↗
PubMed1989

Antroduodenal motility and gastric emptying. Gastroduodenal motility and pH following ingestion of paracetamol.

The influence of paracetamol on antroduodenal motility and gastric pH was studied in 11 healthy subjects and the relationship between gastroduodenal motility and gastric emptying rate time, tmax, to peak concentration of serum paracetamol, Cmax, was evaluated. The incidence of antral phase III activity and the duration of phase III was diminished with paracetamol (P less than 0.05). The other motility parameters assessed were unchanged. Three patterns of motility and absorption were observed. One group (n = 5) were fast absorbers with a tmax of 1 h and a motility pattern characterized by antral activity, a high motility index and a short duration of phase II (33-60 min); the phase IIIs were complete except in one case. The second group (n = 4) had tmax at 1.5 h and their phase II motility was characterized by a longer duration (80-133 min) (P less than 0.05), by antral activity, and by a high motility index; their phase IIIs were all incomplete. The last group (n = 2) were slow absorbers: Cmax was not reached in the investigation period, no antral contractions were seen, and the motility index was low. The area under the serum-concentration curve of paracetamol differed between the groups at 90 and 180 min (P less than 0.01).

Acetaminophen↗
PubMed1989

The effect of general anaesthesia on the haemodynamic events during laparoscopy with CO2-insufflation.

Sixteen women were studied during elective diagnostic laparoscopy with CO2-insufflation to an intraabdominal pressure (IAP) of 2 kPa and Trendelenburg tilt to 30 degrees. They were allocated to either a halothane (Group I) or a balanced (Group II) anaesthesia with relaxation and controlled ventilation. Heart rate (HR), arterial pressure, stroke volume, CO2-elimination, end-tidal CO2 vol.% and total respiratory compliance (TRC) were the parameters measured, and mean arterial pressure (MAP), total peripheral resistance (TPR), stroke index (SI) and cardiac index (CI) were calculated. At maximum haemodynamic strain, SI and CI were on average reduced by 42% in both groups, without significant changes in HR and MAP. TPR increased by 50% in Group I and 100% in Group II. The reduction in SI was related to the changes in TRC. A small increment in CO2-elimination after CO2-insufflation was most pronounced in Group II. SI and CI did not reach the pre-insufflation values after return to the horizontal position and CO2-exsufflation. The haemodynamic differences between the two groups were small compared to the effects of the laparoscopy procedures.

Adolescent↗
PubMed1989

Effects of general anaesthesia with enflurane on antroduodenal motility, pH and gastric emptying rate in man.

Antroduodenal motility, pH and gastric emptying rate were investigated before, during and after general anaesthesia with enflurane in 11 patients undergoing elective surgery not involving the abdomen. Motility was measured by manometry and the gastric emptying rate by the rate of paracetamol absorption. During anaesthesia gastric emptying rate was delayed in nine patients. General anaesthesia with enflurane nearly abolished the motility in the antrum. The duration of successive interdigestive motor complexes was reduced (P less than 0.001) mainly be a reduction in Phase II (P less than 0.01). The frequency of contractions was unchanged in the duodenum during Phase II and decreased during Phase III (P less than 0.01). The amplitudes of contractions were unchanged in the proximal part of the duodenum and decreased in the distal part (P less than 0.01). General anaesthesia with enflurane increased the gastric pH per- and post-operatively (P less than 0.01). Motility in the antrum was rapidly regained in the recovery period. General anaesthesia with enflurane seems to delay gastric emptying rate by affecting the motility in the gastric antrum. The acidity of the stomach contents is reduced.

Adult↗