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Biomedical subjects

B Panning

Publications and source records attributed to B Panning.

At least 19 recordsLinked to original sources
PubMed1991

Short term volume effects of a hypertonic saline bolus during neurosurgery.

Intracranial hypertension which does not respond to customary hyperosmotic agents may successfully be treated with hypertonic saline. The absence of diuresis and the maintainance of intravascular volume are supposed to be the main advantages of hypertonic sodium chloride. Volume overload and toxic hyperosmolality from frequent application of such solutions are possible disadvantages. The presented experiments checked the time course of intravascular volume shifts after a 100 ml 1-molar saline bolus in 14 patients during neurosurgery using plasma protein concentration changes. An initial intravascular volume expansion of about 270 ml remained quite unchanged for the first 8 minutes, followed by a nearly linear decrease. Extrapolation of the curves demonstrated that the preinfusion state would have been reached after about 20 minutes. Osmolality remained increased by about 4 mosmol/kg 15 min after the bolus. Thus it appears that repetitive infusion of these amounts of hypertonic saline will cause no serious volume overload if 30 minutes intervals are kept, but osmolality should be checked before each bolus.

Adult↗
PubMed1991

[Joseph Weiger and the introduction of anesthesia in Vienna].

The first administration of ether in Vienna was performed by Schuh in 1847. 2 days later also von Wattmann used ether for anaesthesia. Approximately at the same time the nowadays nearly unknown dentist Joseph Weiger began to give ether anaesthesia for dental surgery. He reported in 1850 about his experiences in more than 21,000 operations. A further publication in 1851 gave a survey about the known ether literature.

Anesthesia, Dental↗
PubMed1991

[Inner ear deafness following lumbar puncture. A complication requiring patient education?].

Deafness after lumbar puncture has been reported occasionally. Until now this complication has been regarded as spontaneously reversible, but a more recent publication of three cases of irreversible hearing loss possibly caused by lumbar puncture casts doubt on this. It has been proposed that this complication should be included in the pre-operative information given to patients, but we oppose this proposal.

Deafness↗
PubMed1990

Determination of circulating blood volume by measurement of indocyanine green dye in hemolysate: a preliminary study.

In 8 emergency care patients blood volume was determined using Cr5I labelled erythrocytes and indocyanine green (ICG). Prior to measurement of ICG in blood with a spectrophotometer, the blood was hemolyzed with Triton-X. A close correlation of r = 0.97 between the Cr51 and the ICGTR-X estimates was found; the ICGTR-X volume was about 3% lower than the Cr51 volume. In five additional in vitro experiments the ICGTR-X method was found to reflect real volumes with an insignificant error of less than 1%. Blood volume determination with ICGTR-X cannot be applied in cases of circulatory failure. ICG should be administered in a dose of 0.5 mg/kg of body weight. For calibration purposes, a two point calibration curve (point 1: point of intersection of x and y axis; point 2: 5 mg ICG/1 of blood) is sufficient. From these preliminary experiments it is concluded that the ICGTR-X method is a rapid and simple technique of blood volume determination with multiple reproducibility which can be carried out in any clinical laboratory.

Blood Volume Determination↗
PubMed1990

[Cerebral perfusion pressure in acute blood pressure decrease with hyperosmolar sorbitol in anesthesia conditions].

Osmotherapy with sorbitol during intracranial surgery caused a significant decrease in arterial blood pressure. It was shown that this sometimes very desirable reaction did not cause relevant decreases in cerebral perfusion pressure, but was on the contrary accompanied by an increase in cerebral perfusion pressure in patients with severely elevated ICP (greater than 30 mmHg). 8 patients were studied by measuring the arterial and intracranial pressure during intraoperative infusions of sorbitol 40% (3 ml/kg body weight). Our findings are explained by the simultaneous decrease in arterial and intracranial pressure. During intracranial surgery sorbitol can be used as the antihypertensive agent of choice for treating hypertensive dysregulation of arterial blood pressure in the initial phase of craniotomy before opening the dura.

Anesthesia, General↗
PubMed1989

Regulation of cellular genes transduced by herpes simplex virus.

Previous studies demonstrated that the rabbit beta-globin gene is transcribed from its own promoter and regulated as a herpes simplex virus (HSV) early gene following insertion into the early HSV thymidine kinase gene in the intact viral genome (J. R. Smiley, C. Smibert, and R. D. Everrett, J. Virol. 61:2368-2377, 1987). We report here that the beta-globin promoter remained under early control after insertion into the late HSV gene encoding glycoprotein C. On the basis of these findings, we concluded that the beta-globin promoter is functionally equivalent to an HSV early-control region. We found that a transduced human alpha-globin gene was also regulated as an early HSV gene, while two linked Alu elements mimicked the behavior of HSV late genes. These results demonstrate that certain aspects of HSV temporal regulation can be duplicated by cellular elements and provide strong support for the hypothesis that the regulation of HSV gene expression can occur through mechanisms that do not rely on recognition of virus-specific temporal control signals.

Animals↗
PubMed1989

[Chronic subdural hematoma following spinal anesthesia].

A chronic subdural hematoma was observed 4 weeks after spinal anesthesia. The 70-year-old patient complained of severe, long-lasting headache soon after lumbar puncture. The later symptoms of hemiparesis and aphasia were first misinterpreted as a cerebral vascular accident. After evacuation of the hematoma the patient recovered. Long-lasting, severe headaches after lumbar puncture may be caused by a chronic subdural hematoma, a very rare complication. Risk groups are elderly patients and alcoholics, but every age group can be affected, including parturient women who deliver under spinal anesthesia. The diagnostic procedure of choice is computerized tomography (CAT). The application of contrast medium might be necessary if the CAT scan appears suspicious for a hematoma with the same density as the brain tissue. Because this complication is so rare informing the patient before spinal anesthesia does not seem to be necessary. According to expert opinions, a connection between lumbar puncture and subdural hematoma should be possible. In elderly patients and alcoholics, a pre-existing subdural hematoma may be possibly present.

Aged↗
PubMed1989

[Photoplethysmography evaluation of collateral blood flow before puncture of the dorsalis pedis artery].

Prior to cannulation of the dorsalis pedis artery the collateral circulation through the plantar arch should be examined to evaluate the consequence of an occlusion of this artery. Since the performance of the Allen's test is impossible for assessment of the plantar arch, another suitable technique has to be chosen. We selected the photoelectric plethysmography. Toe pulses were recorded with photoelectric plethysmography in 20 neurosurgical patients. The pulse amplitudes were measured before and during successive compression of the dorsalis pedis and the posterior tibial artery. Obvious decrease or absence of the pulse wave during compression of the dorsalis pedis artery is indicating an inadequate collateral circulation and cannulation of this artery seems not to be safe. In our study this occurred in 4 of 32 examined feet (12.5 percent). The photoelectric plethysmography has proved to be a simple and accurate means for assessment of collateral circulation.

Adult↗
PubMed1988

[Nalbuphine in comparison with piritramid and placebo in postoperative pain therapy following intubation anesthesia with halothane. Side effects and effectiveness].

UNLABELLED: The aim of the study was a comparison of the side-effects and efficacy of nalbuphine, piritramide, and placebo in patients during recovery from halothane anesthesia. METHODS: Neurosurgical (vertebral surgery) and otolaryngological patients (surgery of face and neck) were operated under halothane anesthesia. Postoperatively 20 patients received 20 mg nalbuphine, 21 patients 15 mg piritramide, and 19 patients 0.9% NaCl for pain therapy in a randomized and double-blind manner. Respiratory function was monitored by blood gas analysis, hemodynamic function by noninvasive measurements. The analgetic and sedative effects were estimated by the patients (visual analog scale) and the investigator (4-point scale). If the treatment was ineffective, the study was interrupted and a known analgesic was prescribed. RESULTS: The noninvasively measured hemodynamic parameters were unchanged. On the other hand, in the nalbuphine group mean arterial pCO2 increased significantly (max. 55.4 mmHg after 20 min), over the piritramide group (max. 51.2 mmHg before treatment) and the placebo group (max. 55.1 mmHg before treatment). Drowsiness, in 8 patients in each of the treatment groups and 3 patients in the placebo group, was the most frequent side-effect. After nalbuphine the pain threshold was significantly higher than after treatment with piritramide and placebo. The study was interrupted because of inefficacy in no patients from the nalbuphine group, 2 patients from the piritramide group, and 6 patients from the placebo group. There were no differences in the sedative effects. CONCLUSIONS: Nalbuphine seems to have better analgesic effects then piritramide. Both cause no hemodynamic alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Endotracheal↗
PubMed1988

[Critical comments on reports of fatalities in hereditary fructose intolerance in adulthood from the viewpoint of neuroanesthesia].

In view of repeated communications in recent years reporting on lethal infusions of fructose or sorbitol in adults with hereditary fructose intolerance, the known statements on the incidence of 1:20,000 are critically analysed. The validity is relativated. The special indication for sorbitol as an osmotherapeutic preparation for lowering intracranial pressure is pointed out. A modified intravenous fructose tolerance test is suggested.

Adult↗
PubMed1988

[Acute lowering of blood pressure by infusion of hyperosmolal sorbitol solution in brain operations. Dangerous adverse effect or favorable side effect?].

Osmotherapy with sorbitol 40% during intracranial surgery using neurolept analgesia usually produced acute decreases in arterial blood pressure. Haemodynamical measurements during intraoperative infusions of sorbitol in 97 patients showed a rapid decrease of arterial mean pressure from 91 to 72 mm Hg. In 22 of these patients cardiac output measurements were performed. Increases of cardiac index from 2.5 to 4.3 l/min x m2 could be found. The hypotensive side effect can be used for treatment of reactive arterial hypertension in neurosurgical patients during surgery where this therapy is advantageous per se because of its cerebral dehydrating effects. The decrease of blood pressure is obviously caused by peripheral vasodilatation. Cardiac disturbances were not observed. Other side effects, especially the danger of hereditary fructose intolerance are discussed.

Blood Pressure↗
PubMed1987

[The so-called venous air embolism: historical aspects and current diagnosis, prophylaxis and therapy].

The so-called venous air embolism is known as a complication not only of surgical operations but also of other procedures. Two conditions must be fulfilled: a lesion of a non collapsible vein; and a pressure gradient from outside to inside the vein, as occurs for instance during puncture of a large vein in a hypovolemic patient. Air entry into veins is a frequent occurrence during neurosurgery in sitting patients, and thus most diagnostic, prophylactic, and therapeutic innovations were proposed by neuroanesthetists. Due to advances in technique, truly dangerous cases of so-called venous air embolism during neurosurgery in patients in the sitting position are very rare.

Embolism, Air↗
PubMed1987

[Anesthesiological care of female patients with cerebrovascular aneurysms in pregnancy].

This is a report on a patient who suffered subarachnoid haemorrhage from an aneurysm of the a. cerebri media during the 28th week of pregnancy. The aneurysm was clipped under neuroleptanalgesia. Besides monitoring of heart rate, blood pressure and central venous pressure as well as the treatment parameters including end-expiratory CO2, the foetal heart rate was deduced by Doppler sonography. She was hyperventilated intraoperatively with a paCO2 of 3.8-4.1 kPa. During the actual aneurysm surgery, artificial hypotension by 20 mmHg to b.p. values around 100/160 mmHg was initiated by means of nitroglycerin. It is evident from the literature compiled on this occasion that it is mandatory to monitor foetal heart rate during controlled hypotension in pregnancy. Sodium nitroprusside should not be used to initiate artificial hypotension during pregnancy, since it may result in toxic cyanide levels in the foetus. As usual in neurosurgery, hyperventilation can be performed also during pregnancy, since placental blood flow decreases only if the CO2 concentration drops to a very low level.

Adult↗
PubMed1987

[Lumbar epidural hematoma and spinal abscess following peridural anesthesia].

Epidural application of local anesthetics or opiates is commonly used for treatment of severe pain or arterial obstruction. We discuss two cases of complications following peridural anesthesia. As an acute complication, a lumbar epidural hematoma developed hours after placement of the catheter and caused sciatic pain and nearly complete paraplegia. The hemorrhage might have been promoted by heparinization. After decompressive hemilaminectomy the patient recovered but was disabled by a persistent paresis. The second patient suffered from renal failure, arterial obstruction, and phantom limb pain. A peridural catheter was kept in place for 6 weeks. Five months later the patient developed severe sciatica. Spinal computed tomography showed compression of the cauda at the L4/5 level (Fig.4) caused by an abscess that was opened and drained. After insertion of a gentamicin - PMMA - chain (Septopal), the wound healed primarily but the patient suffered from persistent pain. The incidence of vessel puncture after insertion of a peridural catheter is about 1%-10%. The risk of hemorrhage, perforation of the dura, and nerve root irritation is increased in scoliotic or elderly patients with a narrow spinal canal. Persistent pain after removal of the catheter is the most important sign. Although paraplegias following peridural catheterization can occur without anticoagulants, even low-dose heparinization is potentially dangerous. The risk of infectious complications after long-term peridural catheterization may be up to 20%. Hematogenous metastatic infection is more common in patients with malignancies or multiple risk factors than continuous immigration of bacteria. Epidural hematomas and spinal abscesses can cause disability and persistent neurological deficit in spite of aggressive surgical and antibiotic therapy.

Abscess↗