[Remarks on the work of F. Incze et al. Modified methods for carrying out non-intubation anesthesia for laryngomicroscopic interventions].
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Anesthesia↗
Biomedical subjects
C K Spiss
Publications and source records attributed to C K Spiss.
[Monitoring fiberoptic intubation using non-invasive pulse oximetry].
Non-invasive measurements of oxygen saturation are attractive because continuous information is provided, which may result in improved patient care. We evaluated a new finger pulsoximeter as a measure of arterial oxygen saturation during fiberoptic intubation. Secondly, we studied the kinetics of oxygen-haemoglobin desaturation during the procedure. In 15 patients investigated, 118 simultaneous comparisons between in vivo (Pulsoximeter Nellcor N 101) and in vitro (CO-Oximeter Corning 2500) oxygen-haemoglobin saturation were made. Statistical analysis of these pooled data yielded an excellent correlation (r = 0.94, P less than 0.001). Our results demonstrate that non-invasive oxygen monitoring during fiberoptic intubation is reliable, and we detected oxygen desaturation of less than 80% if ventilation was not assisted.
Adult↗
Haemodynamic effects of fentanyl or alfentanil as adjuvants to etomidate for induction of anaesthesia in cardiac patients.
This investigation was designed to study the comparative haemodynamic effects of alfentanil, 5 mg vs. fentanyl 0.5 mg when administered in combination with etomidate for induction of anaesthesia in patients undergoing cardiac surgery. Both groups manifested significant decreases in heart rate (17-22%), cardiac index (12-25%) and mean pulmonary artery pressure (4-17%). The mean arterial pressure was decreased in both groups; however, the decrease was significantly greater in the alfentanil group. In contrast to the fentanyl group, the systemic vascular resistance was transiently decreased in in the alfentanil group. In conclusion, it appears that alfentanil is associated with a greater degree of cardiovascular depression than fentanyl when used in combination with etomidate as part of an induction sequence in cardiac surgery patients.
Adjuvants, Anesthesia↗
Alpha-adrenergic responsiveness correlates with epinephrine dose for arrhythmias during halothane anesthesia in dogs.
The dose of epinephrine required to elicit ventricular arrhythmias during halothane anesthesia may depend on end-organ sensitivity. We determined whether the arrhythmogenic dose for epinephrine (ADE) could be correlated with either alpha- or beta-adrenergic responsiveness. After ADE was determined in 26 dogs anesthetized with 1.2 MAC halothane, an in vivo assessment of adrenergic responsiveness was made. The alpha-adrenergic responsiveness was defined as the dose of phenylephrine required to increase mean arterial pressure by 75% (alpha 75), while the dose of isoproterenol causing a 75% increase in heart rate was a measure of beta-adrenergic responsiveness (beta 75). The correlation coefficients for alpha 75 and beta 75 vs ADE then were determined by multiple linear regression analysis. There was a highly significant correlation with the alpha 75 (F = 9.06; P less than 0.01), while no relationship existed with beta 75 (F = 0.52; P greater than 0.05). Thus the alpha-adrenergic responsiveness in individual patients may be used to predict the threshold for epinephrine-induced arrhythmias during halothane anesthesia.
Anesthesia, General↗
A multicenter study of the prevalence of hepatitis B viral serologic markers in anesthesia personnel.
Health care workers with frequent blood contact are at high risk of infection with hepatitis B virus. We surveyed 154 physician anesthesiologists (MD) and certified registered nurse anesthetists (CRNA) at four university-affiliated medical centers to determine the prevalence of serologic markers of hepatitis B virus (HBV). Questionnaires were used to ascertain historical and demographic information, nonoccupational risk factors, and characteristics of the participants' anesthesia practice. The overall prevalence of seropositivity was 18.8% (range 10.2-30.3%), and there were no statistically significant differences among the four centers, MD and CRNA groups, or males and females. In contrast to other studies, the prevalence of seropositive markers did not increase with an increase in the participants' age or length of time in the specialty. For the groups sampled in this study, geographic location or type of practice did not influence the increased prevalence of HBV seropositivity in anesthesia personnel. The current methods of HBV infection control were not associated with a decreased prevalence of serum markers. The majority of the susceptible anesthesia personnel at these four institutions did not plan to receive the hepatitis B vaccine when surveyed at the time of this study.
Anesthesiology↗
Halothane-epinephrine arrhythmias and adrenergic responsiveness after chronic imipramine administration in dogs.
The incidence of halothane-epinephrine arrhythmias increases after the short-term administration of imipramine, probably because of enhanced noradrenergic transmission. To determine whether this effect persists after long-term imipramine treatment, we have studied the arrhythmogenicity and adrenergic responsiveness in halothane anesthetized dogs after six weeks of imipramine administration, 150 mg X day-1, orally. The mean (+/- SD) arrhythmogenic dose of epinephrine (ADE) in nine dogs anesthetized with 1.2 MAC halothane was 2.57 (+/- 1.04) micrograms X kg-1 X min-1. The alpha-adrenergic responsiveness, assessed as the dose of phenylephrine that caused a 75% increase in mean arterial pressure (alpha 75), was 5.78 +/- 2.39 micrograms X kg-1 X min-1. The dose of isoproterenol that increased heart rate by 75% (beta 75) was 309 +/- 180 ng X kg-1 X min-1. After imipramine treatment, the ADE (2.63 +/- 1.26), alpha 75 (5.16 +/- 2.05), and beta 75 (386 +/- 266) were not statistically different from the pre-imipramine values (P greater than 0.05), despite a fivefold increase in circulating norepinephrine. We conclude that chronic imipramine does not alter arrhythmogenicity and adrenergic responsiveness, since compensatory mechanisms, at the sympathetic nerve terminal, may revert the initial hyper-responsiveness to normal.
Anesthesia↗
[Perforation of the trachea. A lethal complication following tracheostomy prolonged ventilation caused by faulty material (author's transl)].
Among 404 tracheostomies performed for long term ventilation within the last 15 years the first lethal complication (the overall complication rate being 2,97%) was observed: perforation of the membraneous part of the tracheal wall. The complication is directly related to the substitution of a "high-pressure"-cuff tracheostomy tube by a "low-pressure"-cuff-model. Decubital ulceration by the high pressure cuff, injury caused by the stiff uncoated tip of the low pressure model, and a blow-up mechanism by an excentric gas stream are discussed as eventual causal factors of this complication.
Adult↗
[Hydrothorax after catheterization of the right internal jugular vein (author's transl)].
Two cases of hydrothorax are reported which developed as the result of intrapleural catheter malposition after cannulation of the right internal jugular vein. Predisposing factors for this rare, but frequently misdiagnosed, complication are discussed. In both cases control chest radiography with small doses of contrast medium as well as aspiration of blood failed to indicate malpositioning. To prevent this complication the use of larger doses of contrast medium and/or control aspiration shortly after the start of infusion are recommended.
Aged↗
[Intraoperative measurements of the oscillatory impedance in scoliotic patients (author's transl)].
In 10 Skoliose-patients undergoing Harringtons-Operation, measurements of the oszillatory impedance and arterial blood gases were made intraoperatively. The resistance was elevated from the beginning without any change during the operation. The phase was in the inductive range with a further deviation during increasing extension. The possible reasons are the maximal rigidity of thorax and/or parenchyma or change in tracheobronchial "arborisation". Increase in dead space or changes in ventilation-perfusion ratio are suggested by the blood gas measurements. Further investigations will be necessary to determine, if the impedance of the lung is of value in determining the amount of intraoperative extension or postoperative lung function.
Adolescent↗
[Medial AV-nodular rhythm observed during an endolaryngeal micro-surgical intervention (author's transl)].
A case of therapy resistant junctional nodal rhythm in the course of a microsurgical laryngeal operation is reported. The interaction of possible reflex mechanisms is discussed. Attempts to reverse the electrocardioscopic findings with drugs were unsuccessful. Diminuation of the mechanical irritation caused by the operation-laryngoscope resulted in immediate return to sinusrhythm.
Arrhythmias, Cardiac↗