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C Krier

Publications and source records attributed to C Krier.

At least 19 recordsLinked to original sources
PubMed1998

[To our readers].

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Anesthesiology↗
PubMed1997

[Damage due to patient positioning in anesthesia and surgical medicine (1)].

Positioning a patient for surgery requires great care and caution. Correct positioning provides the surgeon with good access to the site, minimizes blood loss and reduces the risk of damage to nerves, soft tissue, compartments and the cardio-pulmonary system. Each position has its specific risks. These have to be evalued against the benefits. Extreme positions of the joints should be avoided whenever possible. The ulnar nerve or the plexus brachialis are at highest risk in the positioning of extremities. Good anatomical comprehension makes it possible to take effective counter-measures. In the case of damage to the ulnar nerve in spite of optimal positioning, some authors found pre-existent non-symptomatic dysfunction in up to 30% of the cases. Patients suffering from peripheral vascular disease are usually at higher risk to suffer acute ischaemia, or, in the extreme, rhabdomyolysis with compartment syndrome, when positioned with elevated extremities (as in lithotomy position) or when a tourniquet is applied. Next to other factors, the duration of surgery seems to be of some importance. Operation sites above the heart carry a higher risk of venous air embolism unrelated to the positioning. In these cases adequate monitoring should be generously applied. Loss of visus is a rare but very severe complication most often seen in connection with the prone position. Still, postoperative blindness has occurred in all positions. It is absolutely imperative to avoid all pressure to the bulbus. The same law applies to surgery and positioning: indicated and correctly executed positioning, to which the patient has effectively consented, is legal, even if damage should occur. If the plaintiff demands compensation for damage, the distribution of onus of proof depends essentially on the accuracy of documentation. If documentation is faulty, the plaintiff may be granted relief or even shift of the onus of proof. This does not apply to a criminal lawsuit; in that case, culpable medical fallibility must be proven, since otherwise, the principle of "in dubio pro reo" applies. The interdisciplinary responsibilities concerning the positioning must be clearly defined and it is essential that the documentation of positioning as well as the documentation of positioning control is carried out as accurately as possible. Correct positioning can effectively aid surgery. Slovenly positioning should not be accepted, as there is a high probability of ill effects, possibly of permanent damage.

Anesthesia, General↗
PubMed1997

[Positioning trauma in anesthesia and surgical intensive care medicine (2)].

Specific modes of positioning are essential for successful surgery. These are again critically assessed in this final part of our review. Technically correct execution can minimize the risk of damage caused by positioning, although the possibility of damage still exists. First of all, the position on the fracture table is discussed. Great care must be taken concerning the perineal post and leg holder. In the lateral decubitus position, the correct positioning of head and spine as well as that of the lower arm are of great importance. When using the Trendelenburg and reverse Trendelenburg position, the effect on the cardiopulmonary system and the intracranial pressure must to be taken into consideration. Prone position and its modifications (i.e. tuck position) demand diligent care concerning the positioning of the head. There must be absolutely no bulbus compression and the abdominal wall should not be under pressure. While employing the sitting position, the patient should be adequately monitored so that venous air embolism can be recognized and treated as soon as possible. Because of the increased occurrence of grave complications, the sitting position should be used only if this is absolutely necessary.

Humans↗
PubMed1997

[Craniosynostosis operations in childhood].

Premature osteosynthesis of one or more cranial bones, either intrauterine or within the first postnatal months, is defined as craniosynostosis. The resulting limitation of intracranial space can cause retardation of cranial growth which, in turn, leads to craniostenosis with increasing intracerebral pressure. Complex forms of craniosynostosis with concomitant malformations (i.e. Apert-, Crouzon-, and Pfeiffer syndromes) must be principally distinguished from simple craniosynostosis. This complex cranio-facial dysostosis is a premature osteosynthesis of cranial and facial bones. In general, as far as Germany is concerned, the incidence of cranio-synostosis amounts to 1/1000 births. If they remain untreated, many of these children will suffer from cortex-associated retardation of intelligence. Surgical management, therefore, is initiated at a very early stage, and should be performed in specialised centres. Recommendations for operation vary from an age of 4 to 36 months. However, an age of 6 months or more is the most frequently preferred age for surgical intervention. Severe respiratory disorders, as well as impossibility of enteral intake of nourishment, are considered absolute indications for surgery, independent of the age; elimination of the stigmatisation regarding environmental contacts of the child is another mandatory indication for operation. The goal of early surgery is reconstruction of physiological, cranial, and facial bone structures ("fronto-orbital" or "fronto-facial advancement"). Correction of craniofacial malformation may be associated with--in part--severe complications for the child. From the anaesthesiologist's point of view, this disease demands highly qualified perioperative management, since a variety of idiosyncrasies and risks must be taken into account: These are, for example, venous air embolism, hypothermia, disorders of water and electrolyte equilibrium, and, extremely vital, difficult intubation and substantial blood loss.

Anesthesia, General↗
PubMed1996

[Mechanical autotransfusion also in transurethral resection of prostatic adenoma? Studies of preserved washed erythrocyte concentrates before possible retransfusion].

AIM: Does cell-saving during transurethral resection of prostatic adenoma (TURP) provide autologous washed erythrocyte concentrates (AWECs) of the same haematological and bacteriological quality as that of established indications of a cell-saving device? Should the cell-saving device be used routinely in TURP? METHODS: 37 patients underwent TURP with written, informed consent. All patients had antibiotic therapy prior to surgery. Shed blood was processed by a cell-saving device. AWECs specimens were analysed for red blood count, electrolytes, LDH, extracellular haemoglobin, osmotic fragility, blood culture and bacterial concentration. In addition, data of urine cultures, adenoma cultures and adenoma histology were analysed. AWEcs were not retransfused. RESULTS: Haematological quality was shown to be comparable to that of established applications of a cell-saving device. However, 82% of the AWECs were contaminated with bacteria. Concentrations were as high as > 10(6) bacteria/ml. Isolated bacteria ranged from e. coli and pseudomonas to staphylococci, streptococci and candidae. Bacteria found in the urine cultures of patients with urinary tract infections could also be isolated in their AWECs. 16% of the patients had prostatic cancer not know preoperatively. Mass of resected adenoma and volume of AWEC did not correlate. CONCLUSIONS: In despite of good haematological quality we considered the rate of 82% bacterial and 16% tumour cell contamination of the AWECs unacceptable and, contrary to some literature data, we no longer use a cell-saving device in TURP.

Aged↗
PubMed1996

[Intubation with the Combitube-TM in massive hemorrhage from the locus Kieselbachii].

Massive nasal haemorrhage occurred during an attempted nasal endotracheal intubation in a 52-year old patient, scheduled for bone grafting to the mandibula. Ventilation of the patient by face mask and conventional endotracheal intubation by laryngoscopy were not possible due to massive bleeding. This situation was successfully managed by the use of a Combitube. The role of the Combitube in difficult airway management as well as its extensive contraindications are discussed. Rare complications when using the Combitube, their diagnosis and treatment are mentioned.

Bone Transplantation↗
PubMed1996

[Mobile blood gas and laboratory monitoring. A new technology in clinical routine].

INTRODUCTION: Decision-making on therapy in acute cases involves clinical examination and monitoring of vital parameters and fluid balance; especially, however, laboratory parameters. The present study compared the results of a new bedside laboratory analysis system (PortLab, i-STAT Corp., Princeton NJ) with the analytical results obtained in our central laboratory. In a second phase personnel costs and turnover times of the two methods were evaluated comparatively. MATERIALS AND METHODS: The PortLab system consists of a basic unit (539 g) with an integrated display and disposable silicon cartridges with thin-film electrodes. Up to 8 parameters can be determined simultaneously in 60 microliters of whole blood. Fifty results obtained with the PortLab system of the parameters sodium, potassium, chlorid, glucose, BUN, hematocrit, the calculated haemoglobin and blood gas analysis were correlated with the results obtained by central laboratory analysis. In a second phase, all procedural steps, the time needed and the turnover times for laboratory analysis were compared with the expenditure for the same analyses performed with the PortLab system. RESULTS AND DISCUSSION: The results obtained using PortLab analysis correlated very well with those of the central laboratory (between 0.966 for the hematocrit and 0.994 for pO2). Three steps were required to perform bedside analysis with the PortLap system. The staff was occupied for 1 min. and 15 sec. and the results were ready within 4 min. and 45 sec. (pure analysis time < 2 min.). Analysis in the central laboratory required 8 steps, the intensive care staff was occupied for 6 min. and 15 sec., 5 min. and 15 sec. of which they were away from the patients' side. Analysis of blood gases required 4 steps, the result was ready in 4 min. 15 sec. The personnel was occupied for an equally long time. The use of PortLab saved personnel resources of 5 minutes per laboratory analysis and 3 minutes per blood gas analysis. CONCLUSION: The PortLab system proved easy to handle and reliable. Valuable personnel resources can be saved. This method cannot replace conventional laboratory analyses, but enables more extensive monitoring of patients and their laboratory parameters. The industry should develop analogous monitoring systems for modular solutions.

Blood Chemical Analysis↗
PubMed1995

[Patient-controlled analgesia (PCA) after urologic interventions].

Patient-controlled analgesia (PCA) is a well-accepted technique in postoperative pain management. We used PCA in three different protocols to find the optimum application form. Our study compared 100 patients with radical prostatectomy or transperitoneal tumor nephrectomy in three groups using piritramide. Group 1 (n = 16) received 1.2 mg/h continuously and a 3 mg bolus with a lock-out time of 90 min. Group 2 (n = 30) received 0.8 mg/h continuously and a 3 mg bolus with a lock-out time of 60 min. Group 3 (n = 54) received the same continuous infusion, but the lock-out time was only 30 min. After 24 hours we evaluated the quality of analgesia using VAS scale. The quantity of piritramide was equal in all groups (35.1 mg). An average of seven bolus applications were made during the observation period. In 27.6% of the patients (group 1: 30.4%; group 2: 35.0%; group 3: 23.1%) the bolus demand was refused by programme. The analgesia level was satisfactory in each group, with a VAS value of 27. There was no respiratory depression observed. In conclusion, on-demand analgesia proved to be a good and practicable method in postoperative pain management. Although the dosage of piritramide was not different in the three groups, we recommend the protocol of group 3 because of the lower refusal of bolus application. Therefore, this seems to be the best patient-adapted application form. Even though respiratory complications in the group 3 scheme are not expected, monitoring of respiration and vigilance are recommended.

Adult↗