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Biomedical subjects

C Krier

Publications and source records attributed to C Krier.

At least 91 records · Page 5Linked to original sources
PubMed1989

[Postoperative arterial oxygen saturation in children].

In 46 pediatric patients (ASA-group I + II) the arterial saturation of oxygen was monitored perioperatively by the Nellcor N-100 and N-200, respectively. During postoperative transportation a statistically significant desaturation could be detected. But the saturation remained within a clinically acceptable range after a trial period of breathing various fractions of oxygen spontaneously before transfer. Motion artifacts occurred to a far lesser extent using the ECG-triggered Nellcor N-200 as compared to the N-100. As there was no significant difference between the lateral and supine position as far as arterial saturation is concerned, the lateral position is still highly recommended for postoperative transportation.

Anesthesia, General↗
PubMed1988

[TUR syndrome as a late postoperative complication. Case report].

A 81-year-old patient developed a TUR-syndrome gradually one and half an hour after termination of TURP. Surgery was complicated by perforation of the bladder dome at the end of TURP. Due to extravasation of the perioperative irrigating fluid intraperitoneally and intravascular resorption a TUR-syndrome became apparent. Early diagnosis and rapid initiation of appropriate intensive care resulted in a benign postoperative course and the patient attained full recovery.

Aged↗
PubMed1988

[AIDS and anesthesia].

AIDS will become a bigger and bigger problem in future, especially for medical staff who will be increasingly in contact with infected patients. The epidemiology of HIV infection (blood, vaginal secretion, sperm) and the threat of this infection require particularly strict observance of hygienic measures. Unqualified handling of infected material such as HIV-contaminated injection needles or pointed objects represent a major risk of HIV infection for medical personnel. Despite the high degree of safety in the preparation of banked blood we cannot completely guarantee that only absolutely safe HIV-free blood will be transfused. Hence, indication for transfusion must be very strictly limited. Autologous transfusion as a safe alternative to homologous transfusion should be employed more frequently. Seroconversion rate after needle-point injury is now stated to be one per cent. According to Goebel et al. in AIFO 5:227 (1988) four nurses carried out mouth-to-mouth resuscitation in an AIDS patient who had jumped from the third floor of a building in attempted suicide. Despite considerable blood contact the HIV antibody tests remained negative even now after 18 months.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Adsorption of insulin to the Perfusor systems].

Using radioimmunoassay determination we examined the recovery rate of 100 units of regular insulin that had been added to 50 ml. of a carrier solution in a plastic Perfusor syringe. We measured the recovery rate with sodium chloride 0.9% as carrier and after adding albumin (10 g./l.) and gelatine (6 g./l. resp. 12 g./l.). An initial insulin loss of 26% (with albumin) to 37% (with gelatine) was followed by only a small loss (less than 9%) during the next 24 hours. We conclude from our results that it is unnecessary to add substances with high molecular weight in order to reduce insulin adsorption to Perfusor systems.

Adsorption↗
PubMed1987

[No indications for barbiturate therapy following complete cerebral ischemia. A comment on "cerebroprotection" by barbiturates following cardiovascular arrest].

Cardiac arrest is followed by complete cerebral ischemia, which is characterized by delayed hypoperfusion and transient hypermetabolism. Brain metabolism depressant drugs, such as barbiturates, were suggested to improve neuronal outcome. The hypothesis of a cerebroprotective effect of barbiturates remained nevertheless controversial. In order to define the utility of large doses of thiopentone, the effect of thiopentone on carbohydrate and energy metabolism of 1-year old Wistar rats was investigated in an experimental model of complete reversible ischemia followed by a recovery period. No beneficial effect of high-dose thiopentone could be demonstrated by means of changes in the carbohydrate metabolism and the energyrich compounds. There were no differences between the treated group and the spontaneous recovery group. These results are mainly confirmed by other investigators. In contrast to focal ischemia and hypoxemia beneficial effects of barbiturates can not be demonstrated after complete cerebral ischemia in experimental studies and in clinical studies as well. In conclusion there is no indication for high-dose barbiturate therapy after cardiac arrest and successfull resuscitation.

Animals↗
PubMed1987

[High-dose thiopental infusion in cerebral dysfunction following extracorporeal circulation].

Thiopentone (thp) infusion was administered to 33 patients with cerebral dysfunction or convulsions out of 2986 patients operated on via extracorporeal circulation because of valvular disease, coronary insufficiency, septum defects and intrathoracic aortic aneurysms. If phenytoin, diazepam and clonazepam proved ineffective, thp 10-15 mg/kg was injected slowly, followed by infusion of 2-4 mg/kg/h for 0.5-5 days. 9 patients died. 18 survivors had a good recovery, 6 were moderately disabled. In the survivors embolisation of particulate matter prevailed as a cause of cerebral dysfunction while in nonsurvivors prolonged pre- and postoperative hypotension was the main cause, with one patient suffering a hemispheric infarction. The amelioration of convulsions and psychosyndromes in the survivors is compatible with the known anticonvulsive effect of thp and its alleged influence on cerebral focal ischaemia. However, in protracted cerebral hypoperfusion as a cause of cerebral dysfunction no protection can be expected from thp. The known effects of barbiturates do not justify the use of these substances for the purpose of cerebral protection.

Adolescent↗
PubMed1987

[Internal jugular vein catheter--success rate and complications with reference to educational status].

In a prospective study the success and complications of internal jugular vein catheterization in relation to the degree of experience were investigated. The internal jugular vein catheter were placed in 200 patients by experienced anaesthetists and by anaesthetists not experienced in this procedure as well. In the case of physicians trained in this procedure, the success rate was 98 percent, whereas in the case of inexperienced collegues, the success rate was 83 percent with a high number of attempted punctures. In addition to the increased rate of haematoma, during the learning period, the incidence of accidental arterial punction was 18 percent resulting in a temporary Horners-syndrome in one patient. In the group of experienced anaesthetists the accidental arterial puncture occurred only in 3 percent without any haematome. In one patient the procedure was interrupted because of temporary AV-Block (3rd degree). The complications of internal jugular vein cannulation are reviewed and the methods to avoid them are presented.

Adolescent↗
PubMed1986

[Perioperative respiratory problems in patients pretreated with bleomycin].

We examined the incidence of an acute respiratory insufficiency in a retrospective study in 100 patients with carcinomas in the head and neck region who had received cytostatic pretreatment with bleomycin. All patients had been ventilated intraoperatively with 28% to 33% oxygen under precise control of blood gas analysis. In 93% of the patients, there were no respiratory problems in the postoperative course. The total lethality was 7%. Extrapulmonary causes were most prominent in five patients. In one patient, pre-existing pulmonary silicosis was suspected to be the cause of the acute respiratory insufficiency. Only in one patient was the acute respiratory insufficiency refractory to therapy very probably attributable to the synergistic toxic effect of bleomycin and oxygen on the lung parenchyma, as postulated by Goldiner and verified later in animal experiments. On the basis of these results, we do not consider that it is justifiable to reduce categorically the inspiratory oxygen concentration to 21% to 25% oxygen in bleomycin-pretreated patients with tumours in the head and neck region, as recommended by Goldiner. Since the majority are elderly patients with pre-existing cardiopulmonary stress, we recommend moderately reduced oxygen concentrations of 28% to a maximum of 33%. Further recommendations to prevent an acute respiratory insufficiency by those patients are discussed.

Adult↗
PubMed1986

Selected blood coagulation parameters during extracorporeal circulation.

We investigated selected coagulation parameters in 13 patients who had undergone open heart surgery with extracorporeal circulation (ECC). During ECC factor XIIa increased considerably to 38%. This may lead to intravascular coagulation, which is however inhibited during ECC by the administered heparin. The C1-inhibitor activity decreased to 12% during ECC, this decrease was considerably greater and lasted longer than the decrease of the C1-inhibitor concentration, which declined to 59%. The levels of the other coagulation factors I, II, V, VII, X, XII, antithrombin III, alpha 2-antiplasmin and platelets decreased to 50-60%. The latter was predominantly due to hemodilution at the beginning of ECC. We assume that the critical period for the coagulation system in ECC appears when ECC is discontinued. At this point we have a high factor XIIa level and a low C1-inhibitor activity so that intravascular coagulation (DIC) may occur because then the inhibitory effect of heparin is neutralized by protamine.

Adult↗
PubMed1985

[I.v. famotidine versus i.v. ranitidine: intragastric pH behavior in surgical intensive care patients].

20 patients of a surgical intensive care unit were treated in a randomised double-blind fashion with i.v. famotidine 10 mg and i.v. ranitidine every 6-12 hours for maximally seven days. Both groups were comparable with respect to the grade of risk of stress-induced bleeding. With both H2-blockers (ranitidine and famotidine) the intragastric pH could be increased to 5.0 and more and kept constant at this level over the whole test period. The mean daily doses required were 22.3 mg for famotidine and 154.3 mg for ranitidine. Stress-induced bleeding as well as adverse reactions could not be observed in both treatment groups.

Adolescent↗
PubMed1985

[Pericardial tamponade: a rare but severe complication of a vena cava catheter. Case report].

A case of catheter-induced cardiac tamponade followed by successfully treated cardiac arrest is reported in a 5-month old infant with oesophageal atresia. The complication occurred after a delay of 16 h following catheter placement and was diagnosed by ultra-sound technique. Treatment consisted of direct pericardial puncture. Cardiac tamponade is an unusual, but potentially fatal complication and is always due to incorrect catheter tip position.

Cardiac Tamponade↗
PubMed1984

Hazards of high dose barbiturate therapy in head-injury patients.

Despite of controversial findings, High-Dose-Barbiturate Therapy is advocated by many authors for treatment of postischemic/anoxic encephalopathy and head trauma with elevated intracranial pressure. The adverse effects to thiopentone are analyzed in a retrospective study including 30 patients treated by high-dose thiopentone for raised intracranial pressure after severe head injury. The pathophysiology and occurrence of clinical complications in many systems of the organism are illustrated. The specific prevention measures and the extended monitoring of barbiturate-treated patients are described. Considering the high incidence of clinical complications the indication for HDBT has to be reevaluated.

Cardiovascular System↗
PubMed1983

Catheter embolization following median sternotomy.

A case of intraoperative internal jugular vein catheter embolization in a patient undergoing median sternotomy for open-heart surgery is described. This complication suggests that right sided cannulation of the internal jugular vein is to be preferred in all patients having a median sternotomy in order to avoid the risk of intersection by median sternotomy.

Brachiocephalic Veins↗
PubMed1982

[Combined use of dihydralazine and nitroglycerin during and after cardiac surgery (author's transl)].

The haemodynamic effect of combined intravenous administration of 18 mg/h dihydralazine and 0.6 mg/h nitroglycerine was examined in the intraoperative and postoperative phases of cardiac surgery (replacement of the aortic and mitral valve or of both valves, and aortocoronary bypass surgery(. Indication for therapy was supplied by a preoperative cardiac index below 2.8 l/min . m2 and an enhanced peripheral resistance above 1200 dyne . sec . cm-5. During a 19-hour observation period the haemodynamic parameters such as cardiac index (+36%) and stroke index (+19%) increased significantly within the investigated group, whereas the peripheral vascular resistance dropped by 16% and the left atrial pressure by 20%. Arterial mean pressure and heart rate did not change. In a patient group treated exclusively with nitroglycerin, the cardiac index decreased (-8%), while the peripheral vascular resistance increased (+6%); an untreated control group showed an increase of the cardiac index by 5%, whereas there was no appreciable change in peripheral vascular resistance and stroke index. The combined use of dihydralazine and nitroglycerin during the perioperative phase of cardiac surgery appears recommendable, since it is possible by such administration to monitor cardiac preload and afterload due to selectivity of the pharmacological sites of action.

Adult↗