Search PubMed⌕ Search

Biomedical subjects

C Spies

Publications and source records attributed to C Spies.

At least 73 records · Page 4Linked to original sources
PubMed1995

Self-administered intranasal meperidine for postoperative pain management.

Recent studies have demonstrated that intranasal is comparable to intravenous opioid titration in its pain-relieving effect. In these studies, however, the intranasal opioid titration was performed by the investigator, and the treatment period was two hours or less. The purpose of this randomized, prospective study was to investigate whether intranasal opioid administration by the patients themselves for a prolonged postoperative period may be regarded as a therapeutic alternative for postoperative pain management. Forty-four orthopaedic patients were studied over a 12-hr period on the first day after surgery. Twenty-two had free access to intranasal meperidine (nasal group) and were allowed to administer six intranasal puffs (27 mg per dose). The next self-administration was only permitted after a delay of at least ten minutes. Another 22 patients received intermittent subcutaneous meperidine injections (25 or 50 mg) on request (sc group). Pain intensity was recorded at 30-min intervals with the aid of the 101-point numerical rating scale. The pain score was lower in the nasal than in the sc group at the 30, 150 to 330, 420 to 480 and 540 to 600 min measuring points (P = < 0.05). The meperidine requirement was 112.9 +/- 81.3 mg in the nasal and 103.4 +/- 41.5 mg in the sc group (NS). Two patients in each group complained of nausea and vomiting. Thirteen of the 21 nasal and nine of the 15 sc patients who completed the final questionnaire rated the pain management as excellent or good (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗
PubMed1995

Safe and normothermic massive transfusions by modification of an infusion warming and pressure device.

A fluid-warming pressure infusion device (H-500/H25i, Level 1) was modified to meet the demands for safe, normothermic, and effective massive transfusions. By incorporating an autoventing 40 microns filter (Pall AV-SP), which was originally manufactured for use in an extracorporal circulation, the risk of accidental air embolism can be eliminated. Feasibility and efficiency of this model were tested in ten patients. The mean volume transfused and infused (packed red cells and colloids) was 6750 mL (SD +/- 2519) during a mean period of acute volume resuscitation of 55 minutes (SD +/- 30). Calculated flow rates averaged 140 mL/min, which were sufficient to stabilize all but one patient. This patient subsequently died because of uncontrollable surgical bleeding. Body temperature remained stable with a minimal mean drop of -0.3 degrees C. Supplying the Level 1 warming and pressure device with a Pall AV-SP filter allows for safe, effective, and demand-adapted massive transfusions in a large number of trauma patients at a reasonable cost.

Blood Transfusion↗
PubMed1995

Feasibility and rate of leucocyte depletion with a single leucocyte depletion filter during massive transfusion.

BACKGROUND: The study examines the feasibility and rate of leucocyte depletion with a single leucocyte depletion filter in combination with the Level 1 heat exchanging infusion/transfusion device H-500/H-25i during massive transfusions. MATERIALS AND METHODS: LeukoGuard-6 filters (LG-6) were manufactured to fit the infusion sets of the Level 1 H-500/H-25i. This modified device was used intraoperatively in six patients with severe haemorrhage. Following determination of the white cell counts (WCC) in each buffy coat poor red cell concentrate prior to administration, WCC were then obtained from blood sampled directly distal to the filter after the first and after the last red cell concentrate was given. Leucocytes were determined in the Nageotte chamber and then calculated to determine leucocytes/250 ml (therapeutic unit). Parameters of feasibility (time for preparation of the system, the amount of transfused red cell concentrates, time interval of transfusions) were recorded. RESULTS: The mean volume of red cell concentrates which were transfused and filtered by a single filter was 2,708 ml (S.D. +/- 797 ml) within a mean time interval of 42.5 min (S.D. +/- 26 min). With a mean WCC of 1.17 +/- 0.68 x 10(9) leucocytes/250 ml in the red cell concentrate prior to filtration the LG-6 achieved a log-3 reduction of leucocyte counts. During the transfusion the WCC distal to the filter increased on average by a factor of 3 (from 0.9 x 10(6) leucocytes/250 ml following the first blood unit to 2.7 x 10(6) leucocytes/250 ml following the last), but remained below 5 x 10(6). CONCLUSION: Modification of the Level 1 H-500/H-25i system by incorporating the LG-6 leucocyte depletion filter provides a significant reduction of the WCC in the transfused red cell concentrates during massive transfusion. The rate of leucocyte depletion by a single leucocyte depletion filter achieves low leucocyte counts which are documented to be of therapeutical value. As the significance of leucocyte-reduced blood products for patients with haemorrhagic shock following trauma or major surgery has still to be elucidated, the presented device may be useful in the performance of future studies related to this subject.

Blood Volume↗
PubMed1995

[Cerebral ischemia during implantation of automatic defibrillators].

In order to study the influence of repetitive episodes of ventricular fibrillation (VF) during defibrillator implantation on the electrical activity of the brain, we performed an electroencephalographic (EEG) monitoring during implantation procedure in 18 patients. For defibrillation threshold testing 62 episodes of VF (1-6 episodes per patient) were induced. The mean duration of VF was 20 +/- 12 s; the mean duration of hypotension during an episode (defined as a mean arterial pressure of 50 mm Hg or less) was 33 +/- 16 s. EEG monitoring was performed using the International 10-20 System. The duration of cardiac arrest-related EEG alteration was assessed by an experienced neurologist and could be determined in 41 test-episodes; in 21 episodes analysis was not possible due to poor recordings. Ischemia-related EEG changes started 7.8 +/- 4.6 s after VF induction and lasted 64 +/- 49 s (range, 12-240). The duration of EEG alteration was significantly (p < .001) correlated with the duration of VF episodes (r = .71) and the associated hypotension (r = .82). With regard to patients the duration of ischemia related EEG changes also correlated significantly (p = .001) with the individual cumulative duration of VF (r = .85) and the associated hypotension (r = .88). In females EEG changes lasted longer than in males (p = .03); this finding, however, was only based on 2 women. Other clinical parameters, such as patient age, degree of congestive heart failure, left ventricular ejection fraction, stroke volume and cardiac index, the order of episodes within the testing sequence, and the time interval between episodes did not correlate with the duration of EEG alteration after VF induction. The duration of ischemia-related EEG alteration during VF episodes depends on the duration of cardiac arrest. In females EEG changes tended to last longer than in males, however, this finding has to be confirmed. An association with other clinical parameters has not been observed. Limitation of VF duration appears to be the most important factor to avoid prolonged cerebral ischemia.

Adult↗
PubMed1994

The relationship between mixed venous and hepatic venous O2 saturation in patients with septic shock.

It was the purpose of this study to measure the relationship between hepatic venous O2 saturation (ShvO2) and mixed venous O2 saturation (SvO2) in septic patients (n = 21) following treatment with various catecholamines (epinephrine, norepinephrine, dopamine, dopexamine). At baseline mean SvO2 was 74 +/- 5% while mean ShvO2 was 59 +/- 12%. Alpha-mimetic substances such as epinephrine and norepinephrine reduced ShvO2 and increased the difference between SvO2 and ShvO2.Beta2-mimetic and dopaminergic substances (dopexamine, dopamine) did not change the difference between SvO2 and ShvO2. These results show that SvO2 does not necessarily reflect all changes of ShvO2. Monitoring ShvO2 may be helpful in managing septic shock by adding information on adequacy of O2 supply/consumption ratio in the crucial splanchnic region.

Dobutamine↗
PubMed1994

The relevance of measuring O2 supply and O2 consumption for assessment of regional tissue oxygenation.

Septic shock and ARDS are associated with disturbed tissue oxygenation. It has been suggested to increase O2 supply (DO2) above the normal level (> 600 ml/min/m2) to compensate for the tissue hypoxia. The lack of a rise in O2 consumption (VO2) after increases of DO2 has been presumed to indicate adequate tissue oxygenation (negative O2 flux test). We were interested in whether a negative O2 flux test precludes an improvement of regional tissue oxygenation. The pH value of the gastric mucosa (pHi) is considered to be a sensitive marker for hypoxia in the splanchnic region. We measured pHi as well as DO2 and VO2 in 10 patients with hyperdynamic septic shock to assess the effect of volume substitution on tissue oxygenation. The initial therapeutic approach (volume substitution and catecholamines) led to a DO2 of 717 +/- 187 ml/min/m2. However, all patients had pHi values < 7.35 indicating regional tissue hypoxia. An additional increase of DO2 by colloidal volume substitution caused a significant rise of pHi from 7.20 +/- 0.05 to 7.25 +/- 0.05 but did not change VO2. We conclude that a negative O2 flux test does not rule out regional tissue hypoxia, and second, an increase in DO2 may improve tissue oxygenation without measurable changes in VO2. Furthermore, adequate volume substitution is an important step in the treatment of septic shock to increase total body blood flow and more specifically regional blood flow.

Biological Transport, Active↗
PubMed1994

[The relevance of CDT (carbohydrate-deficient transferrin). Preoperative diagnosis of chronic alcohol abuse in intensive care patients following elective tumor resection].

The increase of alcoholism-related problems is associated with vital postoperative clinical complications in chronic alcohol abusers. In particular, the alcohol withdrawal syndrome (AWS) may provoke potentially life-threatening complications in alcohol-dependent patients. Hence, a precise diagnosis of alcohol dependence is mandatory preoperatively, requiring an extensive case history using alcoholism-associated questionnaires. Additional new biological markers for detecting alcoholism could improve the accuracy of preoperative diagnosis. Carbohydrate-deficient transferrin (CDT) reflects increased alcohol consumption. The aim of our interdisciplinary study was to investigate whether the validity of the preoperative diagnosis of chronic alcohol abuse might be improved by measuring CDT. METHODS. A total of 45 patients from the departments of Otorhinolaryngology, Maxillofacial Surgery, and Abdominal and Thoracic Surgery were included in our prospective clinical study. Patients underwent resection of malignant oral, pharyngeal, laryngeal, or oesophageal tumours and were transferred to the intensive care unit for postoperative management. Routine preoperative history, examinations, and laboratory tests including GGT, MCV, ASAT, and ALAT, were supplemented by a specific alcohol-related questionnaire and CDT measurement. The patients were categorised in four groups based on history and the questionnaire: continuously abstinent subjects; sober subjects for at least 7 days; chronic abusers; and dependent subjects. CDT was separated by isocratic anion exchange chromatography and quantified by turbidimetric determination. Statistical analysis was performed by the Kruskal-Wallis test. RESULTS. Preoperatively, 21 patients were at major risk for alcoholism-related complications: 12 were chronic abusers and 9 were diagnosed as dependent. CDT was significantly increased in both groups, and was pathologically elevated in 16 of the 21 patients. Sampling occurred significantly long after the last alcohol intake in the 5 patients with normal CDT values (median: 6.0 days; range: 2-12 days) compared with the 16 with pathologically elevated CDT levels (median: 1.0 day; range: 0-4 days; P = 0.002). The sensitivity of CDT elevation was 16 out of 24 (76%), the specificity 16 out of 16 (100%). Sixteen patients had no previous history of alcohol consumption (sober for at least 7 days) and 8 were definitely abstinent. Both of these groups had normal CDT values. CONCLUSIONS. CDT was a sensitive and specific marker for chronic alcohol consumption in our patient population. Since CDT is a state marker, repeated determinations might be useful to estimate a patient's drinking habits. The combination of CDT and an alcohol-related questionnaire was reliable for detecting alcohol-dependent patients preoperatively.

Adult↗
PubMed1993

Fatal intoxication involving etryptamine.

A case of fatal intoxication due to the ingestion of Etryptamine (ethyltryptamine) is reported. Toxicological findings included the following tissue distribution: blood (heart) 5.6 mg/L; urine 80.4 mg/L; vitreous 2.4 mg/L; bile 22.0 mg/L; stomach contents 52.9 mg, brain 16.2 mg/g; liver 18.3 mg/g and kidney 24.0 mg/g. Anatomic pathology showed pulmonary edema and generalized visceral congestion with some epicardial petechiae.

3,4-Methylenedioxyamphetamine↗
PubMed1993

[O2 supply, O2 consumption and the pH value of the gastric mucosa. Indicators of tissue oxygenation].

The lack of a rise in global O2 consumption (VO2) after increased O2 supply (DO2) (negative O2-flux test) is an indication of adequate tissue oxygenation. We were interested in whether a negative O2-flux test precludes an improvement in regional tissue oxygenation. The pH of the gastric mucosa (pHi) is considered a sensitive marker for tissue hypoxia. Method. The study was approved by the ethics committee of our hospital. In 12 intensive-care patients with septic shock, gastric pHi was determined (Trip'TGS catheter, Tonometrics) in addition to measuring O2-transport-related parameters via invasive haemodynamic monitoring. Following the initial measurement, a further increase in the O2 supply via volume substitution was attempted in all already hyperdynamic patients with DO2 in the upper-normal range. Results. Volume substitution with 1.246 +/- 594 ml colloid resulted in an increase in pulmonary capillary wedge pressure from 14 +/- 2 mm Hg to 17 +/- 1 mm Hg (P < 0.01). All patients had an increase in DO2 from 755 +/- 192 ml/min.m2 to 846 +/- 236 ml/min.m2 (P < 0.05). There was no significant change in VO2, at 153 +/- 28 ml/min.m2 before and 156 +/- 35 ml/min.m2 after volume administration. However, pHi increased from 7.19 +/- 0.08 to 7.24 +/- 0.08 (P < 0.01). DISCUSSION AND CONCLUSION. The low pHi at the time of the initial measurement shows that regional tissue hypoxia may be present even in patients with an above-normal O2 supply > 600 ml/min.m2. Apparently, the lack of rise in global O2 consumption after increased O2 supply does not exclude a regional improvement in tissue oxygenation. The less invasive pHi measurement is an additional useful monitoring procedure for the optimisation of regional tissue oxygenation in critically ill patients.

Cell Hypoxia↗
PubMed1993

[Hepatic venous and mixed venous O2 saturation during catecholamine therapy in patients with septic shock].

Mixed venous O2-saturation (SvO2) reflects the ratio of global O2 supply to O2 consumption. However, in septic shock, there may be alterations in the ratio of regional O2 supply to O2 consumption, particularly in the splanchnic region. The aim of the study was therefore to investigate the relation between SvO2 and hepaticovenous O2-saturation (ShvO2) in septic shock with different catecholamine regimens. METHOD. Following approval of the ethics commission at our hospital, SvO2 and ShvO2 were measured simultaneously in 29 patients (7.5-F pulmonary arterial catheter). RESULTS. SvO2 and ShvO2 showed a considerable inter-individual difference with values between 1.3 and 36.9% and a mean of 14.7 +/- 9.3%. Alterations of ShvO2 were only tendentially reflected in alterations of the SvO2. Under different catecholamines SvO2 and ShvO2 showed the same changes but varying in extent (Table 1; Fig. 2). After switching the catecholamine therapy from dobutamine to epinephrine, SvO2 decreased only from 76.7 +/- 3.6 to 76.1 +/- 2.3 but ShvO2 from 61.4 +/- 8.1 to 54.2 +/- 10.3%. When the therapy was switched from dobutamine to norepinephrine, SvO2 decreased from 74.8 +/- 4.9% to 68.5 +/- 4.8%, ShvO2 decreased from 61.9 +/- 12.9% to 49.2 +/- 12.8%. When dopamine was added to norepinephrine, SvO2 increased from 68.6 +/- 4.3% to 73.6 +/- 4.4%, ShvO2 increased from 52.6 +/- 12.7% to 63.7 +/- 9.8%. When dopexamine was added to dobutamine, SvO2 increased from 74.6 +/- 4.5% to 76.9 +/- 2.5%, while ShvO2 increased from 57.6 +/- 11.5% to 58.8 +/- 13.4%. DISCUSSION AND CONCLUSION. The results presented show that SvO2 does not provide sufficient information about the venous O2 saturation of the splanchnic region. The intraindividually variable differences between SvO2 and ShvO2 during therapeutic interventions demonstrate that a selective alteration of blood supply to or O2 consumption of the splanchnic region has taken place, which is insufficiently reflected by the SvO2.

Dobutamine↗
PubMed1992

[The accuracy of 4 different oximeters for continuous monitoring of mixed venous oxygen saturation during abdominal aortic surgery].

Several systems for mixed-venous oximetry are now available. There are one three-wave-length system (Abbott) and three two-wave-length systems with (Spectramed) and without automatic correction for hemoglobin or hematocrit (Edwards). The purpose of this prospective randomized study was to compare the different systems and to examine the accuracy of continuous mixed-venous oximetry during abdominal aortic surgery. Eighty patients had a radial artery cannula and one of the following fiberoptic pulmonary artery catheters inserted before induction of anesthesia: Swan-Ganz oximetry TD catheter (Edwards), Swan-Ganz flow-directed oximetry thermodilution paceport catheter (Baxter, Edwards Division), SpectraCath STP (Spectramed), and Opticath (Abbott). Mixed-venous O2 saturation was monitored by oximetry computers: SAT-1 (Edwards), SAT-2 (Baxter, Edwards Division), Hemopro2 (Spectramed), and Oximetrix 3 (Abbott). As a method of reference, mixed-venous blood samples were drawn and immediately analyzed by an OSM3-Hemoximeter. Data sets were obtained at eight predetermined times. Hemoglobin was kept constant at +/- 1 g.dl-1. Continuous oximetry in comparison to in-vitro measurements yielded a correlation coefficient of r = 0.873 (P less than 0.0001) and a value of bias and precision (b +/- p) of -0.9 +/- 2.6% for the SAT-1, r = 0.815 (P less than or equal to 0.0001) and b +/- p = -2.2 +/- 2.5% for the SAT-2, r = 0.901 (P less than or equal to 0.0001) and b +/- p = 0.35 +/- 2.5% for the Hemopro2, and r = 0.920 (P less than or equal to 0.0001) and b +/- p = 0.1 +/- 1.8% for the Oximetrix 3, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Abdominal↗
PubMed1991

[A comparison of enflurane and propofol in thoracic surgery].

Comparisons between propofol and inhalational anesthetics for maintenance of anesthesia are limited. The purpose of our prospective study was to examine differences between enflurane and propofol during pulmonary resections with one-lung ventilation (1LV). METHOD. 28 patients, ASA risk group II-III, gave written informed consent for inclusion in this institutionally approved study. The patients were randomly allocated to one of the following groups: A: propofol 10 mg kg-1 h-1, B: 1 MAC enflurane, for maintenance of anesthesia. In both groups analgesia was achieved by fentanyl and muscle relaxation, by pancuronium. Ventilation via a double-lumen tube was controlled (FiO2 = 1.0, PaCO2 35-40 mmHg). Measurements, including hemodynamics and arterial and mixed venous blood gases, were obtained before induction (I), during two-lung ventilation (2LV) 15 min after induction in the supine position (II) and 20 min after surgical opening of the chest in the lateral decubitus position (III), 20 min after starting 1LV (IV), and after extubation (V). RESULTS. No significant differences between the two groups were found before induction (I), during 2LV (II, III), or after extubation (V). The only significant differences between the two groups were observed during 1LV (IV): the shunt fraction was 33.9 +/- 2.5% in A and 38.5 +/- 2.6% in B (P less than or equal to 0.05). Hypoxic pulmonary vasoconstriction was not inhibited in A, but was inhibited by 21.5% in group B during 1LV. Since no case of hypoxemia occurred in group A during 1LV (range of PaO2: 75.2-417.0 mmHg), but four patients developed hypoxemia in group B (Range of PaO2: 46.6-431.0 mmHg), regimen A might be of value in high-risk patients during thoracic surgery when 1LV is planned.

Aged↗
PubMed1990

The aged pineal gland: reduction in pinealocyte number and adrenergic innervation in male rats.

Previous biochemical and physiological studies point to an age-related loss of pineal function. Morphological studies revealed increased connective tissue and glial cell numbers in the gland. In the present study we investigated whether the number of parenchymal cells and the incidence of sympathetic fibers in the rat pineal gland is altered with advanced age. The comparison of pineal histology of young adult (2-3 months old) and aged animals (22-26 months old) showed that pinealocyte number in old animals is decreased by 18%. In addition, sympathetic innervation of the gland as revealed by glyoxylic acid fluorescence is drastically reduced in these animals. It is concluded that the age-related decline in pineal metabolism may be due to both decreased parenchymal cell number and reduced sympathetic innervation.

Aging↗
PubMedDate not supplied

"Fast-track"-rehabilitation in surgery, a multimodal concept.

The rates of postoperative local surgical complications (e.g. wound-infection, abscess, anastomotic leakage) and the postoperative mortality have markedly decreased over the past decades. However the occurrence of general medical complications (e.g. cardio-pulmonary or renal dysfunction, nosocomial infections, thromboembolism) after abdominal surgery is still frequent with an incidence of 20-60% (1-6). "Fast-track"-surgery, also called "Fast-track"-rehabilitation or "ERAS" (enhanced recovery after surgery) programme, is a combination of different pre- and intraoperative measures, which have been mainly validated in elective colonic surgery, but they can be principally employed in all surgical settings. With this approach it is possible to accelerate the postoperative convalescence and reduce the rate of general complications markedly (4, 7-10).

Clinical Protocols↗