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Biomedical subjects

D F Zandstra

Publications and source records attributed to D F Zandstra.

65 records · Page 4Linked to original sources
PubMed1985

Effect of mucolytic and bronchodilator aerosol therapy on airway resistance in mechanically ventilated patients.

Nebulisation of a 10% solution of Mesna (Mistabron) in 10 postoperatively ventilated patients without preexisting pulmonary disease caused a significant increase in inspiratory resistance. This increase is effectively blocked by addition of a bronchodilator (i.e. Salbutamol) to the aerosol. No significant changes in airway resistance were observed in the 10 patients receiving salbutamol alone or isotonic saline. The expiratory resistance did not change suggesting that only the larger airways are involved in the constrictive effect of the drug. Although no patient showed clinical signs of bronchospasm, it is worth considering that even in patients without history of obstructive pulmonary disease nebulisation of Mesna should be performed in combination with a bronchodilator.

Aerosols↗
PubMed1985

Inhibition of corticosteroidogenesis by etomidate.

The effects of the intravenous anesthetic etomidate have been investigated on ACTH-induced steroidogenesis in vitro, using purified isolated rat adrenal cells. It was found that etomidate almost completely blocked corticosterone production induced by physiological concentrations of ACTH at doses of 200 ng or greater. The mean inhibitory etomidate concentration resulting in 50% inhibition approximated 1.5 X 10(-7)M which is in the range of concentrations measured after clinical doses of etomidate.

Adrenal Cortex↗
PubMed1984

The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients.

122 multiple trauma patients staying in the ICU for 5 or more days and needing mechanical ventilation were investigated to determine the effect of selective decontamination of the digestive tract on prevention of infection. The (retrospectively studied) control group of 59 patients received no antibiotic prophylaxis. The infection rate during ICU-stay was 81%. Most infections were caused by potentially pathogenic microorganisms (PPM) from the oral cavity or the intestines (i.e. endogenous infections). The oropharynx and the intestines were rapidly colonised with ICU-associated gram-negative bacilli. After 2 weeks more than 80% of patients were found colonised. This secondary colonisation of the digestive tract is a very important stage in the pathogenesis of infections. Sixty-three patients were selectively decontaminated with nonabsorbable antibiotics, administered through the gastric tube even if peristalsis was absent. Emphasis was laid on the selective decontamination of the oral cavity, using topical application of an antibiotic paste. With this technique the oral cavity was free of PPM within 3 days in most patients. No secondary colonisation was found. Rectal colonisation decreased significantly after 5 days. Secondary colonisation occurred in 9 patients with PPM sensitive to the antibiotics used. The prophylactic regimen included systemic cefotaxim, directed against early endogenous infection. The suppression and after some time the absence of the endogenous source of PPM resulted in a significant reduction of colonisation and infection. The total infection rate decreased to 16%.

Administration, Topical↗
PubMed1984

The prevention of superinfection in multiple trauma patients.

In a control group of 59 multiple trauma patients requiring prolonged intensive care, a conventional restrictive antibiotic policy was followed. Forty-eight patients (81%) developed 94 infections. Fifty-one patients received systemic antibiotic therapy with one or more drugs. The total quantity of systemic antibiotics used was very high (18.3 +/- 22.1 antibiotic days per patient). This policy resulted in a very high incidence of superinfections (24%) with multiply-resistant Gram-negative bacteria, mostly emerging from the digestive tract (secondary endogenous infections). Five patients died from infection. A novel technique of infection prevention, based on the maintenance of the colonization resistance and on selective decontamination of the digestive tract in combination with systematic antibiotic prophylaxis with cefotaxime, proved to be very effective. Out of 63 multiple trauma patients, intubated and ventilated for 5 days or more in the ICU, 10 (16%) developed 11 infections. Most infections occurring under this regimen were primary endogenous infections which were treated by continuation of cefotaxime. Only two patients (3%) developed a superinfection with cefotaxime-resistant Gram-negative bacteria. No patient died. This approach to infection prevention in the ICU, shows that prophylactic administration of antibiotics significantly reduced the infection rate of critically ill patients without the development of superinfection.

Adolescent↗
PubMed1983

Antipyretic therapy with diclofenac sodium. Observations on effect and serious side effects in critically ill patients.

The antipyretic activity of diclofenac sodium, 100 mg suppository was studied retrospectively in 21 applications in seven intensive care patients. Diclofenac sodium proved to be a very potent antipyretic agent with serious side effects. Acute oliguria and protracted circulatory shock occurred after administration, necessitating the administration of increasing amounts of dopamine and i.v. fluids. Possible mechanisms involved are discussed.

Acute Disease↗
PubMed1982

Continuous intravenous anesthesia with etomidate for carbon dioxide laser surgery of the larynx.

Twenty-five adult patients undergoing carbon dioxide laser surgery for benign and malignant disease of the larynx were given continuous infusion of etomidate at 60 micrograms . kg-1 . min-1 for induction of anesthesia. Maintenance anesthesia was continued using one of three infusion rates: 20 micrograms . kg-1 . min-1 (n = 5), 30 micrograms . kg-1 . min-1 (n = 10), and 40 micrograms . kg-1 . min-1 (n = 10) of etomidate in air-oxygen mixture. Muscular relaxation was achieved by continuous infusion of succinylcholine, and fentanyl was used for analgesia. Continuous etomidate infusion for induction of anesthesia resulted in a significant decrease in the incidence of pain along the injection site to 8% and involuntary muscular movements to 12% compared with 35% and 44%, respectively, in a group of 25 adult patients undergoing endoscopic procedure who received intravenously a single volus injection of etomidate (0.3 mg .g kg-1). However, a prolonged recovery time was observed after 30 minutes of continuous etomidate infusion.

Adolescent↗
PubMed1981

4-Aminopyridine reversal of fentanyl-induced respiratory depression in normocapnic and hypercapnic patients.

Profound postoperative respiratory depression after larger doses of fentanyl was partially reversed by 4-aminopyridine. This reversal was independent of FIO2' suggesting that the response was not dependent upon peripheral chemoreceptor-mediated drive. Similar reversal of fentanyl-induced depression by 4-aminopyridine was observed before surgery in patients breathing 67% nitrous oxide in oxygen. 4-Aminopyridine had no effect on breathing when given alone in the absence of fentanyl to patients breathing 67% nitrous oxide in oxygen before surgery.

Adolescent↗