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Biomedical subjects

D Kling

Publications and source records attributed to D Kling.

At least 91 records · Page 5Linked to original sources
PubMed1986

[The relation between risk factors and mortality in aortocoronary bypass operations].

Risk factors related to increased mortality were determined on the basis of 329 aortocoronary bypass operations. They were: (1) emergency surgery, (2) poor left ventricular function, (3) reoperation, and (4) pulmonary hypertension. Angina pectoris, recent myocardial infarction, age over 65 years, obesity, significant systemic disturbances, smoking, arterial hypertension, and sex were without effect.

Age Factors↗
PubMed1986

[Effect of glucocorticoids on extravascular lung water following extra-corporeal circulation].

The influence of 3 different, preoperatively given glucocorticoids (30 mg/kg bw methylprednisolone, 3 mg/kg bw dexamethasone, 30 mg/kg hydrocortisone) on extravascular lung water (EVLW) was investigated in a randomised study consisting of 60 patients undergoing elective aortocoronary bypass surgery and compared to a control group having received 0.9% NaCl as placebo. EVLW-measurements were performed by using the double indicator dilution technique with indocyanine green and a microprocessed lung water computer. Besides EVLW-measurements haemodynamics and various laboratory data were studied before as well as after (15 min, 45 min, 5 h) extracorporeal circulation (ECC). ECC was followed by an increase in EVLW, which was less pronounced in the dexamethasone-group without being statistically significant (p = 0.1), however. Pulmonary gas exchange, too, did not differ statistically, in spite of a less pronounced (p = 0.1) deterioration of paO2 in the dexamethasone-group. Haemodynamics and laboratory data in the corticoid-group did not show any significant difference compared to the non-treated control group. It was concluded, that pretreatment with corticoids in pharmacological doses in cardiac surgery had no beneficial effects on extravascular lung water and pulmonary function.

Capillary Permeability↗
PubMed1986

[Hemodynamic effects in high-dose infusion of nimodipine, a new calcium antagonist].

Nimodipine, a new calcium channel blocker, seems to be effective in the treatment of vasospasm in cerebral vasculature. Typical cardiovascular side effects have limited the dose in neurology and neurosurgery to 0.03 mg/kg X h. This study was designed to examine the influence of an infusion of high dose nimodipine (0.09 mg/kg X h) on haemodynamics. 52 patients undergoing aorto-coronary bypass surgery and prospectively randomised in a nimodipine group and a control group having received 0.9% saline solution as placebo were investigated at 3 different times: 1. before induction of anaesthesia (n = 6) 2. during anaesthesia (n = 10) 3. during extracorporeal circulation (ECC n = 10). Predominant effect of high-dose nimodipine was a decrease in total systemic resistance (TSR), followed by a decrease in mean arterial pressure (MAP) and a significant increase in cardiac output. Haemodynamic effects were much more pronounced during anaesthesia in comparison to patients before induction of anaesthesia, thus demonstrating an interaction between anaesthetics and calcium channel blocker. Heart rate (HR -9.3%) and dp/dtmax (-17%) showed a decrease, too. The decrease in MAP and HR in connection with a decrease in left ventricular pressure (-21.9%) and left ventricular end diastolic pressure (-42.8%) indicate a reduction in myocardial oxygen demand. An increasing dosage of nimodipine is accompanied by increasing cardiovascular effects. From the haemodynamic point of view high dosage of nimodipine seems to be of advantage in patients with hypertension and/or coronary heart disease suffering simultaneously from cerebral vasospasm.

Coronary Artery Bypass↗
PubMed1986

New membrane oxygenator (LPM 50): influence on extravascular lung water and pulmonary function in comparison to bubble oxygenator.

A prospective, randomized, clinical study involving 30 patients undergoing aorta-coronary bypass grafting was designed to compare the influence of a new membrane oxygenator and a commonly used bubble oxygenator on extravascular lung water and pulmonary function after extracorporeal circulation. Although membrane oxygenators might have some advantages from the biochemical and biophysical points of view, in this clinical study no differences in lung water accumulation and pulmonary gas exchange could be detected between bubble and membrane oxygenators after extracorporeal circulation.

Body Water↗
PubMed1986

[Hemodynamic effects of nisoldipine (Bay k 5552), a calcium antagonist, in coronary surgery patients].

The hemodynamic effects of the intravenous application of nisoldipine (0.2 microgram/kg bw per minute and 0.1 microgram/kg bw per minute) were studied in 70 patients with coronary artery disease. Measurements were performed before the induction of anesthesia, during anesthesia (prior to the cannulation of the great vessels) and 5 min after the end of extracorporeal circulation (ECC) (with the same preload as before ECC) as well as during ECC. Each group was compared to a group of patients who received a placebo injection. The preoperative and intraoperative application of nisoldipine produced a decrease in the mean arterial pressure and total systemic resistance, whereas the cardiac index and the stroke-volume index increased. Only during preoperative measurement did the heart-rate increase. The central venous pressure, pulmonary artery pressure and pulmonary capillary wedge pressure remained unchanged. There was no change in the dp/dtmax after 0.2 microgram/kg bw per minute of nisoldipine. There was no difference in hemodynamic outcome between the three groups 5 min after the end of ECC. During ECC, nisoldipine did not reduce the vascular resistance, possibly because of the hypothermic conditions. The principal effect of nisoldipine is to increase the cardiac index by decreasing the total systemic resistance without influencing the myocardial contractility.

Calcium Channel Blockers↗
PubMed1985

Influence of nimodipine on cardiovascular parameters during coronary surgery.

A total of 78 patients about to undergo open-heart surgery (ACVB) were given nimodipine, a new calcium antagonist, in different doses (0.5 or 1.0 microgram/kg body weight min or 0.03/0.06 mg/kg h) before and during extracorporeal circulation. During infusion (10 to 40 min), the hemodynamic parameters were recorded, including intrapulmonary pressures, the cardiac output and the left ventricular contractility parameters LVP and dp/dtmax. The administration of nimodipine resulted in a dose-dependent reduction of the pulmonary and peripheral vascular resistance with a subsequent decrease of the mean arterial pressure or perfusion pressure (during extracorporeal circulation). The left ventricular pressure (LVP) was reduced, whereas sometimes the cardiac output increased considerably. The contractility (dp/dtmax) was not impaired even by the high nimodipine dose. The heart rate, too, remained unaffected. The nimodipine dose of 0.5 microgram/kg min used in neurosurgery for therapy did not cause any clinically relevant decrease in blood pressure; at higher doses (greater than or equal to 1.0 microgram/kg min) an excessive fall of the diastolic pressure must be avoided in patients with severe (coronary) sclerosis, because a reduced perfusion of poorly vascularized myocardial regions can occur despite improved global perfusion.

Blood Pressure↗
PubMed1985

[Significance of endocrine parameters of stress].

Thirty two male patients undergoing coronary bypass surgery were given low (group A, 0.01 mg/kg bw) and high dose (group B, 0.035 mg/kg bw) fentanyl anaesthesia. Haemodynamic and hormone responses were investigated from the beginning of anaesthesia until extracorporeal circulation (ECC) (group A: n = 16; group B: n = 16). Significant changes in haemodynamics occurred only in group A including an increase in heart rate (36%) and systolic arterial pressure (21%). Plasma vasopressin (ADH) levels rose significantly in both groups after the beginning or surgical procedure which was markedly less pronounced in patients with high fentanyl (group B). In group A (low dose) a second dose of fentanyl was given after sternotomy, which was followed by a significant decrease in ADH (80% from previous value). No significant variations could be demonstrated in plasma levels of cortisol, ACTH, and human growth hormone (HGH). The data stress the importance of plasma-vasopressin-levels in determining the endocrine stress response following trauma and operation. On the other hand there was a lack of correlation between trauma and pain and frequently reported patterns of the endocrine-metabolic stress response.

Adrenocorticotropic Hormone↗
PubMed1985

[Hemodynamic effects with intravenous infusion of nifedipine (Adalat) in cardiosurgical patients].

The haemodynamic effects of 0.35 micrograms/kg bw/min and 0.70 micrograms/kg bw/min nifedipine (Adalat) as an infusion have been studied in 64 patients undergoing aortocoronary bypass surgery. The measurements were performed at four different times: 1. before induction of anaesthesia, 2. after induction of anaesthesia, 3. before cannulation of the aorta, 4. during extracorporeal circulation (ECC). In a follow-up study haemodynamics were controlled in detail after weaning from ECC. Each group was compared to a control group having received 0.9% NaCl as placebo. Preoperative as well as intraoperative application of nifedipine led to a decrease in arterial pressure and total systemic resistance, whereas cardiac index showed an increase. Heart rate, central venous pressure, pulmonary artery and pulmonary capillary wedge pressure remained almost unchanged. No relevant effect on contractility could be seen. During ECC nifedipine led to a decrease in arterial perfusion pressure and oxygenator-volume, thus indicating arterial vasodilatation and venous pooling. The investigations after ECC demonstrated stabilisation in cardiac rhythm and myocardial function. In conclusion, dose-dependent haemodynamic changes after intravenous application of nifedipine indicate a reduction in myocardial oxygen demand without detrimental effects on myocardial performance.

Blood Pressure↗
PubMed1985

[Hemodynamic changes in infusion with nimodipine].

The haemodynamic effects of 0.03 mg/kg bwxh (approximately equal to 0.5 microgram/kg bwxmin) and 0.06 mg/kg bwxh (approximately equal to 1.0 microgram/kg bwxmin) nimodipine as an infusion has been studied in 64 patients undergoing aorto-coronary-bypass surgery. The measurements were performed at 4 different times: 1. before induction of anaesthesia, 2. after induction of anaesthesia, 3. before cannulation of the aorta, 4. during extracorporeal circulation (ECC). After ECC haemodynamics were controlled in detail as a follow-up study. Each group was compared to a control group having received 0.9% NaCl as placebo. Preoperative infusion of 0.03 mg/kg bwxh nimodipine caused no relevant influence on haemodynamics, whereas 0.06 mg/kg bwxh led to a decrease in arterial blood pressure, peripheral and pulmonary vascular resistance and to a simultaneous increase in cardiac index. Similar haemodynamic effects were registered intraoperatively with both dosages. There was no relevant influence on contractility. During ECC nimodipine led to a decrease in arterial perfusion pressure and oxygenator volume, thus indicating arterial vasodilation and venous pooling. After ECC the investigation revealed a stabilization in cardiac rhythm and myocardial function. With respect to haemodynamics 0.03 mg/kg bwxh nimodipine, a dosage being used in neurosurgery, can be classified as safe. When higher dosages are necessary continuous haemodynamic and cerebral monitoring are recommended in order to avoid a hazardous drop in arterial blood pressure with a consecutive decrease in myocardial and cerebral blood flow (steal phenomena) in spite of better global perfusion.

Anesthesia, General↗
PubMed1985

[Colloid osmotic pressure and extravascular lung water following extracorporeal circulation].

With regard to Starling's equation, two factors are important for fluid regulation in pulmonary tissue: colloid osmotic pressure (COP) and hydrostatic pressure (PCP). The purpose of the study was to evaluate the relationship between COP, COP-PCP-gradient and extravascular lung water (EVLW) immediately after extracorporeal circulation (ECC). 39 consenting patients undergoing elective aorto-coronary bypass surgery received 1000 ml washed erythrocytes (w.e.; cell saver) +400 ml fresh frozen plasma (FFP) after ECC. Additionally, group I (n = 15) received 300 ml albumin 20%, group II (n = 13) 500 ml plasmaexpander (3% HES 200/0.5) and group III (n = 11) no more volume. At three different times, measurement of EVLW was performed by using double-indicator-dilution technique with indocyanine green and a microprocessed lung water computer: 15 minutes after ECC (before infusion), 45 minutes after ECC (after infusion), five hours after ECC. Application of 20% albumin led to a significant increase in COP (+67%) which was less pronounced in group II (+40%) and group III (+41%). Simultaneously, the most pronounced increase in EVLW could be observed in group I (+25%) as well. Pulmonary gas exchange in group I was more compromised (PaO2 -72 mmHg) than in group II (-38 mmHg) and group III (-50 mmHg). No correlation between EVLW and COP-PCP-gradient could be observed. In spite of a significant elevation of COP by using 20% albumin solution, EVLW increased with subsequent deterioration of pulmonary gas exchange. The presented data demonstrate no advantage of albumin 20%; if volume substitution is necessary after ECC, low concentrated plasmaexpanders (up to 10 ml/kg b.w.) may be preferred for several reasons.

Blood Proteins↗
PubMed1985

[Effects of ventilation with various end expiratory pressures on extravascular lung water following extracorporeal circulation].

The influence of ventilation with different endexpiratory pressure (0, 5, 10 cm H2O) on extravascular lung water (EVLW) in the period immediately after extracorporeal circulation (ECC) was investigated in a total of 35 patients undergoing coronary artery bypass surgery. Lung water measurement was performed by using the thermal-green dye double indicator dilution technique with indocyanine green and a microprocessed lung water computer. Ventilation with a moderate PEEP-level (5 cm H2O) led to an intensive reduction in lung water content, whereas EVLW-reduction was less pronounced, when higher PEEP-level (10 cm H2O) was applied. No significant relationship to various hemodynamic parameters, especially pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP) or pulmonary vascular resistance (PVR) could be seen.

Blood Pressure↗
PubMed1985

[Experiences with a new EEG spectral analyzer in carotid surgery].

Spectral analysis with the compressed spectral array display (CSA) and calculation of spectral edge frequency (SEF) was performed in 43 cases undergoing endarterectomy of the carotid bifurcation. New neurologic deficit appeared in 2 patients (= 4.6%). One of them died postoperatively (= 2.3%), the other suffered from permanent paralysis of the hand. Another 9 patients showed loss of high frequency activity (= decrease in SEF) without a new deficit in the postoperative period. A significant EEG event was defined as a decrease in SEF after carotid cross clamping for at least 5 min. Fisher's exact probability test revealed a close correlation between these EEG events and neurologic outcome. The sensitivity of the test, which was calculated on true positive and false negative events, was 100%, the specificity, based on true negative and false positive events, was 76%. The predictability of the test, based on all EEG events, was 18%; respectively 40% when calculated on significant events.

Anesthesia↗
PubMed1985

[Comparative studies on dose adjustment of intraoperative lidocaine therapy in heart failure patients].

From 10 patients with myocardial insufficiency arterial blood samples were taken, in order to study lidocaine plasma concentrations following reduced iv. bolus administration (0.5 mg/kg body weight) and subsequent infusion (2 mg/min). Drug concentrations were monitored by means of gas chromatography. The results obtained from the reduced loading dose of lidocaine were nearly identical to those from patients without myocardial insufficiency and an iv. bolus injection of 1 mg lidocaine/kg body weight. The reduced hepatic metabolism of lidocaine caused by manifest myocardial insufficiency requires a significantly reduced loading dose not exceeding the therapeutic range, even in intraoperative short-term use.

Anesthesia, General↗
PubMed1985

[Calcium antagonists in anesthesia. Additive analgesia using nimodipine in heart surgery].

Stress and pain induced by surgical trauma seem to be attenuated when calcium antagonists have been applied. In order to ascertain the effect of nimodipine, a new strong acting calcium channel blocker on plasma levels of various stress hormones twenty patients undergoing cardiovascular surgery where investigated in two groups. Ten patients received high-dose fentanyl anaesthesia (mean: 2,45 mg fentanyl/patient), whereas another ten patients were treated with 0,1 mg fentanyl/patient in addition to nimodipine 1,0 micrograms/kgbw X min (from onset of anaesthesia until start of extracorporeal circulation). Between the two groups were no significant differences with respect to perioperative course and postoperative demand for analgetics. Plasma levels of ACTH, somatotropin, glucose and free glycerol were markedly elevated in all patients (n = 20) intra- and postoperatively, whereas cortisol and prolactin remained unchanged. The present data suggest an additive analgesic effect of nimodipine during surgery. This phenomenon is possibly due to a blocking effect of calcium channel blockers on nociceptive nerves. The present model assumes that calcium is essential in pain perception and that decreased calcium would result in analgesia.

Analgesia↗
PubMed1985

[Experiences with "etomidate pro infusione" in heart surgery interventions with extracorporeal circulation].

The results of experimental studies with etomidate demonstrating positive hemodynamic effects as well as a decrease in intracranial pressure induced a study using etomidate during cardiac surgery. This randomized study including 506 patients should prove the influence of etomidate on the rate of psychic disturbances after cardiac surgery. Patients treated with etomidate received a loading dose of 1 mg/kg b.w. etomidate within 15 minutes followed by a continuous infusion of 1 mg/kg b.w./h until the end of ECC. Patients without etomidate were the control group. Psychic disturbances were observed in 25% of the control group and in 30% of the etomidate group. In both groups of patients there was a fair number of patients with perioperative cardiopulmonary problems (artificial ventilation longer than 24 hours; catecholamine therapy: epinephrine greater than 5 micrograms/min longer than 3 hours): 8% in the control group and 20% in the etomidate group. These results indicate that etomidate does not beneficially influence the rate of psychic disturbances after open-heart surgery; it may induce, however, cardiopulmonary side effects after cardiac surgery. The results of recent studies indicating drug induced adrenal insufficiency are discussed.

Adolescent↗
PubMed1984

2,4,5,2',4',5'-Hexachlorobiphenyl-lipoprotein (LDL, HDL, VLDL) interaction and induced lipidosis in cultured skin fibroblasts.

2,4,5,2',4',5'-Hexachlorobiphenyl (HCB) induced cytoplasmic inclusions and lipidosis in normal ( AG1437 ) and hypercholesterolemic ( GM488 ) human skin fibroblasts. Quantitative and qualitative microsocopic fluorescence analysis showed that the cytoplasmic inclusions are formed as early as 3 hr after treatment with HCB. The inclusions contain lipids but no detectable nonesterified cholesterol or cholesteryl ester. High density lipoproteins (HDL), low density lipoproteins (LDL), and very low density lipoproteins (VLDL) facilitate the apparent uptake of HCB by skin fibroblasts. HDL and LDL appeared to reverse the induction of cytoplasmic inclusions and lipidosis when cells were pretreated with HCB, the HCB was removed from media, and the cells were incubated with LDL or HDL. The results suggest that lipoproteins participate in the uptake and egress of HCB from skin fibroblasts.

Cells, Cultured↗
PubMed1984

Phospholipid and glyceride biosynthesis in 2,4,5,2',4',5'-hexachlorobiphenyl-treated human skin fibroblasts.

2,4,5,2',4',5'-Hexachlorobiphenyl (HCB) was taken up by cultured human skin fibroblasts ( A61437 ; GM488 ). HCB caused enhanced incorporation of [2-14C]acetate into phospholipids and glycerides at low concentration and reduced incorporation at high concentrations. sn-[U-14C]Glycerol-3-phosphate incorporation into phospholipids was inhibited. No significant change in total cellular phospholipids was observed. Triglyceride cellular content was increased 29%. The observed stimulation and inhibition of phosphoglyceride synthesis are similar to results obtained with rat liver microsomes.

Cells, Cultured↗