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Biomedical subjects

E Ott

Publications and source records attributed to E Ott.

At least 37 records · Page 2Linked to original sources
PubMed1998

Induction of anesthesia by titration of eltanolone compared with thiopental and etomidate for coronary artery bypass grafting.

STUDY OBJECTIVE: To evaluate whether induction of anesthesia with eltanolone in coronary artery bypass graft (CABG) patients is associated with greater hemodynamic stability than either thiopental sodium or etomidate. DESIGN: Randomized, controlled study. SETTING: University hospital. PATIENTS: 75 ASA physical status III and IV patients scheduled for elective CABG over 18 years of age, with left ventricular ejection fraction over 30%. INTERVENTIONS: The participants were prospectively randomized into three groups, each group consisting of 25 patients. Anesthesia was induced by titration of either eltanolone, thiopental sodium, or etomidate. The end point was "loss of verbal contact." MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables were recorded in the awake state, 2 minutes after induction, after administration of fentanyl 0.01 mg/kg, and 2 and 5 minutes after intubation. After induction of anesthesia, cardiac index (CI) decreased from 2.6 +/- 0.5 to 2.2 +/- 0.5 Lxmin-1xm-2 in the eltanolone group and remained at this value throughout the study period in contrast to the control groups. After fentanyl was given, mean arterial pressure was significantly lower in the case of eltanolone (69 +/- 15 mmHg) compared with thiopental (81 +/- 19 mmHg) and etomidate (84 +/- 18 mmHg). Mean arterial pressure remained significantly lower at the points of measurement after intubation. Two minutes after intubation, CI was likewise significantly lower in the eltanolone group (2.2 +/- 0.4 Lxmin-1xm-2) compared with the thiopental group (2.7 +/- 0.7 Lxmin-1xm-2). CONCLUSIONS: Eltanolone produces more hemodynamic depression compared with etomidate and thiopental when administered in combination with fentanyl 10 micrograms/kg.

Aged↗
PubMed1997

[Evaluation of vascular risk factors in patients with Parkinson syndrome].

A vascular etiology of Parkinson's disease (PD) has been long debated. In order to search for an ischemic basis of PD we assessed the clinical symptomatology of a consecutive group of 60 PD patients and compared their frequency of cerebrovascular risk factors, carotid atherosclerosis and ischemic brain lesions with age-matched groups of stroke patients and normals. There were 16 (27%) subjects with PD who also had symptoms of cerebrovascular disease. The frequencies of carotid stenoses, ischemic brain lesions and most of cerebrovascular risk factors seen in the latter group was comparable with those of stroke patients and significantly higher than in the investigational subsets of patients with "pure" PD and normals. Only one (1.6%) individual with PD presented signs suggestive of an ischemic etiology of parkinsonism. These findings suggest that cerebrovascular disease occurs in approximately one fourth of patients with PD, but seldomly is causally related.

Aged↗
PubMed1997

Bolus administration of eltanolone, thiopental, or etomidate does not affect systemic vascular resistance during cardiopulmonary bypass.

OBJECTIVE: To discover possible effects on systemic vascular resistance of the anesthetic induction agent eltanolone in comparison with thiopental and etomidate. The measurements were performed during cardiopulmonary bypass to maintain a constant cardiac output (approximately pump flow). DESIGN: The patients were prospectively randomized in three groups to receive either eltanolone, thiopental, or etomidate. SETTING: University hospital as a single center. PARTICIPANTS: Seventy-five patients scheduled for elective coronary artery bypass grafting. INTERVENTIONS: The anesthetic induction agents were repeated at the same dosage when cardiopulmonary bypass was instituted. The respective mean dosages were eltanolone, 0.41 +/- 0.1 mg/kg; thiopental, 2.88 +/- 0.62 mg/kg; etomidate, 0.26 +/- 0.06 mg/kg. MEASUREMENTS AND MAIN RESULTS: Systemic vascular resistance was calculated from the mean of a triple measurement (normal pump flow and +/- 20%). Points of measurement were before, and 2 and 5 minutes after injection of the hypnotic agent. None of the injected drugs made a significant change in the systemic vascular resistance. A small (not significant) decrease from 1,295 +/- 296 dyne/s/cm-5 to 1,196 +/- 323 dyne/s/cm-5 (mean +/- SD) was seen in the eltanolone group, whereas the other patients did not show any change during the study period. CONCLUSIONS: The reason for the significant reduction of the arterial pressure attributed to anesthetic induction by eltanolone may be more a cardiodepressive effect than a direct vasodilation.

Anesthetics, Intravenous↗
PubMed1997

Radiosurgical lesioning of the caudate nucleus as a treatment for parkinsonism: a preliminary report.

In ten patients with parkinsonism a radiosurgical operation with the Gamma Knife was performed in which a small lesion was created in the head of the caudate nucleus bilaterally. Preoperatively, in all cases bradykinesia was the main complaint and in all patients conventional drug treatment no longer resulted in a satisfactory response. After a follow-up period of one month six patients showed clear benefit. There was no complication or side effect that could be related to this form of treatment. Pre- and post-operative testing was performed with the Unified Parkinson Rating Scale and with objective motor tasks. The main improvement seen concerned bradykinesia and rigidity: tremor was ameliorated to a lesser extent. Possible mechanisms underlying the improved motor function are discussed as well as the role of lesioning of the striatum in light of transplantation neurosurgery.

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PubMed1996

[Awakening from anesthesia and recovery of cognitive function after desflurane or isoflurane].

UNLABELLED: Desflurane is a new volatile anaesthetic with an extremely low blood/gas partition coefficient of 0.42. This should provide a rapid recovery from anaesthesia. METHODS: We studied 100 adult patients, ASA class I or II, undergoing elective orthopaedic surgery randomly assigned to anaesthesia with desflurane (n = 50) or isoflurane (n = 50) supplemented by nitrous oxide in oxygen. Clorazepat was given for premedication, fentanyl and thiopental for induction of anaesthesia, followed by maintenance with desflurane or isoflurane as clinically appropriate. Emergence from anaesthesia was measured as well as return of cognitive functions (extended Aldrete score, digit symbol substitution test, and visual analogue scales [VAS]). RESULTS: While the demographic characteristics and administrated doses of fentanyl and thiopental were comparable, the recovery profiles in both groups were different. After discontinuation of the volatile anaesthetics, times to extubation and ability to follow simple commands were significantly shorter after desflurane than after isoflurane. Extended Aldrete scores, estimation of the patients' physical condition, results of the digit symbol substitution test, measuring cognitive functions, and rates of drowsiness and weakness on VAS showed better recovery with less impairment of cognitive function in the desflurane group than in isoflurane patients even 120 min after anaesthesia. VAS pain scores and doses of analgesic drugs given within the first 2 postoperative hours, however, showed no significant differences. Desflurane patients were also judged fit for discharge from the recovery room significantly faster. CONCLUSIONS: Our results demonstrate that desflurane anaesthesia, even when supplemented by premedication, intraoperative opioids, and nitrous oxide may offer clinical advantages over isoflurane as far as the post-anaesthetic recovery profile is concerned.

Adult↗
PubMed1996

[Hemodynamic effects of three different dosages of the induction hypnotic, eltanolone, in coronary surgery patients].

UNLABELLED: Eltanolone is a new steroid anaesthetic agent that is 5-beta reduced derivative of progesterone. In the present study we investigated the haemodynamic effects of eltanolone or thiopentone in patients scheduled for coronary artery bypass grafting. METHODS: After obtaining approval of the institutional ethics committee and informed patient consent, 40 patients (age 45-70 years, ASA III and IV, ejection fraction > 50%, cardiac index > 2.5 l/min per m2) were randomly assigned to four groups, each containing 10 patients: After premedication with 2 mg flunitrazepam, anaesthesia was induced with 3 mg/kg thiopentone in group 1, 0.5 mg/kg eltanolone in group 2, 0.75 mg/kg eltanolone in group 3, 1.0 mg/kg eltanolone in group 4. Each patient additionally received 3 mirograms/kg fentanyl after induction and 0.1 mg/kg pancuronium. Heart rate, mean arterial pressure, pulmonary arterial pressure, central venous pressure, pulmonary artery occlusion pressure and cardiac output were recorded in the awake state, 2 min after induction of anaesthesia, and 1 and 5 min after intubation. Cardiac index and systemic vascular resistance were calculated. RESULTS: Two minutes after induction, mean arterial pressure was significantly lower than the baseline (P < 0.05) in each group. Mean arterial pressure changes were more prominent in the case of eltanolone, but intergroup tests did not reveal significant differences between the four groups. There was a fall in cardiac index in all groups, and these changes reached the level of significance only in the thiopentone patients. The most obvious difference between eltanolone and thiopentone was systemic vascular resistance. It dropped significantly 2 min after induction with eltanolone at all dosages. In contrast, there was an increase in systemic vascular resistance following induction of anaesthesia with thiopentone. Intergroup tests also showed significantly (P < 0.05) lower systemic vascular resistance 1 and 5 min after intubation with eltanolone compared to thiopentone. DISCUSSION: Mean arterial pressure reduction induced by eltanolone is most likely the result of the combination of a decrease in cardiac contractility and peripheral vasodilatation. In contrast, mean arterial pressure reduction in the case of thiopentone seems to be exclusively related to the negative inotropic properties of the drug. Results of a dosage finding study [5] with eltanolone revealed an AD50 of 0.33 mg/kg. In our study 0.5 mg/kg eltanolone brought all the patients to sleep within 2 minutes. The haemodynamic results do not show any significant difference up to twofold dosage. Therefore, the therapeutic margin seems to be large. Because of considerable interindividual variability additional studies in larger collectives are required for definitive evaluation of the drug.

Aged↗