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Biomedical subjects

G Hempelmann

Publications and source records attributed to G Hempelmann.

At least 577 records · Page 32Linked to original sources
PubMed1979

Cardiorespiratory and metabolic patterns in multiple trauma patients.

During the last 3 years we have performed a detailed study in 50 patients using the Swan-Ganz catheter to provide prognostic haemodynamic and metabolic values at an early stage. There was a total of 320 severe injuries in these 50 patients with a statistical mean of six to seven. The severity of injuries is documented by the volume replacement necessary within the first 24 hr. On average more than 8 litres of whole blood, albumin and dextran were given intravenously. Out of 50 patients, 28 survived. During the first 2h there was a significant difference between survivor and non-survivor in systolic blood pressure and shock index. From the very beginning the surviving patients demonstrated a higher cardiac index than non-survivors. Pulmonary artery pressure and total pulmonary resistance were also elevated from the very beginning. The right ventricular stroke work index was increased; the left ventricular stroke work index was decreased in the group of non-survivors. The arteriovenous oxygen content difference as well as oxygen extraction ratio was elevated, and the oxygen availability was decreased in the group of the non-surviving patients. Of the metabolic parameters, an increase in the lactate/pyruvate ratio as well as in serum glucose and a decrease in base excess values permit an early prediction of a favourable outcome. There were significant differences in the enzymes SGOT, SGPT, LDH, CHE, as well as bilirubin concentrations between survivors and non-survivors from sixth day on.

Acid-Base Equilibrium↗
PubMed1979

Coagulation and fibrinolysis in multiple trauma after early heparinizing.

In 27 multiple trauma patients receiving standard shock management and intensive care, coagulation and fibrinolysis were investigated after early heparinization. The general coagulation tests did not imply any impaired clotting function. Platelets and factors I, II, and V decreased without induction of hypocoagulability. There was considerable decrease in plasminogen, whereas FDP ranged within normal; thus, a hyperplasminemia can be excluded. Antithrombin III remained within normal range; even in nonsurvivors there was no depletion, although their antithrombin III activity was significantly lower. In comparison to 50 trauma patients - a comparable group with regard to trauma patterns, shock management, and intensive care - there were no significant differences in volume requirements or mortality rate. Whether early heparinization is effective in preventing disseminated intravascular coagulation (DIC) related organ failure remains to be seen.

Adult↗
PubMed1979

Early cardiorespiratory prognostic patterns in multiple trauma patients.

Hemodynamic parameters were monitored for one week ( in greatest detail during the first 24 hours) in 50 severely injured people who had been admitted to the hospital for treatment within one hour after the accident and, as judged by the type of injury, had probably lost more than 1 1/2 liters of blood. The estimations included not only blood pressure, heart rate (HR) and shock index but also the cardiac index (CI), pulmonary arterial pressure (PAP), pulmonary capillary pressure (PCP), and parameters of oxygen transport were determined with the aid of Swan-Ganz catheters, CI, SI, and left ventricular stroke work index (LVSWI) were decreased, PAP, total pulmonary resistance (TPR), and total systemic resistance (TSR), were increased from the very beginning in the nonsurviving group, with a high prediction of vital outcome. The Swan-Ganz catheter is valuable in such cases in obtaining early prognostic evaluation and in controlling therapy - ie, volume replacement, vasodilation, and adrenergic therapy.

Adult↗
PubMed1979

[Extrarenal effects of potassium-canrenoate. Haemodynamic investigations during neuroleptanalgesia in cardiosurgical patients (author's transl)].

Direct cardiac and vascular effects of the antikaliuretic diuretic potassium-canrenoate were measured in cardio-surgical patients during extracorporal circulation and immediatly after operations, each time in neuroleptanalgesia. During "steady state" extracorporeal circulation (aorta cross-clamped, constant flow rate of heart-lung-machine, constant hypothermia), in 13 patients no significant influence on peripheral circulation was found after i.v.-injection of 800 mg potassium-canrenoate. Neither arterial perfusion pressure (representing an arterial vascular reaction) nor changes in oxygenator-volume (indicating venous vasodilation or contraction) demonstrated significant differences in comparison to a control group. After cardiac surgery haemodynamic measurements were performed for a period of 60 minutes in 10 patients given 800 mg potassium-canrenoate. In comparison with a control group (n = 6), no significant differences in arterial pressure, heart rate, cardiac index and pulmonary arterial pressure were found. Left ventricular measurements, using a catheter tip manometer, revealed no direct positive inotropic effect of a single i.v.-injection of potassium-canrenoate. In acute myocardial failure during anaesthesia or in "low cardiac ouptut" following open heart surgery no improvement in myocardial contractility is obtained by i.v.-application of potassium-canrenoate; at the present there seems no alternative to other positive inotropic agents such as calcium, glucagon, dopamine, orciprenaline and epinephrine.

Adolescent↗
PubMed1979

[Haemodynamic and vascular effects of dobutamine during and after open heart operations (author's transl)].

In cardiosurgical patients the haemodynamic effects of dobutamine 2.5 microgram/kg . min and 5 microgram/kg . min dobutamine were investigated during neuroleptanalgesia, intra- and immediately postoperatively. Intraoperative measurements were performed in 8 coronary surgical patients each after sternotomy and pericardiotomy, but before the aortocoronary venous bypass operation. The following haemodynamic parameters increased significantly: cardiac index (2.5 microgram/kg . min: 2.6 leads to 2.1 1/min . m2; 6 microgram/kg . min: 1.5 leads to 2.24 1/min . m2), heart rate (80 leads to 91 min-1; 86 leads to 107 min-1), stroke index (16%, 27%), mean arterial pressure (70 leads to 90 mm Hg; 70 leads to 93 mm Hg), mean pulmonary arterial pressure (8%; 14%), LV dp/dtmax (72%; 121%) and calculated myocardial oxygen consumption Eg (35%; 52%). Changes in right (PRA) and left ventricular filling pressure (PLVED), in total systemic resistance and total pulmonary vascular resistance were not significant. Postoperative measurement immediately after open heart operations (ASD-correction n = 5, aortocoronary venous bypass (n = 3) in neuroleptanalgesia too, showed the same haemodynamic results as intraoperatively before correction of coronary stenosis. Only a few premature ventricular beats were observed in 3 patients and there were no changes in S-T segments during dobutamine infusion. In another group of 15 patients selective vascular responses to an infusion of 10 microgram/kg . min dobutamine were examined during steady state cardiopulmonary bypass excluding heart and lungs from the circulation. No relevant direct influence on the arteriolar resistance vessels and the venous capacitance vessels were found. In a dose range of 2.5--5.0 microgram/kg . min dobutamine proved to be a potent inotropic agent causing almost no peripheral and relatively little positive chronotropic effects. But the increase in heart rate was more pronounced than in other clinical investigations in conscious patients, which might be due to an attenuation of vagal reflex by anaesthesia. The results indicate, that dobutamine may be a valuable drug in the treatment of intra- and postoperative low output syndromes especially in patients with coronary heart disease.

Adult↗
PubMed1978

[Predictive value of metabolic profiles in multiple trauma].

An increase in the lactate:pyruvate ratio as well as in serum gluocse levels and a decrease in base excess values permit an early prediction of vital outcome in severely traumatized patients. Further laboratory data such as enzymes, bilirubin, and amino-acid concentrations, however, demonstrate significant differences between survivors and nonsurvivros at a later stage, i.e., from the 6th day on.

Acid-Base Equilibrium↗
PubMed1978

[Comparison of cardiac and vascular effects of sulfentanil (R 30730), a new analgetic, and fentanyl (author's transl)].

In 31 patients with congenital or acquired heart disease, functional class III NYHAC, effects of Sulfentanil (R 30730)--a new analgetic--on hemodynamics, inotropic state and myocardial oxygen consumption have been investigated intraoperatively, during extracorporeal circulation and postoperatively. Results are compared to a fentanyl-group and control-group. There was almost no change in cardiac index and stroke index. In comparison to fentanyl (dose relation fentanyl: sulfentanil = 10:1) there was a more pronounced decrease in aterial pressure, left ventricular pressure, peak dp/dt and myocardial oxygen consumption (-20%) in the sulfentanil-group. In contrast to the fentanyl-group there was, however, no increase in total pulmonary resistance with sulfentanil.

Adult↗
PubMed1978

[Cardio-circulatory effects of aminophylline (Euphyllin) (author's transl)].

In 24 patients with congenital or acquired heart disease, functional class II--IV New York Heart Association Classification, effects of aminophylline on hemodynamics have been investigated intraoperatively, during extracorporeal circulation and postoperatively. Aminophylline caused a decrease in arterial pressure, left ventricular pressure, right and left atrial pressure, total systemic resistance and total pulmonary resistance. At the same time there was an increase in heart peak, peak dp/dt, cardiac index and stroke index. Our results demonstrate beneficial cardiac and extracardiac effects of aminophylline in man.

Adult↗
PubMed1978

[Orthotopic liver transplantation in man from the anaesthesiological point of view (author's transl)].

We report our experience of anaesthesia for orthotopic liver transplantation in seven patients. Pre-, intra- and postoperative management requires highly cooperative team-work. Advantages of neuroleptanalgesia are pointed out for this operative procedure. Intraoperative problems such as mass transfusion, clotting disturbances, changes in haemodynamic parameters, metabolic acidosis, hypovolaemia, hypoglycaemia and hypothermia are discussed and adequate therapeutic measures proposed. The value of an extensive perioperative monitoring is demonstrated. Controlled ventilation has been performed during the immediate postoperative period in all patients.

Acid-Base Equilibrium↗
PubMed1978

[Diazepam (valium). Changes in haemodynamics, myocardial oxygen consumption and vascular tone (author's transl)].

In 30 patients with congenital or acquired heart disease the haemodynamic effects of diazepam (Valium) 0.3 mg/kg were investigated during surgical procedures under neuroleptanalgesia. The following parameters were measured or calculated: Heart rate (HR), arterial pressure (-Part, Psyst, Pdiast), pulmonary artery pressure (-PAP), right (-PRA) and left atrial pressure (-PLA), left ventricular pressure (PLV), left ventricular enddiastolic pressure (PLVED), left ventricular peak dp/dt (dp/dtmax), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), total systemic resistance (TSR), total pulmonary resistance (TPR), work index of the right (RVWI) and left ventricle (LVWI). In comparison with a control group (n = 36) diazepam caused a decrease in arterial pressure cardiac index, stroke index, right and left atrial pressure and dp/dtmax. This, however, was mainly attributable to vasodilatation and not to a negative inotropic effect, which is of only minor importance with diazepam. These haemodynamic changes resulted in a reduction in myocardial oxygen consumption. Diazepam is a valuable drug in neuroleptanalgesia, when an increase in blood pressure can not be controlled by fentanyl or droperidol.

Blood Pressure↗
PubMed1978

[Effects of calcium gluconate and calcium chloride on cardiocirculatory parameters in man (author's transl)].

In 44 patients with congenital or acquired heart disease, functional class II--IV NYHAC, the effects of calcium gluconate (10 ml 10%) and calcium chloride (10 ml 5.5%) on hemodynamics, inotropy and myocardial oxygen consumption were investigated during and immediately after cardiosurgical procedures. There was a significant increase in blood pressure, left ventricular pressure, total systemic resistance, cardiac index, stroke index, peak dp/dt and myocardial oxygen consumption as well as in arterial perfusion pressure during extracorporeal circulation due to i.v.-injection of either one of the drugs. The positive inotropic effects were more pronounced after application of calcium chloride. In emergency situations during anaesthesia or resuscitation, therefore, calcium chloride seems to be of more advantage than calcium gluconate.

Calcium Chloride↗
PubMed1977

Massive doses of methylprednisolone (30 mg/kg) in man: immediate haemodynamic effects in "low output state".

Methylprednisolone, 30 mg/kg body weight, was given as an intravenous bolus injection to a total of 31 cardiosurgical patients. Measurements of left ventricular parameters showed no significant increase in dp/dtmax and no significant decrease in left ventricular end-diastolic pressure. There were no important changes in blood pressure, heart rate, cardiac index, stroke index and total peripheral resistance. During 'steady state' extracorporeal circulation no relevant vasodilating effect could be found. In comparison to a control-group there were no important differences in haemodynamic parameters. In cardio-surgical patients, --mainly functional class III--we were unable to demonstrate any gross cardiovascular effects of large doses of methylprednisolone.

Adult↗
PubMed1977

[Intracardiac correction of congenital heart anomalies in 104 infants (author's transl)].

From 1974 to 1976 104 infants (under 1 year of age) underwent intracardiac correction for congenital heart diseases. Mean age and body weight were 6.6 +/- 3.6 months resp. 5.66 +/- 1.4 kgs. The diagnoses and mortality rates were: transposition of the great arteries (TGA) with intact ventricular septum 27 (0), TGA plus associated anomalies 9 (0), ventricular septal defect (VSD) 20 (1), VSD plus associated anomalies 6 (1), total anomalous pulmonary venous drainage 9 (5), pulmonary stenosis and pulmonary atresia with intact ventricular septum 9 (2), aortic stenosis 7 (3), ASD I or II 7 (0), and miscellaneous 10 (3). Intracardiac correction was performed either on cardiopulmonary bypass and moderate hypothermia or in deep hypothermia with or without total circulatory arrest. The early mortality in the first group was 7% (6 out of 90), in the second group 64% (9 out of 14). With increasing experience, cardiopulmonary bypass has proven to be a save method for intracardiac correction of congenital heart anomalies in infancy even in the youngest age group under three months of age and under emergency conditions.

Age Factors↗