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G Molter

Publications and source records attributed to G Molter.

At least 19 recordsLinked to original sources
PubMed2002

[Narcotrend stages and end-tidal desflurane concentrations. An investigation during recovery from desflurane/remifentanil anaesthesia].

OBJECTIVE: [corrected] As indicated by the manufacturer the EEG monitor Narcotrend trade mark (MonitorTechnik, Bad Bramstedt) can be used to analyse EEG effects of volatile anaesthetics, however, published data are missing. This study evaluated the emergence from a desflurane/remifentanil anaesthetic and was designed to investigate the relationship between Narcotrend stages (version 2.0 AF) and end-tidal desflurane concentrations and to identify the pattern of changes of the Narcotrend stages during recovery. METHODS: Adult patients scheduled for orthopaedic surgery were premedicated with 0.15 mg/kg diazepam orally in the evening and on the morning before surgery. Narcotrend EEG electrodes were positioned on the patient's forehead as recommended by the manufacturer. For induction of anaesthesia, remifentanil was infused at 0.4 microgram/kg/min and propofol 2 mg/kg was given for hypnosis. After neuromuscular blockade and orotracheal intubation, remifentanil was reduced to 0.2 microgram/kg/min, and desflurane in O(2)/air was added according to clinical needs. After termination of surgery, administration of anaesthetics was discontinued and simultaneously, the fresh gas flow was increased to 10 l/min of O(2) while the respirator pattern was left unchanged. Narcotrend stages and end-tidal desflurane concentrations were recorded as data pairs at intervals of 1 min during emergence from anaesthesia; data evaluation included the last 7 min before extubation. RESULTS: A total of 50 patients (mean age +/-SD 44.4+/-13.0 years) were studied and 400 data pairs were obtained. A decreasing depth of anaesthesia as indicated by the Narcotrend was associated with significantly lower end-tidal desflurane concentrations: for E (general anaesthesia with deep hypnosis) 3.6+/-1.0 vol%, for D (general anaesthesia) 1.7+/-0.8 vol%, for C (light anaesthesia) 0.7+/-0.3 vol% and for A and B (awake or sedated) 0.5 vol%. A reduction of end-tidal desflurane concentrations was accompanied by a shift of Narcotrend stages from C/D/E to A/B/C. CONCLUSION: During emergence from desflurane/remifentanil anaesthesia, a reduction of end-tidal desflurane concentrations was detected by the EEG monitor Narcotrend and classified as a typical change of distribution of Narcotrend stages.

Adult↗
PubMed2000

Interpleural analgesia does not influence postthoracotomy pain.

UNLABELLED: The management of postthoracotomy pain is a problem and may contribute to atelectasis, leading to hypoxemia, pulmonary infection, and permanent alveolar damage. We sought to determine the efficacy of interpleural analgesia for pain control and to evaluate independent predictors for postoperative pain intensity. Eighty-three patients undergoing elective anterolateral (n = 37) and posterolateral (n = 46) thoracotomy were included in a prospective, randomized, double-blinded trial. Patients were assigned to receive either 0.5% bupivacaine or saline solution interpleurally every 4 h for 10 doses postoperatively. All patients also received patient-controlled analgesics (PCA) with piritramide as the opioid for additional pain control. Pain was assessed on the basis of PCA requirements and by using a visual analog scale. Visual analog scale scores and PCA requirements were not different between groups. Both interpleural bupivacaine and saline significantly reduced pain scores 30 min after the administration. We concluded that pain reduction by interpleural instillation of bupivacaine reflects a placebo-like effect; however, interpleural analgesia is not effective in patients undergoing lateral thoracotomy. Sex and surgical approach were shown to influence postoperative pain intensity at rest, but not during coughing. The female patients, and those undergoing posterolateral thoracotomy, exhibited higher pain scores. This observation appears to be of only marginal clinical significance. The efficacy of interpleural analgesia to reduce postoperative pain intensity in patients after lateral thoracotomy is controversial. In this study we demonstrated a lack of efficacy of interpleural analgesia. IMPLICATIONS: The efficacy of interpleural analgesia to reduce postoperative pain intensity in patients after lateral thoracotomy is controversial. In this study, we demonstrated a lack of efficacy of interpleural analgesia.

Analgesia↗
PubMed1999

[Bioavailability of sotalol in short bowel syndrome].

BACKGROUND: The individual bioavailability of enterally administered drugs is usually uncertain in case of reduced bowel length. Routine measurements of plasma concentrations are available only for a small number of drugs. The daily dose recommended by the manufacturers may result in subtherapeutic plasma concentrations when given to such patients. CASE REPORT: In 2 patients with hemodynamically relevant atrial fibrillation and reduced gut length application of increasing sotalol doses was initiated. For the assessment of the individual bioavailability plasma concentrations were measured via HPLC immediately before and 2 hours after enteral application of sotalol. Judging by clinical criteria both patients were treated successfully. Even in the patient with severe short bowel syndrome (stomach, duodenum and 50 cm jejunal remnant) doubling of the daily dose led to a substantial increase in plasma concentrations. CONCLUSION: Effective enteral medication with sotalol in patients with short residual bowel is possible. Normal plasma concentrations can be achieved by administering doses according to the manufacturers' instructions. In case of severe short bowel syndrome, the measurements of plasma concentrations may be beneficial in supervising dose-adjustment.

Aged↗
PubMed1999

[Puerperal sepsis due to infected episiotomy wound].

A healthy 31-year-old woman showed a severe septic shock syndrome a few days after vaginal delivery. In the episiotomy wound were found Group A Streptococci and E. coli. Although an antibiotic therapy was instituted immediately, the condition of the patient worsened. Platelet counts fell below 5000/microliter and she developed respiratory, cardiocirculatory and renal insufficiency, so that mechanical ventilation, high-dose-catecholamine therapy and continuous venovenous hemodiafiltration had to be performed. In the course of the disease the patient showed a reversible cardiomegaly with pulmonary hypertension and an extensive desquamation of the skin. Fever persisted in spite of the fact that in all following clinical and laboratory examinations no septic focus could be revealed any longer. She recovered slowly and could not be weaned from the respirator for four weeks because of a severe critical illness polyneuromyopathy.

Adult↗
PubMed1997

[Successful thrombolysis of a fulminant lung embolism during cardiopulmonary resuscitation].

A healthy 38-year-old woman suffered a sudden cardiac arrest 2 days after a vaginal hysterectomy. Although standard cardiac life support (CPR) was instituted immediately after the event, it was not possible to re-establish a spontaneous circulation for about 40 min. Systemic intravenous thrombolytic therapy with slow injection of 1.5 million IU urokinase was performed as a final life-maintaining measure because of the high probability that the underlying cause was a pulmonary embolus; 10 min later (after 60 min of ongoing CPR) the patient regained a stable circulation. She survived without neurological deficit in spite of the long duration of CPR.

Adult↗
PubMed1996

The Bland-White-Garland syndrome. Clinical picture and anaesthesiological management.

We report a five-month-old infant with an impaired left ventricular ejection fraction as a result of Bland-White-Garland-syndrome (BWGS). Total intravenous anaesthesia with fentanyl and midazolam was used as the anaesthetic technique. After aortic reimplantation of the left coronary artery, weaning from cardiopulmonary bypass (CPB) was prolonged and was only successfully managed with high dose noradrenaline, dopamine and dobutamine. Persistent myocardial dysfunction led to prolonged intensive care treatment. Seven months after surgery, left ventricular function and clinical condition have improved significantly.

Adrenergic alpha-Agonists↗
PubMed1994

[Spinal anesthesia in infancy using bupivacaine 0.5%. The effect of an adrenaline addition on duration and hemodynamics].

The duration of spinal anaesthesia in infants is short compared to adult patients. When tetracaine is used, the addition of epinephrine significantly prolongs the duration. For bupivacaine, however, the influence of epinephrine on the duration is not clear. We investigated the effects of epinephrine 1:200,000 added to bupivacaine 0.5% on duration and haemodynamics. PATIENTS AND METHODS. Ten former pre-term infants with postnatal respiratory problems, scheduled for bilateral inguinal hernia repair, were enrolled in the study after informed parental consent had been obtained. The infants were fasted at least 4 h prior to surgery. If they did not receive i.v. infusions before surgery, a bolus of 10 ml/kg Ringer's acetate was injected after inserting the i.v. cannula, followed by a continuous infusion of 8 ml/kg 2/3 N NaCl with 5% dextrose. Spinal anaesthesia was performed in a sitting position with 0.6 ml bupivacaine 0.5%. Five patients received plain bupivacaine (group I) and five bupivacaine with epinephrine 1:200,000 (group II). Heart rate registered by ECG and non-invasive blood pressure were recorded prior to positioning the baby for lumbar puncture and 2, 5, 10, and 20 min after injection of bupivacaine. The duration of spinal anaesthesia was defined as the time from injection to the time when the first movements of the legs were observed after stimulation. For testing statistical differences the U test was used between the groups and the Wilcoxon and Wilcox test within the groups. RESULTS. (expressed as median and range). Additional epinephrine significantly prolonged the duration of spinal anaesthesia (group II: 95 min [60-120] vs group I: 50 min [37-85]). Haemodynamic parameters did not differ at any time between or within the groups. In group I, one infant had high spinal anaesthesia with impaired respiration but without cardiovascular effects; after 10 min of assisted ventilation by mask, sufficient respiration as judged by pulse oximetry and clinical observation had returned. The duration of spinal anaesthesia in this child was 60 min. CONCLUSIONS. Epinephrine 1:200,000 significantly prolongs the duration of spinal anaesthesia in former preterm infants. Haemodynamic parameters in this age group remain unchanged during spinal anaesthesia and are not influenced by the addition of epinephrine.

Anesthesia, Spinal↗
PubMed1993

[The hemodynamic effects of atracurium in geriatric patients during intravenous anesthesia using propofol].

OBJECTIVE: Neuromuscular blocking drugs may produce cardiovascular effects by virtue of drug-induced release of histamine or other vasoactive substances from circulating mast cells, effects at cardiac muscarinic receptors or effects at nicotinic receptors at autonomic ganglia. These haemodynamic reactions may be more pronounced in elderly patients, since cardiovascular compensating mechanisms are attenuated with advancing age. The present study was designed to investigate the cardiovascular effects of atracurium with special regard to the reactions in younger adults and in elderly patients. METHODS: 20 patients, ASA class I-II, who underwent a neurosurgical operation (posterior fossa surgery) were studied. The patients were divided into two groups including patients below (group A) and above (group B) 65 years of age. Anaesthesia was induced with propofol (2.5 mg/kg) and maintained with a Propofol/O2/N2O sequence. Under steady state conditions with propofol every patient received 0.5 mg/kg atracurium besylate. Haemodynamic parameters were recorded and plasma concentrations of epinephrine and norepinephrine were determined before (control) and 2, 5 and 10 minutes after the injection of the neuromuscular blocking agent. All measurements were performed before surgical stimulation in supine position. RESULTS: In the younger adults diastolic blood pressure and systemic vascular resistance decreased significantly 2 minutes after injection of atracurium and reached control level 5 minutes after application of the muscle relaxant. In the elderly patients peripheral vascular resistance decreased significantly after 5 minutes and returned to control 10 minutes after the application of atracurium. In both groups cardiac index, systolic and mean arterial pressure, central venous pressure and the parameters related to the pulmonary circulation were not affected. Plasma concentrations of epinephrine and norepinephrine remained essentially unchanged. Side effects due to a release of histamine such as facial or body blush or bronchial spasms were not noted. CONCLUSION: Since the results of the present study suggest that haemodynamic reactions in younger adults and in the elderly are rare, atracurium can be recommended for neuromuscular blockade in elderly patients under propofol anaesthesia.

Adult↗
PubMed1993

[Patient-controlled administration of alfentanil during interventional measures--an alternative to general anesthesia].

OBJECTIVE: In 360 patients undergoing extracorporal shock wave lithotripsy (ESWL) the effects of an opioid analgesia with alfentanil (Rapifen) were investigated. METHODS: Starting with an intravenous bolus injection of 30 micrograms/kg repetitive injections of 15 micrograms/kg were administered when pain recurred. In 12 patients arterial blood samples were taken to determine alfentanil serum concentrations and blood gases. The pharmacokinetics of alfentanil were described by an open two-compartment model. RESULTS: In spite of multiple applications of the opioid no relevant cumulation could be seen. Although the patients received 3 l/min of oxygen via nasal tube, a significant decrease in paO2 was observed. pH was decreased and there was a significantly increased paCO2. No significant changes in arterial blood pressure were observed. Two patients developed rigidity of the chest wall. CONCLUSION: For short operations with only mild noxious stimuli opioid analgesia with alfentanil is a suitable procedure if applied by an experienced anaesthesiologist.

Adolescent↗
PubMed1993

[Pharmacodynamic effects of the phosphodiesterase inhibitor enoximone during exposure to the volatile anesthetics halothane and isoflurane in coronary surgery patients].

AIM OF THE STUDY: We investigated the pharmacodynamic effects of the phosphodiesterae inhibitor enoximone in the presence of halothane and isoflurane in 20 patients, ASA class III, aged 45-75 years, undergoing coronary artery bypass grafting. The study was approved by the local Medical Ethics Committee and patients' informed written consent was obtained. METHODS: After induction of anaesthesia (midazolam, fentanyl, etomidate and pancuronium) all patients received either halothane 1 MAC (group I, n = 10) or isoflurane 1 MAC (group II, n = 10), followed 20 min later by enoximone 0.5 mg/kg. Haemodynamic variables were measured and blood samples (arterial, mixed venous) were obtained before the administration of the volatile anaesthetics (control, t0), immediately (t1) and 5 (t2) min after steady state conditions with halothane or isoflurane, as verified by the end-expiratory concentration and 5 (t3) and 10 (t4) min after the injection of enoximone. Heart rate (HR), mean arterial pressure (MAP), mean pulmonary artery pressure, pulmonary capillary wedge pressure and right atrial pressure were recorded. Cardiac (CI) and stroke volume indices, systemic (SVR) and pulmonary vascular resistance, oxygen availability (AO2) oxygen consumption and oxygen extraction rate were calculated using standard formulae. RESULTS: In both groups HR remained essentially unchanged throughout the investigation period. MAP decreased significantly in both groups under steady state conditions with the volatile anaesthetics (group I: 19%; group II: 30%) but remained unchanged after subsequent injection of enoximone. After administration of halothane SVR remained essentially unchanged, whereas isoflurane decreased SVR significantly by 20%. After enoximone, there was a significant decrease in SVR in both groups (group I: 26%; group II: 25% compared with the values obtained after halothane and isoflurane respectively). Halothane and isoflurane decreased CI significantly and to a similar degree (group I: 17%; group II: 17%). After the injection of enoximone CI increased significantly and reached control values in both groups. AO2 decreased significantly after administration of the volatile anaesthetics (group I: 19%; group II: 21%) and increased significantly after administration of enoximone, returning to control values. Halothane (7%) and isoflurane (13%) produced a significant increase in oxygen extraction. After bolus injection of enoximone oxygen extraction decreased significantly and returned to control value in group II. In group I enoximone decreased oxygen extraction significantly compared with control. CONCLUSION: Our results suggest that in the presence of halothane or isoflurane the phosphodiesterase inhibitor enoximone produces a comparable increase in cardiac output and decrease in systemic vascular resistance in patients with coronary artery disease.

Aged↗
PubMed1993

Haemodynamic changes produced by inhalation anaesthetics in the presence of phosphodiesterase inhibition.

We have investigated the circulatory effects of halothane and isoflurane in the presence of the phosphodiesterase inhibitor, enoximone, in 20 patients, ASA class III, aged 40-70 yr, undergoing coronary artery bypass grafting. After induction of anaesthesia (midazolam, fentanyl, etomidate and pancuronium) all patients received enoximone 0.5 mg kg-1, followed, 10 min later, by either halothane 1 MAC (group I; n = 10) or isoflurane 1 MAC (group II; n = 10). Haemodynamic variables were measured and blood samples (arterial and mixed venous) were obtained before (control, t0), 5 (t1) and 10 (t2) min after the injection of enoximone and immediately (t3) and 5 (t4) min after steady state conditions with halothane or isoflurane, as verified by the end-expiratory concentration. Heart rate, mean arterial pressure (MAP), mean pulmonary artery pressure, pulmonary capillary wedge pressure and right atrial pressure were recorded. Cardiac (CI) and stroke volume indices, systemic (SVR) and pulmonary vascular resistance, oxygen availability (QO2), oxygen consumption and oxygen extraction rate were calculated using standard formulae. MAP decreased significantly in both groups after bolus injection of enoximone (group I: 11%; group II: 7%). Under steady state conditions with the volatile anaesthetics, a further significant decrease in MAP was observed (group I: 12%; group II: 12%). Enoximone produced a significant increase in CI (group I: 25%; group II: 27% compared with control). After administration of isoflurane, CI remained essentially unchanged, while halothane decreased CI significantly by 20%. In both groups, SVR decreased significantly after administration of enoximone (group I: 26%; group II: 24%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Cardiocirculatory side effects of hyperthermic extremity perfusion].

The risk of cardiocirculatory disorders was investigated in 23 consecutive patients with high-risk melanomas, who had been treated with hyperthermal limb perfusion. Postoperatively, there was a rise in the pulmonary vascular resistance. In addition, 14 patients with vascular occlusive diseases (1-2b, Fontaine) showed intraoperatively an increasing amount of leakage of the extracorporeal circulation. Elevations of thromboxane and prostacyclin in excess of the norm caused by mechanical and thermic traumatization of blood in the heart lung machine were detected in 8 patients investigated during and after the perfusion procedure. Significant increase of cisplatin, one of the two cytostatic agents injected extracorporeally, could not be demonstrated in the blood of the systemic circulation by atomic absorption spectroscopy. Increased pulmonary and arterial pressure disorders were observed in the group with occlusive vascular diseases, caused by a rising rate of vascular collaterals to the body and the rising rate of thromboxane and prostacyclin in the body blood flow. We believe that it is necessary to monitor pulmonary arterial pressure during isolated limb perfusion, especially in patients with vascular occlusive disease.

Adult↗
PubMed1991

[Oral premedication with midazolam in children].

One hundred children aged between 6 months and 10 years undergoing elective urological surgery, received 0.4 mg/kg midazolam orally about 20 minutes prior to the arrival in the operation theatre. The physiological state of the children was estimated and recorded pre- and postoperatively at defined, comparable and representative circumstances by a specially developed design. In the preoperative period orally administered midazolam had only a mild or non sedative effect in 76-84% of the children, 67-88% of the small patients behaved cooperatively or passively and 70-84% showed an indifferent or euphoric state of mind. Postoperatively 57-89% of the children were markedly sedated; therefore, the estimation of behaviour and state of mind was of minor significance. The circulatory parameters were altered only minimally. Systolic blood pressure and heart rate changed slightly but significantly compared to the preoperative values the day before surgery: a preoperative increase to a maximum immediately after the insertion of the venous cannula and a postoperative maximum after recovery. Side effects were rare (hiccough 5%, vomitus 4%, laryngospasm 1%, stridor 1%). Our results suggest that oral premedication with midazolam in children can be recommended to avoid traumatic or unpleasant alterations resulting from intramuscular injections or rectal applications. Therefore, we prefer this kind of premedication in paediatric patients.

Administration, Oral↗
PubMed1990

Determination of cardiac output during positive end-expiratory pressure--noninvasive electrical bioimpedance compared with standard thermodilution.

Many investigators have demonstrated the accuracy and reliability of thoracic electrical bioimpedance (TEB) in spontaneously breathing patients and under mechanical intermittent positive-pressure ventilation. Most of these studies showed a good correlation between TEB and invasive methods, such as thermodilution (TD) or the Fick method. But during PEEP, contrary results occur when comparing TEB and TD. In six patients undergoing neurosurgical interventions, TEB cardiac output measurements were compared during zero end-expiratory pressure (ZEEP) and during PEEP at 8 cm H2O with a low respiratory rate. The data revealed a good correlation during ZEEP (r = .93) and during PEEP (r = .91). There was no significant statistical difference when measuring cardiac output by TEB during ventilation with PEEP. During normal or decreased cardiac output, TEB overestimated cardiac output compared with TD, whereas TEB underestimated cardiac output compared with TD during increased cardiac output, especially during PEEP.

Brain Neoplasms↗
PubMed1989

[A computer-assisted noninvasive monitoring system with graphic display of online determination of cardiovascular parameters].

During anesthesia the cardiovascular system is usually assessed on the basis of heart rate and arterial pressure, although the most important hemodynamic measurement is that of flow. A method for the non-invasive measurement of cardiac output is based on thoracic electrical bio-impedance. The NCCOM3-R7 is a non-invasive cardiac output monitor that makes use of thoracic electrical bioimpedance, which has been shown to provide results comparable with thermodilution in various hemodynamic states both in animals and humans. A new on-line hemodynamic monitoring system has been developed using the non-invasive NCCOM3-R7 (BoMed) cardiac output monitor, a portable microcomputer (NEC Multispeed) in connection with a software package CDDP-1 (BoMed), a Dinamap automatic arterial pressure monitor (Critikon) and an additional 14" display. Every 16 heart beats the cardiac output monitor transfers 11 cardiodynamic parameters in ASCII-format to the microcomputer, where the data are stored. Using the CDDP-1 program the current cardiodynamic status of the patient is displayed numerically and graphically on the monitor screen. Mean arterial pressure is determined by Dinamap and the data must be entered manually in the menu. The program then calculates systemic vascular resistance and left ventricular work index, the CVP being set to 3 torr and PAOP to 6 torr. In the graphic display the current hemodynamic status is shown and the underlying situation is analyzed in terms of systemic vascular resistance and volume-dependent contractility. The reliability of this on-line monitoring system is demonstrated in a high-risk patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1989

[Postoperative monitoring following short duration surgery of the ear, nose and throat. Experiences with midazolam as an anesthesia induction agent].

A combination of midazolam and alfentanil was used on 24 patients for induction of general anaesthesia. Anaesthesia was maintained with N2O/O2 and repeated injections of alfentanil. The mean operation time was 40.8 min. At the end of surgery the patients recovered 4.8 min after antagonisation of the alfentanil with naloxon, and the endotracheal tube could be removed. Thirty, 60 and 120 min after extubation the patients were asked to perform a Marschner's test, which measures the ability to concentrate on fast intellectual work. Up to 660 simple arithmetical additions could be checked within 7.5 min. The intellectual performance recovered quickly: after 30 min 79% of the pre-operative values were reached, after 60 min 85% and after 120 min 90%. Midazolam is suitable as an induction agent for shortlasting otorhinolaryngological surgery.

Adolescent↗