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Biomedical subjects

G Singbartl

Publications and source records attributed to G Singbartl.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Autologous blood donation from the viewpoint of the anesthetist].

The anesthesiological aspect regarding autologous donation/autologous predeposition aims at the following criteria: (1) Which patient is eligible for autologous donation? (2) Which kind of monitoring should be established for the donation procedure? (3) What are the quality criteria the autologous predeposit has to meet? (4) What are the logistical aspects of an autologous predeposit program managed by an anesthesis? Under anesthesiological aspects all patients who have been declared eligible for elective surgery should be able to donate an autologous predeposit. Attention should be paid both to an adequate volume substitution, especially in patients with cardiovascular and/or coronary diseases, and to an adequate monitoring during autologous blood donation; e.g., a 3-lead ECG to monitor of cardiac rhythm and heart rate as well as close and discontinuous blood pressure control appear to be appropriate. There is no doubt that the quality criteria an autologous predeposit should meet are the same as those outlined for a homologous product; especially proof of no bacterial contamination is mandatory. Undoubtedly, an anesthesist managing an autologous predeposit program should have a broad experience in and a good knowledge of transfusion medicine.

Anesthesiology↗
PubMed1993

[Monitoring in hemodilution].

Normovolaemic haemodilution is an established part within the 'Concept of Autologous Transfusion'. According to the mechanisms to compensate for the dilution-induced anaemia, monitoring of haemodilution has to consider (1) maintenance of normovolaemia; (2) stability of the cardio-vascular system and of a normal pulmonary function; (3) an adequate myocardial oxygen supply. (1) Normovolaemia: Under routine clinical conditions normovolaemia is controlled by close monitoring of fluid balance (considering surgical blood loss, diuresis, and insensible perspiration). If the expected blood loss is > 2.0 litres, additional monitoring of the central venous pressure appears to be reasonable. It is not a single value of the central venous pressure (CVP) but rather its time-course that allows conclusions on changes of intravascular volume. (2) Cardio-vascular and pulmonary function: Pulmonary function is easily controlled by intermittent arterial blood gas analysis. Non-invasive and discontinuous or invasive and continuous blood pressure recording, respectively, are routinely used for monitoring of cardiovascular function. Heart rate together with the time-course of the CVP give additional information on the cardio-vascular system. Central-venous oxygen saturation is only a minor substitute for mixed venous oxygen saturation; however, its changes with time make it possible to draw conclusions on global haemodynamics and total body oxygen supply. However, in situations of extreme haemodilution--as in Jehova's witnesses--a pulmonary artery catheter has to be used for monitoring the cardio-vascular system as well as bulk oxygen parameters. (3) Myocardial oxygen supply: Monitoring for myocardial ischaemia is routinely performed by ECG. It is both the number and the kinds of leads chosen that give adequate information.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Loss, Surgical↗
PubMed1991

Spinal epidural hematoma following epidural anesthesia versus spontaneous spinal subdural hematoma. Two case reports.

Two cases of lumbar hemorrhage with subsequent persistent neurologic sequelae are presented and their possible causes are discussed in the context of a literature review: one patient with spontaneous spinal subdural hematoma with no trauma or lumbar puncture and one with spinal epidural hematoma associated with preceding epidural catheterization for postoperative pain relief. The subdural hematoma was associated with a thrombocytopenia of about 90,000/microliters due to intraoperative blood loss. This might have been contributory to the formation or expansion of the hematoma, but it is not convincing since a platelet count of this amount should not lead to spontaneous bleeding. Both patients received low-dose heparin, but since coagulation tests were normal, prolonged bleeding does not appear to be a likely cause, although it cannot be excluded. In conclusion, the reasons for both hematoma remain unclear. With regard to the epidural hematoma and low-dose heparinization, the possible coincidence of spontaneous lumbar hematoma and lumbar regional block should be taken into consideration.

Anesthesia, Epidural↗
PubMed1991

[The "concept of autologous transfusion"].

This study analyzes the need for homologous blood in a prospectively studied group of 4,357 orthopedic-surgical patients after having established the 'Concept of Autologous Transfusion' (CAT) in 1989, in comparison to a retrospectively studied group of 7,485 orthopedic-surgical patients that had been treated exclusively with homologous blood (in 1986 and 1987). Despite an increase by 18% of the number of operations performed (in 1986: 3,698 operations vs. 4,357 operations in 1989), the need for homologous blood has been reduced by more than 80% (in 1986: 12,600 units of homologous packed red blood cells vs. 1989: 2,145 units of homologous blood). This effect has been achieved by the combination of various blood-saving techniques, namely by normovolemic hemodilution in 3,591 patients (82.4%), intra- and post-operative blood salvage in 1,936 patients (44.4%) as well as by 2,261 preoperative autologous blood donations, and by 5,279 preoperative plasmaphereses. Preoperative autologous donations have been accompanied by side effects in 1.3% (mild and moderate); no serious or even fetal complications occurred and all ambulatory patients coming to the hospital just for an autologous donation left for home on the same day.

Blood Component Transfusion↗
PubMed1991

[The safety of preoperative mechanical autologous plasma donation].

Preoperatively performed plasmaphereses in elective surgery enables the patients not only to have an autologous product retransfused but also to receive a product that contains proteins, coagulation factors and immunoglobulins, both in physiological concentration and composition. Moreover, it is a very effective volume substitute, especially in cases in which a great intraoperative blood loss and/or an intense hemodilution may have caused disorders of the coagulatory system due to loss of coagulation factors as well as due to their dilution. Despite the fact that in our study (7540 preoperative autologous plasmaphereses in 4157 patients in 1989) approximately one-third of the patients was older than 70 years and more than 50% had to be put into group IV of the extended/modified ASA-Score, the rate of side effects accompanying autologous plasmapheresis is only 1.3%. No serious or even fatal complications occurred, and all the day-case-patients coming to the hospital just for autologous donations left for home on the same day. Our results demonstrate that a preoperatively performed autologous donation is not only a very effective, but also a very safe method to reduce the need for homologous blood products. If, in elective surgery, a preoperative autologous donation is considered necessary due to the expected blood loss, the general rule for autologous donation is: A patient who is not fit for autologous donation is not fit for elective surgery, either.

Aged↗
PubMed1990

Urapidil-induced increase of the intracranial pressure in head-trauma patients.

This report deals with two patients suffering from a closed head injury who demonstrated a rise of intracranial pressure (ICP) after bolus injections of urapidil to control arterial hypertension. The rapid fall of the arterial pressure was accompanied by an increase of ICP that amounted to approximately 50% to 100% of the initial values (and thereby reaching ICP values between 32.5 and 40 mmHg); cerebral perfusion pressure decreased to less than 50 mmHg, and nearly reached control values at 15 min after administration of urapidil. The mechanism for this ICP rise is unknown and remains speculative. So far, no other clinical or experimental data are known to us reporting a urapidil induced increase of ICP in head trauma patients.

Adolescent↗
PubMed1990

[A paradoxical air embolism in a closed foramen ovale].

This case report deals with a patient who was being operated on for a tumor of the colon and who died from a paradoxical venous air embolism. Accompanying massive blood loss impedes differentiation of hemodynamic disturbances either due to venous air embolism or to hemorrhage, respectively. Air was aspirated from the radial artery catheter that was used for blood-pressure monitoring and for taking blood samples for laboratory analysis. At autopsy, no probe-patent foramen ovale could be demonstrated. The mechanism of air passing from the venous to the systemic circulation in our patient remains speculative; however, mechanical cardiopulmonary reanimation itself with its underlying thoracic pump mechanism has to be considered as contributing to the transport of air from the venous to the arterial side of the circulation.

Anus Neoplasms↗
PubMed1990

[Free intraabdominal air following an isolated gunshot injury to the trachea].

This case report describes a 21-year-old male patient suffering from a close-range suprajugular blank-cartridge injury, i.e. a gunshot injury without a projectile. On arrival at the hospital a cutaneous lesion of 5 mm in diameter was seen 2 cm above the jugular notch with traces of gunpowder in the surrounding skin. The cardiovascular status and spontaneous breathing were sufficient. On attempts to answer questions air was seen to escape from the lesion, indicating a tracheal defect. The patient was rapidly intubated and subjected to further diagnostic procedures. A chest X-ray film revealed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and marked subcutaneous emphysema of the chest and abdominal wall. After insertion of bilateral chest tubes, both lungs promptly reinflated and no air leakage could be demonstrated. As free intra-abdominal air has its source in a ruptured viscus in about 90% of cases, close attention was paid to possible abdominal symptoms. Contrast radiography and computer tomography (1st postoperative day) failed to demonstrate intestinal rupture. As there was no clinical evidence of peritonitis, exploratory laparotomy was not performed. Revision of the cervical lesion revealed locally extended destruction of tissues, including the pyramidal thyroid lobe and the anterior tracheal wall. After anastomosis of the trachea the endotracheal tube was left in place as an intraluminal splint for 8 days. Bronchoscopy at this time showed no evidence of tracheal stenosis and the patient was extubated. Two days later he left the hospital. The underlying pathophysiological mechanisms of free intra-abdominal air in the absence of gastrointestinal lesions are discussed and the literature is reviewed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Cardiovascular and pulmonary changes in patients with an isolated cerebral lesion. I. Hemodynamics].

This study included 44 patients with a severe isolated cerebral lesion (decerebrate posturing on admission) with the purpose of examining the hemodynamic changes caused by cerebral trauma to see whether these changes might give additional information as to the prognosis of these patients. Patients with a previous myocardial infarction, pulmonary edema or embolism, chronic obstructive or restrictive pulmonary disease, proven or suspected aspiration, and polytrauma patients with an accompanying cerebral lesion were excluded. The study started on the day of admission to the intensive care unit and lasted for up to 6 days maximally. Both on admission and throughout the observation period, survivors (S) showed a higher neurological status score on the Innsbruck Coma Scale than non-survivors (NS). The hemodynamic profile was characterized by a hyperdynamic reaction with an increase in cardiac index and systemic arterial pressure. The hyperdynamic state was much more pronounced in S than in NS, who tended to show a normo-or even hypodynamic state. On admission to the intensive care unit 13 of 31 NS (41.9%) had a cardiac index less than 3.01/min.m2 as compared to only 1 of the 13 S (7.7%). With regard to pulmonary artery pressure, there was no difference between S and NS, while the pulmonary vascular resistance was significantly higher in NS than in S. In addition, S showed a kind of circadian rhythm of systemic arterial pressure, that was absent in NS. Rather than one single hemodynamic parameter being of prognostic relevance it is the complex parameter "left-ventricular work index" (LVWI) includes all the relevant parameters of left-ventricular mechanical work. Throughout the observation period, this parameter was consistently higher in S than in NS, although the left ventricular filling pressure (represented by the diastolic pulmonary artery pressure) was equal in both groups. While an inverse relationship between age and LVWI could be shown in S, this could not be demonstrated for NS, indicating that the differences in hemodynamic patterns between S and NS should be due to other reasons, such as the degree of the cerebral lesion affecting the trauma-adaptive regulation of the cardiovascular reaction to a severe isolated cerebral lesion.

Adolescent↗
PubMed1989

[Cardiovascular and pulmonary changes in patients with an isolated cerebral lesion. II. Extravascular lung water and pulmonary gas exchange ("neurogenic lung edema")].

While in animal experiments neurogenically initiated pulmonary edema is a well known event and is supposed to be due to centrally initiated hemodynamic disturbances ("neurohemodynamics") in patients with severe cerebral lesions fulminant alveolar edema is reported to occur very rarely. The questions addressed by this study are: 1. whether and to what extent changes in extravascular lung water (EVTVL) can be demonstrated in patients with a severe isolated cerebral lesion; 2. whether a relationship between the severity of the cerebral lesion and accompanying EVTVL changes can be proven; and 3. whether or not EVTVL changes are associated with corresponding changes in intravascular hydrostatic and oncotic Starling parameters; i.e. cardiogenic or noncardiogenic pulmonary edema accompanying the cerebral lesion. This study included 44 patients presenting with a severe isolated cerebral lesion and decerebrate posturing on admission. EVTVL (by thermo-dye double-indicator technique), pulmonary gas exchange (AaDO2/pAO2), colloid oncotic pressure (COP) and mean systemic arterial (SAP), mean pulmonary arterial (PAP), and pulmonary capillary wedge pressures (PCWP) were measured from the day of admission to the 6th day after the acute cerebral lesion maximally; in addition the microvascular pressure in the pulmonary bed and intravascular filtration pressure were calculated from the above mentioned parameters. The neurological status on admission and throughout the observation period was scored using the Innsbruck Coma Scale (ICS) and the neurological outcome by the Glasgow Outcome Scale (GOS). Statistical analysis was performed using the distribution independent Kruskal Wallis test, the correlation coefficient r (Pearsan and Bravais), and the Spearman rank correlation (RSp); values are given as means +/- SEM; the significance has been set at P less than 0.05. Our results reveal an overall increase in EVTVL from 8.8 +/- 0.8 ml/kg on the day of admission up to 11.3 +/- 1.6 ml/kg on the 4th day. While survivors (n = 13) remained within the normal range of EVTVL (less than 9 ml/kg), non-survivors (n = 31) started at an already elevated level (10.05 +/- 1.04 ml/kg) and reached their maximum values (15.4 +/- 2.3 ml/kg) on day 3 to 4. In 3 non-survivors these increased initial EVTVL values were accompanied by pathologically increased intravascular pressures, indicating that hydrostatic mechanisms were involved in the EVTVL rises. While the hydrostatic pressures normalized spontaneously, EVTVL values stayed within the pathological range throughout the remaining observation period.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1987

[Pathophysiologic principles, emergency medical aspects and anesthesiologic measures in severe brain trauma].

In 60%-90% of cases head injury is a part of multisystem trauma and of very decisive importance for the post-traumatic prognosis. Hypoxia, hypercarbia, and hypotension increase the primary lesion and cause secondary brain damage. Therefore, emergency measures must be directed to the essentials of sustaining vital functions, i.e. intubation/ventilation/oxygenation and stabilization of the circulatory system. All trauma-specific measures should avoid additional increases in intracranial pressure or should decrease it if already elevated. Moderate hyperventilation not only causes cerebral vasoconstriction with a concomitant decrease in intracranial blood volume and intracranial pressure, but also partly restores the disturbed cerebral autoregulation, and is therefore an important part of the emergency care and anesthetic procedure in patients with severe head injuries. It is supplemented by analgesia and sedation to prevent intracranial pressure increases due to painful external stimuli. Elevation of the head and upper part of the body by 30 degrees causes a decrease in intracranial pressure by decreasing intracranial blood volume due to improved venous return from the brain; however, this measure is to be applied only in stable circulatory conditions. The head should be put in mid-position avoiding sideways rotation, flexion, and hyperextension. Osmotically active agents are only indicated in emergency situations when there are signs of clinical deterioration. High-dose barbiturate therapy is reserved as a "last resort", under intensive care conditions, for controlling an otherwise intractable intracranial pressure rise. Calcium antagonists have no indication in this context. Anesthesia in patients with severe head injury must involve only those techniques that do not further increase an already elevated intracranial pressure. As inhalational anesthetics, including nitrous oxide, elevate the intracranial pressure to varying extents due to cerebral vasodilation with a concomitant rise in intracranial blood volume, these substances have to be avoided whenever raised intracranial pressure cannot be excluded. Narcotics, benzodiazepines, small dosages of barbiturates, and long-lasting muscle relaxants can be regarded as useful.

Anesthesia↗
PubMed1986

Unidirectional 8-MHz continuous wave Doppler equipment can facilitate catheterization of the internal jugular vein.

In a prospective study, 8-MHz unidirectional, continuous wave Doppler equipment was shown to improve the success rate of internal jugular vein catheterization. In the first series of 100 patients, punctures were randomly divided into two groups, via the anterior or posterior route, representing the standard technique. The second series of 50 patients underwent punctures guided by the Doppler technique. The Doppler route was successful in 48 test punctures with 47 catheter placements. Via the anterior route, 14 of 50 test punctures were positive, with 11 catheter placements; for the posterior route, test punctures were positive in 25 of 50 cases, with 18 catheter placements. With the Doppler technique, it should be possible to increase the rate of successful catheterization of the internal jugular vein while reducing complications.

Catheterization↗
PubMed1985

[Doppler ultrasound in anesthesia and intensive care medicine].

The ultrasound Doppler technique is a non-invasive method for the evaluation of arterial and venous blood flow. It can be useful in anaesthesia and in intensive medicine for different purposes, e.g. for more exact blood pressure determination in difficult cases, in cases of blood supply disorders or as a helpful guide for the puncture of arterial and venous vessels. This technique has also been used successfully as a screening method of cerebral death, for the evaluation of flow rates during arterio-venous hemofiltration and for the investigation of the effects of peridural anaesthesia on peripheral resistance.

Anesthesia, Epidural↗
PubMed1985

[Significance of preclinical emergency treatment for the prognosis of patients with severe craniocerebral trauma].

In a prospective study in 147 unconscious patients (Glasgow-Coma-Scale less than or equal to 7) we examined the relevance of preclinical care for posttraumatic prognosis-basic life support (BLS) referring to ventilation/oxygenation and circulation, as well as advanced trauma-specific treatment (ATT) referring to medication and positioning. Procedures providing oxygenation and stable cardiovascular function are found to be most important. The overall survival rate amounts to 53.7 per cent (79 of 147 patients). Whereas 56.6 per cent (77 of 136 patients) of the patients being preclinically attended by a physician, survive, the survival rate is only 18.2 per cent (2 of 11 patients) among those not medically cared for. 31.9 per cent (47 of 147 patients) receive trauma-adequate optimal prehospital care, and an additional 29.2 per cent (43 of 147 patients) obtain an acceptable treatment, whereas the remaining 38.8 per cent (57 of 147 patients) must be considered insufficiently for care. Patients with optimal preclinical care have a statistically significant higher survival rate in comparison to the whole group of patients-70.2 per cent vs. 53.7 per cent-and to those receiving a less sufficient attention-70.2 per cent vs. 46.0 per cent. Besides the severity of the cerebral trauma, the quality of the preclinical medical attention, too, has been proven to be of great importance for post-traumatic course and outcome in patients with severe head injury.

Brain Injuries↗
PubMed1983

[Efficacy of respiratory therapy/controlled hyperventilation in cerebral trauma].

In a prospective study in 129 patients with isolated head injury the efficacy of respiratory treatment/controlled moderate hyperventilation on the neurological outcome is to be tested. Indications for mechanical ventilation are either a bad neurological behaviour (GCS less than or equal to 5) or neurogenic-induced disturbances of pulmonary gas exchange. Both oxygenation and neurological behaviour are worse in the ventilated group than in patients breathing spontaneously. Therefore a direct and quantitative comparison between these two groups of patients is not possible; however, conclusions can be drawn on the efficacy of the respiratory management. Survival rate of all patients on discharge from ICU amounts to 61.2%; of the patients breathing spontaneously 96.1% survive the cerebral trauma, while only 39.7% of the ventilated patients survive. The post-traumatic course of the GCS-values shows a transient but statistically and clinically significant decrease for the nonventilated survivors, while a continuous increase can be demonstrated for the patients being ventilated and surviving the cerebral trauma (n = 31). The survival rate for the most severely injured and ventilated group (n =59; GCS less than or equal to 5) amounts to 38.9% (23/59 patients). Out of these 23 patients with initial extensor spasm 15 reach greater than or equal to 10 points on GCS-scale (12.2 +/- 0.5 P.) on discharge from ICU. An additional neurogenic-initiated respiratory failure increases the rate of mortality to a statistically significant extent (P less than 0.025). It is concluded that respiratory treatment with moderate hyperventilation positively influences the quality of the neurological outcome in patients with severe head injury.

Adult↗
PubMed1982

[Disturbed pulmonary gas exchange in patients with cerebral trauma (author's transl)].

In a prospective study on 78 patients the influence of the severity of an isolated head injury on the pulmonary gas exchange has been examined. Our results show that with increasing severity of the isolated cerebral trauma the quotient A -- aDO2/PAO2 increases as well (P less than 0.001). Patients with comparable degrees of head injury but nearly unchanged pulmonary function have a greater chance to survive (P less than 0.05), though with neurological defects, than patients with an additional disturbed pulmonary gas exchange. The overall survival rate amounts to 53.8 per cent.

Adult↗