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Biomedical subjects

H J Eberlein

Publications and source records attributed to H J Eberlein.

At least 19 recordsLinked to original sources
PubMed1991

Transdermal fentanyl for the treatment of pain after major urological operations. A randomized double-blind comparison with placebo using intravenous patient-controlled analgesia.

Transdermal fentanyl 75 micrograms/h (Fentanyl-TTS) was compared with placebo in a randomized double-blind study in the early postoperative period, using 50 patients recovering from major urological operations. Analgesic efficacy was individually titrated with intravenous fentanyl by means of a PCA pump (demand dose 34 micrograms, lockout time 5 min). The test systems were applied 8 h before anaesthesia and were left in situ for 24 h. During the PCA period (18.2 h) patients with Fentanyl-TTS required significantly less additional fentanyl (0.48 vs 0.93 micrograms.kg-1.h-1) and reported less pain than patients in the placebo-group. Patient acceptance was high in both groups. Side-effects were of only minor intensity and did not differ between the two groups. In particular, there was no case of clinically relevant respiratory depression.

Administration, Cutaneous↗
PubMed1991

[An attempt to reconcile differences of opinion in the field of malignant hyperthermia].

Two of the persisting controversies concerning malignant hyperthermia (MH) are discussed: storing and dosage of dantrolene and preoperative tactics to be followed with patients who are MH-susceptible. Reasons are presented for the obligation to store sufficient amounts of dantrolene in every operating suite. The second part discusses the question of pretreatment of MH-susceptible patients with dantrolene.

Dantrolene↗
PubMed1991

[Reasons for the persistent lethality of malignant hyperthermia and recommendations for its reduction].

Dantrolene is the only known specific treatment of malignant hyperthermia (MH). Following official approval an intravenous formulation of dantrolene became clinically available for emergency treatment of MH. At that time it had been anticipated, that with dantrolene therapy combined with constant vigilance each case of MH could be treated successfully and the mortality rate should be close to zero. Surprisingly enough, reports of death due to MH continue to be published up to the present. Analysis of case reports revealed the following reasons for the discrepancy between the expectations and the clinical reality: 1. Delay in early diagnosis due to preoccupation with the name-giving symptom hyperthermia: lack of MH-sensitive monitoring (i.e. capnometry, pulse oximetry, blood gas analysis). 2. Preoccupation with non specific facets of therapy: measures such as cooling, change of the anaesthesia machine, transfer of the patient to the intensive care unit or the administration of drugs which have been shown to be ineffective in treating MH may not only be a waste of time, but fully disregard the prime factor in therapy--intravenous administration of dantrolene. 3. Administration of an insufficient amount of dantrolene and delayed start of specific therapy due to failure to have immediate access to intravenous dantrolene. 4. Failure to increase minute ventilation immediately after making the diagnosis to meet elevated metabolic demands. A recommendation is presented how to diagnose, to treat and prevent MH, considering present day diagnostic and therapeutic measures in the presence of the presumptive diagnosis of MH.

Anesthesia↗
PubMed1987

["Round the clock"--an information service for malignant hyperthermia emergencies].

A 24-hour 7-day telephone service has been created for emergency consultation: MH-hotline 030/3035504 (daytime) or 030/30351 (after office hours). In emergencies callers should ask for a consultant, indicating the code word "malignant hyperthermia" and give their name, the name of the institution and the telephone number.

Emergency Medical Service Communication Systems↗
PubMed1986

[New findings and experiences in the field of malignant hyperthermia].

New publications on malignant hyperthermia (MH), with direct clinical importance, are reported. Since even in the recent past patients have died from MH in spite of therapy with dantrolene, the effectiveness of dantrolene is discussed in particular. Atypical clinical pictures of MH are presented. Special psychiatric syndromes (malignant neuroleptic syndrome and acute febrile catatonia), rhabdomyolysis with myoglobinuria following strenuous exercise or exposure to heat are mentioned, as these disorders appear to be related to MH, in that they are hypermetabolic syndromes implying a muscle membrane dysfunction. The role of slow calcium channel blockers and 5-hydroxytryptamine antagonists as prophylactic or therapeutic agents in MH is discussed. A schedule describing how to diagnose, treat and prevent MH, considering recent advances, is presented.

Anesthesia↗
PubMed1985

[Dantrolene in the treatment of life-threatening psychiatric disease pictures. A contribution to the therapy of the malignant neuroleptic syndrome and acute febrile catatonia].

The malignant neuroleptic syndrome and acute febrile catatonia are life-threatening psychiatric disorders which frequently are treated in intensive care units outside psychiatric departments. Their manifestations are very similar to those of anaesthesia-specific malignant hyperthermia. The three syndromes have in common signs of increased muscle metabolism. Dantrolene, a specific drug in the treatment of malignant hyperthermia, has been used successfully several times recently in the treatment of the malignant neuroleptic syndrome. One such case is reported. In a 23-year-old man with signs of acute febrile catatonia parenteral dantrolene and electroconvulsive shocks succeeded in counteracting the symptoms of the abnormally raised muscle metabolism.

Adult↗
PubMed1983

Postoperative malignant hyperthermia and dantrolene therapy.

A case of malignant hyperthermia (MH) in a three-year eight-month-old girl is presented. Definite symptoms of MH developed in the awake patient 30 min after termination of anaesthesia which had lasted five hours. This postoperative MH-episode resolved promptly following intravenous administration of dantrolene (2.5 mg X kg-1 initially, followed by 5 mg X kg-1 over 12 hours). Results of serial serum samples revealed a steady increase in creatine kinase (CK) concentration with the highest value being observed at the second day, despite dantrolene therapy. The unusual occurrence of MH in the postoperative period, when the major effects of anaesthesia were no longer an important consideration, is discussed with regard to the "human stress syndrome." The necessity to give this information to people usually not familiar in diagnosing MH (e.g., medical personnel in surgical wards) is stressed.

Child, Preschool↗
PubMed1983

[Malignant hyperthermia].

Malignant hyperthermia (MH) is a rare syndrome seen when susceptible individuals are exposed to one or more of various triggering agents, most commonly a depolarizing muscle relaxant or an inhalational anaesthetic agent. There is a dramatic rise in metabolic rate and oxygen consumption which if not treated promptly and effectively results, in the majority of cases, in the patient's death. Fatal responses to physical stress associated with the familial muscular disease known as MH are being increasingly reported in situations not related to anaesthesia or drugs. Moreover, cases of MH were recognized to be "induced" in the postoperative period when obviously the major effects of anaesthesia were no longer of important consideration. Therefore a more expanded concept of MH seems to develop, including the assumption that one of the other factors in MH is stress. The implication of this extends far beyond the scope of anaesthesiology. The acute hypermetabolic state in MH, resulting in acidosis, heat production and muscular activity is probably due to an inability to control calcium concentration within the skeletal muscle fiber, and may involve a generalized alteration in cellular or subcellular membrane permeability. The susceptibility to develop MH is controlled by several genetic factors. Evaluation of affected families is guided by in vitro analysis of drug-induced contractures in muscle biopsy specimens; a practical and reliable non-invasive test to predict the susceptibility is still being sought. At the present time there is incontrovertible evidence that the hydantoin derivate dantrolene sodium is the only known specific drug in treatment and prophylaxis of MH. A concept for the treatment of MH and guidelines for the management of a patient at risk are presented; medico legal aspects of the complication are stressed.

Acidosis↗
PubMed1983

[Cyanosis as a result of drug-induced methemoglobinemia. A case report].

A 39-old, anaemic woman, admitted to hospital because of a fistula between bladder and bowel, developed a moderate degree of methaemoglobinaemia (19% of total haemoglobin) after prescription of 3 X 200 mg/die phenazopyridine (Pyridium) for 4 weeks. She showed a greyish discoloration of the skin; lips and nailbeds were cyanosed. On the basis of a glucose-6ph-dehydrogenase deficiency (71 mU/10(9) RBCs instead of 131 +/- 13 mU/10(9) RBCs - the normal value for adults) the medication with phenazopyridine induced methaemoglobinaemia. The coincidence of anaemia (8.7 g/dl Hb) and methaemoglobinaemia (19%) caused mild signs of hypoxia (fatigue, headache, feebleness and dyspnoea on exertion).

Adult↗
PubMed1981

[Monitoring of cerebral electrical activity during cardiac surgery (author's transl)].

Continuous recording of cerebral activity by the Cerebral Function Monitor is a useful supplementation to anaesthetic monitoring in cardiac surgery. It is a simple and reliable method for early detection of cerebral damage during heart surgery and in other situations with possible cerebral impairment. The operating principles of the Cerebral Function Monitor and the interpretation of the electrical activity tracings are presented. Therapeutic considerations to minimize or to prevent anoxic brain damage are offered.

Age Factors↗