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Biomedical subjects

I Pichlmayr

Publications and source records attributed to I Pichlmayr.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Pain therapy in gynecologic neoplasms].

A great number of patients with gynaecological malignant diseases suffer from severe pain, caused, for example, by bone metastases of breast cancer or tumour infiltration of the pelvis and the lumbar plexus in uterine cancer. Several methods of treatment are available depending upon the origin of pain. It is possible to achieve pain relief by radiotherapy or by cytostatic therapy. Sometimes, anaesthesiological and neurosurgical measures are successful, but the most important method is treatment with analgesics. Strong opioids are given, if pain relief is insufficient under treatment with non-narcotic drugs or weak opioids, like codeine. Morphine and other strong opioids are not reserved for pain control only in terminally sick women, as they can be administered successfully for long periods without severe side effects. If possible, the oral route should be selected. If vomiting occurs, or if patients are unable to take oral medication, morphine can be given peridurally, intrathecally or by infusion. Often, an additional treatment is necessary with different medicaments like tricyclic antidepressants and corticosteroids.

Analgesics↗
PubMed1990

[Postoperative ventilation in non-intubated patients with iron lung versus conventional ventilation].

Postoperative ventilation using a steel lung is an alternative to conventional ventilation through an endotracheal cannula. Both methods were compared in two groups of patients undergoing major abdominal surgery. Group A was ventilated using a Servo Ventilator 900C, whereas group B was ventilated using a newly designed steel lung. The duration of ventilation using the steel lung and that of postoperative intubation were significantly shorter than those used in group A, in spite of a higher anesthesiological and surgical risk in patients in group B. pO2 was significantly increased during ventilation with the steel lung in comparison to conventional ventilation. An automatic classification of EEG activity was used to estimate depth of anesthesia. This showed a close correlation between clinical signs and anesthesiological levels. The spectroanalytical evaluation of ventilation curves allowed the early recognition of spontaneous breathing and determined tidal volumes using steel lung ventilation.

Aged↗
PubMed1990

[Postoperative ventilation in the "iron lung"].

Postoperative artificial ventilation by using an endotracheal tube may cause a pulmonary infection. A possibly necessary permanent sedation and relaxation may result in an additional danger for the patient. The principle of the "iron lung" represents an alternative to endotracheal artificial respiration, which applies especially to endangered patients who are under postoperative artificial respiration. After an abdominal operation five patients have been extubated and artificially respirated by using the "iron lung" principle while not being able to breath by themselves. The degree of the sedation was monitored both intraoperatively and postoperatively using an automatic EEG classification. The performance spectrum of the respiratory curve enabled very early detection of the onset of spontaneous respiration.

Abdomen↗
PubMed1990

[Fat emulsions in parenteral feeding following liver transplantation. I. Effect on the recovery of RES function in the transplant].

Following liver transplantation, the effect of postoperative parenteral nutrition with MCT/LCT fatty emulsions on the recovery of RES function in the allograft was investigated in a randomised prospective study of three groups of patients (group I: 50 g MCT/LCT fats twice weekly, group II: 0.7 g/kg body weight per day MCT/LCT fats, group III: 1.5 g/kg body weight per day MCT/LCT fats). RES function was assessed using 99mTc-HSA-MM clearance. There were no statistically significant differences in the recovery of RES function after transplantation between the three groups. A negative effect on RES function as a result of the administration of MCT/LCT fats up to 1.5 g/kg body weight per day can therefore be excluded.

Fat Emulsions, Intravenous↗
PubMed1990

[The effects of ketamine on the electroencephalogram--typical patterns and spectral representations].

In 40 female patients aged between 17 and 79 years, the pre- and intraoperative EEG was recorded and processed by personal computer. For induction of general anesthesia patients received between 2 and 3 mg/kg ketamine i.v. within 30 s. In the phase of diminished ketamine effects enflurane was given in addition. Activity in the theta band was observed in all patients during general anesthesia, and in 30% there were complexes. These complexes differ in their spectral content of burst suppression patterns. Under effect of ketamine nearly all patients showed fast beta waves in the EEG. It is proposed that the spectral domain of EEG evaluations be enhanced to an upper limit of 45 Hz.

Adolescent↗
PubMed1990

[The ovarian hyperstimulation syndrome. Anesthesiologic aspects based on a severe case].

Ovarian hyperstimulation syndrome (OHS) is an iatrogenic syndrome in which induction of ovulation results in a wide spectrum of clinical symptoms and signs and laboratory manifestations. Based on the severity of the symptoms and signs, three degrees of hyperstimulation have been described: mild, moderate and severe. The most severe manifestation, presented in this paper with reference to the case of a 27-year-old woman, takes the form of massive ovarian enlargement with multiple cysts, hemoconcentration and third-space accumulation of fluid in the form of ascites, pleural and pericardial effusion. The full-blown clinical syndrome may be complicated by renal failure and oliguria, hypovolemic shock, thromboembolic episodes, adult respiratory distress syndrome (ARDS) and even death. The pathophysiologic mechanisms responsible for the development of OHS are still not known. The incidence of this iatrogenic syndrome can be reduced by monitoring plasma estradiol and by ultrasonographic evaluation of growing follicles. The anesthesiological aspects of OHS are discussed. A strategy for treatment, based on repeated ultrasonographic examination, clinical and biochemical evaluation, plasma volume replacement, abdominal paracentesis and aspiration puncture of the pleural effusion, is suggested.

Adult↗
PubMed1989

[Atelectasis treatment by ventilatory support using an iron lung].

Total atelectasis of the left lung occurred in a 61-year-old woman after several weeks ventilator-assisted breathing following an operation for ileus, when the tracheal cannula was removed. It was quickly replaced and artificial ventilation resumed. But despite daily bronchoscopic suction for three weeks the patient's state failed to improve (vital capacity 39%, arterial pO2 47 mm Hg, pCO2 37 mm Hg). Mechanical ventilation with an "iron lung" was therefore instituted over a six month period, at first for two hours daily (as an in-patient) and then weekly (as out-patient). During this time her condition and general state clearly improved. On re-hospitalization to remove the tracheal cannula her vital capacity was 75%, pO2 78 mm Hg and pCO2 38 mm Hg.

Carbon Dioxide↗
PubMed1987

General anesthesia and postnarcotic sleep disorders.

Sleep rhythm can be influenced by narcotics and exogenous disturbances causing persistent insomnia, exhaustion and moodiness. In this study the influence of anesthesia on the patients' sleep during the first postoperative night was investigated. It was attempted to differentiate between the influences due to anesthesia, namely to surgery, and due to intensive care. In 10 patients with halothane narcosis, 12 patients with neuroleptanalgesia, 12 young patients and 12 patients more than 70 years of age with halothane/fentanyl anesthesia a sleep study was performed during the first postoperative night. Electrodes were placed according to the criteria of Rechtschaffen and Kales [US Department of Health, Education and Welfare, Public Health Service, Bethesda 1968]. The group of controls consisted of 10 healthy female volunteers, who had to sleep under identical conditions. The sleep stages were visually evaluated by criteria of Rechtschaffen and Kales [US Department of Health, Education and Welfare Public Health Service, Bethesda 1968]. The disturbances by nurses did not, on the whole, interfere with the sleep rhythms of the 10 healthy volunteers: 4-5 REM phases and stage IV sleep were seen regularly. The patients had a maximum of 1 REM phase. Stage II sleep was reached after falling asleep and maintained for several hours. Stage III and IV were hardly seen in all patient groups. Geriatric patients showed the most obvious changes in their sleep. They were sleepless during 41.1% of the monitored period. Stage II was slightly reduced. Night sleep of patients after anesthesia is disturbed not only by intensive care unit conditions, but also by direct effects of narcotics and surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Electroencephalographic evaluation potentials in severely burned patients in intensive care].

In severely burned patients water and electrolyte imbalance is the most obvious disturbance during the shock period but problems also occur because of large protein losses and absorption of toxic products from the damaged skin. These factors may impair brain function and this may be further affected by the action of drugs used for therapy. Brain function was assessed in 12 burned patients by EEG recordings. The EEG records showed no changes specific to burned patients. Changes were seen similar to those seen in patients under intensive care for other surgical conditions and seemed to be related to the level of consciousness and to the drug therapy.

Adult↗
PubMed1985

[EEG parameters in the monitoring of ventilated intensive care patients under various sedation methods].

Visual evaluation of the EEG and spectral analysis of the background activity are useful in monitoring changes of cerebral function caused by sedatives, hypoxia and changes in state of health. Continuous slow changes of the EEG are indicative of critical situations of cerebral blood flow or metabolism. Monitoring cerebral function of 40 sedated and ventilated patients on an intensive care unit, we found typical EEG changes dependent on different regimes of sedation, amount of sedatives and patient condition. In patients sedated with etomidate, there was a good correlation between the relative power of the delta and beta-band and patient condition. Sedation with thiopental caused flattening and slowing of the EEG, as well as a decrease of total power, if the doses were increased. The EEG was an aid to predicting the outcome of intensive care and to demonstrate the degree of cerebral damage. In patients with septicaemia, cerebral function was more depressed than in patients with cardiac failure. Spectral analysis and computed parameters proved to be valuable in monitoring cerebral changes caused by sedation and state of health in ventilated patients.

Abdomen↗
PubMed1984

[The EEG in anesthesia and intensive care monitoring].

Electroencephalographic monitoring during anaesthesia and during intensive therapy has definite advantages. It aids the individual regulation and assessment of general anaesthesiological measures, and signals cerebral insufficiency in the patient under treatment. Examples illustrating initial cerebral states and characteristic changes of cerebral function related to anaesthesia in general, to various forms of anaesthesia as well as to the depth of anaesthesia, are presented. Other examples illustrate the significance of this method in interpreting the actual state of cerebral function during the course of intensive treatment. Possibilities of performing electroencephalographic registration during routine anaesthesiological procedures are discussed.

Anesthesia, General↗
PubMed1984

[Postoperative ventilation using the iron lung principle. A renaissance of this form of artificial respiration?].

Artificial ventilation using the iron lung as an alternative to endotracheal intubation and respiration may be a useful method in reducing bronchopulmonary infections attributed to postoperative ventilation or resulting during intensive care treatment. The concept of transferring and further developing this "external" respiratory principle to anaesthesiological situations is presented. Four high-risk surgical patients were subjected to post-operative artificial ventilation with the iron lung: the results demonstrated that this method was effective and well tolerated. Another speciality planned for its employment is transplant surgery. Numerous other fields could also be considered. Before the iron lung can be put to use in anaesthesiology certain further developments are required. These developments relate to its practical aspects and more importantly to the additional ventilation possibilities which can be achieved. The future extent of employment of the iron lung in anaesthesiology cannot be predicted at present. In our opinion, however, this form of respiration could prove an adequate method in special situations.

Aged↗
PubMed1983

EEG monitoring in anesthesiology and intensive care.

Knowledge of the actual state of cerebral function and of the changes induced by psychotropic drugs is important not only to neurologically oriented specialties but also to other branches of medicine concerned with altering cerebral function. This applies especially to anesthesiology which involves numerous procedures leading to a temporary loss of cognitive brain function. Recently, the application of EEG combined with spectral analysis performed during anesthesia and intensive-care treatment has attracted attention: we investigated the changes in EEG during standardized anesthesiological and therapeutical procedures pre-, intra- and postoperatively, or during intensive-care treatment in 1,500 patients undergoing general surgery from 1977 to 1982. Two-track EEG leads accompanied by spectral analysis were used on line. The evaluation of routinely applied EEG monitoring justifies the following statements: EEG monitoring can be adapted technically and organized to comply with the working conditions and daily activities of an anesthesiological department. Spectral analytic representations allow the assessment of the EEG by the anesthesiologist. The various methods of general anesthesia produce specific EEG changes which can be obliterated by the cumulative effect of drugs. The actual depth of anesthesia is visible in the EEG. During a defined constant anesthetic depth, potentially hazardous cerebral dysfunctions can be detected early and treated accordingly. EEG monitoring can be useful in solving urgent medical problems of intensive-care therapy.

Anesthesia, General↗
PubMed1983

[Transcutaneous electrical nerve stimulation (TENS) in the treatment of a peripheral lesion of the brachial plexus].

This case report describes the clinical history of a patient on dialysis, who suffered from a lesion of the brachial plexus, secondary to a mechanical damage after attempted suicide. Therapy with transcutaneous electrical nerve stimulation (TENS) revealed both sufficient analgesia and a striking improvement of the functional situation. Possible causes of the therapeutic success are discussed. The analgesia of TENS therapy, which has almost no side-effects, with the secondarily improved psychic situation, is regarded as the major responsible factor. This method appears to be a rewarding alternative in the treatment of pain syndromes secondary to peripheral nerve lesions.

Adult↗