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Biomedical subjects

J Motsch

Publications and source records attributed to J Motsch.

At least 109 records · Page 6Linked to original sources
PubMed1994

Prevention of bacterial colonization of intravenous catheters by antiseptic impregnation of polyurethane polymers.

The use of intravascular catheters is associated with infectious complications. Using plastic materials with antibacterial activity may reduce catheter-related bacterial colonization. A novel intravascular catheter impregnated with the antiseptics silver-sulphadiazine and chlorhexidine was tested in an in-vivo model using implantation of catheters into the internal jugular veins of rats. The rate and magnitude of bacterial colonization in groups with implantation of silver-sulphadiazine and chlorhexidine bonded (SSC) and control (C) catheters were assessed 3 and 7 days after intravenous implantation, and local challenge at the exit site by 10(7) cfu Staphylococcus epidermidis ATCC 35984. Significant reductions in the culture positivity of catheters were observed in the test compared with control groups. After 3 and 7 days, the magnitude of bacterial colonization of implanted catheter segments was significantly lower compared with control catheters (P < 0.01). These findings indicate that antiseptic-bonded catheters substantially reduce the incidence and magnitude of catheter-related bacterial colonization, and may subsequently reduce catheter-related infection.

Animals↗
PubMed1994

Long-term sedation with propofol and green discolouration of the liver.

Propofol has been reported to cause discolouration of urine and hair. A case of green discolouration of the liver is reported in a 56-year-old man after long-term sedation with propofol in the intensive care unit. After discontinuation of propofol the discolouration of the liver disappeared. This phenomenon is due to metabolism of propofol which may lead to a phenolic green chromophore which is conjugated in the liver and excreted in the urine.

Chemical and Drug Induced Liver Injury↗
PubMed1994

Time course of action and recovery of rocuronium bromide in children during halothane anaesthesia--a preliminary report.

In this preliminary study, two groups of 15 patients, aged 1-4 years and 5-10 years respectively, received one of four doses of rocuronium (0.12, 0.17, 0.22 or 0.27 mg kg-1) and when block was maximal a supplementary dose to bring them all to a total of 0.5 mg kg-1. In half the patients, the block was reversed with atropine and neostigmine at a T1 recovery of 25%. The remainder were allowed to recover spontaneously. The total dose produced a block of 95-100% in all patients. The clinical duration of action was shorter under halothane anaesthesia in children (mean 15 min approximately) than has previously been reported in adults under intravenous anesthesia. Mean spontaneous recovery time from T1 25% to a train-of-four ratio of 0.7 was about 11 min. Neostigmine doubled the rate of recovery. There was a moderate increase in heart rate in the younger age range.

Androstanols↗
PubMed1994

[Diagnosis and therapy of perioperative lung embolism].

Pulmonary embolism is a major cause of postoperative problems, accounting for 12-20% postoperative deaths. 0.1% to 0.4% of all hospitalised patients die due to acute pulmonary embolism. Thus, pulmonary embolism should be included in the differential diagnostic considerations. Blood gas analysis, ECG, chest roentgenography, scintigraphy, pulmonary arterial catheterisation, echocardiography, digital subtraction angiography, and angiography are important diagnostic tools. When pulmonary embolism is not life-threatening, heparinisation may be an adequate therapeutic approach. In the case of severe cardiovascular instability, recanalisation of the pulmonary arterial tree has to be achieved. Recent studies show that preceding surgery may not be an absolute contraindication to thrombolysis. Recommendations for thrombolytic therapy include the bolus administration of 250,000 U of urokinase followed by a continuous infusion of 40-60,000 U per hour. In an emergency situation, a bolus dose of 1-2,000,000 U may be administered. A neurosurgical operation in the preceding 10 days is still considered an absolute contraindication to thrombolysis. Patient outcome in the case of cardiopulmonary resuscitation for massive pulmonary embolism may be improved by the bolus application of 2-3,000,000 U of urokinase. In addition or alternatively, mechanical thrombus fragmentation via catheter or surgical embolectomy may be used in certain hospitals.

Angiography, Digital Subtraction↗
PubMed1994

[Prevention of infections caused by intravascular catheters--a review of the literature].

OBJECTIVE: The literature on catheter-related infections was reviewed to discuss appropriate strategies for the prevention of infections related to intravenous catheters. DATA SOURCES AND SELECTION CRITERIA: The data bases Medline, Biosis and Embase (publication years 1988 to June 1993) were used to retrieve all articles with the key words catheter and infection. Papers covering infections related to intravenous catheters were included. Furthermore, landmark articles from previous years were selected. Only a selected number of articles was listed in the References. RESULTS: Most authors stress the importance of strict aseptic precautions in the management of intravenous lines and the need for dedicated, specialized care of intravascular devices. Quantitative culture of catheter segments and molecular subtyping of microorganisms provide new insights into the pathogenesis and diagnosis of catheter-related infections and enable the evaluation of preventive measures. Technological advances in manufacturing catheter polymers with anti-infective properties will facilitate a reduction in the incidence of catheter-related infections to a greater extent than with any other methods used to date. CONCLUSION: Prevention of catheter-related infections is based on the care of these devices according to strict hygienic standards. In the near future, modification of plastic polymers with anti-infective properties will allow for a further reduction in these infections.

Asepsis↗
PubMed1993

Prevention of catheter-related infections by antiseptic bonding.

A novel catheter pretreated with the antiseptics chlorhexidine and silver-sulfadiazine, designed to reduce catheter-related colonization and infection, was tested in both in vitro and in vivo studies. In vitro experiments demonstrated the long-lasting antibacterial properties of this catheter. For the in vivo study a total of 40 rats divided into different experimental groups were used. Colonization rates of both antiseptic bonded (AS) and control (C) catheters were assessed either three (-3) or seven (-7) days after implantation and local challenge using live Staphylococcus epidermidis ATCC 35984 with 10(7) colony-forming units (cfu) per inoculum. At the time of removal, catheters, organ specimens, and blood samples were taken for cultivation. Significant reductions in the magnitude of colonization of the antiseptic catheters by the test organism were observed in all groups. The average number of cfu colonizing control segments exceeded those found on the treated catheter segments by log 3 (C3/AS3) and log 5 (C7/AS7), respectively (C3: 1.2 x 10(6) +/- 4.1 x 10(5) cfu/segment and AS3: 1.8 x 10(3) +/- 6.6 x 10(2); C7: 2.7 x 10(5) +/- 8.6 x 10(4) and AS7: 1.1 +/- 0.7; mean +/- standard error of the mean, all differences between matching groups statistically significant, Wilcoxon rank sum test, P < 0.0001). These data suggest that antiseptic catheters may substantially decrease the magnitude of catheter-related microbial colonization and subsequent catheter-related infections and may offer a more effective alternative to current methods.

Animals↗
PubMed1993

[Anesthesia and intensive therapy in autonomic dysfunction].

Familial dysautonomia (Riley-Day syndrome) is a rare genetic disorder that is transmitted via an autosomal recessive gene. The disease, typically involving Jewish children, affects the central nervous system and can be characterised by pathological deficits in peripheral autonomic and sensory neurones. The signs, which begin in early childhood, include poor perception of pain and temperature, poor co-ordination of muscles, emotional crises with hypertension and profound sweating, postural hypotension, and excessive vagal reflexes. We present the case of a 1.5-year-old child who underwent general anaesthesia for gastrostomy and fundoplication because of chronic aspiration. The technique consisted of balanced anaesthesia with invasive monitoring: intra-arterial line, central venous catheter, pulse oximetry, capnography, and monitoring of urinary output, temperature, and metabolic changes. Pulmonary problems included a dramatic decrease in SaO2 during intubation, massive bronchial secretions, and a high fluid requirement. The haemodynamic parameters remained stable. In the postoperative period, pulmonary problems included severe pneumonia with variable pulmonary shunting and requiring an inspired oxygen fraction of between 0.5 and 1.0, accompanied by bronchoconstriction, atelectasis, and profuse bronchial secretions. Controlled ventilation had to be maintained for 4 days. The cardiovascular system was unstable with intermittent episodes of bradycardia, tachycardia, and hypo- or hypertension. The patient also showed signs of autonomic crises, which were treated with diazepam. Although patients with autonomic dysfunction are at high risk in the perioperative period, they can be managed safely when therapeutic efforts are optimised.

Anesthesia, General↗
PubMed1992

[Surfactant administration in acute respiratory failure].

We report the case of a 21-year-old man who developed adult respiratory distress syndrome (ARDS) after severe lung contusion due to a car accident. At the scene of the accident the patient was awake and oriented, but there were signs of hypoxaemia (SaO2 by pulse oximetry: 86%). The trachea was intubated in the emergency room and, after diagnosis of multiple rib fractures on the right side (the patient nos. 4-11) and emergency treatment, was extubated 16 h later. During spontaneous breathing there was no improvement of pulmonary function, and the patient was transferred to the intensive care unit 5 days later and reintubated because of acute respiratory failure. He then developed the signs of severe ARDS. No improvement occurred during conventional ventilatory treatment including inversed-ratio ventilation, high-frequency ventilation, and ventilation via a double-lumen tube. On day 15 a bovine surfactant preparation (38 mg/kg body wt.) was instilled into both lungs. Initially there was deterioration of the pulmonary function, probably due to crusts in the bronchial mucous membrane. After aspiration of the crusts at bronchoscopy, there was progressive respiratory improvement. The inspired oxygen concentration and PEEP level could be reduced, and the ventilatory ratio normalised within 14 days. This therapeutic intervention improved pulmonary function and probably led to the successful outcome after 36 days of ventilatory support.

Accidents, Traffic↗
PubMed1992

[Acute jugular engorgement in liver transplantation].

A 56-year-old patient with chronic liver failure underwent liver transplantation; a Denver shunt had been placed 6 months previously. Following an initially uneventful operative course, during fashioning of the proximal caval anastomosis in the anhepatic phase, the patient developed very marked jugular engorgement. The central venous pressure rose to 45 mmHg and this lasted some 15 min. With the opening of the venous anastomosis and placement of the liver in its anatomical site, the central venous pressure returned to normal values once again. It can be concluded that during fashioning of the anastomosis, both the right atrium and distal superior vena cava were obstructed. While normally not haemodynamically significant, in this case, however, the superior vena cava became more narrow by the routinely placed venous lines and the Denver shunt. This in turn, gave rise to this particular clinical manifestation.

Acute Disease↗
PubMed1992

[Cognitive and psychomotor performance following isoflurane, midazolam/alfentanil and propofol anesthesia. A comparative study].

Mental and psychomotor abilities are impaired to varying degrees after general anaesthesia. This has important implications for the time over which patients are monitored in the recovery room and for the discharge of outpatients after day surgery. The present study was undertaken to compare recovery and mental and psychomotor skills in the first 60 min following general anaesthesia with isoflurane, midazolam/alfentanil and propofol. METHODS. A total of 45 patients undergoing microsurgical lumbar nucleotomy were randomized to three study groups. Group 1 (n = 15): anaesthesia was induced with thiopentone and maintained with isoflurane; group 2 (n = 15): anaesthesia was induced with midazolam and maintained with alfentanil; group 3 (n = 15): anaesthesia was induced and maintained with propofol. Vecuronium was used for muscle relaxation and the lungs were ventilated with a mixture of 66% nitrous oxide in oxygen. The following were checked 15, 30, 45, and 60 min after extubation: choice reaction times and critical flicker fusion for psychomotor testing; the maze test and a modification of the ball-bearing test for discrimination of motor and mental activities; and short- and long-term memory. RESULTS. Immediate recovery did not differ in the three different groups. In all patients psychomotor function was impaired compared with baseline for more than 60 min after general anaesthesia. However, impairment was significantly less pronounced after propofol, and recovery to preanaesthesia values was faster following propofol than after midazolam/alfentanil, and slowest after isoflurane-anaesthesia (Figs. 1, 2). The flicker fusion frequency, a very sensitive parameter for the persisting effects of anaesthetics, was significantly higher following propofol anaesthesia and remained so throughout the entire study period (Fig. 3). By 30 min after extubation, short-term memory was already normal in patients who had undergone propofol anaesthesia, and a statistically significant difference from the midazolam/alfentanil and isoflurane anaesthesia groups was obvious throughout the entire study period. However, no differences in long-term memory were found. At 30 min after propofol anaesthesia all patients were able to perform the ball-bearing test, as against 13 patients following midazolam/alfentanil and 10 patients following isoflurane (Table 3). The maze test was mostly impaired after midazolam/alfentanil anaesthesia. Patients who underwent isoflurane anaesthesia needed the same time for the maze test at 60 min afterwards propofol patients needed after 30 min (Table 2). Side effects, e.g., nausea, vomiting, and double vision, were observed significantly more often in groups 1 and 2 (Table 4). DISCUSSION AND CONCLUSION. The results indicate that in operations of approximately 90 min duration the return of motor and mental abilities is faster following propofol anaesthesia. At 30 min after extubation following propofol anaesthesia patients had test results that allow their transfer from the recovery room, while it took 60 min for patients in the two other groups to reach the same levels of motor and mental function. This is important for the duration of monitoring in the recovery room and, especially, for day case anaesthesia.

Adult↗