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J Obwegeser

Publications and source records attributed to J Obwegeser.

6 recordsLinked to original sources
PubMed2002

Evaluation of remifentanil as single drug for awake fiberoptic intubation.

BACKGROUND: Awake fiberoptic intubation is the standard of care for difficult airway management. Quality and success of this technique depend on the experience of the intubating physician and the proper preparation of the patient. The aim of this study was to compare remifentanil (R) as single agent to the combination of fentanyl (F) and midazolam (M), which have been the drugs for analgesia and sedation for this procedure. METHODS: Seventy-four adult patients requiring nasotracheal intubation were randomly assigned to one of two groups. In group I, (n=37) R was administered in incremental dosages (0.1-0.25-0.5 microg/kg/min) by an infusion pump according to comfort, level of sedation and respiratory depression. In group II, (n=37) analgesia and sedation was achieved by F 1.5 microg/kg and doses of between 1 and 10 mg M, titrated to the individual needs. Patient reactions like grimacing, movement and coughing during intubation were assessed, as well as patient recall of the procedure. Haemodynamic and respiratory parameters were continuously recorded. RESULTS: Group I patients better tolerated nasal tube passage (P<0.001) and laryngeal tube advancement (P<0.001) than group II. Remifentanil better suppressed hemodynamic response to nasal intubation (P<0.001). No significant difference in respiratory data was recorded. In group I more recall of the procedure was observed (six vs. zero patients, P<0.05). CONCLUSION: Remifentanil in high doses, as the single agent for patient preparation for awake fiberoptic intubation seems to improve intubating conditions, quality and reliability of the procedure. However, a higher incidence of recall is to be expected.

Adjuvants, Anesthesia↗
PubMed2002

Use of remifentanil for awake fiberoptic intubation in a morbidly obese patient with severe inflammation of the neck.

Impending upper airway obstruction due to odontogenic facial and cervical spreading infection is a potential fatal situation that requires urgent treatment. In particular, securing the threatened airway is a priority and a precondition to the pressing need for surgery. The best approach to establish the difficult airway is awake fiberoptic intubation or scheduled tracheotomy under local anesthesia. We report a critical case of severe swelling of the neck in a morbidly obese patient with no alternative to awake fiberoptic intubation. The primary goals of optimal safety for the patient and appropriate intubating conditions for the anesthesiologist made us to consider a new method of patient medication.

Airway Obstruction↗
PubMed1989

Clinical efficacy of amoxycillin/clavulanate in laparoscopically confirmed salpingitis.

To test the efficacy and safety of amoxycillin/clavulanate (Augmentin), 102 hospital patients with laparoscopically confirmed acute salpingitis were treated with parenteral amoxycillin/clavulanate (1.2 g qid for three days) followed by oral amoxycillin/clavulanate (two tablets of 625 mg tid for a further six days). Bacteriological samples were obtained from the cervix uteri and the pouch of Douglas. One hundred patients were assessable for clinical outcome using several variables including pain scores. Amoxycillin/clavulanate alone was effective in 95 patients (95%). Three patients (3%) responded to amoxycillin/clavulanate with marked improvement but another antibiotic was subsequently added to their treatment regimen. Treatment failed in two patients. At follow-up two weeks after hospital discharge, three patients (3.8%) had relapsed or were re-infected. Adverse drug events included one case of drug fever, one case of rash and one case of severe diarrhoea. Treatment was stopped in all three cases. Gastrointestinal reactions, mainly mild diarrhoea, were seen in 31 patients. No clinically relevant changes in haematological or clinical chemical indices were attributable to the amoxycillin/clavulanate treatment. We conclude that amoxycillin/clavulanate is a clinically effective and safe treatment for acute salpingitis.

Acute Disease↗
PubMed1984

[Unrecognized malignant lymphomas simulating a primary gynecologic malignancy].

The discovery of a so far unknown lymphoma in the female genital tract is rare. According to Chorlton et al., malignant lymphoma manifests itself primarily in the ovary and uterus in 0.3% and 0.12% of cases respectively. Four personally observed cases are reported with special emphasis on the clinical and histological difficulties encountered in the diagnosis of this rare clinical picture. After analysis of data in the literature, an attempt is made to define criteria, which should lead clinicians and pathologists to consider the possibility of such an event. Women of all age groups may be affected. Malignant lymphoma occurring primarily in the uterus usually mimics infiltrative carcinoma of the cervix causing vaginal discharge and post-coital bleeding. There are no specific symptoms. The presence of an undifferentiated round-cell tumor which is difficult to classify histologically and develops rapidly should suggest the possibility of malignant lymphoma. When the primary manifestation is an ovarian tumor, the lesion is bilateral in about 55% of cases. The presence of ascites is very rarely reported. In most cases these tumors are histologically misdiagnosed primarily as granulosa cell tumors, dysgerminomas or undifferentiated carcinomas. The diffuse and poorly differentiated lymphocytic type is most frequently encountered in adults. In children, granulocytic sarcoma or so-called chloroma may be found. In the presence of bilateral ovarian tumor without ascites and displaying unclear histological features in frozen sections, the possibility of malignant lymphoma should always be considered. In such cases it is advisable to process some of the tumor tissue for special subsequent morphologic and/or immunologic investigations.

Adolescent↗