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Biomedical subjects

J Seebacher

Publications and source records attributed to J Seebacher.

34 records · Page 2Linked to original sources
PubMed1989

[Cicatricial uteri. Vaginal delivery under peridural analgesia].

The results of 108 attempts to deliver women who had previously had caesarean sections vaginally under epidural analgesia are studied. 94 patients (87%) delivered vaginally taking the usual length of time for dilatation and delivery. These confirm that epidural analgesia does not alter the prognosis for this type of delivery. However, one uterus unfortunately ruptured with the rapid death of the baby. This study makes it possible to define certain rules that should be carried out to lessen or even get rid completely of the risk of these accidents. As far as the anaesthetic is concerned, epidural analgesia should be carried out and watched very carefully. Small doses of anesthetics should be used and those in low concentrations. Symmetry analgesia should be good. Medics should be aware of the cumulative effect of adding dose on dose. Finally, morphine or morphine-like substances should either be used carefully or forbidden altogether. These precautions will limit the quantities of epidural analgesics that are delivered and assure that there is symmetry so that it is easier to recognize the signs before rupture of the uterus. As far as the obstetrical side is concerned, although we did not use oxytocics very often (37%) we did not find that there was any risk attached to it. We recommend, however, that internal monitoring should be carried out very often whether oxytocics are used or not. Routinely, instruments should be used for the delivery to lessen the efforts required to expel the baby. Exploring the cavity of the uterus after the delivery does not seem to us to be necessary unless there are the usual obstetric indications for doing this.

Adult↗
PubMed1986

[Noninvasive diagnosis of deep venous thromboses by Doppler ultrasound].

A Duplex ultrasound technique combining real time ultrasound B imaging with pulsed Doppler investigation was used for non-invasive exploration of peripheral venous trunks. A series of 72 patients (21 men and 51 women including 26 pregnant women) was investigated by the examination of deep venous trunks of upper limbs (68 cases) and of lower limbs (4 cases). Lesions were identified in 19 cases (26%), including 9 total thrombosis, 6 partial thrombosis, 3 sequelae of a previous thrombosis and 1 case of valve incontinence. Morphologic (caliber, wall, intraluminal echos) and functional (expansion, flow rate, compression) features establishing diagnosis are discussed. Phlebography findings in 8 of the 15 cases of thrombosis (total or partial) provided very satisfactor correlation, clinical correlation being considered sufficient in the other cases. This duplex technique is a reliable, reproducible and non-invasive method for diagnosis and for follow up of medical treatment of thrombophlebitis.

Arm↗
PubMed1978

[The use of Marcaine in obstetrical analgesia].

Bupivacaine (Marcaine) is being used increasingly in obstetrics for epidural analgesia, by virtue of the good sensory block obtained and the minimum of side-effects on the mother and newborn infant. At a concentration of less than 0.5 p. 100, analgesia is excellent with a minimal effect on motor fibres. Side-effects and toxicity are limited by the use of fractionated doses from the beginning of labour or of a single dose during or at the end of labour calculated in relation to the effect sought. Any action on the newborn infant would appear to be exceptional, if dose recommendations are respected, the high percentage of Marcaine bound to proteins limiting its transplacental passage.

Anesthesia, Epidural↗
PubMed1975

Cannulation of the proximal aorta during long-term membrane lung perfusion.

Prolonged extracorporeal oxygenator support for acute respiratory failure is a clinical reality. Recent experience with 4 patients has demonstrated an advantage in delivery of saturated blood to the root of the aorta during venoarterial (VA) bypass. We have been able to perfuse the heart and bilateral cerebral hemispheres by advancing the tip of a large perfusion cannula to the aortic root from the common femoral artery. When the catheter did not pass beyond the transverse aortic arch, there was marked asymmetry of oxygenator perfusion, as determined by differential oxygen tension in right and left radial artery blood and by xenon-133 scans following isotope injection into the arterial return line. Long-term VA bypass lasting from 5 to 11 days resulted in long-term survival in 2 patients with post-traumatic gram-negative pneumonitis. The other patients, who had viral pneumonitis and post-transfusion respiratory failure, died after 9 and 11 days of membrane oxygenator support. No embolic lesions or arterial or valvular injuries were discovered at autopsy. This is a safe and useful method of providing oxygenated blood to the aortic root for equal distribution to the rest of the body.

Adult↗
PubMed1975

[Drugs most frequently used during pregnancy and labor and their effects].

It is rather difficult to draw up a list of the drugs most frequently used during pregnancy, and to specify their action on the mother, the uterus ans the fetus bearing in mind the differences between them. This difficulty results in particular from the high number of drugs owing to: the frequency of prescriptions and selfmedication in the pregnant woman who suffers from numerous disorders, and the possibility of a pathology associated with the pregnancy or a pathology due to the pregnancy itself thereby defining the "high risk" pregnancy. On this background already modified by pregnancy, under the hold of numerous drugs, an anesthetic can be necessary in addition during labour or delivery, the frequency of which can be estimated as being approximately 20 per cent. It is not possible to study all therapeutic agents in a single communication. One can only evoke the influence of the most currently used drugs; analgesics, antibiotics, diuretics, sleeping tablets, anti-hypertensives and those aimed at the neuropsychiatric system (anti-depression agents, neuroleptics, tranquillizers) which are so frequently used at present. Finally, during labour the number of parturients who receive no drugs is rare: ocytocic and anti-spasmodic agents can also interfere with an anesthetic. All of these ideas which are more and more difficult to acquire are important to know. In fact the person in charge of the delivery must prescribe as little drugs as possible (in order to avoid multiple drug interference which is rather difficult to predict) knowing the possible action of drugs on the fetus (in order to allow best adaptation to life in our atmosphere after delivery) and foreseeing the possible necessity for an anesthetic. In his turn, the anesthetist should have a good knowledge of obstetrical physiology and pathology and the drugs capable of being used during pregnancy and labour in order to be able to choose the best adapted anesthetic. This emphasized the importance of a well integrated obstetrico-anesthetic team in which each member knows the problems of the other, with the aim of being the least possible noxious for the mother, and the future newborn, the fetus. This also emphasizes the necessity for anesthetists attached to the ostetrical unit, knowing like the obstetrician the histories of those women with "high risk" pregnancies. Obstetrical anesthetics cannot be improvised.

Analgesics↗