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Biomedical subjects

K Eyrich

Publications and source records attributed to K Eyrich.

At least 19 recordsLinked to original sources
PubMed1992

[Muscular dystrophy as a risk factor in anesthesia].

Three cases of muscular dystrophy are reported on (8 years, 4 months, 10 months) in which serious conditions arose under anaesthetic (bradycardia, asystolia, hyperkalemia, rising CPK). In the first two cases there was no way of avoiding a fatal outcome, but in the third case the child survived with no permanent damage. The cause of incidents of this kind is discussed first as being hyperkalemia due to acute rhabdomyolysis, and secondly malign hyperthermia. There were no indications of malign hyperthermia in this case. It is hardly possible to distinguish this in an acute clinical ward, as the clinical symptoms are very similar. If it is known that muscular dystrophy is present, depolarising relaxants should be given sparingly. This also applies, as the first case shows, for muscular dystrophy of the Becker type, which can on the whole be regarded as benign in comparison with progressive muscular dystrophy of the Duchenne type. In this instance a forensic and anaesthetic expert's opinion even had to be produced at the request of the Public Prosecutor. The post mortem was carried out under the heading of a possible "mistaken medical treatment" but there was no evidence to justify such an assumption.

Anesthesia, General↗
PubMed1991

[The status of anesthesiology in Berlin].

At present in West Berlin hospitals (whether university, state run or private) almost 450 anaesthesiologists carry out 140,000 anaesthesias of all types a year through their individual anaesthesiology institutes with their corresponding head physicians. The specialist portion with a variation between almost 0 and 100% is on average 45%. The state run anaesthesiological care is supplemented by established anaesthesiologists in private practice or group-clinics. Operative intensive care lies largely in the hands of anaesthesiologists, as does to some extent--particularly in smaller hospitals--the care of conservative intensive care patients. Intensive care and likewise anaesthesiology for serious burns is carried out in a special department at "Urban Hospital". In contrast to days gone by, increasing numbers of anaesthesiologists are now involved in emergency medicine, frequently working on prominent joint projects together with internist colleagues. A rescue helicopter authorized for West Berlin is based at University Clinic Steglitz. Pain management is practised at only a few hospitals. In the entire area under review, a substantial deficit exists in this field, a deficit which would be quickly eliminated, despite substantial administration and emotional difficulties. Not unproblematic is the insufficient number of nursing personnel. Here again deficits exist with regard to equipment and the filling of vacancies.

Anesthesiology↗
PubMed1990

[Alcohol withdrawal syndrome in the postoperative phase--therapy or prevention?].

In a prospective study 50 patients who reported regular ethanol consumption and who underwent neck dissection were evaluated by clinical examination and the Munich alcohol test (MALT). 31 patients were not classified as alcohol abusers and none of them developed withdrawal symptoms (WS) postoperatively. 19 patients were diagnosed as alcohol abusers; 9 of them (group 1) received symptomatic therapy with clomethiazol and haloperidol, 10 patients (group 2) received continuous ethanol infusions (2-4 g/h) postoperatively as prophylaxis for WS. 6 patients in group 1 developed WS; none of group 2 developed WS. Thus the period of intensive care therapy of group 2 was significantly shorter (3.0 versus 11.5 days). It was concluded that postoperative continuous ethanol infusions prevent the occurrence of WS and should be administered to severely alcoholic patients.

Alcohol Withdrawal Delirium↗
PubMed1990

[Long-term antidepressive medication-- an increased anesthetic risk?].

Antidepressants inhibit the re-uptake of norepinephrine at the monoaminergic synapse from the synaptic fissure, leading in this way to an increased sensitivity to catecholamines. In addition, antidepressants have alpha1-, H1- and H2-receptor blocking effects and also anticholinergic effects; the tricyclic antidepressants in particular are known for these properties. A few animal experiments and some case reports indicate that a long-term treatment with these substances can lead to intra-operative blood pressure fluctuations, tachycardia and arrhythmias. Therefore a number of authors recommend that antidepressants be withdrawn 3 days before a planned operation. In view of the pharmacokinetics of these substances and the long-term adapting processes at the monoaminergic synapse this period is certainly too short to achieve complete loss of effectiveness. Other authors think preoperative withdrawal is not indicated if there is careful intraoperative monitoring. We agree with the latter opinion. Inhalation anesthesia with isoflurane or enflurane should be preferred. The muscle relaxant pancuronium should not be used, and exogenous intake of catecholamines should be avoided. Opiates seem to have a positive effect on cardiac stability. Benzodiazepines show the least interactions with antidepressants and are therefore recommended for premedication. In the postoperative period the possibility of an anticholinergic syndrome has to be considered.

Anesthesia↗
PubMed1989

[The effect of pre-oxygenation on hemodynamics and oxygen consumption].

Pre-oxygenation is routinely used prior to anesthesia and intubation. In awake, premedicated patients scheduled for major aortic surgery we assessed the effects of breathing oxygen for 10 min via a loosely fitting face mask on hemodynamics and oxygen consumption (VO2). RESULTS. O2-breathing increased arterial PO2 to 51 +/- 13 kPa and decreased VO2 from 109 +/- 18 to 92 +/- 24 ml.min-1.m-2 (P less than 0.001 for both variables). This reduction of VO2 resulted from both a fall in cardiac index from 3.22 +/- 0.67 to 3.04 +/- 0.75 1.min-1/m-2 (P less than 0.05) and a decrease in arterio-venous oxygen content difference from 3.45 +/- 0.60 to 3.03 +/- 0.57 ml/dl (P less than 0.001). Systemic peripheral vascular resistance increased slightly from 1453 +/- 359 to 1538 +/- 383 dyne.s.cm-5.m-2 (P less than 0.05). CONCLUSIONS. These results indicate that an increase in F1O2 in patients without severe limitations of oxygen uptake by the lungs or oxygen transport to the tissues does not improve tissue oxygenation. We speculate that increased peripheral shunting acts to protect tissue PO2 during high arterial PO2 levels.

Aorta, Abdominal↗
PubMed1989

Effects of thoracic epidural anesthesia on systemic hemodynamic function and systemic oxygen supply-demand relationship.

The effects of thoracic epidural anesthesia (TEA) on total body oxygen supply-demand ratio are complex due to potential influences on both O2 delivery (QO2) and consumption (VO2). One hundred and five patients undergoing abdominal aortic surgery were randomly assigned to one of three groups to compare the cardiovascular and metabolic responses associated with (1) thoracic epidural anesthesia plus light general anesthesia (group TEA); (2) general anesthesia with halothane (group H); and (3) neuroleptanalgesia (group NLA). Values of cardiac index (CI) and QO2 were less intraoperatively in the TEA group than in the H or NLA groups, while VO2 values were similar. VO2 during recovery was greater in both the TEA and NLA groups than in the H group. Consequently the oxygen supply-demand ratio (QO2/VO2) was less in the TEA group throughout the perioperative period and about 30% below baseline values during early recovery. At comparable VO2, CI and mixed venous O2 saturation were always less in the TEA group than in the NLA group. Heart rate was slowest intraoperatively during TEA, and stroke work was less with TEA than with NLA. As cardiac filling pressure and systemic vascular resistance did not differ among the three groups, reduced adaptation of CI to tissue O2 needs during TEA was attributed to negative inotropic and chronotropic effects of the sympathetic blockade. We conclude that in patients undergoing abdominal aortic surgery, TEA has no apparent advantage over general anesthesia.

Anesthesia, Epidural↗
PubMed1989

[Catheter induced rupture of a proximal pulmonary artery caused by vigorous coughing in a spontaneously breathing patient].

A complication is occurred during insertion of a pulmonary artery catheter in a 73-year-old woman with class III NYHA cardiac failure. After easy insertion of the catheter, massive haemoptysis developed as the patient coughed while the balloon of the catheter was inflated. Despite prompt emergency measures, the patient did not survive. Autopsy revealed a 2.7-cm perforation of the proximal pulmonary artery with penetration into the right lower lobe bronchus. This complication and its prevention are discussed.

Aged↗
PubMed1985

Comparison of midazolam, diazepam and placebo i.m. as premedication for regional anaesthesia. A randomized double-blind study.

In a randomized double-blind study, midazolam 0.1 mg kg-1 i.m. was compared with diazepam 0.2 mg kg-1 and placebo as premedication for patients undergoing urological interventions under spinal anaesthesia. The sedative and anxiolytic effects of midazolam were evident 5-10 min after administration, and were maximum between 30 and 90 min. After this, rapid recovery was observed. More than 90% of the patients receiving midazolam were totally or partially amnesic for the procedures in the induction room and the operation theatre. Amnesia was not seen in the patients receiving diazepam or placebo and, in contrast to midazolam, diazepam had almost no sleep-inducing effect. In a few patients, the depth of sleep achieved with midazolam 0.1 mg kg-1 was such that co-operation was impaired.

Aged↗
PubMed1985

The effect of dopamine on muscle PO2 in healthy volunteers and intensive care patients.

The effect of systemic dopamine administration (2-10 micrograms kg-1 min-1) on the Po2 distribution (histograms) and the mean Po2 in the m. vastus lateralis of m. quadriceps femoris in nine healthy volunteers and seven critically ill patients has been studied with a newly developed bedside measuring procedure. Dopamine initially raised mean muscular Po2 in both groups. In the volunteers, mean muscular Po2 thereafter decreased gradually but still remained slightly elevated after 30 min of dopamine infusion. This increase in muscle oxygenation could be abolished by the administration of a dopamine antagonist (metoclopramide). In the patients, the initial dopamine-induced increase of Po2 was significantly slower and reached a plateau within 30 min. The results are discussed with special attention given to the data available on the action of dopamine on given peripheral circulation.

Critical Care↗
PubMed1983

[Respiratory and sleep-inducing effects of i.m. midazolam as premedication for regional anesthesia. Comparison with diazepam, promethazine/pethidine and placebo].

The effects of respiratory depression and sleep induction produced by 0.1 mg/kg and 0.15 mg/kg of midazolam i.m. were examined in patients in whom urological interventions had to be performed under spinal anesthesia. The same parameters were evaluated for 0.2 mg/kg of diazepam i.m. as well as 50 mg/50 mg of pethidine/promethazine i.m. and placebo i.m. The major difference between 0.1 mg and 0.15 mg/kg body weight of midazolam was a more pronounced PCO2-increase in the group with the higher dosage. Both dosages led to anterograde amnesia in 8 or 9 of 10 patients respectively. No amnesia developed in the control groups. Respiratory depression and sleep induction occurred later with promethazine/pethidine (at 60 min) or diazepam (at 120 min) than with midazolam. Noteworthy in the Diazepam and placebo group was a hyperventilation lasting 60 and 120 min respectively. The arterial PO2 decreased in all groups during the intervention. Under midazolam, the decrease was significantly higher statistically than in the control groups during the first 60 min at both dosages. Premedication with 0.1 mg/kg i.m. of midazolam proved to be sufficient in all patients. The rapid onset of action, the sleep during the intervention and the amnesia associated with it suggest that this form of premedication is more favorable than the other procedures examined. The dosage of 0.15 mg/kg of midazolam proved to be too high: in addition to producing a stronger respiratory depression, it had the effect of rendering cooperation with some patients more difficult.

Aged↗