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Biomedical subjects

M Fischler

Publications and source records attributed to M Fischler.

At least 91 records · Page 5Linked to original sources
PubMed1985

Pharmacokinetics of phenoperidine in anaesthetized patients undergoing general surgery.

The pharmacokinetics of phenoperidine have been studied in five anaesthetized patients receiving a 2-mg bolus dose i.v. Plasma concentrations were measured using a sensitive radioimmunoassay method. The distribution of phenoperidine was described according to a two-compartment open model. The mean distribution half-life (T1/2 alpha) for the five patients was short (2.2 min); the mean elimination half-life (T1/2 beta) was 193 min. The mean whole body clearance was 22 ml min-1 kg-1 and the apparent steady state distribution volume (VSS) was 5.7 litre kg-1. Secondary concentration peaks occurred in all patients; in two patients these were substantial and occurred 80 min after injection.

Anesthesia, General↗
PubMed1985

Pharmacokinetics of phenoperidine in patients undergoing cardiopulmonary bypass.

Phenoperidine concentrations were studied, using radioimmunoassay, in five patients submitted to coronary artery bypass graft surgery. Administration of phenoperidine consisted of a 5-mg bolus dose followed by constant infusion of 5 mg h-1. Before cardiopulmonary bypass, phenoperidine concentrations were stable in an individual patient, but there was a large scatter between patients. The concentrations decreased immediately following the start of the bypass, but this decrease was short. During cardiopulmonary bypass, the phenoperidine concentrations increased progressively and were greater at the end of the bypass than before it. The increase in concentration continued following the discontinuation of bypass. The ratios of change of the observed results were in accord with a theoretical evaluation, although the observed concentrations were all greater than those calculated, except at one point. This difference in phenoperidine concentration is probably related to an alteration of liver plasma flow. Haemodilution as a result of the priming of the cardiopulmonary bypass circuit played only a transient role.

Adult↗
PubMed1985

Hypertensive responses during operation for phaeochromocytoma: a study of plasma catecholamine and haemodynamic changes.

Virtually all patients undergoing resection of a phaeochromocytoma exhibit hypertensive crises at some period perioperatively. In order to study the events associated with hypertensive responses, cardiovascular variables were measured with a Swan-Ganz pulmonary artery catheter and plasma catecholamine levels were determined simultaneously in eight patients during surgery for phaeochromocytoma. Hypertensive responses requiring vasodilator treatment occurred in five patients, i.e. systolic blood pressure (BP) greater than 200 mmHg for more than 1 min. Transient elevation, at least in systolic BP, to greater than 200 mmHg occurred in all patients. Hypertensive responses were identified associated with two circumstances: the first in association with noxious stimuli, i.e. intubation, skin incision, etc., but were not generally accompanied by an elevation in plasma noradrenaline and adrenaline levels; the second occurring during tumour manipulation were more severe and were always accompanied by elevated plasma noradrenaline and adrenaline levels. Transient left ventricular dysfunction, defined by increased pulmonary capillary wedge pressure (PCWP) and decreased cardiac index (CI) secondary to a marked increase in systemic vascular resistance (SVR), was observed in four patients during palpation of the tumour, while one patient exhibited more marked and prolonged ventricular dysfunction. It is concluded that hypertensive responses associated with noxious stimuli may be controlled with deep anaesthesia while those due to tumour manipulation cannot be prevented and are best treated with vasodilators.

Adrenal Gland Neoplasms↗
PubMed1984

[Loss of consciousness during benign intracranial hypertension. Correlations between cerebrospinal fluid pressure and the electroencephalogram].

A patient with benign intracranial hypertension developed paroxysmal attacks of falling due to loss of consciousness. Prolonged simultaneous recordings of CSF pressure, through a lumbar needle, and of EEG showed that these episodes resulted from bouts of elevation of CSF pressure (120 mm Hg systolic pressure). The pathophysiology of the increased pressure waves, described as Lundberg 's A waves or plateau waves, is discussed. The analogy between EEG records and those observed in normal subjects during Valsalva's manoeuvre is a further argument in favor of cerebral anoxia during the increased pressure plateau, this being apparently the explanation for the clinical disorders.

Electroencephalography↗
PubMed1984

[Exercise test under catheterization in mitral stenosis].

The sensitivity of basal hemodynamic data and the value of those observed during exercise in the diagnosis of severe mitral stenosis (MS) were investigated by comparing the results under basal conditions and during dynamic exercise with the operative findings in 55 patients with pure MS, aged between 18 and 73 years (average, 43 years), 29 with mild stenosis (Group I) and 26 with severe stenosis (Group II). Under basal conditions, mean pulmonary capillary pressure (PCP) was significantly higher in Group II than in Group I (15.7 +/- 4.4 mm Hg compared to 12.2 +/- 3.5 mm Hg, p less than 0.01). The same difference was observed in mean pulmonary arterial pressure: Group I, 18.2 +/- 5.4 mm Hg; Group II: 23.0 +/- 6.1 mm Hg, p less than 0.01; but cardiac and systolic indices were comparable in the two groups. On exercise, only PCP (Group I: 29.6 +/- 6.8; Group II: 34.7 +/- 4.9 mm Hg) and systolic index (Group I: 39.9 +/- 10.0; Group II: 33.4 +/- 8.2 ml/m2) were significantly different (p less than 0.01). Pulmonary capillary and arterial pressures rose in the same proportion in the two groups on exercise but systolic index fell in severe MS (-4 p. 100) and rose in mild MS (+30 p. 100) (p less than 0.001). The formulae for calculating mitral valve surface area only give discriminating results between the two groups when the hemodynamic data on exercise are used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

High frequency jet ventilation v. manual jet ventilation during bronchoscopy in patients with tracheo-bronchial stenosis.

Six patients with airway stenosis were submitted to bronchoscopy under general anaesthesia. Each was ventilated with a gas mixture of 50% oxygen and nitrogen using successively manual jet insufflation (JV) using the Sanders technique at 20 b.p.m., and high frequency jet ventilation (HFJV) at rates of 150, 300 and 500 b.p.m. The effects on alveolar ventilation were assessed by blood-gas analysis and the transcutaneous monitoring of carbon dioxide tension. It is concluded that HFJV achieves satisfactory operating conditions, and provides adequate gas exchanges up to a rate of 300 b.p.m. At the faster rate some degree of hypoxaemia and hypercarbia were noted. The correlation between PaCO2 and transcutaneous carbon dioxide tension was satisfactory.

Anesthesia, General↗
PubMed1983

Manual jet ventilation v. high frequency jet ventilation during laser resection of tracheo-bronchial stenosis.

Manual jet ventilation (20 b.p.m.) and high frequency jet ventilation (300 b.p.m.) were compared during laser resection of tracheo-bronchial stenosis under general anaesthesia. Both methods provided similar blood-gas tensions at the 10th min of surgery in patients with tracheal stenosis. In patients with bronchial stenosis high frequency jet ventilation resulted in modest hypercarbia and manual jet ventilation appeared to be the preferred method in these particular patients.

Anesthesia, General↗
PubMed1983

[Hemodynamic characteristics of aortic insufficiencies].

The surgical indications in aortic regurgitation (AR) depend on the functional performances of the left ventricle (LV) and its reactions to the chronic volume overload. The relation between patient symptomatology and the hemodynamic data in isolated chronic AR were studied by correlating parameters obtained at catheterisation and biplane left cineventriculography under basal conditions and post-extrasystolic potentialisation (PEP) with the NYHA functional classification of 51 patients with AR. Fifteen patients were in Class I, 26 in Class II, 10 in Class III and none in Class IV. The mean regurgitant fraction (0,55 +/- 0,15), cardiac index (3,1 +/- 0,7 1/min/m2) and left ventricular end diastolic pressure (LVEDP) (14 +/- 7 mmHg) were comparable in the 3 classes of patients. Three significant differences were observed between Class I and Class III: --The LV ejection fraction was significantly lower (I = 0,53 +/- 0,13; II = 0,50 +/- 0,39; III = 0,42 +/- 0,17, p less than 0,04). --The LV end systolic volume was significantly higher (I = 88 +/- 48; II = 90 +/- 31; III = 138 +/- 68 ml/m2, p less than 0,02). --The myocardial mass was significantly greater (I = 168 +/- 57; II = 204 +/- 94; III = 291 +/- 128 g/m2, p less than 0,003). Under basal conditions, this was the only parameter distinguishing asymptomatic from symptomatic AR. The increase in LV ejection fraction during PEP was similar in all 3 groups, as was the increase in LVEDP (+36 p. 100). The LV systolic pressure of the potentialised complex was the only parameter which distinguished Class I and Class III patients.

Aortic Valve Insufficiency↗
PubMed1981

[Relationship between symptoms and hemodynamics in aortic insufficiency (author's transl)].

To determine the relationship between functional classes (NYHA) and hemodynamics in patients (pts) with chronic aortic insufficiency, indices of left ventricular (LV) function derived from hemodynamic and biplane left cineventriculographic data were compared with the clinical status in 51 AI pts, including 15 pts in class I, 26 pts in class II and 10 pts in class III. Regurgitant fraction (0.55 +/- 0.15 mean +/- SD), cardiac index (3.1 +/- 0.7 l/mn/m2) and LV end-diastolic pressure (14 +/- 7 mmHg) were of the same order of magnitude in 3 classes patients. A significant correlation was evidenced between functional classes and 1/LV ejection fraction (0.53 +/- 0.13, 0.50 +/- 0.39, 0.42 +/- 0.17 in class I, II, III pts, respectively, p less than 0.04), 2/LV end-systolic volume (88 +/- 48, 90 +/- 31, 138 +/- 68 ml/m2 in class I, II and III pts, respectively p less than 0.02), 3/ and LV mass (168 +/- 57, 204 +/- 94, 291 +/- 128 g/m2 in class I, II and III pts respectively, p less than 0.003). Only the latter parameter could discriminate symptomatic from asymptomatic AI pts.

Adult↗