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Biomedical subjects

N Rolf

Publications and source records attributed to N Rolf.

51 records · Page 3Linked to original sources
PubMed1995

[Inhalation anesthesia and intravenous anesthesia from the medical and economic viewpoint].

The unique pharmacokinetic properties of propofol gave rise to a widespread use of the technique of total intravenous anaesthesia. These properties of propofol are reviewed and compared to those of barbiturates and benzodiazepines. Based on this comparison and with respect to their respective intra- and postoperative effects, a cost-benefit analysis of both inhalational- and intravenous anaesthesia is presented. The choice of an anaesthetic technique must not only be made with regard to medical implications; economical aspects have also to be taken into account without challenge to the quality of care. A consequent use of low-flow techniques and a market oriented purchase of drugs and disposables may allow cost savings in anesthesia.

Anesthesia, General↗
PubMed1991

A single-blind study of combined pulse oximetry and capnography in children.

This single-blind study examined four levels of monitoring in 402 pediatric cases. Patients were randomly assigned to one of four groups: 1) oximeter and capnograph; 2) only oximeter; 3) only capnograph; or 4) neither oximeter nor capnograph data available to the anesthesia team. An anesthesiologist, not involved in patient care, observed all cases and continuously recorded hemoglobin oxygen saturation (Spo2), ECG, expired CO2, and the oximeter plethysmographic output. Mean age, weight, ASA physical status, airway management (mask or endotracheal tube), and anesthetic technique were similar in each group. Two-hundred sixty problems were documented in 153 patients. Fifty-nine events in 43 patients resulted in "major" desaturation (Spo2 less than or equal to 85% for greater than or equal to 30 s). Fifteen "major" capnograph events (esophageal intubation, disconnection, accidental extubation, or obstructed endotracheal tube) were observed in 11 patients; 8 of these also developed varying degrees of desaturation. One-hundred thirty "minor" desaturation events (Spo2 less than or equal to 95% for greater than 60 s) and 79 "minor" desaturation events (hypercarbaria or hypocarbia) were observed. A number of problems fulfilled criteria in multiple categories. Infants less than or equal to 6 months of age had the highest incidence of major desaturation events (18 of 65 [27%]) compared to toddlers 7-24 months of age or children greater than 24 months of age (P less than 0.001). Blinding the oximeter data increased the number of patients (12 vs. 31) experiencing major desaturation events (P = 0.003); blinding the capnograph data altered neither the frequency of desaturation events nor the incidence of major capnograph events.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1991

Persistent cardiac arrhythmias in pediatric patients: effects of age, expired carbon dioxide values, depth of anesthesia, and airway management.

The presence of persistent arrhythmias was correlated with hypercarbia (end-tidal CO2 greater than or equal to 55 mm Hg for greater than or equal to 60 s). A continuous strip chart recording of oxygen saturation, a capnogram, and an electrocardiogram were obtained from 402 children. No episodes of arrhythmia occurred in 153 patients younger than 2 yr compared with 24 patients 2 yr of age or older (P = 0.0001). Older patients whose airways were managed via a mask had a higher incidence (13.2% [21 of 159 patients]) than tracheally intubated patients (3.3% [3 of 90 patients]) (P = 0.01). In older patients whose tracheas were intubated, hypercarbia was associated with arrhythmia in 1 of 20 hypercarbia episodes. Seven of 16 patients with hypercarbia, whose airways were managed via a mask, had an arrhythmia (P = 0.0014); in eight, arrhythmias were associated with light anesthesia; in seven, arrhythmias were not associated with either hypercarbia or light anesthesia. Arrhythmias developed in 13 of 55 patients 2 yr old or older whose airways were managed via a mask and who were undergoing orchiopexy or herniorrhaphy as compared with 1 of 30 tracheally intubated patients (P = 0.016). There was a higher incidence of arrhythmias during halothane anesthesia compared with that during all other techniques (P = 0.035). The authors conclude that the incidence of arrhythmias is extremely low in infants younger than 2 yr. Hypercarbia is associated with arrhythmias in pediatric patients whose airways are managed via a mask but not in patients whose tracheas are intubated.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1990

Results of a long-term administration of omega-3 fatty acids in haemodialysis patients with dyslipoproteinaemia.

In this study we evaluated the effect of a daily administration of 1 g salmon-oil concentrate containing 0.2 g eicosapentaenoic acid (EPA) on the blood pressure, serum cholesterol, HDL and LDL cholesterol, triglycerides and magnesium of ten patients on chronic haemodialysis. Systolic and diastolic blood pressure values decreased significantly from 156 +/- 27.7/84 +/- 14.3 to 140 +/- 22.8/75.6 +/- 8.21 mmHg. Concordantly, mean arterial pressure (MAP) decreased significantly from 108 to 96 mmHg. Total serum cholesterol decreased significantly by 64%, HDL cholesterol increased by 47% (P less than 0.001). Serum triglyceride values decreased significantly to 48%. There was a distinct decline of magnesium from 1.42 +/- 0.27 to 1.28 +/- 0.13 mg/dl (P less than 0.001). According to these results, the administration of omega-3 fatty acids may be considered as a reasonable approach in the treatment of dyslipoproteinaemia in patients on continuous haemodialysis.

Animals↗
PubMed1990

Hemofiltration in myoglobinuric acute renal failure.

The frequency of myoglobinuric renal failure is estimated between 8 and 20%. Despite early onset of therapy often the use of renal substitution by hemodialysis or hemofiltration is required. This study of the clinical course of nine patients with myoglobinuric acute renal failure reveals continuous arterio-venous hemofiltration (CAVH) to have an effective clearance for myoglobin. Thus, the time until recovery of renal function as well as the frequency of secondary complications in rhabdomyolysis induced acute renal failure can be distinctly reduced.

Acute Kidney Injury↗
PubMed1989

[Rare variants and unusual course of Cushing's syndrome].

Cushing's syndrome is a rarely observed disease with a poor prognosis when not treated appropriately. Knowledge of clinical features of the different forms of the disease together with a specific and subtle method of cortisol detection is indispensable for an early out-patient diagnostic program. In this study the characteristic features of the rare benign and malignant forms of Cushing's syndrome are presented in typical case-reports. As it has been proven in clinical experience, the necessary diagnostic measures for clarification of the syndrome consists of only few methods reliable concerning their diagnostic validity. The success of any curative treatment of the benign forms or any palliative measure of the malignant forms essentially depends on early diagnosis and differentiation of the various appearances of Cushing's disease.

Adrenal Gland Diseases↗
PubMed1987

Differences in plasma and tissue aluminum concentrations due to different aluminum-containing drugs in patients with renal insufficiency and with normal renal function.

The gastrointestinal absorption of aluminum from orally administered aluminum-containing drugs is well documented. Retention of the absorbed aluminum leads to elevated levels of this metal in the tissue of patients with renal failure. We studied two groups of dialysis patients who had received equal amounts of the different aluminum-containing phosphate-binders Aludrox and Antiphosphat. It has recently been shown that Antiphosphat releases only a few aluminum ions in an environment of low pH. Consistent with this finding, we found the aluminum levels to be significantly higher in the plasma, bone, and hair of patients who had received Aludrox as phosphate binder. Subjects with normal renal function excreted most of the ingested and absorbed aluminum. No data are available concerning the tissue load of the element in these subjects. We studied two groups of patients with normal renal function who had received antacid drugs prior to neurosurgery on a brain tumor. The first group of patients were treated with an aluminum-rich antacid (Maalox 70); the other group received an aluminum-poor drug (magaldrate) for 10 days prior to the operation. Analysis of the brain-tissue removed revealed twofold higher aluminum levels in the patients who had received Maalox 70. These results indicate that administration of aluminum-containing drugs leads to a tissue load of aluminum in patients with an impaired renal function as well as in those with a normal function. The extent of the aluminum load depends on the aluminum content and the liberation rate of the drug.

Aluminum↗
PubMedDate not supplied

Frequency and severity of desaturation events during general anesthesia in children with and without upper respiratory infections.

STUDY OBJECTIVE: To determine whether anesthesia in the presence of a mild upper respiratory infection (URI) was associated with episodes of desaturation or reactive airway problems. DESIGN: A prospective study. SETTING: Inpatient and outpatient units of a university medical center. PATIENTS: Four hundred two pediatric patients. INTERVENTIONS: Patients were monitored with continuous recordings of oxygen saturation (SpO2), capnography, and electrocardiogram. A separate anesthesiologist was present throughout each case to observe for complications and interview the anesthesia team. The decision to anesthetize patients with a URI was left to the discretion of the anesthesia team. MEASUREMENTS AND MAIN RESULTS: Thirty patients with a URI and 372 patients without one were studied. One hundred ninety-six patients were managed with endotracheal intubation and 206 with face mask; 15 in each group had a URI. There was no increase in major desaturation events (SpO2 of 85% or less for 30 or more seconds) but minor desaturation events (SpO2 of 95% or less for 60 or more seconds) were increased (p = 0.02). There was no increased frequency of laryngospasm (1 in 30 vs. 22 in 372), but there was a higher frequency of bronchospasm in intubated patients (2 in 15 vs. 1 in 181; p = 0.016). CONCLUSIONS: Children with a mild URI have an increased frequency of minor desaturation episodes, and intubated patients with a URI have an increased frequency of bronchospasm. It appears that children with a mild URI may be safely anesthetized, since the problems encountered are generally easily treated and without long-term sequelae.

Anesthesia, General↗
PubMedDate not supplied

Acute ascending motoric paraplegia following intrathecal chemotherapy for treatment of acute lymphoblastic leukemia in children: case reports and review of the literature.

Severe side effects of chemotherapy in pediatric patients with acute lymphoblastic leukemia are rare, but well-known. We present two pediatric patients who developed ascending motoric paraplegia (AMP) following intrathecal chemotherapy. Both patients suffered from progressive weakness of their lower extremities, neurogenic bladder dysfunction, autonomous neural dysregulation and minor sensory deficits. Despite an initially similar clinical picture, progression and outcome were fairly different. There is convincing evidence that AMP is caused by spinal cord toxicity of intrathecally applied toxic agents such as cytarabin and/or methotrexate leading to spinal demyelinisation as demonstrated by elevated myelin basic protein in cerebrospinal fluid.

Acute Disease↗