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Biomedical subjects

R Klose

Publications and source records attributed to R Klose.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Does a cone-shaped cannula needle offer an advantage in spinal anesthesia?].

The so-called atraumatic spinal cannula of Sprotte is a modification of the Whitacre spinal needle. It consists of a conical tip with a lateral opening. This cannula (24 G) is said to cause a very low incidence of postspinal headache. In a prospective study, it was compared to a 25 G cannula with a Quincke tip. PATIENTS AND METHOD. The study was carried out on 500 patients who received spinal anesthesia for operations on the lower extremities. The cannulas were randomly assigned to the patients. Puncture characteristics and number of incomplete blocks were evaluated. Postoperatively patients were interviewed on days 1, 3, 5, and 7. Neither the subjects nor the investigator were aware of the type of cannula used. RESULTS. There were no differences with regard to age and sex; 80% of the patients ranged between 15 and 55 years, with a homogeneous spread. Performance of the block was superior with the Sprotte cannula and the incidence of incomplete blocks was lower (1.6% vs 7.8%, P = 0.0011). There was no significant difference with regard to postspinal headache (8.2% vs 7.8%). CONCLUSIONS. The atraumatic cannula had better puncture characteristics, but there was no statistically significant difference with regard to postspinal headaches.

Adolescent↗
PubMed1990

[Problems of intubation using the flexible LF-1 fiberoptic bronchoscope. Development of an intubation aid].

Fiberoptic endotracheal intubation with an endoscope (external diameter 4 mm) especially designed for anesthesiologists proved to be safe providing small-diameter tubes were used. The use of large-diameter tubes (I.D. 7.5-8.5 (mm)) involves a risk of the tip of the tube clinging to the arytenoid cartilages preventing any further advancement. To avoid this complication another special tube has been constructed, which fills the space between the endotracheal tube and the bronchoscope and centers the bronchoscope within the endotracheal tube. When this new tube was used there were no problems either in passing the bronchoscope through this "inner" tube or in withdrawing the inner tube after successful intubation. With the new device it was even possible to pass tubes with wider lumen into the trachea over the fiberscope with minimal difficulty and trauma.

Bronchoscopes↗
PubMed1989

[Continuous axillary catheter plexus anesthesia--a method of postoperative analgesia and sympathetic nerve block following hand surgery].

During a period of one year (March 1985 to March 1986) 52 axillary brachial plexus catheters were left in place for two to twelve days. The main indications were postoperative analgesia and sympatholysis after microvascular surgery of the hand. With the continuous infusion of 0.25% or 0.375% bupivacaine, 6-8 ml/h a sufficient effect was seen. There was no evidence of accumulation of the administered drug after a prolonged period of infusion. A steady state of serum levels built up in the range between 0.5 to 1.5 micrograms/ml. There were no toxic side effects by the local anaesthetic agent. In one case an infection of the axillary region developed, which disappeared after removal of the catheter without any consequences. In summary the continuous axillary brachial plexus block is an acceptable method for intra and postoperative analgesia and sympatholysis in microvascular surgery of the hand.

Autonomic Nerve Block↗
PubMed1988

[Axillary blockade of the brachial plexus. A prospective evaluation of 1133 cases of plexus catheter anesthesia].

UNLABELLED: The results of 1133 axillary catheter brachial blocks are reported. Effectiveness and side-effects were monitored in a prospective manner over a period of 1 year. METHOD: The puncture was performed with an 18-gauge plastic cannula fitted with a solid steel stylet. The stylet has a 45 degrees, short bevel with rounded edges. When puncturing the axillary neurovascular sheath, no attempt was made to elicit paresthesias with the needle. A distinct "click" and very easy advancement of the plastic cannula were signs of being well inside the neurovascular sheath. To confirm the correct positioning, 0.5-3 ml refrigerated saline solution were injected. If no paresthesias could be produced, a new puncture was performed using a nerve stimulator. The plastic cannula was fixed to the skin. For long-lasting operations or if postoperative analgesia or sympatholysis was required, a more flexible catheter was introduced through the plastic cannula. As an initial dose 40 ml 1% mepivacaine was injected via the cannula. If there was an insufficient block after 20 min, another 20 ml 1% mepivacaine was given. For long-lasting operations, 40 ml 1% mepivacaine was injected every 2 h. RESULTS: Surgery was completed in 72% of patients; 24% required some form of supplementation including 17.2% of patients who received a "top-up" after 20 min (Table 1). In 3.8% of cases the technique was considered to be a complete failure, meaning that patients needed some type of general anesthesia including the use of i.v. ketamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Axilla↗
PubMed1987

Evidence against increased glomerular pressure initiating diabetic nephropathy.

Studies were carried out to determine whether exaggerated glomerular hydraulic pressure (PG) initiates the development of glomerular pathology and proteinuria in insulin-dependent diabetic rats. Normotensive (WKY) and hypertensive rats (SHR) were made diabetic by streptozotocin injection. One group of SHR diabetic rats was treated with antihypertensive drugs to reduce blood pressure. One week after onset of diabetes, micropuncture determinations of PG, measured by stopped-flow technique, revealed that PG was higher in WKY diabetics than in non-diabetic WKY controls, and that PG was even higher in SHR diabetics (P less than 0.05). Similarly prepared groups of animals were followed for six months, approximately one fifth to one third of the expected life span of these rats. Tail systolic blood-pressure measurements documented continuous severe systolic-hypertension in SHR diabetics, normal pressure in the WKY diabetics and hypotension in the SHR diabetics treated continuously with antihypertensive drugs. Urinary protein excretion, measured monthly, was statistically the same in all groups, with no evidence of a progressive rise in the SHR diabetics. PG measured in two rats from each group after four months of diabetes was similar to values found after one week of diabetes. Semiquantitative histologic scoring of glomerular mesangial expansion after six months of diabetes failed to demonstrate any significant difference between the normotensive WKY diabetics and the hypertensive SHR diabetics. These observations suggest that elevated PG does not in itself initiate glomerular pathology or proteinuria in diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

[Effect of 10% hydroxyethyl starch 200/0.5 and 10% dextran 40 on the flow property and coagulation of whole blood in vivo].

In randomized order 18 hypovolemic patients undergoing minor surgery received either 500 ml of 10% dextran 40 (n = 8) or 500 ml of 10% hydroxyethylstarch 200/0.5 (n = 10) preoperatively. There were no significant changes in hemoglobin, hematocrit, colloid osmotic pressure, total serum protein, platelet count, platelet aggregation and hemostatic tests. The shear dependent viscosity of whole blood was determined at the relevant range of 1.24-91.0 s-1. Both colloids cause a marked decrease of whole blood viscosity, which is detectable at low shear rates still 24 h later. Plasma viscosity shows no changes in either group. The criteria for preferring one of the colloids for decreasing the blood viscosity will depend on the incidence and severity of undesired adverse reactions.

Adult↗
PubMed1987

[Contusion of the heart].

Whereas heart contusion can be identified by autopsy as a traumatic damage to the heart, clinical diagnosis during life is mostly made by exclusion only and subsequently, the more so since there is no absolutely reliable parameter that permits diagnosis ad hoc. Complications often develop only hours or days after the accident. Heart contusion can be masked by haemorrhagic-traumatic shock and accompanying injuries and delay its diagnosis. Traumatic damage to the myocardium can equal a myocardial infarction. Hence, it is imperative that persons injured in an accident who are suspected of having suffered a contusion of the heart, are placed in an intensive-care ward to recognise complications well in time and to institute therapeutic measures without delay. As is the case with acute myocardial infarction, anaesthesia and surgery can be performed only in case of a vital indication.

Arrhythmias, Cardiac↗
PubMed1987

[Comparative study of 1% prilocaine and 1% mepivacaine in axillary plexus anesthesia].

In a randomized double-blind study, the latency period and spread of axillary brachial plexus block using 40 ml mepivacaine hydrochloride (1% solution), or prilocaine (1% solution) was studied in 60 patients scheduled for surgery of the hand and forearm regions. The sensory block of the axillary, musculocutaneus, radial, median, ulnar and medial brachial cutaneous nerves was recorded using the pin-prick test every 5 min after injection and the motor block was assessed by testing the power of the corresponding muscles up to 30 min after injection. The degree of intraoperative analgesia attained was also determined. The venous methemoglobin level was determined before and 2 h after the administration of the local anesthetic agent. The development of sensory blockade was significantly faster after 10 min and 15 min in the radial nerve, and the development of motor blockade after 15 min and 20 min in the axillary nerve, using mepivacaine. After 30 min, there were no significant differences in the degree of sensory or motor block attained between the two groups. Intraoperative analgesia was attained in 27 patients of the mepivacaine group, versus 23 patients of the prilocaine group (NS). The methemoglobin level was always elevated following prilocaine, but not following mepivacaine. Two patients had an increase of the methemoglobin concentration to more than 11% after the administration of prilocaine. Neither the higher toxicity to the central nervous and cardiovascular systems from mepivacaine, nor the methemoglobin formed by prilocaine seems to be of clinical significance with the dosage and technique employed.

Anesthesia, Local↗
PubMed1986

[Comparison of the effect and serum level of mepivacaine HCL and mepivacaine CO2 in axillary brachial plexus anesthesia].

The latency period and spread of axillary plexus block using 40 ml mepivacaine carbonate (1% solution) or mepivacaine hydrochloride was studied in thirty patients scheduled for surgery of the hand-forearm region. The sensory block of the nervus axillaris, musculocutaneus, radialis, medianus, ulnaris and cutaneus brachii medialis was recorded using the pin prick test every 4 min after injection and the motor block was assessed by testing the strength of the corresponding muscles. The only significant difference between the two local anaesthetic solutions was a few more frequent and faster anaesthesia of the nervus musculocutaneus after 16, 20 and 24 min. A comparison between the serum levels of the first five patients of each group showed a faster increase and a higher level after the injection of carbonated mepivacaine. Carbonated mepivacaine doesn't have any practical advantage for axillary plexus block.

Anesthesia, Conduction↗
PubMed1986

[Mepivacaine in brachial plexus anesthesia in surgical interventions of long duration].

To evaluate the use of mepivacaine-HCl for continuous axillary brachial plexus block for surgery lasting several hours a prospective study was performed. Mepivacaine-HCl 400 mg was injected every two hours. Over a period of eight to twenty hours there was in all cases adequate analgesia and muscle relaxation for microsurgical repair of limbs. Mean serum levels of mepivacaine-HCl did not exceed the concentration of 5-6 micrograms/ml. There were no side effects caused by the local anaesthetic agent.

Anesthesia, Conduction↗
PubMed1984

[Peculiarities of anesthesia in severely burned patients].

The main problem of anaesthesia for necrectomy and grafting is the correct evaluation of blood loss. Intensive monitoring enables one to avoid major complications. One has to have at least two venous lines of large calibre. Loss of volume is substituted by packed erythrocytes, fresh frozen plasma, warm whole blood and crystalloids. No particular type of anaesthesia is to be preferred. One should avoid depolarizing muscle relaxants between 5 to 90 days after the burn. Because of the possibility of microstomia and contractures the anaesthetist should be familiar with the technique of bronchofiberscope intubation.

Anesthesia, General↗
PubMed1984

Proximal tubular Na, Cl, and HCO3 reabsorption and renal oxygen consumption.

The majority of the oxygen consumed by the rat kidney appears to occur in the proximal tubule. Therefore changes in metabolically linked ion transport in this segment of the nephron should result in changes in renal oxygen consumption. To study the role of bicarbonate reabsorption in metabolically linked proximal tubular ion transport a series of micropuncture-clearance-extraction experiments were performed comparing the effects of the carbonic anhydrase inhibitor benzolamide and of hypertonic sodium bicarbonate infusion with control conditions in the rat. End-proximal tubular fluid and chloride reabsorption were measured. From these, the rates of sodium and bicarbonate reabsorption were estimated. Simultaneously with the tubular fluids, extraction collections were obtained for determination of renal oxygen consumption. Both benzolamide and hypertonic bicarbonate reduced proximal tubular fluid reabsorption while concomitantly reducing the transepithelial gradient for chloride. The mean rate of renal oxygen consumption did not differ from the control rate in either experimental group and could be dissociated from the calculated net rates of proximal tubular sodium, chloride, and bicarbonate reabsorption. We interpret these data as evidence that proximal tubular hydrogen ion secretion supporting bicarbonate reabsorption requires at most small amounts of oxidative energy, less than detectable by these techniques. The data, in contrast, support the conclusion that the chloride-bicarbonate transepithelial gradient appears to be an important passive driving force in vivo for proximal tubular fluid reabsorption.

Animals↗
PubMed1983

Evidence for PAH extraction from superficial cortical efferent vessel plasma.

Consistent with its anatomical association with the proximal tubule we have previously shown that superficial cortical efferent vessel blood contains an admixture of early and late proximal tubular reabsorbate. Since tubular secretion of p-aminohippurate (PAH) occurs predominantly in the late proximal tubule, extraction of this compound should occur preferentially from efferent vessel blood. As a result, the midportion of the proximal convoluted tubule supplied by the more downstream peritubular capillaries would receive blood containing a disproportionately reduced concentration of PAH. To study this, proximal and distal tubular fluid and efferent vessel blood samples were collected from rats. The data confirm that preferential secretion of PAH occurs in the pars recta and demonstrate that PAH is extracted from efferent vessel plasma by the pars recta. This in turn preferentially reduces PAH concentration in early postglomerular blood before it reaches the peritubular capillary network. We speculate that PAH and similar substances secreted by the pars recta are short-circuited by rapid extraction from early postglomerular blood, reducing their delivery to the mid-proximal convoluted tubule. Such circumstances must be considered in any analysis of organic compound secretion by the in vivo proximal tubule.

Aminohippuric Acids↗
PubMed1983

[Effects of positive end-expiratory pressure (PEEP) or prolonged inspiration time on lung mechanics, gas exchange and hemodynamics in differential pulmonary ventilation].

In the case of patients with unilateral lung disorders one must anticipate a further increase in the intake volume of the more elastic lung and a decrease in intake volume of the less elastic lung when the inspiratory pressure is increased or the inspiratory time is extended within the framework of mechanical ventilation. Therefore, differential pulmonary ventilation lends itself for the treatment of unilateral damage of the lung by enabling the selective application of a positive end-expiratory pressure or an inverse inspiratory time. For a better understanding of the overlapping pathophysiologic reactions, the changes in lung mechanics, haemodynamics and gas exchange were measured on the healthy lung with unilateral application of a positive and expiratory pressure or an increased inspiratory time. Thirteen male and female patients, who had to undergo intracranial surgery were ventilated with two synchronized servoventilators using a Carlens tube. The positive end expiratory pressure varied in the right lung in spans of 6 cm each, 0-12 cm H2O, inspiratory time varied 34-70%. The left lung was ventilated with a 35% inspiratory time and an end expiratory pressure of 0. The respiratory intake volume was divided up into 45% (left lung) and 55% (right lung) based on the physiological difference in size between the left and right lung. Our results show that a directed unilateral application of a positive end expiratory pressure or an increased inspiratory time does not have any relevant damaging effects on the other lung. It can be expected that in the case of non-differentiated mechanical ventilation the ensuing unequal distribution of alveolar ventilation and perfusion with consecutive increase of intrapulmonary shunt volume can be decreased by the discriminate treatment of each lung.

Adult↗
PubMed1982

Evidence for an osmotic effect of glucose in the in vivo rat proximal tubule.

A series of micropuncture experiments were performed to assess whether phlorizin inhibition of proximal tubular glucose reabsorption inhibits proximal tubular fluid reabsorption due to a change in the transepithelial osmotic gradient for glucose. End proximal tubular filtrate reabsorption was measured, control vs experimental, in the same rat. The effects of infusing phlorizin in one group were compared to those of graded small infusions of mannitol in a second group of rats. In the phlorizin series tubular fluid and peripheral plasma were analyzed for glucose. Net renal sodium and renal oxygen consumption were measured in these same rats. In the mannitol series tubular fluid and peripheral plasma mannitol concentrations were determined. The results show that phlorizin inhibits proximal tubular fluid and glucose reabsorption without changing renal oxygen consumption. Mannitol inhibits proximal fluid reabsorption per unit transepithelial concentration difference to the same extent as does glucose during phlorizin infusion. We interpret these data as most consistent with the conclusion that the reduction in proximal tubular fluid reabsorption during phlorizin infusion is primarily due to the resultant change in the effective transepithelial osmotic gradient for glucose. Normally this gradient favors net fluid reabsorption. During phlorizin it favors retention of fluid in the proximal tubular lumen.

Animals↗
PubMed1982

[The influence of buprenorphine and tramadol on the postoperative CO2 response after general anaesthesia (author's transl)].

The degree of respiratory depression caused by buprenorphine and tramadol were studied in two groups of 25 patients each by means of Read's re-breathing technique. The estimations were made during the immediate postoperative stage in order to include potential residual effects of the general anaesthesia. The slope of the CO2 curve as a measure of respiratory depression decreased by 27 per cent after administration of 0.3 mg of buprenorphine, a reduction which equals that produced by potent morphine-type analgesics. The response to 50 mg of tramadol was a non-significant decrease by 3 per cent. At doses mentioned buprenorphine produced reliable pain relief, whereas with tramadol the failure rate was 28 per cent. There was no difference between the two drugs in respect of circulatory reactions and side-effects. Despite its depressing effect on the respiration (an action it shares with all potent analgesics) buprenorphine is a very useful analgesic because it provides excellent pain relief, has no or only minimal addictive properties and is not subject to the Dangerous Drugs Act.

Analgesia↗
PubMed1982

[Experimental studies on the intracranial pressure increase by ketamine in haemorrhagic shock (author's transl)].

In 12 normocapnic ventilated dogs the intracranial pressure (ICP) was increased 3-4 fold by distension of the balloon of a Foley catheter (imitating a space occupying lesion). Thereafter a shock state (aortic pressure PsA 80 mm Hg) over 20 min was induced by arterial bleeding. ICP and more pronounced cerebral perfusion pressure (CPP) decreased. Injection of Ketamine 0.5 mg/kg b.w. was followed by a transient increase of PsA (mean 10 mm Hg), ICP (mean 2,6 mm Hg) and cerebral perfusion pressure (mean 3,9 mm Hg). After ketamine 5.0 mg/kg v.w. PsA, ICP and CPP decreased. Retransfusion of the withdrawn blood volume (44 ml/kg b.w.) caused a significant increase of PsA, ICP and CPP to near control levels. A further increase of PsA, ICP and especially CPP was seen after ketamine 1,0 mg/kg b.w. Based on this study it should be possible to use ketamine in small dose for induction of anaesthesia in the emergency of haemorrhagic shock even in head injury patients with increased ICP. There is no further serious increase in ICP.

Animals↗