Search PubMed⌕ Search

Biomedical subjects

S Kleinschmidt

Publications and source records attributed to S Kleinschmidt.

16 recordsLinked to original sources
PubMed1997

The addition of clonidine to prilocaine for intravenous regional anaesthesia.

The effect of the addition of clonidine 2 micrograms kg-1 to prilocaine 0.5% for intravenous regional anaesthesia (IVRA) in the arm was investigated in 56 healthy patients using a randomized, double-blind study. The characteristics of the sensory and motor block, quality of analgesia, development of post-operative pain sensations and haemodynamic variables were studied in three groups (IVRA with prilocaine, IVRA with prilocaine and clonidine, IVRA with prilocaine and systemic application of clonidine at tourniquet release). There were no significant differences between the groups concerning the onset and recovery characteristics of sensory and motor blockade, post-operative pain or side effects. In those patients receiving clonidine, mean arterial pressure decreased significantly (24-28%, respectively) after tourniquet release, while heart rate remained unchanged. Clonidine as an adjunct to prilocaine seems to be of limited benefit during and after intravenous regional anaesthesia.

Adrenergic alpha-Agonists↗
PubMed1996

Prospective study of hand-sutured anastomosis after colorectal resection.

A total of 370 patients underwent colorectal resection: 320 had a primary single-layer seromucosal anastomosis without a protective colostomy, 22 had Hartmann's procedure and 28 abdominoperineal resection. There were 260 elective procedures and 110 patients had peritonitis and/or bowel obstruction at the time of surgery. Overall the mortality rate was 2.7 per cent, the morbidity rate was 18.3 per cent and clinical anastomotic leak rate 3.4 per cent. After elective operation, the leak rate for intraperitoneal anastomosis was 0.6 per cent and for low extraperitoneal anastomosis 7 per cent. The mortality rate was 1.2 per cent and morbidity rate 11.9 per cent. Patients with peritonitis had a significant increase in morbidity rate (46 per cent) in comparison with those having elective surgery (chi 2 = 31.5, 1 d.f., P < 0.0001). Patients who had bowel obstruction and no bowel preparation had a significantly higher morbidity rate of 26 per cent and mortality rate of 7 per cent, compared with those having an elective procedure (chi 2 = 11.2, 1 d.f., P < 0.001; chi 2 = 8.7, 1 d.f., P < 0.005 respectively). Patients having palliative surgery had the highest mortality rate (19 per cent), compared with those operated on with curative intent (1.5 per cent) (chi 2 = 28.7, 1 d.f., P < 0.0001). Cost-saving hand-sutured anastomosis is effective and, in experienced hands, technically feasible after all kinds of colorectal resection and should remain the standard in colorectal surgery.

Adult↗
PubMed1996

[Accuracy of measurement and overestimation of CO2 of two capnometers intended for potential use in emergency medicine].

UNLABELLED: Capnometry, the noninvasive measurement of end-expiratory CO2 concentration (cCO2, vol%) or calculation of its respective partial pressure (pCO2; mmHg) is an established method. However, for prehospital settings, capnometry is still used very restrictively, mainly owing to the respective devices used. The prerequisite for their use is sufficient accuracy (+/-2 mmHg) and easy handling. Two special capnometers (STAT CAP. Nellcor: mainstream, semiquantitative estimation; Capnocheck 8200, BCI: sidestream, quantitative measurement, numeric display), developed recently for potential use in emergency medicine, are said to fit these criteria. Therefore, the objective of the present investigation was to assess the accuracy and precision of both devices, comparing methods under standardized in vitro (reference gases) and in vivo (intubated and ventilated patients) conditions. METHODS: Both devices ("STAT CAP": pCO2 range, light bars; "Capnocheck 8200") were evaluated regarding the accuracy of pCO2 (Capnocheck) and the precision of the CO2 range (STAT CAP). Tests were performed with four dry gas mixtures (STPD) of defined composition and during ventilation of 20 intubated patients (BTPS). All measurements were compared with the alveolar gas monitor "AGM 1304" (Brüel & Kjaer, Denmark) as a reference method with a proven +/- 1 mmHg accuracy of pCO2 measurement. RESULTS: The "Capnocheck" (BCI) presented an accuracy of the pregiven pCO2 of 0.7-1.4 mmHg (dry gas mixtures, STPD) and an overestimation of 0.2 +/- 4.1 mmHg (BTPS) during ventilation with pure oxygen; inaccuracy during ventilation with 70% N2O in O2 proved to be + 1.2 +/- 1.7 mmHg (BTPS). Nellcor's "STAT CAP" failed to reach the target value in 10% of analyses, as shown by the respective segment bar of the display. CONCLUSION: Evaluation of the accuracy of capnometers must focus on the necessary pH2O correction and the possible effects exercised by O2 (and N2O) as well as the possible dependence on barometric pressure (if pCO2, mmHg, is the desired value). The "Capnocheck" showed an accuracy of more than 2 mmHg in dry gas mixtures as well as in humidified air. Concerning the practical use during constant artificial ventilation, the digital display and accuracy of the sidestream capnometer allow for reliable conclusions on patients' ventilation and circulation (CO2 elimination). The 90% accuracy of the segment bar display of Nellcor's "STAT CAP", per se covering only a rather broad range of 20 mmHg, obviously does not provide more than a rough overview. Therefore, the STAT CAP cannot be recommended for prehospital capnometry in the field. However, both the accuracy of the BCI capnometer (Capnocheck) and its numeric display and easy handling strongly recommend this device also for clinical use.

Blood Gas Analysis↗
PubMed1996

Cardiovascular effects of desflurane and isoflurane in patients with coronary artery disease.

BACKGROUND: Anaesthesia in patients with ischaemic heart disease may cause adverse haemodynamic reactions. This investigation compares the cardiovascular effects of equipotent concentrations of desflurane and isoflurane in 30 patients (ASA III) with coronary artery disease before surgical stimulation. METHODS: After standardised induction of anaesthesia with etomidate, fentanyl and pancuronium and tracheal intubation patients randomly received either desflurane (group I, n = 15) or isoflurane (group II, n = 15) in slowly increasing concentrations. ST-segment analysis and haemodynamic measurements were performed at 0.25, 0.5, 0.75 and 1.0 MAC of desflurane or isoflurane. RESULTS: Cardiac index did not change significantly in the two groups during the administration of the inhalational anaesthetics. Desflurane and isoflurane both caused a dose-dependent significant decrease of mean arterial blood pressure (group I: -16%; group II: -18%). As with isoflurane, the decrease of mean arterial pressure produced by desflurane primarily resulted from a decrease in systemic vascular resistance (group I: -26%, group II: -21%). Central venous pressure was not affected by the two volatile anaesthetics. Pulmonary artery pressure and pulmonary capillary wedge pressure remained unchanged during the administration of isoflurane, but in contrast both parameters significantly increased in patients receiving desflurane (PAP 24%, PCWP 40%). ST-segment analysis provided no signs of myocardial ischaemia. CONCLUSION: The results of this study demonstrate that in patients with coronary artery disease the haemodynamic effects of equipotent concentrations of desflurane and isoflurane are similar except for a significant increase in PAP and PCWP caused by desflurane. Therefore, desflurane should be administered with great caution if it is used as an alternative anaesthetic in patients with ischaemic heart disease.

Adult↗
PubMed1996

The Bland-White-Garland syndrome. Clinical picture and anaesthesiological management.

We report a five-month-old infant with an impaired left ventricular ejection fraction as a result of Bland-White-Garland-syndrome (BWGS). Total intravenous anaesthesia with fentanyl and midazolam was used as the anaesthetic technique. After aortic reimplantation of the left coronary artery, weaning from cardiopulmonary bypass (CPB) was prolonged and was only successfully managed with high dose noradrenaline, dopamine and dobutamine. Persistent myocardial dysfunction led to prolonged intensive care treatment. Seven months after surgery, left ventricular function and clinical condition have improved significantly.

Adrenergic alpha-Agonists↗
PubMed1995

[Controlled hypotension].

Induced hypotension is defined as a reduction in mean arterial blood pressure to 50-60 mm Hg in normotensive subjects. The aim of induced hypotension is to decrease intraoperative blood loss, decrease the need for blood transfusions and improve operating conditions. Most studies indicate that induced hypotension can decrease intraoperative blood loss by 50% in many surgical procedures; however, some studies report that blood loss is not significantly reduced. Current methods of induced hypotension are based on the use of rapid and short-acting vasodilators as primary agents (nitroprusside, nitroglycerine, urapidil), supplemented by volatile anesthetics (isoflurane) and/or beta-blockers (esmolol) to improve effect, reduce dosage and prevent side effects (reflex tachycardia, tachyphylaxis, rebound hypertension). Proper positioning of the patient and controlled ventilation aid in reducing blood loss. Major risks of induced hypotension are a reduction in blood flow (i.e. ischaemia) of vital organs (brain, myocardium) and elevation of intracranial pressure in neurosurgical patients. Thus, major contraindications of induced hypotension are severe coronary artery disease, hypertension combined with arteriosclerosis of cerebral vessels and increased intracranial pressure in patients with cerebral disease. Complications are rare in otherwise healthy patients, but may be higher in elderly patients and those with underlying organ dysfunction. Therefore, careful assessment and selection of patients, together with consideration of the potential complications, appropriate choice of drugs and invasive beat-by-beat monitoring, are essential for the safe practice of induced hypotension.

Anesthesia↗
PubMed1995

[Gamma-hydroxybutyric acid--significance for anesthesia and intensive care medicine?].

Gamma-hydroxybutyric acid (GHB) as a natural component of the mammalian brain was first introduced in clinical anaesthetic practice more than 30 years ago. Although GHB induced a reliable state of sedation and anaesthesia without depressing either respiratory or cardiocirculatory parameters or liver and kidney function, the drug was nearly displaced from clinical practice because of its prolonged duration of action. The results of recent clinical studies indicate a re-evaluation of GHB in emergency and critical care medicine. GHB is regarded as a natural neuronal transmitter with circuits which synthesise, accumulate and release GHB. Specific binding sites have also been demonstrated and identified. GHB is completely metabolized in the liver to the natural substrates carbon dioxide and water without accumulation in central or peripheral tissues. The reduction of energy metabolism and its possible properties as an "oxygen radical scavenger" may be of therapeutic benefit if tissues are exposed to hypoxia or reperfusion. Therefore, the application of GHB seems to be of advantage in states of traumatic brain injury with cerebral oedema or ischaemic lesions of brain or extraneural tissues. In hypovolaemic states or in patients with impaired cardiovascular function, the pressure effects of GHB may be beneficial for the prevention of tissue damage and may improve survival in the case of cardiocirculatory resuscitation. In the intensive care unit, GHB might be a favourable alternative to established sedative agents. Occurrence of side effects such as tolerance and withdrawal syndromes after the application of sedative drugs, an impaired metabolism with the accumulation of metabolites in the case of liver or kidney dysfunction as well as an insufficient regulation of natural sleep may be diminished by the application of GHB. The results of various clinical studies also suggest that GHB may be useful in the treatment of alcohol and opiate withdrawal syndrome. However, further studies are necessary to specify the proposed indications of GHB in anaesthesiology and critical care medicine.

Anesthesia, Intravenous↗
PubMed1995

[Psychiatric diagnosis in general practice. ICD 10-Primary Health Care].

Along with Chapter V (F) of ICD-10 (International Classification of Diseases, 10th Revision) the WHO (World Health Organisation) developed a number of diagnostic instruments for different purposes. The ICD-10-PHC (Primary Health Care) is a short classification system which is to be used in general practice and primary health care. This system is tested in a worldwide field trial. The ICD-10-PHC and the study design in German-speaking countries are described in the following paper. First results of the field trial in Lübeck show that the OFFeral conception of the system was assessed useful (72%). The ease of the diagnostic process was assessed "easy" (30.4%) or "moderate" (47.6%). Between 23% and 34% of the participants of the field trial had proposals for changes. The results show that the ICD-10-PHC can hopefully lead to better standards in the treatment of psychiatric patients in primary care.

Attitude of Health Personnel↗
PubMed1995

Heparin-associated thrombocytopenia (HAT)--still a diagnostic and therapeutical problem in clinical practice.

Type II of heparin-associated thrombocytopenia (HAT) is well known, but the cardinal symptom, thrombocytopenia, is rarely adequately considered. Serious and potential lethal complications such as pulmonary embolism, cerebral stroke, or limb gangrene are often falsely regarded as insufficient anticoagulation. Guided diagnosis and therapy are of vital importance for the patient's outcome. Based on the experience of patients with HAT Type II treated in the intensive care unit, a diagnostic and therapeutic approach to the cardinal symptom thrombocytopenia is presented. A recently developed heparin-induced platelet activation assay (HIPAA) seems to be a highly sensitive laboratory test. The first therapeutic principle in case of presumed and diagnosed HAT is the cessation of unfractioned or low-molecular-weight heparins. ORG 10172 (Orgaran), a low-sulfated heparinoid with a low cross-reactivity (10%) to heparins, can be regarded as the most effective anticoagulant in patients with HAT Type II.

Adult↗
PubMed1994

[Clinical aspects, analysis and follow-up of poisoning with the alkyl phosphate demeton-S-methylsulfoxide (Metasystox R)].

UNLABELLED: We report on a 52-year old woman who had taken an unknown dose of the organophosphate insecticide Metasystox R with suicidal intention. Ingestion was followed by cardio-respiratory failure. After successful cardio-pulmonary resuscitation, main therapeutic principles were the immediate application of atropine and decontamination procedures such as gastric lavage, induction of diarrhoea and instillation of carbon. A single combined haemoperfusion and haemodialysis treatment was performed as a secondary elimination technique. After rapid toxicological analysis, obidoxime was administered as a supplementary antidote. After 14 days of treatment, the patient could leave the ICU with a complete restitution. CONCLUSION: Our case report demonstrates the efficiency of immediate application of antidotal therapy (atropine), decontamination and elimination techniques even in case of cardio- respiratory failure after organophosphate poisoning. Toxicological analysis will be beneficial for diagnosis and the indication of further treatment with obidoxime.

Atropine↗
PubMed1994

[Importance of proximal femoral fractures in elderly patients. Results of a prospective study of 61 patients].

In a prospective study we found good results concerning postoperative complications (21%), perioperative lethality (3.2%) and lethality during hospital stay (6.5%) after implantation of dynamic hip screws (DHS) in patients with per- and subtrochanteric fractures of the femur. The ability to walk, as well as housing and social care postoperatively and follow-up for at least six months after dismissal demonstrates the importance of these fractures for the elderly. One of three patients needs professional care, 21% at home, 13% in nursing homes. Six months after operation the lethality is nearly 20%, i.e. three times higher than in hospital. These are the essential data for all techniques of osteosynthesis used in patients with these fractures, which could only be documented in prospective studies.

Aged↗
PubMed1993

[Septic-toxic heart failure as a result of a heparin-induced thrombocytopenia with "white-clot-syndrome"].

A patient is presented who developed pulmonary artery embolism and thrombocytopenia with various arterial clots several days after an ankle joint osteosynthesis, which finally caused the amputation of the right arm. Unfractionated heparin was applied for the prevention of postoperative thrombosis. Obviously as a consequence of the liberation of toxic metabolites from the gangrenous lower arm, the patient developed septic shock which was exacerbated by a severe pneumonia caused by methicillin-resistant S. aureus bacteria (MRSA). Laboratory investigations showed an antibody (IgG) induced thrombopenia mediated by all low molecular weight and unfractionated heparins. By eliminating heparin and further treatment with a low molecular weight heparinoid (ORG 10,172), platelet count rose sufficiently and thrombotic process ceased completely. Septic shock was successfully treated by fluid replacement, antibiotics and inotropic substances.

Adult↗
PubMed1993

[The effect of intermittent prone position on pulmonary gas exchange in acute lung failure].

In a clinical trial, the influence of repeated intermittent prone position on pulmonary gas exchange was investigated in 6 patients with severe ARDS. Despite various intra- and interindividual differences, oxygenation index (calculated by the paO2:FiO2 ratio) was improved significantly by change from supine to prone position in the first two days of treatment, whereas paCO2 remained unchanged. Later on, a significant improvement of oxygenation could not be verified. In patients with proven or presumed densities of dorsal lung regions, body position changes from supine to prone position in the early phase of treatment may improve arterial oxygenation and may be regarded as a therapeutic principle in conventional ARDS treatment.

Adult↗
PubMed1991

[Comparative studies of atracurium and vecuronium for medium-length surgical procedures in infants and young children].

Onset time, intubation condition and recovery time after single bolus injection of atracurium (0.3 mg/kg in body weight less than 10 kg (Group 1), 0.5 mg/kg in body weight greater than 10 kg (Group 2] and vecuronium (0.05 mg/kg in body weight less than 10 kg (Group 3), 0.1 mg/kg in body weight greater than 10 kg (Group 4] were studied in 40 infants and children anaesthetised with halothane. At the end of the onset time (time from the end of the bolus injection of the muscle relaxant until the maximal twitch depression of the m. adductor pollicis) the intubation conditions were judged as good or very good in both groups. The onset time after bolus injection of atracurium (92.5 +/- 31.9 sec in Group 1, 117.0 +/- 25.2 sec in Group 2) was slightly shorter than after vecuronium (135.7 +/- 64.1 sec in Group 3, 123.3 +/- 26.8 sec in Group 4). The duration from the time of injection to 75% recovery of T1 had been longer by using atracurium (45.2 min in Group 1 + 2) than by vecuronium (36.6 min in Group 3, 34.2 min in Group 4). In infants (Group 1 + 3) the recovery time (duration from 25% to 75% recovery of control twitch height) after relaxation with atracurium as well as vecuronium was longer than in children (Group 2 + 4). Neither cardiovascular side effects nor signs of histamine release occurred after the injection of both muscle relaxants at our dosage level. It is concluded that in infants and children atracurium is a real alternative to vecuronium for relaxation for medium long surgical procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗
PubMed1989

[Effect of demographic changes on the case rate and days of care for hospitalized internal medicine patients].

Using case categories at the Center for Internal Medicine of the Medical University at Lübeck and predictions of future population trends by the German Federal Statistical Office, likely future numbers of inpatients and days of hospital stay were calculated. Assuming other conditions remaining constant, an annual rise of 0.9% of medical cases is to be expected until the year 2005. An increase above this average is expected for cases of cardiovascular and respiratory disease and of malignant neoplasms, while it will be below average for renal or gastrointestinal diseases. These data are similar to comparable projections made, on the basis of Federal statistics, of hospital cases registered with local health insurance schemes. In addition they indicate an increase of 3% for all non-paediatric admissions up to 2005.

Age Factors↗