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U Grundmann

Publications and source records attributed to U Grundmann.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Procalcitonin after extracorporeal circulation. Synthesis in the hepatosplanchnic region].

UNLABELLED: Procalcitonin (PCT) is an inflammatory peptide of still unknown origin. In this study we investigated a potential source for circulating PCT in patients undergoing coronary artery bypass grafting. METHODS: To determine PCT concentrations, arterial, liver-venous and mixed-venous blood samples were collected time matched perioperatively in 20 patients scheduled for cardiac surgery using cardiopulmonary bypass (CPB). RESULTS: PCT concentrations significantly increased 4 hours postoperatively compared to baseline values (0.74 +/- 0.45 vs. 0.16 +/- 0.04 ng/ml). The highest concentrations were measured 18 hours postoperatively (1.44 +/- 1.01 ng/ml). PCT concentrations in liver venous samples were significantly higher (1.67 +/- 1.29 ng/ml) than in time matched collected arterial samples (1.44 +/- 1.01 ng/ml). CONCLUSION: These results provide evidence, that hepatosplanchnicus is a source for PCT synthesis in patients following CPB. The mechanism of PCT induction remains unclear. A loss of gut mucosal barrier function with translocation of endotoxins and the inflammatory response with release of cytokines following cardiopulmonary bypass has to be discussed.

Calcitonin↗
PubMed1999

[Effects of dopexamine on splanchnic perfusion in cardiac surgery].

UNLABELLED: The present study investigates the effects of dopexamine on the splanchnic perfusion and the general circulation in patients undergoing coronary artery bypass grafting. METHODS: 34 Patients undergoing elective coronary artery bypass grafting were randomized to receive either dopexamine (1 microg/kg/min) or placebo (0,9% NaCl. ) Cardiac output was measured by thermodilution using a pulmonary artery catheter. Splanchnic blood flow was determined by constant infusion technique of indocyanine green dye (ICG) using a hepatic vein catheter. RESULTS: Under steady state conditions before surgery, dopexamine increased systemic oxygen supply and cardiac output by an increase in heart rate and stroke volume, with no increase in systemic oxygen demand. Before surgery dopexamine increased splanchnic blood flow together with an increase in cardiac output. After cardiopulmonary bypass dopexamine increased splanchnic perfusion without a concomittant rise in cardiac output. CONCLUSION: These results provide evidence that dopexamine improves splanchnic blood flow in patients with coronary artery disease before and after pulmonary bypass without impairment of general hemodynamics.

Aged↗
PubMed1998

[Remifentanil-propofol anesthesia in vertebral disc operations: a comparison with desflurane-N2O inhalation anesthesia. Effect on hemodynamics and recovery].

OBJECTIVE: To ascertain whether there is a difference between total intravenous anaesthesia with propofol (P) and remifentanil (R) and inhalational anaesthesia with desflurane (D) and nitrous oxide (N) with regard to haemodynamic reactions, recovery profile and postoperative analgesic demand in patients scheduled for elective microsurgical vertebral disc resection. METHODS: 50 patients (ASA I-II, 18-65 years) were randomly assigned to receive total intravenous anaesthesia with propofol and remifentanil or inhalational anaesthesia with desflurane and nitrous oxide. After standardised induction of anaesthesia in both groups (1 microgram.kg-1 remifentanil, 1.5 mg.kg-1 propofol 0.1 mg.kg-1 cisatracurium), anaesthesia was maintained in the D/N group with desflurane in 50% N2O. The patients of the P/R group received a constant infusion of 2 mg.kg-1.h-1 propofol and a constant infusion of 0.5 microgram.kg-1.min-1 remifentanil, which was reduced after 15 min by 50%. The administration of desflurane and the infusion of the anaesthetics were adjusted to maintain a surgical depth of anaesthesia. At the end of surgery the anaesthetics were discontinued and early emergence from anaesthesia was assessed by measuring time to spontaneous ventilation (VT > 4 ml/kg), tracheal extubation, opening of the eyes and stating correct name and data of birth. The frequency of analgesics and total demand for analgesics were determined using patient-controlled analgesia and recorded for 2 h postoperatively. In addition the pain level of the patients was measured on a visual analogue scale and the incidence of postoperative shivering, nausea and vomiting was noted. RESULTS: Patients anaesthetised with desflurane responded to tracheal intubation and skin incision with increasing blood pressure and showed higher heart rates than patients anaesthetised with propofol and remifentanil, but there were no other haemodynamic differences between the groups in response to surgical stimuli. There were significantly shorter times to spontaneous ventilation (3.2 vs. 6.3 min), extubation (3.8 vs. 9.5 min), eye opening (3.0 vs. 11.5 min) and giving name and date of birth (4.8 vs. 14.3 min) in patients anaesthetised with remifentanil and propofol than in those receiving desflurane and nitrous oxide. In addition, patients anaesthetised with remifentanil and propofol had a greater incidence of postoperative shivering. There were no significant differences between the two groups in the patients' pain scores, analgesic demand and incidence of nausea and vomiting. CONCLUSION: Patients anaesthetised with propofol and remifentanil have significantly shorter emergence times than patients anaesthetised with desflurane and nitrous oxide. The low incidence of postoperative pain after microsurgical vertebral disc resections requires no large-scale analgesic therapy, even after total intravenous anaesthesia including remifentanil.

Adult↗
PubMed1998

Desflurane or isoflurane for paediatric ENT anaesthesia. A comparison of intubating conditions and recovery profile.

BACKGROUND: The inhaled anaesthetic desflurane is characterized by a rapid wash-in and wash-out and may be useful for short paediatric ENT procedures. Therefore, this study was designed to compare the effects of desflurane or isoflurane on intubating conditions and recovery characteristics in paediatric ENT patients. METHODS: In this prospective, randomised investigation, we studied 44 children scheduled for ENT surgery, aged 4-12 yr and classified ASA I-II. After thiopentone induction (5-8 mg/kg) the lungs were ventilated by face mask and the vaporizer was dialed to 1 MAC (age-adapted) of desflurane of isoflurane. A reduced dose of vecuronium (0.05 mg/kg) was administered, and intubating conditions were rated 3 min later. Following tracheal intubation, 50% nitrous oxide were added, and the concentration of desflurane or isoflurane was adjusted according to clinical needs. At the end of surgery all anaesthetics were discontinued simultaneously and recovery times were recorded. RESULTS: Intubating conditions were rated significantly better for desflurane (excellent or good 20 of 22) than for isoflurane (12 of 22). Recovery times were significantly shorter for desflurane than for isoflurane (mean +/- SE): spontaneous ventilation 4.0 +/- 0.5 min vs. 6.0 +/- 0.7 min, extubation 8.4 +/- 0.7 vs. 11.4 +/- 1.1 min and arrival at PACU 11.5 +/- 0.8 vs. 16.6 +/- 1.5 min. No airway complications (coughing, laryngospasm, or desaturation < 97%) were noted for either anaesthetic. CONCLUSIONS: Following an intravenous induction improved intubating conditions, shorter recovery times and the lack of airway complications make desflurane a suitable alternative to isoflurane for paediatric ENT anaesthesia.

Anesthesia Recovery Period↗
PubMed1998

Valve-preserving replacement of the ascending aorta: remodeling versus reimplantation.

OBJECTIVE: Aortic valve regurgitation in combination with dilatation of the ascending aorta and root requires a combined procedure to restore valve function and eliminate pathologic dilatation of the proximal aorta. Two techniques have been proposed for this purpose; the aortic root may be either remodeled with an especially configured vascular graft or replaced with reimplantation of the aortic valve within the graft. We have used both techniques depending on the individual pathologic condition of the aortic root. METHODS: Of 107 patients undergoing operation for proximal aortic disease between October 1995 and November 1997, 40 patients had morphologically intact aortic valve leaflets in conjunction with dilatation of the aortic root. Of these, 15 patients underwent an operation as a surgical emergency for acute aortic dissection type A. In 29 instances, root remodeling in conjunction with ascending aortic replacement was performed; 11 patients underwent radical replacement of the proximal aorta with reimplantation of the aortic valve. Partial or total arch replacement was performed additionally in 27 of these patients. Other concomitant procedures were coronary artery bypass grafts (n = 11) and mitral reconstruction (n = 1). RESULTS: Two patients died after repair of acute aortic dissection, for a total operative mortality rate of 5%. No patient died after elective surgery. Aortic valve function could be effectively restored with both techniques. No patient underwent reoperation on the proximal aorta; freedom from aortic regurgitation of grade II or more at 1 year is 88% with both techniques. CONCLUSIONS: Depending on individual root pathologic condition, both the remodeling and the reimplantation techniques appeared to have their individual merits. Both result in adequate restoration of aortic valve function and elimination of pathologic aortic dilatation.

Adult↗
PubMed1998

Total intravenous anaesthesia with gamma-hydroxybutyrate (GHB) and sufentanil in patients undergoing coronary artery bypass graft surgery: a comparison in patients with unimpaired and impaired left ventricular function.

The haemodynamic effects of anaesthesia with gamma-hydroxybutyrate (GHB)/sufentanil for elective coronary artery bypass grafting (CABG) were investigated and compared in patients with unimpaired left ventricular function (ejection fraction > or = 45%, left ventricular end diastolic pressure < or = 16 mmHg) and patients with impaired left ventricular function. In 38 consecutive patients scheduled for CABG (21 with unimpaired and 17 with impaired left ventricular function), anaesthesia was induced with etomidate, sufentanil and pancuronium. After tracheal intubation, the lungs were normoventilated (end tidal Pco2 4.9-5.6 kPa) with an oxygen-air mixture (Fio2 0.5). Total intravenous anaesthesia was maintained with GHB (20 mg kg-1 h-1 after a 'priming dose' of 40 mg kg-1) and sufentanil (2 micrograms kg-1 h-1). Haemodynamic measurements were made after induction of anaesthesia and at various times in the prebypass period. Patients in both groups showed similar haemodynamic trends. Mean arterial pressure showed a maximum reduction of 10%, whereas heart rate and right- and left-sided filling pressures remained unchanged within the groups after the induction of anaesthesia. Cardiac index remained unchanged in both groups, although values differed between the groups. A total of 14 out of 21 patients (67%) with unimpaired and 10 out of 17 patients (59%) with impaired ventricular function required supplementary administration of opioids to control temporary hypertension after sternotomy. No episodes of myocardial ischaemia were detected during the study period using ST segment analysis (leads II and V5). The results of this study suggest that GHB provides adequate haemodynamic conditions in the prebypass period and may be a suitable agent for TIVA also in patients with impaired left ventricular function undergoing CABG.

Aged↗
PubMed1998

Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desflurane-nitrous oxide inhalation anaesthesia.

BACKGROUND: Remifentanil is a new rapid-acting and ultra-short acting mu-opioid receptor agonist with few reports from use in children. Therefore, we compared a propofol-remifentanil-anaesthesia (TIVA) with a desflurane-N2O-anaesthesia (DN) with particular regard to the recovery of characteristics in children. METHODS: 50 children (4-11 yr) scheduled for ENT surgery were randomly assigned to receive TIVA (n = 25) or DN (N = 25). After standardised i.v. induction of anaesthesia in both groups with remifentanil, propofol and cisatracurium, TIVA was maintained with infusion of propofol and remifentanil. Ventilation was with oxygen in air. DN was maintained with desflurane in 50% N20. The administration of volatile and intravenous anaesthetics was adjusted to maintain a surgical plane of anaesthesia. At the end of surgery all anaesthetics were terminated without tapering and early emergence and recovery were assessed. In addition, side effects were noted. RESULTS: Both anaesthesia methods resulted in stable haemodynamics but significantly higher heart rate with desflurane. Recovery did not differ between the groups except for delayed spontaneous respiration after TIVA. Spontaneous ventilation occurred after 11 +/- 03.7 min versus 7.2 +/- 2.8 min (mean +/- SD, TIVA versus DN), extubation after 11 +/- 3.7 min versus 9.4 +/- 2.9 min, eye opening after 11 +/- 3.9 min versus 14 +/- 7.6 min and Aldrete score > or = 9 after 17 +/- 6.8 min versus 17 +/- 7.5 min. Postoperatively, there was a significant higher incidence of agitation in the DN group (80% vs. 44%) but a low incidence (< 10%) of nausea and vomiting in both groups. CONCLUSION: In children, TIVA with remifentanil and propofol is a well-tolerated anaesthesia method, with a lower peroperative heart rate and less postoperative agitation compared with a desflurane-N2O based anaesthesia.

Adenoidectomy↗
PubMed1998

[Aneurysm of the aortic arch: presenting as mediastinal tumor].

We report the case of a 62-year-old woman who presented with severe abdominal pain. The routine chest x-ray showed an anterior mediastinal mass measuring approximately 10 cm in diameter. CT-Scan and angiography demonstrated an aneurysm of the aortic arch compromising the left pulmonary artery and main bronchus. An additional aneurysm of the abdominal aorta and right iliac artery was seen, which apparently led to the abdominal symptoms. Coronary angiography revealed coronary artery disease. The aortic arch aneurysm was treated by interposition of a vascular graft. Aorto-coronary bypass grafts were implanted. The abdominal aneurysm was resected in a staged approach after recovery from the first operation.

Aorta, Thoracic↗
PubMed1997

Total intravenous anaesthesia using propofol, gamma-hydroxybutyrate or midazolam in combination with sufentanil for patients undergoing coronary artery bypass surgery.

Total intravenous anaesthesia (TIVA) using propofol, gamma-hydroxybutyrate (GHB) or midazolam in combination with sufentanil was investigated in 45 patients undergoing coronary artery bypass grafting (CABG). Anaesthesia was induced with sufentanil, etomidate and pancuronium. After endotracheal intubation, anaesthesia was continued with sufentanil (2 micrograms kg-1 h-1) for all patients. Patients were randomized to receive supplementary propofol (2 mg kg-1 h-1, n = 15), gamma-hydroxybutyrate (20 mg kg-1 h-1, n = 15) or midazolam (0.06 mg kg-1 h-1, n = 15). Haemodynamic measurements were performed after induction and at various times in the pre-bypass period. In the propofol group, a significant decrease in heart rate (HR 12% +/- 3%), cardiac index (CI 23% +/- 4%), mean arterial pressure (MAP 16% +/- 3%) and left ventricular stroke work index (LVSWI 17% +/- 4%) occurred until sternotomy was performed. With the exception of cardiac index, both midazolam and gamma-hydroxybutyrate produced similar haemodynamic effects: cardiac index was temporarily decreased (19% +/- 4%) by midazolam and remained unchanged after gamma-hydroxybutyrate. In both groups, sternotomy was followed by temporary hypertension, associated with a significant rise in systemic vascular resistance. No electrocardiographical signs of ischaemia were observed in any patient. In the case of propofol and midazolam, gamma-hydroxybutyrate showed adequate haemodynamic stability especially after induction of anaesthesia and may also be a suitable agent for total intravenous anaesthesia in patients with coronary artery disease. However, during sternotomy, supplementary administration of opioids was required.

Aged↗
PubMed1997

[Comparative study of pethidine and clonidine for prevention of postoperative shivering. A prospective, randomized, placebo-controlled double-blind study].

OBJECTIVE: Patients with ischaemic heart disease and cardiac failure are endangered by an increase in oxygen consumption caused by postoperative shivering. The purpose of this study was to evaluate if pethidine and clonidine, which are well known for their effectiveness in the treatment of this undesirable side effect, can also prevent postoperative shivering if administered at the end of surgery. In addition it was investigated whether their intraoperative application influences the time of extubation and analgesics demand in the early postoperative period. METHODS: 60 patients (ASA I-II) scheduled for elective microsurgical vertebral disc resection were included in the study. After standardised induction of anaesthesia (5 mg x kg-1 thiopental, 2 micrograms x kg-1 fentanyl, 0.1 mg x kg-1 vecuronium) lungs were ventilated with isoflurane vaporized in 66% N2O and 33% O2. The concentration of the inhalation anaesthetic was adjusted to maintain a surgical plane of anaesthesia without supplementary doses of opioids. Patients were randomly allocated in a double-blind fashion to one of three groups (each n = 20) to receive either pethidine (0.3 mg x kg-1) or clonidine (2 micrograms x kg-1) or 0.9% saline (control) 5 minutes prior to the end of surgery. Heart rate, arterial blood pressure and rectal temperature were measured at defined times, as well as the recovery time between the end of anaesthesia and extubation, incidence of postoperative shivering, and the pain level of the patients with a visual analog scale. The frequency and total demand of analgesics were determined using patient controlled analgesia and recorded for two hours postoperatively. RESULTS: The incidence of postoperative shivering in the clonidine group (5%) was less than in the pethidine group (25%) and significantly less than in the saline group (55%). Heart rate and blood pressure values after the administration of clonidine were lower than after pethidine and significantly lower than after saline. The time between end of surgery and extubation was similar in all groups with an average of 18 minutes. No significant differences among the pain scores and the analgesics demand were noted among any of the groups, including the saline control-group. CONCLUSION: Intraoperative administration of clonidine (2 micrograms x kg-1) is suitable for prevention of postoperative shivering. Despite its sedative effects the recovery time until extubation was not prolonged. 0.3 mg x kg-1 pethidine proved to be less beneficial.

Adjuvants, Anesthesia↗
PubMed1997

[Craniosynostosis operations in childhood].

Premature osteosynthesis of one or more cranial bones, either intrauterine or within the first postnatal months, is defined as craniosynostosis. The resulting limitation of intracranial space can cause retardation of cranial growth which, in turn, leads to craniostenosis with increasing intracerebral pressure. Complex forms of craniosynostosis with concomitant malformations (i.e. Apert-, Crouzon-, and Pfeiffer syndromes) must be principally distinguished from simple craniosynostosis. This complex cranio-facial dysostosis is a premature osteosynthesis of cranial and facial bones. In general, as far as Germany is concerned, the incidence of cranio-synostosis amounts to 1/1000 births. If they remain untreated, many of these children will suffer from cortex-associated retardation of intelligence. Surgical management, therefore, is initiated at a very early stage, and should be performed in specialised centres. Recommendations for operation vary from an age of 4 to 36 months. However, an age of 6 months or more is the most frequently preferred age for surgical intervention. Severe respiratory disorders, as well as impossibility of enteral intake of nourishment, are considered absolute indications for surgery, independent of the age; elimination of the stigmatisation regarding environmental contacts of the child is another mandatory indication for operation. The goal of early surgery is reconstruction of physiological, cranial, and facial bone structures ("fronto-orbital" or "fronto-facial advancement"). Correction of craniofacial malformation may be associated with--in part--severe complications for the child. From the anaesthesiologist's point of view, this disease demands highly qualified perioperative management, since a variety of idiosyncrasies and risks must be taken into account: These are, for example, venous air embolism, hypothermia, disorders of water and electrolyte equilibrium, and, extremely vital, difficult intubation and substantial blood loss.

Anesthesia, General↗
PubMed1997

In vivo effects of halothane, enflurane, and isoflurane on hepatic sinusoidal microcirculation.

BACKGROUND: It has been proposed that halogenated anaesthetics interfere with the endothelium-dependent circulatory control by attenuating the effects of endothelium-derived relaxing factor (EDRF/NO). This study was designed to determine whether or not volatile anaesthetics in vivo influence the microvascular tone in hepatic sinusoids. METHODS: Using epifluorescence videomicroscopy, we compared the effects of the volatile anaesthetics halothane, enflurane, and isoflurane on hepatic microcirculation halothane, enflurane, and Animals were initially anaesthetized with pentobarbitone (50 mg.kg-1 i.p.) to allow instrumentation and laparotomy and were randomly allocated to one of 4 groups (n = 5-6 each) to receive either a supplementary dose of i.v. pentobarbitone (25 mg.kg-1; control group) or 0.75 MAC halothane, enflurane or isoflurane (1.5 MAC.h). RESULTS: Halothane decreased significantly the volumetric blood flow as compared with isoflurane (P < 0.05) or pentobarbitone controls (P < 0.05). The decrease in sinusoidal blood flow caused by halothane was largely attributable to a decrease in sinusoidal diameter (P < 0.05), while red blood cells velocity remained unchanged. Isoflurane led to a significant decrease in sinusoidal width compared with controls (P < 0.05) but an increase in red cell velocity offset the effect of sinusoidal narrowing of volumetric blood flow, while enflurane had no significant effect on any of the measured parameters. CONCLUSION: This study provides the first direct evidence that the volatile anaesthetics halothane and isoflurane in vivo shift the hepatic microvascular tone toward a more constricted state; however, flow velocity is enhanced with isoflurane, offsetting this effect. As a result the volumetric flow is at least affected by isoflurane, then enflurane and most significantly by halothane. Furthermore, our data are consistent with the concept that volatile anaesthetics in clinically relevant concentrations may influence the balance between endothelium-derived vasoactive factors which control microvascular tone.

Anesthetics, Inhalation↗
PubMed1997

[Laparoscopic cholecystectomy--effect of position changes and CO2 pneumoperitoneum on hemodynamic, respiratory and endocrinologic parameters].

UNLABELLED: The effect of laparoscopic cholecystectomy on cardiopulmonary and endocrinological parameters results from various factors such as increased intraabdominal pressure (IAP), CO2, and the positioning. However, positioning has not yet been regarded. Reliable examination of the individual influencing factors requires standardized anesthesiological procedure and constant IAP. Presently, the effect of positioning is observed separately from those effects caused by the pneumoperitoneum with CO2 (PP) under standardized conditions. METHODS: 40 patients with no history of cardiopulmonary disease were analyzed. Preoperative medication, induction and management of general anesthesia, positioning of the patient and IAP (12 mmHg) were standardized. Hemodynamic, respiratory and endocrinological parameters were determined with the patient in a supine position and in the position typical for the procedure (15 degrees head-down and 10 degrees slant to the left), each with and without PP. Heart rate (ECG), endexpiratory pCO2 (peECO2), invasive blood pressure (radial art.), central venous pressure, partial arterial O2 saturation (psaO2), and ventilation pressures (peak, plateau) were monitored throughout anesthesia. The parameters pH, pCO2, BE, HCO3-, COHb, vasopressin, lactate, and ammonia were analysed in arterial and venous blood samples at predetermined set points: base line, 10 min after CO2 insufflation, 10 min after desufflation, and 1 h after extubation (cf. table 1). Statistical analysis was performed using the Wilcoxon-test with p < or = 0.05 considered statistically significant. RESULTS: Insufflation of CO2 lead to a 12% increase of heart rate in supine position and to even 18% in the position required for surgery. Same significant changes were observed for arterial blood pressure (21 or respectively 28%). Central venous pressure increased by more than 200% after CO2 insufflation. Endexpiratory pCO2 increased by 2.4 mmHg after CO2 insufflation in the supine position and by 5 mmHg in the surgical position. Ventilation pressures increased significantly by 16%. Analysis of the effect of PP on blood gases showed that pH decreased from 7.47 to 7.43, and arterial pCO2 increased by 5.1 mmHg to 38.7 mmHg and increased further after desufflation to values of up to 43.9 mmHg. Arterial pO2 decreased steadily (18% after insufflation). Vasopressin plasma levels increased exponentially from 3.03 to maximal values of 104.45 pg/ml. Ammonia and lactate showed the expected, nearly identical course. Lactate increased within the clinically and methodically irrelevative range, from 1.12 to 1.159 mmol/l. Ammonia decreased by 29%. CONCLUSIONS: The observed changes, i.e. heart rate, central venous pressure, and arterial blood pressure are caused and altered by CO2 insufflation and the various positioning of patients. The increased vasopressin concentration more than likely contributes to these changes. The query whether the position of the patient also causes a change in respiratory parameters and blood gas analysis cannot be differentiated except for the end-tidal pCO2. Inspite of the observed changes no cardiopulmonary complications occurred in this patient group. Therefore, it seems possible to omit invasive monitoring in cardiopulmonary healthy patients. In patients with concomitant history of cardiopulmonary disease, however, deteriorations due to laparoscopy should be thoroughly taken into consideration and studied further.

Acid-Base Equilibrium↗
PubMed1997

[Effect of gamma-hydroxybutyric acid and pentoxifylline on kidney function parameters in coronary surgery interventions].

After cardiac surgery, transient renal dysfunction often occurs. The main reasons for impairment of renal function are intraoperative hypotension, ischemia/reperfusion injury and inflammatory response to cardiopulmonary bypass (CPB). Pentoxifylline is known to have anti-inflammatory properties. Gamma-hydroxybutyrate (GHB), an endogenous regulator of energy metabolism, showed beneficial effects on experimental intestinal ischemia/reperfusion injury and liver graft function. Both drugs may be of practical interest in diminishing renal damage during and after cardiac surgery. After approval by the ethics committee and informed consent, 45 patients for elective coronary artery bypass grafting with no clinical and laboratory impairment of renal function were randomized into 3 groups (15 patients each): group 1 received saline as control, group 2 received pentoxifylline intraoperatively (1 mg/kg/h after a priming dose of 1 mg/kg) and group 3 received GHB intraoperatively (25 mg/kg/h after a priming dose of 25 mg/kg) in a double-blinded fashion. During 3 periods (before CPB, from the beginning of CPB until the end of surgery, 24 hours postoperatively), glomerular (creatinine clearance, CCr) and tubular markers of renal function (beta-NAG, alpha 1-microglobulin) were detected in addition to clinical routine standards (creatinine, urea, fractional excretion of sodium). Changes in glomerular and in tubular function were comparable in all groups without characteristic effects of either GHB or pentoxifylline. With CPB, CCr decreased significantly until the end of operation, but showed a rise to preoperative levels on the first day after operation. Tubular function markers (beta-NAG, alpha 1-microglobulin, related to simultaneous excretion of creatinine) showed a remarkable rise after the beginning of CPB up to the postoperative period. The results of the present pilot study suggest the detection of tubular proteins and enzymes a useful addition to present routine clinical standards for recognizing early intraoperative changes in renal function. In the patients studied, there were no clinical signs of renal dysfunction. Neither GHB nor pentoxifylline--in the doses applied--was able to show a therapeutic benefit despite the theoretical advantages.

Aged↗
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

[Life threatening anaphylaxis after repeated cisplatin administration: case report and neu therapy concepts].

The present case reports of a 58-year-old female patient presenting with severe (III degrees) anaphylactic reaction due to repeated chemotherapy with Cisplatin. After resection of the advanced ovarian carcinoma the patient was presented with complaints of itching, angioneurotic edema and dyspnea in 1990 when Cisplatin had been infused for the first time. Due to relapse after four years a further operation was performed and as much of the tumour as possible was resected. Then again, Cisplatin was applied. Cortisone, H1- and H2-blockers were given prior to its application increasing the tolerance of treatment. Subsequent treatment with further Cisplatin infusion, however, resulted in severe anaphylactic shock with dyspnea and cold sweat. Emergency treatment included application of pure oxygen, two large i.v. cannulas, and 1.5 l of crystalloid, and 0.5 l of colloids (Gelafundin). Additionally, a potent vasoconstrictor (Akrinor) and 750 mg Methylprednisolone were given. Symptoms improved as blood pressure normalised, and the patient felt much better 20 minutes later. In summary, the present case report proves that anaphylactic shock induced by Cisplatin demands interdisciplinary action. This particularly applies to the interval between occurrence of the first shock signs and arrival of the emergency team.

Anaphylaxis↗
PubMed1995

[Effects of desflurane on liver microcirculation in comparison with isoflurane and pentobarbital. An intravital microscopy study in the rat].

OBJECTIVE: It is well known that the volatile anaesthetics halothane, enflurane and isoflurane alter hepatic blood flow in a dose-dependent manner. However, there are only a few studies investigating the effect of the new anaesthetic desflurane on the hepatic blood flow. In particular no information is available about the influence of desflurane on liver microcirculation. Therefore, the aim of this study was to evaluate the effects of desflurane in comparison to isoflurane and pentobarbital on microcirculation of the liver in vivo using intravital fluorescence microscopy. MATERIALS: 18 female Sprague-Dawley rats were anaesthetised with pentobarbital sodium, tracheotomised and mechanically ventilated using a rodent ventilator. A midline laparotomy was performed for later intravital microscopy of the liver. At the beginning of the one-hour ventilation period the animals were assigned to one of the following groups: isoflurane 0.75 MAC, desflurane 0.75 MAC and pentobarbital group. Animals of the pentobarbital group received additionally 25 mg/kg pentobarbital intravenously. After 60 min of ventilation and continuous monitoring of the systemic circulation the hepatic microcirculation was investigated by intravital fluorscence microscopy. RESULTS: Mean arterial blood pressure decreased slightly in the isoflurane and the desflurane groups compared to the pentobarbital group. Neither isoflurane nor desflurane did affect the sinusoidal diameters or the sinusoidal blood flow compared to the pentobarbital group. CONCLUSION: Hepatic microcirculation is not affected by one-hour anaesthesia with 0.75 MAC isoflurane or desflurane in comparison to pentobarbital.

Anesthetics, Inhalation↗