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Biomedical subjects

W Dick

Publications and source records attributed to W Dick.

At least 271 records · Page 15Linked to original sources
PubMed1981

[Important metabolic parameters in the peripartum period as affected by peridural anesthesia].

In a clinical study we compared two groups of healthy patients at term: - 10 patients received no analgesics or very small doses of pethidine (control group) during the course of labour, - 17 patients were given CO2-bupivacaine via epidural catheter because they asked for it and because their obstetricians prescribed it (CEDA-group). After giving the same infusion solution of 120 ml/h 5% half-isotonic fructose to all the parturients, the following biochemical parameters were measured at the beginning and at the end of the first stage of labour, at delivery, and two hours later: Blood gases and acid-base status, blood sugar, lactate, betahydroxybutyric acid, ACTH, cortisol, hematocrit, electrolytes, and serum osmolality. The above mentioned parameters, except electrolytes and serum osmolality, were also determined in umbilical-cord blood immediately after delivery. In the labour ward, infants were observed and their capillary blood gases, acid-bases status, and blood sugar were measured 30, 60, and 120 minutes after birth. Lactate, betahydroxybutyric acid, ACTH, and cortisol levels rose significantly until delivery in both of the groups; significant differences between the two groups could be seen in blood gases, blood sugar, and ACTH levels. In the umbilical cord there were only significant differences in blood sugar. In summary it can be concluded that although labour pain can be controlled by epidural analgesia, the stress of labour is only influenced by different analgesic methods to a certain degree.

3-Hydroxybutyric Acid↗
PubMed1981

[A clinical study of co2-elimination using a modified bain-system (author's transl)].

Of three groups of anaesthetized and intubated patients (n = 7) under controlled ventilation two received fresh gas flows of 70 ml/kg . min, 100 ml/kg . min and 130 ml/kg . min either in increasing or in decreasing amounts via a Bain circuit, while the third group was ventilated via a conventional semi-closed anaesthesia circuit. Blood gas analyses and cardiovascular parameters were recorded. In one patient temperatures and relative humidities of in- and expired gases were obtained by psychrometry. A modification of the Bain system afforded control of respiratory minute volumes and airway pressures. CO2-elimination proved to be adequate at a fresh gas flow of 130 ml/kg. min. At 100 ml/kg. min it was acceptable still, however pH values were outside normal range. With 70 ml/kg . min mean capillary pCO2 values (42.6 mmHg and 43.2 mmHg) and mean pH values (7.32 and 7.33) in the two respective groups proved a respiratory acidosis. Capillary pO2 was above 100 mmHg in all groups. Temperature and relative humidity of inspired gases were 24 degrees C and 40 per cent, 23 degrees C and 25 per cent, 22 degrees C and 3 per cent at fresh gas flows of 70, 100 and 130 ml/kg . min respectively.

Adult↗
PubMed1981

[Comparative studies on perioperative infusion therapy in infants].

Four different infusion solutions, consisting of various amounts of sodium, potassium, chloride, phosphate and carbohydrates, were administered to infants from ten days to six months of age. The effects of these infusions on different parameters in the blood serum and on the urinary excretion were measured. It could be demonstrated that even major variations of electrolyte administration could be compensated by the infants' renal function resulting in almost constant serum parameters and adequate water balances. The administration of sodium and chloride ranged from 5-7 mmol/kg per day or from 4.44-7.55 mmol/kg per day respectively, the substitution of potassium varied between 0.25 an 2.4 mmol/kg per day and the substitution of phosphate between 0 and 0.7 mmol/kg per day. Variations of any clinical importance could only be detected for serum phosphate concentrations if phosphate-free infusion solutions had been administered. The postoperative blood glucose concentrations did not show any alterations which could be related to the glucose or glucose-xylitol contents of the infusion solutions. Following these results and according to previously reported studies in children recommendations for the sodium, potassium, chloride, phosphate and carbohydrate contents of the infusion solutions can be made as well as suggestions for the perioperative dosage of these solutions in infants and children.

Blood Glucose↗
PubMed1981

[Droperidol-ketamine. Clinical studies of an intravenous anaesthesia for peripheral operations on children (author's transl)].

Children aged 4 to 13 years who underwent small surgical operations, received anaesthesia with an intravenous injection of droperidol and ketamine. The children breathed spontaneously. The first group breathed room air only, the second group were given air enriched with oxygen at 21 per min. Five, 15, 25, and 35 minutes after the first injection we made the following measurements: pulse rate, arterial blood pressure, respiratory minute volume and frequency, and arterial blood gases. Arterial pCO2 values remained within the normal range. Arterial pO2 values showed a broad variation from 68 to 162 mm Hg. In the first group 25% of values lay between 68 and 75 mm Hg, where oxygen saturation is still sufficient but the oxygen dissociation curve steepens. In the second group with a higher inspiratory oxygen concentration we never found values below 75 mm Hg. As a result of these investigations we can say that this intravenous combination anaesthesia can be recommended for peripheral operations of short duration if an increased inspiratory oxygen concentration under spontaneous breathing is used.

Adolescent↗
PubMed1981

[Postoperative responsiveness following halothane- or enflurane-anaesthesia for short operative procedures (author's transl)].

A comparative study was carried out on 139 patients, divided into eight groups. Either halothane or enflurane were given as inhalational agent, and for induction either Trapanal or Brevimytal were given. Some groups received a standard premedication, other not. The post-operative level of consciousness, responsiveness and motor performance were assessed, and venous halothane/enflurane levels measured. No marked differences were found in the level of consciousness, responsiveness, or motor performance, between the halothane and enflurane groups. The respective plasma levels of halothane and enflurane were practically identical at corresponding time intervals of measurement. In those groups which were not premedicated, no difference could be found following induction with either Trapanal or Brevimytal. In the premedicated groups those patients who had been given Brevimytal woke earlier, and showed a greater degree of responsiveness.

Adolescent↗
PubMed1981

[The effect of preoperative food and fluid restrictions on various metabolic parameters in geriatric patients].

This clinical investigation was carried out in order to determine whether the 10-12 hr food and fluid restrictions imposed before elective operations have detrimental effects on older patients according to various metabolic parameters. Thirty male urological patients aged between 60 and 90 years were chosen for study (group I 60-70 years, group II 70-80 years, group III 89-90 years). The following parameters were measured at 7 p.m. the evening before the operation, and at 7. a.m. on the morning of operation: body weight, hematocrit, blood-gas analysis, electrolytes, serum osmolality, urea, creatinine, total protein with electrophoresis and blood glucose. Urine was collected during the period of abstinence and osmolality, electrolytes, total nitrogen, creatinine and urea were estimated. All patients showed a reduced creatinine clearance to a degree that was expected for their age. In all three groups a significant weight reduction (p less than 0,001) occurred during the time of observation. The 12 hr urine volume increased from one age group to the next whereas perspiration decreased, indicating deficient thermal regulations in older patients. The hypohydration on the morning of operation, especially in group II and III, marked a relatively lower hematocrit and hypoproteinemia. In all three groups the urea and creatinine values were slightly lower in the morning than in the evening before, indicating the occurrence of further hypohydration due to fasting. The low elimination of total nitrogen, urea, and creatinine in the urine could be an indication that the 12 hr food and fluid restriction caused no marked catabolism. Our study shows that geriatric patients are indeed able to compensate for a 12 hr-period of abstinence. When however, these patients also have to undergo an operation, possibly associated with a considerable loss of body fluids or when restriction of oral intake extends to 16-20 hrs, decompensation may rapidly occur leading to deleterious consequences.

Age Factors↗
PubMed1981

[Postoperative analgesia with epidural morphine injection after urologic operations (author's transl)].

Eleven patients were given morphine 5 mg via an epidural catheter to provide analgesia after urologic surgery. Morphine levels were determined in serum and urine by radioimmunoassay. Cardiovascular reactions (heart rate, blood pressure) and arterial pO2 were recorded. Analgesia ensued very rapidly and lasted 29 hours on the average. For 4 hours after epidural administration, the serum morphine levels were within the range required for analgesia after intravenous injection. Side effects on the cardiovascular system and the respiratory system were not observed. Epidural morphine application is recommended as a good method for postoperative analgesia.

Aged↗
PubMed1980

[Aspects of primary PEEP ventilation for immediate treatment of emergency patients (author's transl)].

PEEP ventilation is frequently used in intensive care patients: its particular effects in the immediate treatment of emergency patients are discussed. In animal experiments different studies were performed using manually operated resuscitators combined with a newly designed PEEP valve. The most important results in neonatal pigs show that the post partum compliances and the neonatal PO2 values were much better after primary PEEP ventilation than after IPPB or 2-phases unfolding inflation. The worst method of respiratory resuscitation is the use of PNPB. In 2 other groups of animals immediate PEEP ventilation was compared to IPPB, after 25 ml of fresh water/kg BW had been instilled into the animals lungs. The PaO2 and AaDO2 values of those animals, treated immediately with PEEP were much better than the corresponding values of the ZEEP group animals. But, the PEEP-treated animals showed a significant reduction of the cardiac output. The article deals further with the results of different authors, as far as PEEP and lung edema, PEEP and CPR, PEEP and shock are concerned. In our opinion, the present clinical and experimental results lead to the following conclusions: The immediate PEEP ventilation at the scene is indicated 1. in neonatal resuscitation - 2. in near drowning - 3. in lung edema - 4. in cardiopulmonary resuscitation. PEEP ventilation should however not exceed 10 cm H2O.

Animals↗
PubMed1980

[Maternal risk from general anaesthesia and regional anaesthesia (author's transl)].

It may be presumed that in 1979, 150 maternal deaths will occur in obstetrics (0.27 per 1000) in the Fed. Rep. of Germany, 40% of which will be due to caesarean sections. From 30% to 50% of this maternal death rate, must be related in one or another aspect to general or local anaesthesia. The maternal morbidity rate may be even higher, because 500,000 parturients a year are treated with caesarean sections, and up to 50% of all parturients with epidural anaesthesia. General anesthesia as well as regional anaesthesia can be maternal risk factors, due to hypoxia or hypercarbia, due to hyper- or hypotension, arrhythmias, inferior vena cava occlusion etc. By endotracheal intubation adequate ventilation can be guaranteed and mothers may be protected from aspiration; the same procedure can also be responsible for hypoxic death or aspiration. Water-electrolyte balance and metabolism carry maternal risks, when inadequate substitution is performed or when fluid and electrolytes are administered in excess, together with modern obstetric drugs. Anaesthesists as well as obstetricians should be aware of the increased maternal risk from general or local anaesthesia. The maternal risk should be minimized. This can either be achieved if experienced anaesthesists only are responsible for obstetric anaesthesia (general as well as epidural, spinal etc.) if anaesthesia (general as well as local) is not considered as a comfortable service only but a strictly indicated medical procedure, and if new methods are developed to overcome the particular maternal risk in some regard.

Anesthesia, General↗
PubMed1980

[Peripheral venous amino acid substitution].

Under the aspect of the special function and importance of amino acids a modified procedure of infusion therapy via peripheral veins has been investigated. This regimen is characterized by the combination of amino acids with carbohydrates to ensure the minimal obligatory amount of glucose on which some tissues are dependent. On the basis of these investigations the concept of Blackburn et al. is discussed in detail where the main aspect concerns the question of endogenous energy supply by beta-oxidation of fatty acids. It is shown on the basis of gaz exchange measurements that under the treatment with the carbohydrate-containing solution the mobilization of NEFA non esterified fatty acids is not suppressed.

Amino Acids↗
PubMed1980

[lysozyme level in urine during pregnancy (author's transl)].

In the urine in adults lysozyme is only found in traces or not at all. During the course of a normal pregnancy however, lysozymuria is present. In early pregnancy lysozyme is excreted only in small amounts; between the 31st and 40th week of gestation a larger amount of lysozyme in excreted into the urine. In comparing the urine lysozyme level in the 40th week of gestation and one week post partum, a significant reduction in the lysozyme level appears in the latter. On the other hand, the lysozyme level in the maternal serum and the fetal cord blood shows no significant difference.

Adult↗
PubMed1980

[Serum lysozyme activity in term and preterm newborns (author's transl)].

Serum levels of lysozyme were studied in 43 term and 36 premature newborns. Levels in premature babies were found to be significantly (p less than 0,001) lower than those of matures. Observation over two weeks revealed a rise of serum lysozyme in premature babies and a decline in mature newborns. The level seems to depend upon the turnover of neutrophile granulocytes. In 5 premature babies with clinical signs of sepsis the serum lysozyme concentrations were significantly (p less than 0,01) lower than those in healthy prematures. It is assumed that the activity of the intraneutrophilic lysozyme in patients with bacterial infections is reduced to as little as 50%. Urine controls for lysozyme in 43 newborns (mature and premature) did not show evidence of measurable lysozyme concentrations.

Age Factors↗