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Biomedical subjects

W Seeling

Publications and source records attributed to W Seeling.

At least 73 records · Page 4Linked to original sources
PubMed1990

[No reduction in postoperative complications by the use of catheterized epidural analgesia following major abdominal surgery].

This study was designed to assess whether intra- and postoperative epidural analgesia would diminish the overall rate of postoperative complications after major abdominal operations when compared to a standard anesthetic and postoperative analgesic regimen. A total of 214 patients undergoing infrarenal aortic bypass operations, gastric resection, gastrectomy, Whipple's operation, or duodenum-preserving pancreatic resection were randomly divided into two groups. Patients in the epidural group (n = 98) were operated on under light general anesthesia (midazolam, low-dose fentanyl, N2O/O2, pancuronium bromide). In addition, a mixture of bupivacaine (0.25%) and fentanyl (2 micrograms/ml) was infused (6-10 ml/h) via a thoracic epidural catheter intra- and postoperatively for 76:1.45 h (logarithmic normal distribution). Patients in the control group (n = 116) were operated on under a standard general anesthesia (midazolam, fentanyl, N2O/O2, isoflurane, pancuronium-bromide). Piritramid was injected for postoperative pain relief, either i.v. (recovery room, intensive care unit) or i.m. (surgical ward). In the epidural group the quality of analgesia and ability to cough were significantly better (2 P less than 0.0071) than in the control group (four observations each on the 1st and 2nd postoperative days). Heart rate and mean arterial pressure were lower in the epidural group at the same points of observation (2 P less than 0.01), as was the plasma glucose on the 1st postoperative day. The time up to the first postoperative defecation was shorter in the epidural group (79:1.51 h) as compared to the control group (93:1.38 h; 2 P less than 0.0167). The time to hospital discharge was equal in both groups (epidural group 19:1.6 days, control group 18:1.6 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1987

[Effects and side effects of somatostatin].

Somatostatin, a peptide hormone with a wide range of actions, was first described in 1973. It is found in neurons of the central and peripheral nervous systems and D cells of the gut and pancreas. Somatostatin acts as a neurotransmitter, a local tissue factor, and a hormone. The intrinsic metabolic effects of somatostatin have been well investigated during the past 10 years. It inhibits the release of gastrointestinal secretions and delays the absorption of glucose and amino acids. Somatostatin inhibits the effects of the release of several of the hormones involved in water-electrolyte homeostasis. It exerts an influence on the regulation of several endocrine and exocrine functions, acting as a "shock absorber". In the nervous system somatostatin functions as a neurotransmitter; intrathecal application causes characteristic changes in the motor system and behavioral aberrations. Furthermore, it has been suggested that it may be a potent analgesic. Side-effects seen during animal experiments are many: marked increases in blood glucose, various behavioral changes, respiratory failure, and death. This article compares the effects and potential side-effects of somatostatin with particular regard to the recent observation that this substance may be a potent analgesic.

Humans↗
PubMed1986

[The eventration syndrome: prostacyclin liberation and acute hypoxemia due to eventration of the small intestine].

In 13 patients undergoing infrarenal aortic bypass operation under neuroleptic anaesthesia, prostaglandins (KH2PGF2 alpha, PGF2 alpha, 6-keto-PGF1 alpha) and thromboxane (TXB2) were measured immediately prior to, 5 min after and 15 min after eventration of the gut. Blood gas analyses were performed at the same points in time. The levels of PGF2 alpha, although slightly elevated, remained stable, as did the levels of TXB2 (more than half the values being below the limit of detection). In 9 patients there was an immediate increase in the level of 6-keto-PGF1 alpha (a stable metabolite of prostacyclin), associated with a significant fall in the arterial oxygen tension. In 4 patients, the levels of 6-keto-PGF1 alpha remained low and no decrease in arterial oxygen tension was observed. KH2PGF2 alpha levels remained within the normal range, indicating that there was no stimulation of general prostaglandin secretion, but an isolated release of prostacyclin. In 7 patients, a mild, moderate or pronounced flush developed which did not, however, correlate to increases in the concentration of 6-keto-PGF1 alpha. These findings indicate that eventration of the gut is followed by prostacyclin liberation in considerable amounts due to the manipulation involved or to the impairment of the intestinal circulation. The concomitant fall in the oxygen tension is caused by pulmonary vasodilation, which increases the perfusion of underventilated parts of the lung.

Adult↗
PubMed1986

[Malignant hyperthermia in a 41-year-old woman].

Malignant hyperthermia is one of the most devastating crises encountered in anaesthesia and it frequently occurs unexpectedly. Although malignant hyperthermia develops in young individuals (mean age approximately 22 years), older people can also be affected. The case of a 41-year-old woman with a history of several previously uneventful general anaesthetics is described. She developed the complete symptomatology of malignant hyperthermia triggered by halothane anaesthesia, with tachycardia, cardiac arrhythmia, cyanosis, combined respiratory and metabolic acidosis and hyperpyrexia. Because treatment with dantrolene and hyperventilation with 100% O2 was started immediately, the symptoms of malignant hyperthermia were stopped within a short time. It should always be remembered, that the life threatening crises which can be caused by malignant hyperthermia can occur at any age and even after several uneventful anaesthetics.

Adult↗
PubMed1986

[Aortofemoral bifurcation bypass. Effect of the anesthesia procedure (NLA, thoracic continuous catheter peridural anesthesia) on circulation, respiration and metabolism. Homeostasis and oxygen transport].

50 patients were investigated during induction of anaesthesia and infrarenal aortic bypass surgery. 26 were operated on under neuroleptanaesthesia (NA group) and 24 under continuous epidural combined with a light general anaesthesia (epidural group). Blood losses were replaced with 5 per cent human albumin, red cell concentrates, and fresh frozen plasma. Ringer lactate solution was used to replace the functional extracellular fluid volume. During induction and maintenance of anaesthesia body temperature fell (NA group from 36.7 to 35.3 degrees C; epidural group from 36.7 to 34.9 degrees C) but no statistically significant difference could be found between the groups, in spite of better surface perfusion of the lower part of the body in the epidural group. The increase of plasma glucose concentration was lower in the epidural group as compared to the NA group. Stress mediated hypokalaemia was of the same degree in both groups, the median values of the plasma potassium concentrations being in the lower reference range (3.5-3.7 mmol X 1(-1], although large amounts of red cell concentrates were given. During clamping of the aorta a moderate compensated acidosis developed in both groups. Declamping caused a more marked increase of paCO2 and a greater fall of pH in the NA group as compared to the epidural group. Induction of anaesthesia was followed by a fall in oxygen uptake (NA group from 221 to 163 ml X min-1; epidural group from 230 to 189 ml X min-1) which appears to be delayed in the epidural group, with a short lasting statistically significant difference between the groups after eventration of the gut (NA group: 162 ml X min-1 less than epidural group 184 ml X min-1). Later on, oxygen uptake was equal in both groups, with no further changes due to clamping or declamping of the aorta. At the end of the operation, when nitrous oxide had been turned of, the oxygen uptake increased considerably in several patients, despite continuing artificial ventilation and intravenous hypnotics and analgesics having been given. Eventration and exterioration of the gut caused the most marked changes in haemodynamics and oxygen transport with significant differences between the groups. Immediately after eventration there was a sudden fall in paO2 in both groups (NA group from 99 to 83 mm Hg; epidural group from 96 to 84 mm Hg) and an increase of the calculated intrapulmonary right-to-left-shunt (NA group from 7 to 21%; epidural group from 10 to 19%).(ABSTRACT TRUNCATED AT 400 WORDS)

Acid-Base Equilibrium↗
PubMed1985

[Aortofemoral bifurcation bypass--effect of the anesthesia procedure (NLA, thoracic continuous catheter peridural anesthesia) on circulation, respiration and metabolism. Intraoperative circulatory reactions].

51 patients who were selected for aorto-bifemoral bypass operation (infrarenal aortic aneurysm, iliac or iliofemoral occlusive disease) were randomized into two groups. 26 patients were operated on under neuroleptanaesthesia and 25 patients had a continuous thoracic epidural, which was supplemented with a light general anaesthesia during the operation. All patients were optimally volume loaded prior to surgery. The most marked haemodynamic alterations (tachycardia, arterial hypertension, increase of cardiac index, left ventricular stroke work index and cardiac minute work) were provoked by eventration of the gut. In the epidural group, these changes were attenuated and in contrast to the neuroleptanaesthesia group, there were a few patients who had a serious fall in blood pressure. These reactions were regularly accompanied by a generalized flush which led to the hypothesis that they were caused by the release of intestinal hormones, reactive peptides and neurotransmitters, from the mechanically irritated gut. Clamping of the aorta was relatively uneventful. Heart rate and cardiac index decreased in both groups but mean arterial pressure and pulmonary capillary wedge pressure remained stable. Systemic vascular resistance increased slightly in the neuroleptanaesthesia, but not in the epidural group. Declamping was followed by significant but transient falls in systemic vascular resistance and arterial pressure in both groups, despite sufficient volume loading before opening the clamp. In the neuroleptanaesthesia group these changes spontaneously returned to normal; in the epidural group 6 patients received vasopressors or positive inotropic drugs. These results indicate the following: Epidural anaesthesia prevents hypertension and tachycardia and lowers cardiac minute work. Eventration of the gut, acute blood losses and declamping of the aorta may be critical situations, which can lead to profound hypotension. Under neuroleptanaesthesia eventration of the gut is followed by tachycardia and hypertension whereas blood losses and declamping are not as critical as when an epidural is used. Only experienced anaesthetists should use epidural anaesthesia for aortic surgery. An intensive monitoring of haemodynamic function during this form of anaesthesia is mandatory.

Adult↗
PubMed1985

[Imbalances of the water and electrolyte status].

Nutritional therapy can be impaired if imbalances in water and electrolyte status have led to gross disorders of the cardiovascular, pulmonary, renal, metabolic, and central nervous systems. Restauration and maintenance of the functional extracellular fluid volume is the primary therapeutic goal in water and electrolyte resuscitation. Hyper- and hypoosmolar disturbances are automatically corrected by intrinsic regulatory mechanisms. Potassium deficiency or overload, or potassium disequilibrium between the intracellular and extracellular space can lead to dangerous cardiac arrhythmias. Hyper- and hypokalemia usually develop within days or even weeks and should not be corrected within a few hours. If life threatening hyperkalemia develops during acute renal failure, 20 ml 10% calcium gluconate solution can be given intravenously in order to avoid ventricular fibrillation or cardiac arrest. The discrimination between prerenal disease, acute tubular necrosis and other causes of acute renal failure is based on special investigations, such as urinary osmolality, urinary sodium concentration, clearance of creatinine, osmolar solutes, free water, and fractional sodium excretion. The clinical examination of a patient should be the basis of assessing his water and electrolyte state. Laboratory findings which are in disagreement with the clinical state have to be repeated, critically interpreted, but not completely rejected. Third space losses make fluid balance difficult.

Acid-Base Equilibrium↗
PubMed1985

[Early postoperative mobilization of the knee joint following arthrolysis with continuous catheter peridural anesthesia].

21 patients with stiffness of the knee were operated on, for mobilisation under epidural analgesia. As soon as the patients returned to the ward the leg was placed on a mobilisation-splint driven by an electric motor. Epidural analgesia was continued by infusion of 0.25 ml/kg . h of 0.125% bupivacaine via epidural catheter for a period of four to six days whereafter the catheter was removed. Analgesia during mobilisation was complete or almost complete in 15 patients. In 5 cases loss of sensitivity was present predominantly or selectively in the contralateral extremity, in one patient segmental extension of epidural analgesia did not include the knee. The bladder had to be catheterized in 9 patients, three suffered from decubital ulcers which disappeared after removal of the epidural catheter. In spite of the frequency of side effects, which can be diminished by further experience, continuous epidural analgesia is advantageous for early mobilisation of the knee after arthrolysis. The patients must be informed about side effects and possible complications before giving their consent for this method of long lasting analgesia.

Adolescent↗
PubMed1985

[Aortofemoral bifurcation bypass--effect of anesthesia procedure (NLA, thoracic continuous catheter peridural anesthesia) on circulation, respiration and metabolism. Hemodynamic changes caused by peridural anesthesia and anesthesia induction].

UNLABELLED: In 50 patients scheduled for infrarenal aortic bypass surgery the cardiovascular effects of two anaesthetic regimes were investigated prior to surgery. A Swan-Ganz-catheter was used for haemodynamic measurements. These patients, having been randomized into two groups, were optimally volume loaded (PCWP 10 mmHg) before anaesthesia. In 24 patients a thoracic epidural was induced with 12-15 ml 0.25% plain bupivacaine. When segmental anaesthesia had extended from T4/5 to L1/2 general anaesthesia was additionally applied (flunitrazepam 1.5-2 mg, pancuronium bromide 0.1 mg/kg). In 26 patients neuroleptanaesthesia was induced (droperidol 0.1-0.2 mg/kg, fentanyl 0.01 mg/kg, pancuronium bromide 0.1 mg/kg, and thiopentone 100-150 mg. Haemodynamic measurements were made before injection into the epidural catheter, after complete spread of anaesthesia, before commencing general anaesthesia and 10-15 min thereafter. RESULTS: Neither of the two procedures were associated with severe haemodynamic alterations. In the epidural group HR fell slightly during latency of complete spread and increased to the same extend following general anaesthesia. The epidural caused MAP (104 to 88 mmHg), mean PAP (20 to 14 mmHg), PCWP (10 to 7.5 mmHg), and RAP (4.5 to 2.5 mmHg) to decrease moderately but no further changes were effected by the subsequent general anaesthesia. SVR and PVR were not influenced by either epidural or by general anaesthesia. CI (3.6 to 3.41 . min-1 . m-2), LVSWI (67 to 52 p . m-1), and cardiac minute work index (55 to 40 J . min-1 . m-2) decreased during latency of complete spread but were no further influenced by general anaesthesia. The haemodynamic changes of neuroleptanaesthesia were almost identical to those of the combined epidural-general anaesthesia. For the operation which followed, a continuous infusion of 0.125 per cent plain bupivacaine (0.25 ml/kg X h) via epidural catheter (in combination with N2O/O2-anaesthesia) was sufficient for complete analgesia in the epidural group. These findings lead to the conclusion that a small bolus volume and a low concentration of bupivacaine result in good anaesthesia while avoiding serious haemodynamic alterations.

Adult↗
PubMed1985

[Massive intraoperative lung embolism caused by the introduction of a telescope pin (Bailey-Dubow pin) in a child with osteogenesis imperfecta].

We report the case of a massive pulmonary embolism in a three year old boy with osteogenesis imperfecta during a closed insertion of a Bailey-Dubow-rod. An increased intramedullary pressure with consecutive entering of medullary particles or air into the blood stream due to the insertion of the Bailey-Dubow-rod is discussed as the cause of the pulmonary embolus.

Brain Edema↗
PubMed1984

[Blood glucose, ACTH, cortisol, T4, T3 and rT3 after cholecystectomy. Comparative studies of continuous peridural anesthesia and neuroleptanalgesia].

15 patients (12 women and 3 men) undergoing cholecystectomy were randomized into two groups. 8 patients were operated on under continuous thoracic epidural anaesthesia in combination with light general anaesthesia. Postoperatively they were kept painfree by continuous infusion of an 0.125% solution of bupivacaine via epidural catheter at a rate of 0.25-0.3 ml/kg X h over a period of four days. The 7 patients in the control group were operated on under neuroleptanalgesia. Piritramide was given for postoperative analgesia. All patients received 40 ml/kg X day of electrolyte solution during the period of investigation. Blood was collected at 8 am, 12 am, 4 pm, 8 pm, and 12 pm on the day of operation and on the third postoperative day, at 8 am on the first and second postoperative day, and at 8 am, 12 am, and 4 pm on the fourth postoperative day. Plasma glucose, ACTH, cortisol, T4, T3, and reverse T3 were measured. During the operation and for 12 h thereafter a mild hyperglycaemia was observed in the neuroleptanalgesia group but not in the epidural group. The differences were significant. A rise in ACTH was seen in both groups during and shortly after operation. The increase in cortisol concentration following this ACTH release was significant only in the neuroleptanalgesia, but not in the epidural group. From the first to the fourth postoperative day ACTH levels were low and cortisol concentrations within the normal range. On the third day it appeared that a diurnal variation in cortisol levels was again present. Cortisol suppression following the administration of 2 mg dexamethasone on the fourth postoperative day was detectable in both groups. Of the thyroid hormones, T4 remained unchanged and at a normal level during the investigation. T3 decreased and reverse T3 increased significantly, the maximum rise being observed on the second day. There were no differences between the groups. These changes are defined as low T3 syndrome, following caloric deprivation, injury, and stress. The metabolic and hormonal alterations caused by cholecystectomy are marked only during operation and shortly thereafter and only in this period are they influenced by epidural analgesia. From the first postoperative day onwards they are almost negligible so that a mitigation by using continuous epidural analgesia is not to be expected.

Adrenocorticotropic Hormone↗
PubMed1984

[Thoracic epidural anesthesia with 0.75% bupivacaine has no effect on ACTH-stimulated cortisol secretion].

The basis of this investigation was the question of whether low plasma cortisol concentrations during epidural anaesthesia are caused by sympathetic denervation of the adrenals. In 6 otherwise healthy patients undergoing upper abdominal operation 15-20 ml 0.75% bupivacaine was given via epidural catheter which had been inserted thoracically. Ringer's lactate solution 1,000 ml was infused during the time of onset of anaesthesia. When segmental epidural anaesthesia had spread from T2/3 to T12/L1/2 0.01 U/kg of ACTH were given intravenously. 5, 10, 20, and 30 minutes thereafter plasma ACTH and cortisol concentrations were measured. The same experimental procedure was carried out in a control group without epidural anaesthesia. The patients in both groups were unpremedicated and unanaesthetized. Plasma ACTH levels rose from 100 pg/ml (basic values) to 500-600 pg/ml immediately after ACTH injection in both groups and then decreased logarithmically. The increase of plasma cortisol concentrations was significant 15 minutes after the ACTH peak and rose from 0.28-0.3 mumol/l (10-11 micrograms/dl) up to 0.7 mumol/l (25 micrograms/dl) in both groups. We can, therefore, rule out that thoracic epidural anaesthesia with 0.75% bupivacaine impairs ACTH stimulated cortisol secretion.

Adrenocorticotropic Hormone↗
PubMed1984

[Post-traumatic metabolism--bases and clinical aspects].

In order to rationalize the nutritional therapy of polytraumatized patients we have developed a concept to explain the humoral response and subsequent metabolic reactions to trauma, which is based on current reports in the literature and our own investigations. Three separate phases should be defined. a) The acute phase: catecholamines dominate in the initial phase following severe trauma. Insulin secretion is suppressed, and the levels of the anti-insulin hormones glucagon, cortisol and growth hormone are increased. Under modern conditions of treatment this phase lasts between 12-24 h. Nutritional therapy cannot be carried out during this phase of maximal glycogenolysis, lipolysis and gluconeogenesis because of the danger that a major metabolic imbalance might develop. b) The intermediate phase: This phase can be said to occur when after 12-24 h the primary stabilisation of the acute phase is complete. Insulin secretion can now be stimulated, but the levels of anti-insulin hormones remain high. This phase lasts for a number of days. The gradual introduction of nutritional therapy is now possible, but the danger of metabolic imbalances arising when abrupt substrate increases are made is nevertheless present. Should complications arise this phase can at any time revert to the acute phase. Patients who are only slightly injured or have undergone moderately extensive surgery are from the onset in this phase. c) The repair phase: In uncomplicated cases the intermediate phase passes after a number of days into the repair phase. This stage lasts for a number of weeks and is dominated by the presence of insulin. The levels of the anti-insulin hormones have returned to normal values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Behavior of plasma amino acids, blood sugar, insulin and glucagon in the early post-traumatic phase with sole substitution of fluid and electrolytes].

The findings on the changes in amino acid metabolism and hormonal regulation after severe trauma and the conclusions draw from these are rather controversial. It is well documented that even small amounts of carbohydrates may significantly influence amino acid and carbohydrate metabolism especially in stress situations. Very few studies have been carried out on polytraumatized patients given an absolutely carbohydrate-free diet however. The following study was carried out on 20 polytraumatized, ventilated patients, substituted with water and electrolytes only over a period of 4 days after trauma. Besides amino acids in plasma and urine, blood glucose, insulin and glucagon levels were determined every day as was energy expenditure, nitrogen excretion and parameters reflecting homeostasis. The total plasma amino acid concentration showed a slight increase, but remained nearly unchanged and within the reference range over the entire period of investigation. The plasma branched chain amino acids showed the most marked change. Their total concentration increased continuously from the first (median: 301 mumol X l-1), to the 4. day (median: 743 mumol X l-1) after trauma. Less affected, but also submitted to marked changes in plasma concentration in the early period after trauma were alanine, proline and phenylalanine. Although blood glucose concentrations were high, and clearly above reference range, insulin concentrations remained relatively low at all times (median: 24 microU X ml-1) while plasma glucagon concentrations were increased at all points of measurement (median: 327 pg X ml-1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Postoperative pulmonary function following abdominal surgery. Comparison of continuous, segmental thoracic peridural anesthesia and intramuscular piritramide injections].

Respiratory function was studied in 35 patients after upper abdominal surgery, who had been randomized into two groups. 15 patients (median age: 59 years) were operated on using neuroleptanalgesia and received intramuscular piritramide as postoperative analgesic. A continuous thoracic epidural was placed prior to surgery in 20 patients (median age 52 years). A light general anaesthesia was additionally given when these patients were operated on. Postoperatively, epidural analgesia was continued by infusion of 0.25-0.3 ml/kg X h 0.125% bupivacaine via epidural catheter over a period of 4 days. If pain prevention during coughing and getting up was not complete, top-ups of 6-10 ml 0.25% bupivacaine were given additionally. Respiratory function (FVC, peak expiratory flow, VT, VD/VT, RR, MV, VA, AaDO2(0.21), PaO2 and PaCO2) was investigated before surgery, and on the 1st, 3rd and 5th postoperative day, the patients breathing room air. Results (the median of each groups is plotted, the values of the epidural group being in brackets. 0: preop., 1: first, 3: third, 5: fifth postop. day): FVC 0: 3.05 (3.16) 1: 1.42 (1.40) 3: 1.64 (1.42) 5: 1.39 (2.27) 1. Peak expiratory flow 0: 310 (287) 1: 118 (113) 3: 130 (127) 5: 153 (194) 1/min. Respiratory rate 0: 16 (14.5) 1: 20 (18.5) 3: 16 (18.5) 5: 17 (17) min-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1984

[Catheter peridural anesthesia with bupivacaine HCI and bupivacaine CO2. A comparison and the effects of premedication].

A controlled prospective randomized study was carried out to compare the action of 0.5% bupivacaine-CO2 and 0.5% bupivacaine-HCI both with and without diazepam premedication. Those patients given an epidural with 0.5% bupivacaine-CO2 and diazepam premedication showed both the briefest time to onset of action and the greatest degree of motor block. In contrast to the other three groups, none of these patients had missed segments. Despite the fact that no significant differences could be calculated, the difference in intensity of action observed in this investigation may well be of clinical relevance.

Aged↗