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PubMed1986

[Primary management of patients with chest injuries at the scene of the accident].

The role of emergency medicine concerning the management of thoracic trauma patients at the site of accident is described, as well as the underlying causes of the development of the mediastinal shock as there are chest wall instability, tension pneumothorax, cardiac tamponade and cardiac contusion. Diagnosis and emergency treatment of these acute situations and the technique of safe chest tube placement are described. The role of volume support, artificial respiration and suction drainage of the chest at the site of accident are emphasized.

Accidents, Traffic↗

PubMed2003

Oxidative stress and antioxidant defense systems in patients after heart transplantation.

Heart transplantation ranks among those surgical interventions associated with ischemia-reperfusion injury to the donor heart as well as to the recipient. These events are connected with increased production of reactive oxygen species which evoke metabolic, structural and functional disturbances. Twenty-four transplant patients were investigated for oxidative stress (plasma levels of thiobarbituric acid reactive substances, TBARS) and antioxidant capacity (plasma total antioxidant status, TAS), and for activities of erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GPx) during the first year after heart transplantation. The post-transplant period was characterized by progressive decrease of plasma TAS, indicating a significant long-term drop of antioxidant reserves in patients after successful heart transplantation. The decrease in plasma TAS is accompanied by long-lasting increase of TBARS levels, which may represent oxidative stress of the organism. We conclude that additional therapy with antioxidant substances should be an important component of the complex therapeutic programme of patients after heart transplantation.

Adult↗

PubMed2001

[Preoperative risk assessment and perioperative management of HIV-infected patients].

PROBLEM: Due to their impaired immune function, unusual multimorbidity, and extensive concomitant medication HIV-infected patients impose special and specific demands on those who deal with their perioperative care. PREOPERATIVE ASSESSMENT: Beside standardized diagnostic and therapeutic preparations the preoperative knowledge, quantification, and treatment of HIV-associated opportunistic disorders and chronic organ damage are of particular importance. This requires an extended problem-orientated work-up. Furthermore, antiretroviral medication may interact with perioperatively administered pharmaceutics and lead to hardly foreseeable synergistic and antagonistic adverse effects. In contrast, "drug holidays" favor the development of HIV drug resistance. OPERATIVE MANAGEMENT: Anesthetic and surgical procedures basically depend on the underlying indication and consequently follow common principles. Laparoscopic techniques do not have any specific advantage in HIV-infected subjects. PERIOPERATIVE MORBIDITY: During their postoperative course, HIV-infected patients have to be more often admitted to intensive care unit and kept on artificial respiration unplannedly. Perioperative morbidity of HIV-infected patients increases with the stage of their disease. It is, however, not significantly elevated compared to that of HIV-negative subjects in similar preoperative health condition.

Anti-HIV Agents↗

PubMed1997

Celiprolol: agonist and antagonist effects at cardiac beta 1- and vascular beta 2-adrenoceptors determined under in vivo conditions in the rat.

Celiprolol is a beta-adrenoceptor antagonist which has desirable ancillary properties since it is relatively cardioselective and can exert direct vasodilator and bronchodilator effects. Here agonist and antagonist effects of celiprolol at cardiac beta 1- and vascular beta 2-adrenoceptors were determined under in vivo conditions in the rat. All experiments were carried out in catecholamine-depleted, pentobarbital anesthetized and vagotomized rats, placed under artificial respiration. I.v. administrations were made via the femoral vein. Blood pressure was measured from the cannulated right carotid artery and heart rate was recorded with a cardiotachometer. Celiprolol (10 micrograms/kg to 1 mg/kg i.v.) produced dose-related increases in heart rate and decreases in mean carotid artery blood pressure which were of longer duration than those mediated by standard agonists of beta 1-(isoprenaline) or beta 2-(salbutamol) adrenoceptors respectively. Although the maximal increase in heart rate by celiprolol (110 +/- 4 beats/min, n = 7) was approximately half that of isoprenaline (198 +/- 1 beats/min, n = 5), isoprenaline acted at doses 200-fold lower than celiprolol. Betaxolol (0.03-0.3 mg/kg i.v.), a beta 1-adrenoceptor antagonist, inhibited strongly and with similar potency the tachycardiac effects of celiprolol (DR10 = 45 micrograms/kg i.v.) as well as isoprenaline (DR10 = 45 micrograms/kg i.v.). On the other hand, the hypotensive effects of celiprolol and salbutamol were antagonized markedly and with similar potency by ICI 118,551, a relatively selective beta 2-adrenoceptor antagonist (DR10 = 15 and 25 micrograms/kg i.v. respectively). In rats pretreated with celiprolol (0.03 to 0.3 mg/kg i.v.), the heart rate dose-response curves to isoprenaline were shifted to the right of those determined in matched groups of vehicle-pretreated animals. In this respect, celiprolol was half as potent as betaxolol in blocking cardiac beta 1-adrenoceptors. Furthermore, celiprolol also antagonized the hypotensive effects of salbutamol, but, in this respect, celiprolol was 90-fold less potent than ICI 118,551. In conclusion, these results clearly indicate that celiprolol has the ability of stimulating and blocking not only cardiac beta 1- but also vascular beta 2-adrenoceptors. The effects on cardiac beta 1-adrenoceptors as well as the agonism of beta 2-adrenoceptors are produced by similar doses of celiprolol. These doses are notably lower than those necessary to block beta 2-adrenoceptors. Thus, this pharmacological profile, which has also been demonstrated in humans, indicates that celiprolol is a modulator of cardiac beta 1-adrenoceptors with vascular beta 2-adrenoceptor agonist properties.

Adrenergic beta-Agonists↗

PubMed2002

[Tracheostomy. Indications, methods, risks].

Tracheostomy is one of the oldest procedures in surgery. Although it was traditionally used for treatment of upper airway stenosis, the primary surgical indication is now in the long-term intensive care unit patient. Here, the aims are avoidance of damage to the larynx, earlier weaning from artificial respiration and improved nursing care. Apart from the conventional operating method, minimally invasive procedures have been increasingly employed. More than 20,000 ICU patients per annum are now treated in Germany by these modern methods. Common features of these procedures are the initial puncture of the trachea with subsequent dilatation of the puncture channel. Current meta-analyses of prospectively randomised studies show a lower complication rate than with conventional methods. Furthermore, serious sequelae such as tracheal stenosis are rare in the long-term course. However, conventional operative tracheostomy still has its place, particularly in circumstances where the new methods are contraindicated.

Critical Care↗

PubMed1996

[Interaction of frequency-adaptive pacemakers and anesthetic management. Discussion of current literature and two case reports].

UNLABELLED: We describe unexpected episodes of paced tachycardia in two patients with rate-responsive pacemakers during anaesthesia. Five months after a heart transplant and implantation of a pacemaker a 43-year-old patient suffered cardiac tamponade as a result of chronic pericarditis. The second case involved embolic occlusion of the femoral artery in a 33-year-old female patient previously operated on for tricuspid valve replacement and implantation of a pacemaker. In both cases induction of anaesthesia was performed with fentanyl, etomidate and vecuronium. Following intubation and mechanical ventilation, the heart rates (HR) of the two patients increased to 140 and 130 min-1 respectively. This was interpreted as a sign of inadequate anaesthesia, and therefore additional doses of fentanyl and etomidate were given, with no effect on the tachycardia. After exclusion of other possible reasons for this complication such as hypokalaemia, hypercapnia, hypoxaemia or allergic reactions, unexpected functioning of the rate-responsive pacemakers due to thoracic impedance changes was assumed. Minute ventilation was reduced, lowering paced HR in 3-5 min. CONCLUSIONS: These case reports suggest that anaesthetic management affects the action of rate-responsive pacemakers, causing haemodynamic complications, and inadequate interventions by the anaesthesiologist. Thus, it is necessary for anaesthesiologists to make a preoperative evaluation of the underlying medical disease and the type of pacemaker in order to adjust anaesthetic management accordingly and to understand the haemodynamic responses that may occur during the perioperative period. Preoperative programming to exclude the rate-responsive function is advised.

Adult↗

PubMed2000

[Determinants of the global quality of life after polytrauma].

This study investigated multiple trauma patients, who were injured between 1991 and 1995 and treated in our department. The aim of this study was to identify the determinants of quality of life after multiple trauma. From a total of 186 patients 173 (93%) were examined. The patients were asked to rate their quality of life according to the Nottingham Health Profile (NHP) and to a visual analogue scale (VAS). The VAS and the NHP isolated the age of the patients, the duration of artificial respiration, and the duration of rehabilitation as the predictors for a reduced overall quality of life. These results show that quality of life after multiple trauma not only depends on the severity of injury but also on demographic and psychosocial factors.

Adolescent↗

PubMed2006

[Glycogenesis Type II (M. Pompe). Selective failure of the respiratory musculature--a rare first symptom].

Late-onset Pompe's disease, a generalized lysosomal glycogen storage disease caused by acid maltase deficiency, usually presents as a slowly progressive muscular weakness of proximal muscles in lower limbs, followed by involvement of respiratory muscles. In the case presented here, however, respiratory failure was the first and selective symptom which caused the uncommon appearance of a patient entering our outpatient clinic on foot carrying his own artificial respirator. Intercostal muscle biopsy eventually led to the diagnosis.

Adult↗

PubMed2005

[Basics of acute stroke treatment].

Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O2 delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 degrees C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of "malignant" media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by "PWI-DWI mismatch MRI," specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias.

Acute Disease↗

PubMed2000

Effects of PAD on conduction of action potentials within segmental and ascending branches of single muscle afferents in the cat spinal cord.

In anesthetized and paralyzed cats under artificial respiration, we examined the extent to which primary afferent depolarization (PAD) might affect invasion of action potentials in intraspinal axonal and/or terminal branches of single muscle afferents. To this end, one stimulating micropipette was placed at the L6 spinal level within the intermediate or motor nucleus, and another one at the L3 level, in or close to Clarke's column. Antidromically conducted responses produced in single muscle afferents by stimulation at these two spinal levels were recorded from fine lateral gastrocnemius nerve filaments. In all fibers examined, stimulation of one branch, with strengths producing action potentials, increased the intraspinal threshold of the other branch when applied at short conditioning testing stimulus intervals (<1.5-2.0 ms), because of the refractoriness produced by the action potentials invading the tested branch. Similar increases in the intraspinal threshold were found in branches showing tonic PAD and also during the PAD evoked by stimulation of group I afferent fibers in muscle nerves. It is concluded that during tonic or evoked PAD, axonal branches in the dorsal columns and myelinated terminals of muscle afferents ending deep in the L6 and L3 segmental levels continue to be invaded by action potentials. These findings strengthen the view that presynaptic inhibition of muscle afferents produced by activation of GABAergic mechanisms is more likely to result from changes in the synaptic effectiveness of the afferent terminals than from conduction failure because of PAD.

Action Potentials↗

PubMed1984

Out-of-hospital management of cardiac arrest by basic emergency medical technicians.

The outcome in 126 consecutive patients with nontraumatic out-of-hospital cardiac arrest was analyzed to determine the effectiveness of a standard ambulance system over 22 months. Therapy was limited to basic life support (that is, administration of oxygen by mask, i.v. fluids, closed-chest massage and artificial respiration) by emergency medical technicians in a community in which less than 1% of the population had been trained in cardiopulmonary resuscitation (CPR). Analyses of patient data were performed to determine the relations between survival to hospital admission or discharge and 6 variables; response time, prior CPR, initial rhythm, acute myocardial infarction, initial blood pressure and initial pulse. Of 126 patients, 28 (22%) survived to hospital admission and 11 (9%) to hospital discharge. Two patient subgroups had a higher discharge rate: those with an initial rhythm of ventricular tachycardia or fibrillation (7 of 50, 14%), and those with an initial blood pressure greater than or equal to 90 mm Hg and a pulse rate of greater than 50 beats/min (3 of 6, 50%). For patients in arrest before ambulance arrival, there was no difference in outcome between those who did or those who did not receive prior CPR. Results of this study can be used as a basis for evaluating and comparing interventions directed toward stabilization of patients during the prehospital phase of cardiac arrest.

Allied Health Personnel↗

PubMed1996

Measurement of the force needed to restrain eruptive movement of the rat mandibular incisor.

This study describes the precise determination of the extrusive force in the rat mandibular incisor measured for a relatively longer period of time under artificial respiration with halothane anaesthesia. Following restraint of the eruptive movement of the incisor for a period of 20 h, the pushing force increased gradually and was maintained as an extremely gentle slope toward the end of the experimental period. The maximum pushing forces were estimated to be 9.1 +/- 2.5 (SD) mN in impeded incisors and 9.8 +/- 2.3 mN in unimpeded incisors. When force was converted to pressure, values were 30 +/- 8 (SD)mmHg and 32 +/- 8 mmHg, respectively; the difference was not significant. The maximum pushing force decreased rapidly--almost in parallel--with the fall of systemic arterial blood pressure after death of the animals; the amounts of reduction were 7.2 +/- 1.8 mN (24 +/- 6 mmHg) in impeded incisors and 7.0 +/- 2.0 mN (23 +/- 7 mmHg) in unimpeded incisors. Residual pushing forces were 1.7 +/- 1.0 mN (5.6 +/- 3.3 mmHg) in impeded incisors and 2.5 +/- 0.6 mN (8.2 +/- 2.0 mmHg) in unimpeded incisors; the difference was significant (P < 0.05). These results suggest that, under these experimental conditions, the pushing force of the rat incisor originates primarily from localized blood pressure within the incisor socket and, in part, from tissue growth.

Alveolar Process↗

PubMed1976

Catecholamines released from cerebral cortex in the cat; decrease during sensory stimulation.

In an attempt to determine the functional role of catecholamine (CA) nerve terminals in cerebral cortex the release of endogenous norepinephrine (NE) and dopamine (DA) into superfusates from visual and somatosensory cortex of the cat have been measured by a sensitive radiometric enzymatic assay based on the methylation of CA by catechol-O-methyltransferase (COMT) in the presence of a [3H]-methyl donor and followed by resolution of 3H derivatives through a series of organic extractions. In the flaxedilized animal maintained under local anaesthesia with artificial respiration the concentration of CA measured in 30-min superfusates was fairly constant in a given experiment under basal conditions without sensory stimulation, but varied widely from one experiment to another. Variations in NE were often independent of those for DA. For visual cortex the average basal release of NE in experiments was 20.09 +/- 3.64 pg/min/sq.cm while the average for DA was 34.01 +/- 7.62 pg/min/sq.cm. In all experiments intermittent visual stimulation (15/sec) produced a significant reduction in release rate averaging about 42% for NE and 64% for DA in visual cortex. The reduction was relatively non-specific since visual or somatic sensory stimulation produced a decrease in release from both visual and somatic sensory cortical areas. Since it has been shown that there is a relatively non-specific increase in acetylcholine (ACh) release from sensory cortex during stimulation, it is proposed that ACh may regulate CA release at presynaptic CA terminals in the cortex as it does in the periphery. A marked increase in CA release observed on perfusing with nicotine or atropine is consistent with this hypothesis.

Acetylcholine↗

PubMed1982

Changes in multiunit activity of nigral neurons induced by cholinergic and dopaminergic stimulation of the caudate nucleus.

The effects of stimulation of the caudate cholinergic and dopaminergic receptors on multiunit activity in the ipsilateral substantia nigra were studied in cats locally anesthetized, paralyzed and artificially respired. Cholinergic stimulation by intracaudate microinjections of 10 micrograms of carbachol diminished multiunit activity by 36% in the ventral substantia nigra (SN) and increased activity by 48% in the dorsal SN. This effect was abolished after electrolytic lesion of the ipsilateral striatonigral pathway. Opposite responses were observed following intracaudate administration of 20 micrograms of dopamine or 20 micrograms of D-amphetamine. Multiunit activity in the ventral SN increased by 36% and 34%, respectively, while the activity in the dorsal SN was reduced by 56% and 53%, respectively. Similar results were obtained in response to systemic administration of D-amphetamine. Extracaudate microinjections of carbachol and dopamine left multiunit activity in the SN unaffected. In conclusion, our results indicate an opposite action of caudate cholinergic and dopaminergic receptors on multiunit activity in the SN of the cat.

Animals↗

PubMed1982

Effect of ethanol on stretch response of muscle receptors in cats.

The response of muscle spindles and tendon organs to steady and sinusoidal muscle stretch was investigated at different blood alcohol concentrations (BAC). After initial anesthesia (pentobarbital), cats were spinalized, the lumbar ventral roots cut and the gastrocnemius muscles of one hindleg prepared for controlled stretching. The animals were paralyzed and artificial respiration was applied. Action potentials from isolated Ia/Ib/II afferent fibers could be recorded. Under steady stretch conditions, all fibers responded to an increasing BAC with an increase in firing rate. This could be observed already at 0.8 mg/ml BAC. The increase in discharge rate reached at the most 80 imp/s. During intoxication the regularity of firing was higher than in the no-alcohol situation. At blood alcohol concentrations higher than 5 mg/ml, the neuronal activity suddenly dropped to zero, exhibiting an irregular impulse pattern. The increase in discharge rate at steady stretch is regarded to be of minor significance in the explanation of the impairment of motor performance under ethanol. When sinusoidal stretch was applied, the increase in the mean discharge rate was smaller than at steady stretch conditions. Up to about 10 mg/ml BAC the periodical modulation of firing rate during sinusoidal stretch of a large amplitude remained mainly unchanged. After the discharge rate had dropped to zero for the steady stretch condition at high BAC, elicitation of action potentials was always possible using dynamic stretch.

Afferent Pathways↗

PubMed1982

Desynchronized sleep-like pattern of sympathetic activity elicited by electrical stimulation of sites in the brainstem.

In unanaesthetized mid-collicular decrebrate cats, paralyzed and artificially respired, recordings were made of sympathetic activity in nerves to heart (CN), to kidney (RN) and in identified vasoconstrictor nerves to skeletal muscle (SFM), whilst stimulating electrically with monopolar electrodes at various sites throughout the pons and medulla. Comparing RN and SFM, 1 of 3 patterns of response was observed at any one site: an increase in RN and SFM activity, a reduction or abolition of activity in both or a reduction or abolition of RN activity with a simultaneous facilitation of SFM activity. The latter differential pattern of sympathetic activity is characteristic of desynchronized sleep-like periods and could only be elicited from a discrete region in the mid-line of the caudal brainstem. Stimulation in this same region produced a reduction or abolition of CN as well as RN. It was suggested that neurones within the caudal part of nucleus raphe obscurus can generate a pattern of sympathetic activity similar to that occurring naturally in desynchronized sleep.

Animals↗

PubMed1983

(-)-Sulpiride activates the firing rate and tyrosine hydroxylase activity of dopaminergic neurons in unanesthetized rats.

The effect of i.v. sulpiride on the firing rate of dopaminergic neurons in the substantia nigra, pars compacta (SN-DA cells) and tyrosine hydroxylase (TH) activity in the caudate nucleus was studied. In rats, paralyzed with succinylcholine and artificially respirated, (-)-sulpiride (10-50 mg/kg) produced a dose-related increase in the firing rate of SN-DA cells and in TH activity. On the contrary, in rats anesthetized with halothane, (-)-sulpiride (up to 50 mg/kg) activated neither dopaminergic firing nor TH activity. However, (-)-sulpiride (10-25 mg/kg) readily reversed the inhibitory effect of i.v. apomorphine (25 micrograms/kg) on dopaminergic firing in both anesthetized and unanesthetized rats. Since sulpiride fails to inhibit DA-sensitive adenylate cyclase, it may be concluded that DA receptors, whose blockade results in increased dopaminergic firing and TH activation, are not coupled with this enzyme. Moreover, the results indicate that the mechanism responsible for firing and TH stimulation is inhibited by halothane anesthesia. The latter significantly decreased also the stimulant effect of i.v. haloperidol on striatal TH activity.

Animals↗

PubMed1984

Effect of morphine on regional cerebral oxygen consumption and supply.

The effects of acute opiate receptor stimulation on regional cerebral oxygen consumption and blood flow were examined in 9 regions of the artificially respired, alpha-chloralose-anesthetized cat. Regional cerebral arterial and venous oxygen saturation were examined microspectrophotometrically and regional cerebral blood flow was monitored using radioactively tagged microspheres (15 +/- 3 micron in diameter). Oxygen consumption was calculated as the product of flow and oxygen extraction. In 8 cats, after control cerebral blood flow was obtained, and in 8 experimental cats after this same measurement was obtained before and 40 min after the administration of 1.5 mg/kg morphine sulfate; the cats' heads were simultaneously sawed in 3 places and quickly frozen in liquid nitrogen-cooled propane. Systolic and diastolic blood pressure were significantly decreased by treatment. The heterogeneity of venous oxygen saturation was significantly reduced by morphine. Average cerebral blood flow, oxygen extraction and consumption were not altered significantly by morphine. Regional cerebral blood flow in the hypothalamus, thalamic oxygen extraction, and hypothalamic and thalamic oxygen consumption were significantly decreased by treatment. This low dose of morphine may produce changes in cerebral neuronal and/or synthetic activity which lowers oxygen consumption in some regions rich in opiate receptors, while not affecting overall brain oxygen supply or consumption.

Animals↗