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PubMed1985

[Clinical experiences with the anesthesia and brain monitor (ABM)].

The Anaesthesia and Brain Monitor (ABM) was employed in 83 patients (of 24 to 86 years of age) who were subjected to abdominal surgery, and in 21 intensive-care patients under artificial respiration and sedative treatment (of 45 to 74 years of age), the equipment being used for monitoring anaesthesia or sedation. With this method it became possible to effect a largely integrated surveillance of EEG, EMG, NMT, pCO2, as well as, if desired, external blood pressure measurement by time-synchronous measurement and integration of parameters largely used singly in clinical practice to date. Whereas the EEG parameters (amplitude, frequency), if considered singly, do not yield clear information on the stage of anaesthesia, they can supply additional information especially in very light or very deep anaesthesia, together with the other measured parameters. In intensive care, they afford an estimation of the degree of the sedation.

Anesthesia, General↗
PubMed1986

[Myasthenia gravis as an anesthesia risk].

Myasthenics must be considered as surgical risk patients. It is imperative to know the exact pathophysiology of the disease pattern with its three types of crisis including their treatment in order to perform safe anaesthesia and to reduce the rate of perioperative complications. In the preoperative phase we must consider a few specific angles besides the routine manipulations: Treatment with cholinesterase inhibitors as practised in myasthenics is continued unchanged or with only slightly reduced dosage up to the day of the operation. If necessary, oral administration may be changed to intramuscular or intravenous application. Premedication is carried out as far as possible without any drugs contraindicated in myasthenics. The patient may get regional or full anaesthesia, the latter always via intubation. We prefer inhalation anaesthetics because they are easily monitored. Neuroleptanalgesia, however, is also possible. One must accept the somewhat higher risk of postoperative respiratory insufficiency since in most cases subsequent artificial respiration must be performed anyway. Relaxation is effected, if at all necessary, via a non-depolarising muscle relaxant in low dosage (one-half to one-tenth of normal dosage). Measurement and monitoring of neuromuscular transmission via the nerve stimulator is mandatory. Succinylcholine is used only in case of vital indication (half of the normal dose). After surgery the patient is transferred to the intensive care ward in intubated position, extubation being performed only after spontaneous breathing has been safely assured. In postoperative analgetic treatment the opiate antagonist pentazocine (Fortral) showed the best results as far as our experience goes. With careful monitoring, however, it is also possible to employ other highly effective analgesics.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1988

[The principle of "balanced anesthesia" in high risk canine patients].

The concept of balanced anaesthesia aims at an anaesthetic method for high risk patients by combination of different anaesthetic drugs. The anaesthetics and muscle-relaxants have to work in a way as to potentiate their effects and to reduce the side effects as well as the applied dosage. With this sensible regime the circulation and the metabolic energy should be less burdened. For the introduction of balanced anaesthesia, a combination of benzodiazepines (relaxing and sedative), morphine (analgetic and sedative) and quickly metabolizing hypnotics of the imidazol group (hypnotic and relaxing) is used. A fentanyl-drip-infusion continues and deepens the analgesia. After endotracheal intubation with the help of the carrier-gas nitrous oxide (weakly analgetic) and oxygen (2:1) a low concentration of volatile inhalation anaesthetics (weakly hypnotic) is added. Under artificial respiration low doses of competitive antidepolarizing neuromuscular blockers help to potentiate and reduce drug amounts of other anaesthetics especially of that for inhalation. At the end of balanced anaesthesia an antagonization of benzodiazepines, morphines and competitive neuromuscular blockers is recommended for emergency situations only because of possibly occurring changes of cardiovascular parameters.

Anesthesia↗
PubMedDate not supplied

Use of protease inhibitor (trasylol) and heparin in cardiorespiratory resuscitation. II. Gasometric investigations of arterial blood.

The purpose of the present work was to assess the effect of trasylol--an inhibitor of proteases--and heparin on gasometric values in arterial blood during cardio-respiratory resuscitation. The investigations were carried out on rabbits in three experimental groups. In group I the simplest resuscitation procedures were applied: artificial respiration with AMBU self-expanding bag and heart massage. In group II oxygen was given for respiration, heart massage was applied, cardiac, vasoactive and alkalinizing drugs were given. Group III received the above drugs and procedures but trasylol and herparin were used additionally. Cardiac arrest was obtained by means of acute hypoxia following suxamethonium administration. The investigations showed that in groups I and II despite resuscitation management arterial hypoxaemia and metabolic acidosis persisted while in group III a certain return of normal gasometric values was observed and the animals in this group survived the experiment.

Acid-Base Equilibrium↗
PubMed1988

[Acute abdomen in gynecology].

The aim of the present study is, to describe the morbidity and mortality of 196 patients with an acute abdominal condition who underwent surgery at the Department of Gynecology and Obstetrics of the TU Munich between 1982 and 1986. This is a percentage of 2.7 of all 7,167 operations carried out during this period. 118 of these patients had an extrauterine pregnancy and were therefore excluded from the study. The second group of 79 patients, mostly with inflammatory diseases, were analyzed. In most of these cases the acute abdominal condition was caused by a tuboovarian abscess (48.1%), followed by peritonitis because of a bowel-disease (11.4%). 6 patients suffered from an abscessing endometritis due to a caesarean section with sepsis in 5 cases. A generalized peritonitis occurred in 5 cases and was treated with a planned relaparatomy with lavage. 63% of the patients had no complications within 28 days after operation, 13% developed a subileus; in 7% a relaparatomy was necessary. 6% of the patients had problems of wound-healing. One patient with stomach-cancer died 3 weeks after the operation because of a fulminant lung-embolism. Thus the mortality rate was 1.5%. A further 27% were treated at the intensive care-unit and 18% needed artificial respiration. The average postoperative period of hospitalisation was 15 days. In comparison, patients with elective operations remained 13 days. The morbidity and mortality of patients due to surgery of an acute abdominal condition was relatively small; postoperative complications could be well treated in all cases and is probably the result of a positive and early indication for surgical intervention.

Abdomen, Acute↗
PubMed1988

Antianginal effects of the new calcium antagonist benidipine hydrochloride in anesthetized rats and spontaneously hypertensive rats. Electrocardiographic study.

Antianginal effects of (+/-)-(R*)-2,6-dimethyl-4-(m-nitrophenyl)- 1,4-dihydropyridine-3,5-dicarboxylic acid (R*)-1-benzyl-3-piperidinyl ester, methyl ester hydrochloride (benidipine hydrochloride, KW-3049) in various experimental angina-pectoris models (anesthetized rats, spontaneously hypertensive rats (SHR] were compared with those of nifedipine, propranolol and hydralazine. Furthermore, the effects of these drugs on the pressure-rate product were evaluated. 1. Vasopressin test (SHR): The administration of KW-3049 at 10 micrograms/kg (i.v.) developed an inhibitory effect comparable to that of nifedipine at 200 micrograms/kg (i.v.) against the ischemic ECG changes caused by the intravenous administration of vasopressin at 1 U/kg. The effects of KW-3049 at 3 and 10 mg/kg (p.o.) lasted for 8 h or more. 2. Coronary occlusion test (rat): The rise of T-wave of epicardial ECG following ligation of coronary artery was inhibited by the administration of KW-3049 at doses of 30 and 100 micrograms/kg i.v. Nifedipine at dose of 200 micrograms/kg i.v. was slightly effective. 3. Isoproterenol (isoprenaline) test (rat): The fall of ST in ECG by the continuous infusion of isoprenaline (10 micrograms/kg/min) was almost completely prevented by propranolol (500 micrograms/kg i.v.). Also, KW-3049 (200 micrograms/kg i.v.) and nifedipine (200 micrograms/kg i.v.) significantly inhibited the decline of ST, in which the former was more effective than the latter. 4. Anoxia test (SHR): The fall of ST and rise of T-wave of ECG, induced by stopping artificial respiration of gallamine-immobilized SHR, were suppressed by the administration of KW-3049 at doses of 10 and 30 micrograms/kg i.v.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1988

[Electroencephalographic changes during experimental plateau waves].

The present study was designed to induce plateau waves by electrical stimulation of the brain stem and examine the changes in EEG during the plateau waves. Experiments were carried out on 10 adult mongrel dogs which were slightly anesthetized, immobilized and artificially respired. Electroencephalogram (EEG), intracranial pressure (ICP), systemic blood pressure (SBP) and cerebral perfusion pressure were simultaneously recorded on the electromagnetic tape after transorbital puncture of the intracavernous internal carotid artery. EEGs were recorded from cortical electrodes, and were analyzed by a frequency analysis. At the stage of increased ICP, the mesencephalic reticular formation was stimulated. Stimulation parameters, i.e., intensity, duration and frequency, were 0.1 mA, 1 msec and 40 - 50 Hz, respectively. The total duration of each period was 5 seconds. Spontaneous plateau waves occurred in 2 dogs associated with subarachnoid hemorrhage, subdural hematoma and intraventricular hemorrhage. Plateau waves were induced by electrical stimulation in the mesencephalic reticular formation in one of two dogs with spontaneous plateau waves. Twenty-one repetitions of electrical stimulation induced ten plateau waves. Two plateau waves were induced during slow EEG associated with desynchronization of EEG. Eight plateau waves were induced during fast EEG activity with no changes in EEG before and after the stimulation. In addition, plateau waves occurred immediately after short duration (5 seconds) of electrical stimulation. It seems that CBV increases during plateau waves are due to rapidly occurring neurogenic vasodilatation of cerebral vessels, later augmented by increases in cerebral metabolism. In conclusion, plateau waves are produced in a rigid condition within the cranial cavity by stimulation of the brainstem reticular formation which influences cortical activation and cerebral vasodilatation.

Animals↗
PubMed1988

[The effect of S-adenosyl-L-methionine sulfate tosylate (FO-1561) on survival time in various brain damage models].

The effect of S-adenosyl-L-methionine sulfate tosylate (FO-1561) on survival time in various brain damage models (cerebral anoxia or ischemia) was studied. 1) In KCN-induced or normobaric anoxia of ddY mice, FO-1561 (30-100 mg/kg as amount of S-adenosyl-L-methionine) administered intravenously 15-30 min prior to the treatment showed significant increase of survival time dose-dependently. 2) In asphyxic anoxia of Wistar rats, FO-1561 (100 mg/kg) administered intravenously 15 min prior to the treatment (cessation of artificial respiration) delayed the time until the disappearance of electrocorticogram. 3) In cerebral ischemia of Mongolian gerbils, FO-1561 (50 mg/kg) injected five times at 1 hr interval intraperitoneally 3 hr after the unilateral ligation of common carotid arteries showed significant increase of survival time. These results suggested that FO-1561 may be effective in ameliorating cerebral anoxic or ischemic damage, without observing any side effects like sedation and motor depression which pentobarbital showed with the effective doses in these damage models.

Animals↗
PubMed1987

[Validity of the electroencephalogram and evoked potentials in the diagnosis of brain death].

Alterations of electroencephalogramm and evoked potentials in brain dead patients are known. We are going to discuss the value of the various parameters as well as their comparison with the clinical symptoms. Newer guidelines recommend the brain-stem acoustic evoked responses, too. So we analysed those comatose patients requiring for artificial respiration in whom brain stem acoustic responses could not be evoked. We found 21 patients out of 103 unselected consecutive patients with primary cerebral disease. All patients with isoelectric EEG were brain dead. Absence of acoustic response was not sure combined with clinical symptoms of brain death. Earlier SSEP components were frequent, deformed flash evoked potentials were found in all brain dead patients. In all brain dead patients there was an absence of early acoustic evoked responses and an isoelectric electroencephalogramm. The longer the symptoms of brain death lasted, the more complete the disappearance of evoked potentials was. The investigations demonstrate the value of clinical examination and electroencephalogramm in the diagnosis of brain death, but also point to the value of evoked potentials as additional parameter, esp. in order to get informations of the pathophysiological mechanisms leading to death.

Brain↗
PubMed1987

[Transformation of vestibular signals by cerebral cortical neurons in the cat].

Extracellular unit activity of cortical vestibular projections was recorded in wakeful, immobilized and artificially respirated cats. Natural vestibular stimulation included both sinusoidal and trapezoidal position profiles in the horizontal plane. Tonic and phasic neurons were discriminated. The responses of phasic neurons were direction-specific. The transformation of the vestibular signals by cortical neurons had quasilinear properties: linearity existed only in the velocity range from 0 to 30-50 deg.s-1. A conclusion is made that only a complex of responses of direction-specific neurons can give the full information about changes in the angular velocity.

Acceleration↗
PubMed1987

[Severe poisoning with a cholinesterase inhibitor].

We report on a case of severe intoxication in an 18-year-old female who had ingested an insecticide with suicidal intent. The insecticide (thionacine) is a cholinesterase inhibitor used in gardening and agriculture. The resources of modern intensive care permitted successful treatment with artificial respiration and atropine. Treatment with oximes is controversial and may be dangerous. We suggest hospitalization even in mild cases of intoxication, in view of danger of changes in the course of the illness.

Adult↗
PubMed1987

[Direct effect of hypoxia on the function of skeletal muscle blood vessels in the cat].

In decentralized skeletal muscles of the cat hindlimbs, pO2 of arterial blood dropped from 105 to 87, 68 and 37 mm Hg in artificial respiration with 18% O2 (slight), 14% O2 (moderate) and 8% O2 (grave hypoxia) mixtures, resp. The slight hypoxia practically did not affect vascular resistance and capacity, distensibility of veins, capillary filtration coefficient and mean capillary hydrostatic pressure. Moderate and grave hypoxia reduced perfusion pressure by 3.5% and 9%, resp., increased the capillary filtration coefficient by 16% and 19%, resp., and did not alter the vascular capacity, distensibility of veins and capillary hydrostatic pressure. Precapillary sphincters and arterioles are most sensitive to hypoxia in skeletal muscles.

Adrenergic Fibers↗
PubMed1986

[Fenoterol (Partusisten)-associated lung edema. A case report].

The side effects of a beta 2-mimetic tocolytic therapy are of importance for anaesthesiologists who administer anaesthesia for obstetric operations, as our case report illustrates. In a healthy 28 year old pregnant woman during the 32nd week of pregnancy i.v. fenoterol was started because of premature labor. After two days severe respiratory failure developed and cesarean section was performed. The patient needed mechanical ventilation with positive endexpiratory pressure and high inspiratory oxygen concentrations (F1O2 greater than 0.7) for 5 days thereafter. The chest x-ray revealed a fluid lung. With artificial respiration and a consequent diuretic therapy with dopamine and furosemide (10 mg . h-1 continuously, negative water balance--5,000 ml on the 4th day) gas exchange improved and extubation was possible on the 6th postoperative day. After exclusion of cardiac or renal disease as well as aspiration of gastric content, the diagnosis of a fenoterol-associated pulmonary edema was thought probable. From the literature it is known that beta 2-mimetics can aggravate the increased water and sodium retention during pregnancy and cause pulmonary edema by an additional increase in pulmonary artery pressure. Therapy consists of adequate oxygenation and induction of diuresis with continuous furosemide and dopamine to achieve negative water balance. When administering anaesthesia to patients on tocolytic therapy positive water balance has to be avoided and great care must be directed to the postoperative gas exchange.

Adult↗
PubMed1986

[Electric activity of hippocampal neurons during asphyxia].

The unit activity was studied in the dorsal and ventral hippocampus of anesthetized and immobilized cats. The state of asphyxia was caused by disconnection of artificial respiration for 3-9 min. The hypoxia induced phasic changes of the neuronal activity. Hippocampal neurons revealed a higher resistance against oxygen deficiency as compared to other brain areas.

Action Potentials↗
PubMed1986

[Primary treatment of chest injuries in polytrauma].

Lung damage in the wake of thorax trauma has often occurred with delay. Treatment of such cases is difficult, and pulmonary failure has often been the result. Extended shock phase due to haemato-pneumothorax is one of the causes involved in this type of complication. Surgical treatment is often necessary of abdominal and thoracic injuries which occur in combination. The severity of haemorrhagic shock can be detected by early drainage of the thorax as a way of lung relief, and it will provide some safety for prolonged diagnostic and therapeutic action and for situations of obstruction. The lung can thus be more effectively protected. Hence, some generosity should be exercised in deciding primary thorax drainage for patients with multiple injuries, with suspicion of polytraumatisation, unconsciousness, and with artificial respiration.

Abdominal Injuries↗
PubMed1986

[Cortical somatosensory evoked potential associated with experimental chronic cord compression by epidural neoplasm in rabbits].

An experimental model of spinal cord compression was developed in rabbits by epidural neoplasms which were injected anterior to the T 13 vertebral body and grew into the spinal canal through the intervertebral foramina. With this experimental model, the neurological condition of the animals was monitored using a scale and changes of somatosensory evoked potentials (SEPs) were studied to evaluate the neurophysiological effect of experimental chronic cord compression. The animals were immobilized with pancuronium bromide and artificial respiration was maintained through a tracheostomy. SEPs were recorded by silver ball electrodes which were positioned epidurally over the somatosensory cortex through small burr holes. A subcutaneous needle placed at the nose served as a reference electrode. Right hind paw was stimulated via two percutaneous needles with 0.1 msec rectangular impulses sufficiently strong to produce motor responses, ranging from 10 to 20 volt in control rabbits. Electrical stimuli were delivered at a rate of 1 Hz. The intensity of electrical stimulation was raised up to 300 volt, when no consistent SEP was observed in the rabbit with spinal neoplasm. The SEP was summated by averaging 50 successive cortical transients with the analysis time of 200 and 500 msec. The cortical SEPs in the rabbit normally consisted of a positive-negative sequence, which we labelled P1, N1, P2, N2 and so on. Early peaks, P1 and N1, were observed constantly with average latencies of 30.1 and 53.3 msec respectively in normal rabbits. The variability of amplitudes seen even in control animals made them a less useful measure of function than latencies. Normal SEPs were preserved until the animals demonstrated moderate paraparesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

High-dose corticosteroids in thoracic trauma.

Experimental data show that lung injury may be prevented or reduced when steroids are administered early. It seems, however, difficult to reverse a lung injury which is already established. Accordingly, we have since 1976 administered high doses of methylprednisolone already on admission in patients with multiple rib fractures and/or flail chest (30 mg/kg i.v. X 3 at 8 hr intervals). A retrospective analysis of 143 patients with severe blunt chest trauma, most of whom were multitraumatized (72%) and many in shock (19%) revealed a significantly lower mortality for 44 steroid treated patients compared to 99 nonsteroid patients with similar injuries (9.1 vs 29.3%, p = 0.02). The incidence of bronchial infection and septicemia was not increased in steroid treated patients. There was also a lower incidence of multiple organ failure in the steroid treated group (4.5%) as compared to the control group (9.1%, n.s.). Hemodynamic and blood gas changes were examined in a prospective controlled study including 40 patients with multiple rib fractures and lung contusion. Pulmonary vascular resistance (PVR), which is a good parameter of injury severity, was reduced significantly in the steroid treated group. This led to a reduction in right heart work. The corticosteroid induced reduction in PVR was seen whether the patient was on a ventilator or breathed spontaneously. There were no significant differences in the a-v oxygen difference or in intrapulmonary shunting. Both the number of complications and the duration of artificial respiration were reduced in the steroid group.

Female↗
PubMed1985

Diaphragm pacing in the treatment of ventilatory failure.

Thirty years of clinical and technical research have produced a reliable apparatus for diaphragm pacing. This entails electrical stimulation to the phrenic nerve by a remote radio-frequency transmitter. Prerequisites for diaphragm pacing are adequate alveolar gas exchange, an intact phrenic nerve and diaphragm muscle, and a co-operative patient for the prolonged period of rehabilitation. Diaphragm pacing has been used in cases of central alveolar hypoventilation and chronic obstructive airway disease, as well as for lesions of the cervical cord. To avoid fatigue and possible irreversible injury to the muscle, the right and left hemidiaphragms are paced alternately. We demonstrate the effectiveness of diaphragm pacing for long-term artificial respiration in a patient with transection of the cord at C3/4. The decisive benefit of diaphragm pacing for the quadriplegic patient is that it renders him free of dependence on a mechanical ventilator with its associated social and psychological impediments.

Adult↗