[Intensive therapy in small hospitals].
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Accidents, Traffic↗
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Peritoneal transfer of carbon dioxide.
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Anesthesia↗
[Limitations of mass transfusion].
As a result of blood conservation there is nearly no limit to transfusion therapy. This is shown by reviews of the University Clinic of Hamburg-Eppendorf. A still existent limitation in patients with irregular antibodies requires a supraregional cooperation the possibilities of which are discussed. In intensive care medicine an especially critical indication is necessary. Blood transfusion in hopeless cases (ut aliquid fiere) is as unjustifiable as artificial respiration is in patients having an EEG 0-line.
Antibodies↗
[Intensive care in the modern hospital--why and how?].
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Anticoagulants↗
[Studies on the mechanism of action of clonidine after pretreatment with reserpine (author's transl)].
The effects of 3.7--30 micrograms 2-(2,6-dichlorophenolamino)-2-imidazoline hydrochloride (clonidine)/kg i.v. on the arterial blood pressure and the central nervous activities of the sympathetic and the phrenic nerves were studied in 33 anaesthetized, relaxed and artificially respirated cats. In part of the experiments the animals were pretreated with reserpine at a dosage of 2X0.3 mg/kg. In normal animals clonidine caused a fall in blood pressure, a reduction of nicotinic pressure effect and an inhibition of sympathetic activity. In pretreated animals the antinicotinic as well as the sympathetic inhibitory actions of clonidine were significantly increased at a dosage of 30 micrograms/kg. The single application of reserpine caused no changes of these two parameters. As a result clonidine probably caused a stimulation of central nervous postsynaptic alpha-adrenoceptors and after the pretreatment with reserpine in addition to this an inhibition of the release of epinephrine.
Animals↗
[Electrophysiologic shifts in the functional antagonism between phosphororganic pesticides and their antidotes].
The authors carried out studies on 18 nonanesthetised and anesthetised cats under the conditions of complete imobilization with tricuran and under artificial respiration and examined the temporary consequence of the effects on the spontaneous and induced cerebral activity after poisoning with lethal doses of phosdrine and treatment with Doline, which is the therapeutic antidote of phosphorganic pesticides. The authors established that after lethal poisoning with phosdrin the secondary induced cerebral hypoxia enhanced deepening of the disintegration in the intercerebral interrelationships, which caused the appearence of epileptiform activity. The antidote Doline within 1-2 minutes, after its muscular administration abolished effectively the generalized epileptic seizure and repaired quickly the electrophysiological indices-peculiar for the normal EEG.
Animals↗
[Early diagnosis of severe brain damage of premature and newborn infants under intensive care. A polygraphic study (author's transl)].
24 premature and newborn infants under intensive care (intubation and artificial respiration) were subjected to a polygraphic examination in order to diagnose severe brain damage already in the acute stage of a disease. The results collected in the polygraphic recording were correlated to the further development and progress of the infant. Nine infants die within one week--all of these underwent a post-Mortem examination. Diagnosis of brain damage was confirmed by post-mortem examination or by a clinical neurological follow-up examination. All infants with severe brain damage showed pathological polygraphic recordings. In contrast to this, clinical neurological examination at the time of the polygraphic recording did not reveal such pathological results in all of these infants. Important was the EEG, supplemented by determining the bioelectric brain maturation, the differentiation of sleep states and the correlation of these derived parameter to the behavior pattern of the infant. The heart rate frequency and variability could not be used to make an useful diagnostic statement.
Acute Disease↗
The dental practitioner's role in emergency health services.
In a national disaster, the medical profession would lose physicians and auxiliary personnel and would need assistance. Canada's 22,000 physicians and 85,000 nurses are located for the most part in potential target areas. Survivors among Canada's 6396 dentists could supply 30% reinforcement. The dentist's training, his manual dexterity and experience acquired in the management of hemorrhage, shock, débridement, suturing, reduction and immobilization of fractures, and control of pain and infection would be valuable. Additional functions he could perform would be first-aid, including but not limited to artificial respiration, early management of chest wounds, preparation of casualties for movement, and assistance in general surgical procedures. Dentists with special training in anesthesia, oral surgery or public health could be of particular value in relieving anesthetists, surgeons, radiologists and public health officers of some of their duties. Joint training of physicians and dentists in mass casualty care could increase the efficiency of the team work in disaster and is being considered by many medical and dental faculties.
Canada↗
[Effects of almitrine on the pulmonary circulation].
Almitrine was injected intravenously at a dose of 1 mg.kg-1 over a period of sixty minutes in eight men aged from 49 to 69 years suffering from chronic bronchitis and obstructive airway disease, with signs of chronic cor pulmonale. During the study, patients on artificial respirator were in stable ventilation. Measurements gave the following results: arterial pO2 rose at all the times of study (P < 0.02). Arterial pCO2 decreased, the difference being significant 20 minutes after the end of the infusion. Q tended to increase accompanied by a slowing in heart rate, an increase in cardiac index and in systolic ejection work (P < 0.01 at T60). Pw increased (with P < 0.05 at the 20th minute) and subsequently varied in the same direction in parallel with pulmonary resistance. The authors concluded that almitrine, apart from its well known effects on ventilatory mechanics, results in blood gas changes with are not directly correlated with variations in VE by direct action on pulmonary vascular flow with any notable improvement in the upper zones of the lung.
Aged↗
[Treatment of pain and anesthesia in emergency and catastrophe medicine (author's transl)].
Catastrophe conditions for anesthesia and the treatment of pain arise when otherwise conventional techniques and procedures, including supervision of the patient, can only be carried out incompletely or not at all. Pain must be controlled with analgesics which have the least possible side-effects. When supplies of energy and gas fail, inhalation anesthesia can only be carried out under certain circumstances. In its place intravenous anesthesia can be used, with or without relaxation, with air breathing or artificial respiration. Reports in the literature of studies and experience attribute particular importance to ketamine in this respect.
Analgesics, Opioid↗
Hypothalamic neurons responding to hemodynamic input and to stimulation in the pons may influence adrenocorticotropin release.
Experiments were designed to identify hemodynamically sensitive neurons in the mediodorsal hypothalamus and to determine if they were also sensitive to electrical stimulation of areas in the dorsal rostral pons that were implicated previously in the control of adrenocorticotropin (ACTH) release. Cats were anesthetized with chloralose and urethane, immobilized with gallamine, and artificially respired. Hemodynamic stimuli included constriction (CC) of the supradiaphragmatic inferior vena cava to reduce venous return and sinusoidal volume pulsation (RA) of the right atrium (1 ml peak at 1 Hz). Previously, CC was shown to facilitate and RA was shown to inhibit ACTH release. Electrical stimulation in the pons consisted of single shocks (500 microA DC, 0.05 msec, negative-to-tip) delivered on each of an array of three or four bipolar co-axial electrodes in the pons. Twenty-three neurons were tested with only RA. Of these, two were inhibited, two were facilitated, and 19 did not respond. Thirty-two neurons were tested with CC. Of these, nine were inhibited, nine were facilitated, and 14 did not respond. Seventeen neurons that responded either to RA or to CC were tested with stimulation in the pons. Of these, three were orthodromically activated and two were inhibited from a total of eight pontine sites. Six of the eight sites were within 300 microns of an area shown previously to contain neurons that responded to CC. Of 31 additional sites that were stimulated, but at which stimulation did not drive neurons that responded to hemodynamic stimuli, 26 were located more than 300 microns from this area (p less than 0.01, X2 test). The data suggest that some hypothalamic neurons involved in the hemodynamic control of ACTH release receive a projection from or through the dorsal raphe nucleus medially, and the ventral locus ceruleus, locus subceruleus, and underlying reticular formation laterally. However, other neurons may receive projections that bypass these regions.
Adrenocorticotropic Hormone↗
[Changes in the electromyographic potentials in cats poisoned with superlethal doses of phosdrin and treated with doline].
The authors carried out studies on 10 cats, anesthetized by urethane, under atropine protection and under the conditions of artificial respiration and examined the influence of therapeutic antidote of phosphorganic pesticides-Doline on the induced eletromyographic activity during total neuro-muscular block, induced by superlethal doses of phosphadrine. It was established that superlethal doses of phosphadrine induced total block of electropotentials in neuro-muscular conduction of the peripheral musculature, which was removed immediately after venous and muscular administration of the antidote Doline.
Animals↗
Sustained coronary constriction and its antagonism by calcium-blocking agents in monkeys and baboons.
Experiments were performed on five Japanese monkeys and one anubis baboon anesthetized initially with ketamine hydrochloride and subsequently with sodium pentobarbital, and maintained on artificial respiration. The left anterior descending coronary artery (LAD) was cannulated and its vascular bed was perfused with arterial blood. Perfusion pressure was kept constant at a value slightly higher than the mean systemic arterial pressure. Blood flow through the LAD was measured by an electromagnetic flow meter. All drugs were administered into the LAD. Single injections of acetylcholine produced a biphasic change in blood flow; an initial decrease (vasoconstriction) followed by an increase (vasodilation). Infusion of acetylcholine produced a sustained decrease in blood flow in all the animals used except one Japanese monkey in which oscillatory changes in blood flow were induced. With infusions of acetylcholine, however, left ventricular pressure (LVP), and maximum rate of rise of LVP (LV dP/dt max), heart rate, and systemic arterial pressure remained unchanged. Single injections of diltiazem and nifedipine, calcium-blocking agents, and nitroglycerin produced a dose-related increase in blood flow. Diltiazem and nifedipine exerted no effects on other cardiohemodynamic variables, whereas nitroglycerin produced a decrease in systemic arterial pressure and an increase in heart rate. When blood flow through the LAD was reduced to nearly half of the basal value by infusion of acetylcholine, diltiazem and nifedipine produced an increase in blood flow as much as in control, whereas nitroglycerin produced less of an increase than in control.
Acetylcholine↗
[A new CO2 analyzer for monitoring of artificial ventilation (author's transl)].
A new CO2-Analyzer for continuous measurement of CO2 content during artificial respiration is described. Based on infra red absorption, this device may be used for measuring the carbon dioxide content of expiration in anaesthesia and intensive care. Carbon dioxide infrared absorption is affected by nitrous oxide. This side effect can be compensated by a single switch, if the sample contans N2O.
Anesthesia↗
[Acute treatment of severe cardiogenic pulmonary edema. Effect and tolerability of ISDN as bolus and continuous infusion].
Isosorbide dinitrate (ISDN) was administered intravenously to 21 patients with severe cardiogenic pulmonary edema. In 15 cases the condition was due to coronary heart disease (3 of them had arterial hypertension additionally), and 3 patients due to cardiomyopathy. In the remaining 3 valvular disorders were prevailing. The ISDN solution was administered as an i.v. bolus followed by continuous i.v. injection from an automatic perfusion device. Oxygen, furosemide, and in some cases digitalis were given in addition. Monitoring consisted of clinical surveillance, blood gas analyses, and repeated X-ray control. The results obtained confirm the efficacy and safety of this mode of ISDN administration. This applies particularly for patients in whose therapy is aimed at fast control of life-threatening hypoxia. Despite extreme asphyxia, only three patients needed artificial respiration, one died in cardiogenic shock, while all others were rapidly improved. It could thus be demonstrated that this type of therapy may be safely and efficiently handled by careful clinical supervision, without invasive hemodynamic monitoring.
Acute Disease↗
[Participation of neurons of different hypothalamic areas in the reaction of the body to hypoxia].
In anesthetized cats, spontaneous activity was recorded in neurons of the anterior, supraoptic, lateral, ventro-medial and posterior nuclei of the hypothalamus under conditions of oxygen deficit induced by the blood loss or discontinuation of artificial respiration. Phases of activation and suppression of electric activity of different hypothalamic nuclei did not develop simultaneously. At the onset of hypoxia development of activation involved the anterior areas and then propagated to the posterior hypothalamic structures. The supraoptic nucleus seems to play a triggering role in the development of compensatory-adaptive response in the hypothalamus under the effect of stress.
Adaptation, Physiological↗
[Preoperative risk evaluation in juvenile ileus].
Preoperative risk calculation in children with bowel obstruction allows early therapeutic measures to improve prognosis. In a retrospective study the preoperative status was evaluated in 310 newborns and 127 children beyond the newborn period who had to be operated for bowel obstruction. Preoperative parameters were: age, birth weight (newborns), weight, body temperature, red and white blood count, electrolytes, urea-nitrogen, total serum protein, pH, PO2, PCO2 and base excess. These parameters were compared in surviving children and children who died postoperatively. In newborns a statistically significant difference between both groups was found for birth weight, rectal temperature, pH and total serum protein, whereas in children beyond the newborn age the same was true for age, weight and total serum protein. Besides well balanced electrolytes and good management of artificial respiration, total serum protein and in newborns additionally blood-pH and rectal temperature must be normalized preoperatively to reduce the risk in children with bowel obstruction.
Acid-Base Equilibrium↗